Additional fees for PPE

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

© The Straight Tooth 2020

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/

© The Straight Tooth 2020

Why isn’t my dentist open yet?

In BC, a “Restart Plan” exists. Dental offices are permitted to open with enhanced protocols as of the start of Phase 2, which was May 18, 2020. Similarly across Canada, based on their provincial plans, the public may be expecting their dental office to now be open or to be opening soon.

So why isn’t my dentist open? Most dental clinics are operated by the dentist-owner as a small business. Before reopening, dentists have an enormous number of requirements to satisfy in order to ensure the health and safety not only of all patients, but also staff and any third parties visiting the premises.

Requirements are specified by several authorities and have been developed, issued and revised as the COVID-19 situation has progressed. These requirements do not always correspond to each other and sometimes clarification is required to apply to a specific dental workplace. In BC, the relevant authorities include:

• BC Centre for Disease Control (BCCDC)
• Ministry of Health and the office of the Public Health Officer (PHO)
• WorkSafe BC
• The College of Dental Surgeons of BC (CDSBC)

A responsible dentist-owner needs to navigate and satisfy these requirements plus deal with COVID-10 complications related to staffing, supply procurement, rent payments, etc. Needless to say, the situation is complex and your dentist may not be ready to re-open safely.

My advice to patients:

• If you feel you have an emergency or urgent concern, do not wait to contact your dentist! Your dentist should be able to provide emergency care or at least refer you to someone who can.
• If you are waiting for routine, preventive or elective care, please be patient. Monitor your dentist’s website to watch for announcements. Many dental offices are currently answering their phone and you will be able to ask a staff member your questions.
• Continue to take care of your teeth at home. See a previous post about Preventing Dental Emergencies.

© The Straight Tooth 2020

How to Wash your Hands

This procedure ensures that you reach all the surfaces of your hands. When using alcohol-based hand sanitizer, dispense a dollop the size of a loonie, rub all surfaces as if washing your hands, and keep rubbing until dry.

Image from: https://www.buzzfeed.com/terripous/how-to-wash-hands-properly-according-to-science

How to Correctly Wear a Mask

Remember that a mask cannot prevent infection. Wearing a mask incorrectly may provide a false sense of security and actually result in an increased risk.

Key points:

• Wash/disinfect your hands before starting.
• Ensure the mask is the right side out. The material on either side have different characteristics.
• Form-fit the mask to fit snuggly around the nose.
• Pull the mask down to fit snugly over your chin.
• When removing your mask, assume that the outside surface is contaminated.
• Wash/disinfect your hands after removing your mask.
• Disposible masks are not intended to be re-used.

 

© The Straight Tooth 2020

COVID-19: The Connections Between the Dots

General facts on viruses (from medicalnewstoday.com)

• Viruses cannot replicate without a host cell.
• Before entering a cell, viruses exist in a form known as virions and they are very small, roughly one-hundredth the size of a bacterium.
• They are considered the most abundant biological entity on the planet.

 

How COVID-19 spreads (from canada.ca and cdc.gov)

• Most commonly spread through droplets and contact.
• An infected person creates an imperceivable spray zone of droplets when they breath, talk or cough.
• A respiratory droplet is a particle of mostly water, of greater than 5 microns in diameter (1 micro = 1/1000 of a millimeter). The width of a human hair is 70 microns.
• Note that some news sources incorrectly interchange the terms aerosol and droplet.
• Droplets are larger than aerosols: whereas aerosols evaporate in the air, droplets ultimately drop onto a surface.
• A droplet may remain suspended in the air for up to 3 hours.
• The virus survives longer on hard resiliant surfaces compared with porous surfaces and may survive for up to 3 days.
• Therefore, a person can be exposed to the virus by either inhaling the respiratory droplets, or by touching a contaminated surface and then touching one’s mouth, nose or eyes.

 

Tips to limit your COVID-19 exposure

• Avoid close proximity with other people, i.e. keep a distance of 2 meters minimum.
• Plan your essential outings early in the day to avoid crowds.
• Breezy outdoor spaces are safer than confined indoor spaces.
• Avoid touching anything, especially your face, while out in public areas.
• Use alcohol hand sanitizer when getting back into your car.
• Leave purchases that you don’t immediately need in an isolated location (ex. your garage) for a couple days.
• Wash your hands with soap and water immediately upon entering your home.
• Schedule your day so that you shower-up and change into fresh clothes upon arriving back home.

 

© The Straight Tooth 2020

Understanding Emergency, Urgent and Elective Dental Care

These definitions are from the College of Dental Surgeons of BC (CDSBC). All conditions are subject to dentist’s professional judgement based on the patient’s clinical presentation (appearance and symptoms).

