HOW DO YOU PROPERLY CLASSIFY DENTAL TREATMENTS IN THE NEW NORM OF DENTAL PRACTICE?
Our risk in contracting CoVid-19 virus, along with the rest of the other healthcare workers will remain very high until vaccine or treatment is discovered and invented for COVID-19 virus. In our dental practice, the use of high-speed handpieces and ultrasonic instruments can create our patients’ saliva or blood to turn and become droplets or aerosol which maybe easily transported to us even with one simple mistake in our protocols that can end fatal.
As we are all aware that our dental procedures are done with us operating in close proximity to our patient and the fact that droplets spread within a radius of three feet from the operator greatly emphasizes already the eminent danger of us contracting this disease. Even though there exists standard protective measures in doing our daily clinical works, they may not be always effective to prevent the spread of COVID-19 for various reasons or factors. Such as most patients who are in the incubation period are usually unaware that they’re infected, or worse our patient gives false information and not disclose the fact that she/he is CoVid-19 positive. Thus, a lot of us chose to not practice yet and open our dental clinics or just be selective of what we prefer to do first. Majority of us up to now becomes very selective on when to practice and only address emergency procedures. However, we all know that as dentists we are also oblige to fulfill our Hippocratic Oath and as human beings we feel responsible as well to help our patients even at our own peril. So, how can we properly classify dental cases from elective, emergency to urgent and address the needs of our patients especially at the time of their dire need of our dental treatment?
PATIENT MANAGEMENT
All health organizations want us to be clearly aware on the manner on how we identify the risks and limitations and be able to smartly decide as to when there’s really a need to attend to our patient if at the current situation you don’t feel you are ready yet to fully open your practice. This is why triaging becomes very important. Triage is a critical process in managing, sorting and prioritizing dental emergencies before proceeding to clinical treatment. It is also a process of determining the priority of patients’ treatments based on the severity of their condition.
So, how can we properly do the triage process in our dental office? It actually begins when our patient calls for a probable dental emergency. Thus, it is important that our staff or you gather as much information as possible during the initial conversation and screening with the patient. This thorough information- taking increases our level of efficiency to address the current situation of your patient. The main goal is to learn and record adequate pertinent information, so, the appointment can be set at the best possible time both for your patient and you. By doing this, your dental clinic will be well prepared for you to receive your patient and do the treatment properly with all the necessary protocols, materials and equipment prepared and ready to eliminate or minimize the risk of either your patient or you making things worst and unknowingly transmit this virus to the other as one of you happens to be an asymptomatic patient or in state of denial.
PATIENT SCREENING PROTOCOLS
Right now, the rule of thumb is, everyone is a CoVid-19 patient unless proven otherwise. Thus, strict screening of patients must be done without exceptions. So, how do we accomplish this without unnecessary exposure? By doing telephone or online screening of all patients for symptoms consistent with COVID-19 condition. If the patient reports similar symptoms of COVID-19 disease, then, definitely avoid non-emergency dental care. Better yet, if possible, delay dental care until the patient has recovered or refer the patient to a colleague who is willing and ready to take the dental case out of your hands.
If you are interested to have a copy of DMD Center Questionnaire Form and Consent Form, you might like to read this Post, click this, “Contact Tracing: Relevance to Dental Practice” and download it from there. Here are the list of steps to do:
- Apply telephone or online triage process with all of your patients in need of dental care. Assess the patient’s dental condition and determine whether the patient needs to be seen in the dental setting for treatment or not.
- Offer Teledentistry options as an alternative to In-Office care.
- Request that the patient to have no companion in his/her dental appointment in your dental clinic for treatment unless truly necessary only such as the patient is a child, senior citizen or person with disability.
- Advise patient and companion, if there’s a need to have one, that they both have to wear a face mask, wash their hands or hand sanitize upon entry to your clinic and will undergo screening for fever and symptoms consistent with COVID-19 on their scheduled appointment.
- If upon diagnostic test, the patient is febrile (temperature > 37.5˚C) but didn’t have yet other symptoms consistent with COVID-19, then, automatically the infectious control protocols during the emergency treatment must be strictly implemented by you or your staff.
- Asks the patient to re-don their face covering at the completion of their clinical dental care when they leave the treatment area.
CLASSIFICATION OF LEVEL OF URGENCY
I. Dental Emergencies are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding, alleviate severe pain or infection.
LEVEL: PRIORITY
What are the conditions?
- Uncontrolled bleeding
- Cellulitis or diffuse bacterial infection leading to intra-oral or extra oral edema potential risk of damage to airways
- Facial bone trauma which may damage the patient’s airway
II. Urgent Dental Procedures focuses on the management of conditions that require immediate attention to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments. These should be treated as minimally invasive as possible.
LEVEL: IMMEDIATE
What are the conditions?
III. Elective Dental Procedures are routine or non-urgent dental procedures, esthetic procedures which are non-life threatening.
LEVEL: CAN BE DELAYED
What are the conditions?
- Oral Prophylaxis
- Scaling and Root Planing
- Orthodontic Adjustment
- Bleaching
- Replacement of Crowns for Decayed Tooth
- Filling of Moderate or Incipient Caries
- Extraction of Asymptomatic Teeth
- Restorative Dentistry Including Treatment of Asymptomatic Carious Lesions
CONCLUSION
Doctors, Dentists and other Health Care Workers are also human, we all do feel anxiety and fear as we do our duties and responsibilities to our patients. Thus, we do have a choice whether we want to already open our dental practice for all dental treatments or not. Nobody has the right to force and judge you if you opt not to especially if you are also among compromised patients yourself with age and health conditions that can even be more detrimental to yourself if you contracted this virus. So, whatever, you do decide, do it according to your conscience, intent and logical assessment as a doctor.
Contributor:
Dr. Bryan Anduiza – Writer
Dr. Jean Galindez – Writer | Editor
