June 2020 – The Straight Tooth

As dental clinics are re-opening for routine care across the country, there has been discussion within the dental community how to deal with the additional costs associated with operating in compliance with current infection control guidelines. In order to treat patients, many dentists have been subject to additional expenses such as: implementing building modifications, procuring medical-grade ventilation equipment, compensating staff for added responsibilities, sourcing and purchasing personal protective equipment (PPE). Less obviously, the additional COVID precautions requires more time between patients to properly prepare a room for treatment and to clean-up afterwards and often makes procedures more time-consuming, which represents less income-generating potential.

Many types of PPE, such as masks and respirators, gloves, gowns, shoe covers, and patient drapes, are single-use disposable items and represent a discrete cost directly associated with each patient visit. Currently, some PPE is in short supply and has thus resulted in higher prices. For example, a disposable gown may cost more than $5 each. This has prompted the creation of two new fee codes: (1) 99901 for PPE required for non-aerosol generating procedures (such as exams), and (2) 99902 for PPE required for aerosol generating procedures (such as most restorations and surgical extractions).

The Canadian Dental Association (CDA) manages a Uniform System of Coding and List of Services (USC&LS), which provides a standard system for dentists across Canada to document their services and prepare claim forms to insurance carriers. Provincial dental associations use the USC&LS to publish a suggested fee guide which is reviewed regularly. It is important to emphasize that provincial fee guides are suggestions only, as dentists are free to charge for their services whatever they deem reasonable. In BC for example, the British Columbia Dental Association (BCDA) suggests $10 for both 99901 and 99902.

The new existence of fee codes does not necessarily mean that the cost is being reimbursed by insurance carriers. These codes are still under review by many carriers. Until your carrier decides makes a decision about coverage, this additional cost will be an out-of-pocket expense for the patient.

Image from : Main Street Dental Group in Venture, California

https://www.dentistrytoday.com/news/todays-dental-news/item/6223-inspiring-dentists-provide-emergency-care-during-the-covid-19-crisis

Non-medical masks and face coverings

The following has been copied from: https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection/prevention-risks/about-non-medical-masks-face-coverings.html

Wearing a homemade non-medical mask/facial covering in the community is recommended for periods of time when it is not possible to consistently maintain a 2-metre physical distance from others, particularly in crowded public settings, such as:

stores
shopping areas
public transportation

Public health officials will make recommendations based on a number of factors, including the rates of infection and/or transmission in the community. Recommendations may vary from location to location.

Wearing a mask alone will not prevent the spread of COVID-19. You must consistently and strictly adhere to good hygiene and public health measures, including frequent hand washing and physical (social) distancing.

Appropriate use of non-medical mask or face covering

When worn properly, a person wearing a non-medical mask or face covering can reduce the spread of his or her own infectious respiratory droplets.

Non-medical face masks or face coverings should:

allow for easy breathing
fit securely to the head with ties or ear loops
maintain their shape after washing and drying
be changed as soon as possible if damp or dirty
be comfortable and not require frequent adjustment
be made of at least 2 layers of tightly woven material fabric (such as cotton or linen)
be large enough to completely and comfortably cover the nose and mouth without gaping

Some masks also include a pocket to accommodate a paper towel or disposable coffee filter, for increased benefit.

Non-medical masks or face coverings should:

not be shared with others
not impair vision or interfere with tasks
not be placed on children under the age of 2 years
not be made of plastic or other non-breathable materials
not be secured with tape or other inappropriate materials
not be made exclusively of materials that easily fall apart, such as tissues
not be placed on anyone unable to remove them without assistance or anyone who has trouble breathing

Limitations

Homemade masks are not medical devices and are not regulated like medical masks and respirators:

they have not been tested to recognized standards
the fabrics are not the same as used in surgical masks or respirators
the edges are not designed to form a seal around the nose and mouth

These types of masks may not be effective in blocking virus particles that may be transmitted by coughing, sneezing or certain medical procedures. They do not provide complete protection from virus particles because of a potential loose fit and the materials used.

Some commercially available masks have exhalation valves that make the mask more breathable for the person wearing it, but these valves also allow infectious respiratory droplets to spread outside the mask.

Masks with exhalation valves are not recommended, because they don’t protect others from COVID-19 and don’t limit the spread of the virus.

Medical masks, including surgical, medical procedure face masks and respirators (like N95 masks), must be kept for health care workers and others providing direct care to COVID-19 patients.

Image from: https://www.todayville.com/edmonton/to-or-not-to-wear-a-homemade-mask-that-is-the-question/