New questions when dentists reopen
By Anne Blythe
Now that the state’s dental offices have started bringing in patients for routine cleanings, the state board charged with ensuring they provide standard care practice during this unprecedented time is grappling with unique questions.
the North Carolina State Dental Examining Board held its monthly board meeting on Zoom on June 12 and discussed a series of issues related to cleaning teeth and providing oral health care with COVID-19 so prevalent throughout the state.
During much of April and early May, many offices were closed except to provide emergency care.
For almost a month now, many have been opened under new recommendations and guidelines issued by the eight-member board in April. In the document, the committee refrained from codifying infection control measures and personal protective equipment. Nonetheless, he states that “failure to adhere to recommendations for enhanced infection control, sterilization and patient safety can be viewed as a breach of the standard of care necessary to provide treatment during the COVID-19 pandemic.”
The board is now grappling with how to handle complaints from hygienists and other employees, as well as patients concerned that specific offices are lax on infection control measures.
Dentists and hygienists working alongside them have been described as very high exposure risk category to COVID-19 by the Centers for Disease Control and Prevention.
“The cases we have come from patients concerned about their interactions with a practice,” said Catherine Watkins, secretary-treasurer of the state dental board. and a Winston-Salem dentist. She declined to give details, however.
Bobby White, chief executive of the board, said investigators did not visit offices during the pandemic to perform routine inspections.
White and Merlin Young, the chairman of the board, discussed how to provide personal protective equipment to investigators going to firms where issues have been reported.
Young, a dentist in Wendell, said he had material from his office that he could go to council if needed, but feared putting investigators at risk.
“I don’t want them to go to an active office because I don’t want them exposed,” Young said.
How to perform safe inspections
Board members questioned whether going outside of working hours would give a true picture of what is going on in a given practice.
“If you don’t go in during operations, you won’t be able to see what kind of screening process they have,” Watkins said.
At more common times, the board follows a specific process when a complaint is made. It would be assigned to an investigation committee, which would then recommend any corrective or punitive action to be considered by the full board.
The economists cited in a recent New York Times article said dentists could be a key economic indicator to watch as the country goes through the pandemic. If their businesses return after the March, April and May breaks, economists said, and patients walk with them, it could bode well for the country and the financial recovery.
But patients will need to be confident that their dentists will take extra care, even if this sometimes means patients will be turned away.
Raleigh Wright, Chief of Staff of Lane & Associates Family Dentistry and board member, said all complaints to the dental board may not warrant investigation. He recounted an experience at his office with a patient who was upset after being refused treatment at one of the practice’s 34 offices because the patient had a temperature of 101 degrees.
Watkins then recounted an experience to his practice, a large one with 129 employees and at least 16 dentists, some of whom are not working due to risk factors associated with the pandemic. A nurse who works in an environment where COVID-19 is a known risk was not stopped outside the front door, as she should have been, according to Watkins.
“In our personal office we had a nurse who came in for a hygiene appointment, but she is directly involved every day with Novant, the COVID-positive patients,” Watkins said. “She was not required by Novant to take a screening test, and she made it to our third floor.
“Our doctor and hygienist were very uncomfortable and asked her to leave until she could come back with a negative screening test. So that’s what we did on the basis of this individual case, but the lack of consistency affects us personally and obviously for other people in the state.
Difficulty getting answers
There has been confusion among dentists and hygienists about what to do if they discover during a screening before a routine cleaning or other procedure that a person has been in contact with someone infected with COVID- 19.
There is also a lack of consistency in responses across the state about how an office should react if someone working there tests positive for the virus.
While searching for answers to some of the questions, Wright said he called the Centers for Disease Control and Prevention and was returned to the state Department of Health and Social Services, then to the county health services.
“I’ve been told we’re a decentralized health department and that means each county has its own set of requirements and recommendations,” Wright said. “I won’t say which county, but we were told that if one of our employees tested positive for COVID, they could return to work the next day as long as they wear a mask. And all the counties neighboring that county said, “Absolutely not, they need to be quarantined for 14 days.
“Each county has its own policies and rules.”
“ Some take it seriously and some are not‘
Instead of dispatching investigators immediately, the council decided that White would write a letter that would be emailed to all dental providers in the state. Before launching a formal investigation, they wanted to make sure dentists understand that concerns about safety in some offices had already been brought to the attention of the board and encourage dentists to address the issue.
“I just feel like dental offices are everywhere,” Watkins said. “Some take this very seriously and some are not. To avoid receiving more and more complaints, maybe we could let them control themselves a bit if they knew we were looking into the situation and received concerns.
Buddy Wester, a Henderson dentist and a board member who served as chairman at one point suggested a carrot approach before proceeding with a stick for cowardly practices with infection control. He described the kind of message he thought the executive director could send.
“I think Bobby could write one of his fireside chat letters, so that you know ‘We’re here with you.” We’re here for you, but please be aware that if we receive a complaint about a patient’s infection control in your practice, then we’ll have to investigate, “not just ‘Well, we’re going to start investigating,” “Wester suggested.
“Make sure you let them know that if there is a complaint, a written complaint, we will have to open an investigation. But he can put a lot of flowers in it. People will sing the kumbaya. “
Although the board has received complaints from hygienists that their suppliers provide disposable gowns, members agreed that these complaints came from the employee and the employer and that the Occupational Safety and Health Administration work was a better place to broadcast these disputes.