Emergency – Potentially life-threatening conditions requiring immediate management or treatment to stop ongoing tissue bleeding or alleviate severe pain or infection, such as trauma impairing the airway or uncontrolled infection.

Urgent – Conditions that require immediate attention to relieve pain and/or risk of infection, such as third molar (wisdom tooth) pain, avulsion (knocked out tooth), or painful abscess (infected tooth). These are separate from emergencies.

Elective – Routine or non-urgent dental procedure, such as aesthetic procedures, dental hygiene, restorations (fillings), and preventative treatments.

Whether during a pandemic or not, from a patient’s perspective, it helps to understand these categories in order to:

• Have realistic expectations about what conditions can wait and what needs to be addressed right away.
• Help communicate, as best as possible, an accurate representation of your condition when you are speaking to your dentist over the phone. This aids the dentist forming appropriate initial recommendations and helps clinic staff preparing necessary equipment for your appointment (if necessary).

 

© The Straight Tooth 2020

What does dentistry look like during COVID-19 restrictions?

Note that as the COVID-19 situation differs throughout Canada and is changing on a daily basis, the information in this post should be considered valid only in BC and around this posting date.

Along with medicine, nursing and many other professional healthcare providers, dentistry is a regulated healthcare profession, which means that there are regulatory bodies that govern the practice of dentistry at the provincial level with the intention of protecting the public’s health and safety. Two examples of regulatory bodies are: Royal College of Dental Surgeons of Ontario (RCDSO) and the College of Dental Surgeons of BC (CDSBC). These organizations have been constantly monitoring the situation, disseminating the newest scientific evidence, and issuing updated practice recommendations and guidelines.

Starting in March, for example, many dental regulatory bodies across Canada recommended that dental offices cease to see patients for non-essential (elective) care, and that only clinics properly-equipped shall treat emergent (emergency) and essential (urgent) care. See my next post for further explanation of these terms.

There are many factors that determine whether a clinic is “properly-equipped” to deal with this unique risk. For example, is there:

• Certain physical features (such as closed dental operatories and plexiglass shields at the receptionist counter)?
• An adequate supply of specific personal protective equipment (PPE) to protect both staff and patients?
• A robust infection prevention and control (IPAC) program capable of attaining the more thorough levels of surface disinfection now required?

Some clinics may be prepared to see patients for clinical assessment, a procedure that is relatively low risk of spreading COVID-19, but do not have the higher level of PPE required to actually conduct treatment. Relatively few clinics are currently prepared to treat emergency patients. Many regulatory bodies across Canada have published lists of emergency clinics which are updated regularly.

At all times, pandemic or not, dentists are legally and professionally obliged to provide emergency dental care to their patients in need, or make a reasonable attempt to provide alternative arrangements in their absence (such as outside of regular clinic hours).

So dentists may meet this obligation in different ways. An automated messaging service or website may provide an emergency contact number. Many clinics continue to answer their phone or regularly monitor their phone messages. A dentist speaking to a patient by phone will ask questions to determine the nature of their dental emergency.

If the patient’s condition can be managed by medication, this is the preferred treatment approach at this time. If a condition cannot be adequately managed this way, a patient exam (clinical assessment) is necessary. The patient may be either asked to come into the clinic or referred to an emergency clinic. 

© The Straight Tooth 2020

Welcome back friends!

I created this blog way back in 2012. At that time, I was a Dental Hygienist in Ottawa. Among my most rewarding work experiences was with Portable Ottawa Dental Service (PODS), providing free treatment to underpriviliged young parents and their children.

I found such a passion in helping people through their oral health that I pursued dental studies at McGill University. I am currently practicing in group provider and private practice settings. In these current uncertain times of physical distancing, I think it’s a great opportunity to revive this blog. Enjoy! And please follow.

© The Straight Tooth 2020

Good resources to prepare your child for their first visit to the dentist (2014)

The Canadian Dental Association recommends that the first visit to the dentist should be no later than the age of 12 months. If you have any concern about your infant’s oral health, do not hesitate to contact your dentist’s office for their advice.

Pediatric dentists specialize in dental care for children, however in most cases your usual family dentist or dental hygienist would be capable and more than happy to see your child along with the rest of your family. Your dentist will refer you to a pediatric dentist if specialized care is required.

Several books are recommended to prepare your child for their first visit to the dentist:

• The Berenstain Bears Visit the Dentist, by Stan and Jan Berenstain
• Show Me Your Smile: A Visit to the Dentist, a book in the Dora the Explorer series
• Going to the Dentist, by Anne Civardi
• Elmo Visits the Dentist, a book in the Sesame Street series

 

© The Straight Tooth 2014