As the COVID-19 pandemic continues to sweep the nation, dental emergencies carry on—a reality Penn Dental Medicine has been keenly in tune with and proactive about.
When Pennsylvania Governor Tom Wolf issued guidelines on March 22 that prevented dental practices without N95 masks and negative-pressure rooms from operating, nearly every dentist in the state was shut down for the better part of a week.
“Everybody, everything was shut down and patients in severe pain were referred to the hospital setting,” explains Najeed Saleh, Penn Dental Medicine’s associate dean for clinical affairs.
Because of the need for emergency dental care, and in light of the fact that N95 masks were being prioritized for health centers caring for COVID-19 patients, School of Dental Medicine Dean Mark Wolff collaborated with Temple University Kornberg School of Dentistry Dean Amid Ismail and University of Pittsburgh School of Dental Medicine Dean Bernard Costello to push for a reevaluation of the guidance from the governor and Pennsylvania Department of Health. The result, as of March 30, is that Penn Dental Medicine’s clinic and Family Practice locations are now seeing patients in emergency situations—with strict screening measures and protocol to protect dental medical professionals and patients.
“We have been working under the umbrella of patient urgent care right now,” says Saleh. “We still don’t have the [N95] masks, and that is something we must use for procedures that [produce aerosol].”
Aerosol generation is a significant roadblock for treating patients in a dental setting during the pandemic, as drills dispense droplets into the air that could be a mode of infection. To treat patients with aerosol producing procedures, a N95 mask would be mandatory for a dental professional—and are currently in short supply.
“Dentistry is one of the most dangerous professions in terms of COVID-19 because the aerosol generated by a dental hand piece is an easy transmission route,” says Frank Setzer, assistant professor of endodontics, who has been treating patients in the clinic during the crisis. “So, at this point we’re prohibited from using anything with aerosol, drilling … And without a drill, there’s not a lot to do [as] a dentist.”
Wolff says the last day of regular operation of Penn Dental Medicine clinics was March 13. Afterwards, patients were screened at the entrance with a questionnaire inquiring about their travel and symptoms, followed by a temperature reading and additional questionnaire upon entering the building. On March 16, a focus was placed on emergency care, and patients began being screened through teledentistry to diagnose the severity of their problem. If they were considered in need of same-day care in person, they were invited to the clinic but required to undergo the screenings before receiving treatment. Penn Dental Medicine has limited its services to established patients for the time being.
Dental emergencies, clarifies Saleh, are ones that should be taken seriously and have serious implications for pain and suffering when patient complications are not attended to. For some people, it can be a life-or-death scenario, which is why emergency care in dental clinics continues.
“The dental emergency can be on a wide gamut; it can be as simple as a sensitive tooth because of exposed root to life-threatening, such as uncontrolled bleeding or infection with facial swelling that can easily spread into vital structure,” explains Saleh. “Not to mention that the mouth is just next door to the brain and infections could potentially spread through the blood supply into the brain.”
Saleh says Penn Dental Medicine has seen approximately 12-20 patients per day in person, with about 40 teledentistry visits scheduled daily, consulting with one of three licensed dentists. Remotely, they’ve been able to prescribe medications and answer questions, while in person they’ve been able to conduct procedures that do not produce aerosol, such as tooth extractions and temporary crown replacements. Only a handful have had to be referred to neighboring hospitals.
“I think the patients are very pleased their needs are being addressed,” Saleh says, “that at least somebody is trying to help them. And it’s certainly not ideal, but they are understanding and there are certain cases where we resolve the problem for the patient completely and they’re very appreciative.”
In one case, he says, a truck driver visited in early April in need of a tooth extraction; to help out, he came back later that day to donate a box of his own disposable gloves to the practice.
“Patients are especially appreciative when no one else is providing this care, for the most part, because all of these [other] dental offices are closed,” Saleh adds.
Wolff expresses understanding about the restrictions set up by the state, citing the need for medical professionals to stay protected—while also trying to convey to state officials how patients are affected statewide.
“Dentistry, like medicine, has to delay elective procedures to preserve patient protection equipment. Am I happy about that? No. Is it necessary? Yes,” Wolff says of state measures. “We have to do what we can to make sure our medical professionals are well-protected, so I support that concept. I think we’re an essential part of people being healthy, but there are priorities at this particular moment.”
Still, he points to the success of teledentistry as a significant takeaway of the pandemic response so far.
“I think we will find new ways of doing this and interacting with patients,” Wolff says. “A patient is always calling on Saturday evenings, and the dentist spends time talking on the phone, ‘What does it look like?’ before sending them to the emergency room … so the ability to introduce face time, to see a picture, that’s a big deal.”
He’s especially hopeful that the current relaxing of HIPAA restrictions will be reexamined once the pandemic ends, which would allow expanded access to dental services remotely. (One example he cites: the ability to bill patients for remote visits—while clarifying that no patient is currently being billed for teledentistry here at Penn Dental.)
Long-term, Penn Dental is focused on reestablishing regular treatment for patients.
“At some point we have to start treating patients,” Wolff says. “What’s next for us is figuring out how to start safely bringing people into the facility and delivering care that is safe to the provider and patients as they come through. We have always been good at infection control as part of our core mission, but we have to run another step forward and the enhanced infection control necessary to protect patients and providers.”
Penn Dental Medicine has established an emergency fund to help meet the costs related to patient care during this crisis, including obtaining essential clinical supplies, supporting teledentistry programming, and meeting other vital needs.
“We are grateful for those who are helping us meet this need,” adds Wolff. “We’re going to get back to normal; people need a good smile. We’re in the business of making people smile, and that’s important.”