March 30, 2020
Good afternoon Governor Polis,
On behalf of more than 3,500 members of the Colorado Dental Association (CDA), we commend you on your decision to postpone all elective surgeries and issue a Stay at Home order to slow further spread of COVID-19. At this uncertain and troubling time in our history it is paramount that we have strong and decisive leadership like yours. We support your actions for taking the necessary steps to protect our community members’ health.
With an increasing number of COVID-19 cases and the associated strain on the broader healthcare system, the CDA strongly believes it is critical to continue to see dental emergencies in our dental clinics and offices. Our goal is to keep patients suffering from dental emergencies away from our Colorado emergency rooms and hospitals to preserve capacity there. Safely treating their dental emergencies within our offices will maintain their health and safety as well as the health of the community as a whole.
We have advised our members of your Executive orders and recommended that all members adhere to the American Dental Association guidelines regarding dental emergencies. We appreciate your administration taking a strong stance to protect patients and providers in Friday’s Dental Board communication indicating potential licensure violations and enforcement actions against dental offices that fail to adhere to essential and emergency treatment only. In light of this directive, we also believe it’s imperative that there is clear guidance on what constitutes a dental emergency to allow dental offices to fully comply. We have advised our Colorado dental community to limit their services to the following, consistent with national guidelines from the American Dental Association defining emergency dental procedures, while adhering to the CDC protocols:
Essential emergency procedures:
- Uncontrolled Bleeding
- Swelling, cellulitis, abscess
- Facial trauma
- Biopsies that cannot wait 6 weeks
Essential urgent procedures:
- Severe dental pain
- Dry socket after an extraction
- Tooth fracture
- Tooth avulsion/luxation from trauma
- Final crown delivery if the temporary is broken or lost
- Dental treatment required prior to critical medical procedures
- Any other emergent/urgent issue that “corrects a serious medical condition” and allows the patient to forego a trip to the hospital emergency room or urgent care facility
We are advising our members to triage all other dental concerns via telehealth and manage pain and infection through prescription therapies as much as possible in the short-term in order to keep everyone sheltered at home.
The guidance referenced here on emergency dental procedures is consistent with previous guidance issued by the Department of Regulatory Agencies (DORA) on March 20, but was not directly referenced in the most recent communication issued March 27. We understand the most recent communication supplements, not replaces, previous DORA guidance. However, if this guidance has changed, it is critical that this be promptly communicated to the dental profession.
Also, in light of PPE shortages and potential executive orders that would acquire PPE from healthcare practices that are under order to limit operations, it is critical that dentists maintain access to the necessary PPE to treat emergency dental needs to include N95 masks, face shields, and gowns. We ask you to consider the best mechanisms for maintaining this access as you design PPE acquisition policies – whether that involves retention of PPE by dental offices or allows dentists access to any state stockpile of PPE. This will allow the dental profession to continue to offset hospital patient loads by providing the critical dental services described above.
We are also beginning the process to prepare our dental professionals for deployment into front-line hospitals and clinics to aid our overburdened medical staff. We are encouraging all dental professionals to register on covolunteers.state.co.us and complete the two FEMA courses. They can also list their skillset which could be utilized in a hospital setting to assist medical staff.
Some of these skills include:
- Up to date training on infection control and PPE donning and doffing procedures
- Sterilization and autoclave (instrument processing)
- Disinfecting treatment rooms
- Patient assessment and monitoring of vital signs
- Phlebotomy and IV administration
- Advanced airway management
- Anesthesia services (local anesthesia, IV sedation, general anesthesia)
- Vaccinations (at the point a COVID-19 vaccination becomes available)
- Any other service needed (triage, COVID-19 testing etc.) working under the supervision of a medical provider
- Some of our dentists also hold a medical degree and medical licensure in the state of Colorado
It is our goal to have our dental personnel equipped and ready to deploy within a 30-minute window of an executive order from you.
If there is anything the Colorado Dental Association or the Colorado dental community can do to assist or lighten the asks of you and your team during this public health emergency, please reach out to us anytime.
Dr. Jeff Kahl, D.D.S.
President
Colorado Dental Association
Greg Hill, J.D.
Executive Director
Colorado Dental Association
Kevin M. Patterson, D.D.S., M.D.
Past President
Colorado Society of Oral Maxillofacial Surgeons
Marc Weideman, D.M.D., M.D.
President
Colorado Society of Oral Maxillofacial Surgeons