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Practice Interruption Due to COVID-19

Based on recommendations and guidance from the CDC, the governor’s office and the California Department of Public Health, CDA is advising dental practices to limit patient treatment to emergency care only due to the COVID-19 pandemic. It is recommended that dentists practicing in California voluntarily suspend non-emergent dental care at this time.  

Why restrict your dental practice to emergency care only? 

CDA is strongly advising dental offices to limit patient treatment to only care for those patients with emergent oral health needs. Reducing patient visits to emergency care only reduce the amount of contact that potential COVID-19 carriers have with others in the community, reduces the risk of disease exposure for your patients, your staff and yourself, and preserves PPE within the healthcare system for frontline health care providers in this pandemic. CDA’s recommendation comes amidst many similar advisories from experts who warn that the steep curve of community transmission occurring across California and the nation must be flattened to lower COVID-19 morbidity and mortality.  

How do we define “life-threatening” dental emergencies?  

CDA’s updated advisoryintends to protect the dentist, the dental team, patients and the community from the transmission of COVID-19 and prevent the unnecessary use of the PPE resources that are in extremely short supply, especially N95 masks. As health care providers, dentists understand their patients’ conditions and use their professional judgment to diagnose if a patient is experiencing a true dental emergency and determine if it is appropriate to treat with the appropriate PPE. 

This recommendation does not limit dentists from seeing patients that they determine to have a condition needing emergency dental care. Dental emergencies should be evaluated on a case-by-case basis to determine the appropriate and necessary timing of in-person treatment. 

What do I tell my staff/team? 

Here’s some suggested language:  

In order to ensure the continued health of our patients, we are limiting treatment to emergency patients only at this timeThe health and welfare of our patients and our staff are the utmost priority and we want to do our part to limit the spread of COVID-19, to reduce patient hospitalizations and lessen the strain on resources needed to treat patientsI value your assistance in making this a smooth transition.I appreciate your commitment to working together to get through this difficult time.  

Address payroll and benefits for members of your staff during the practice interruption. See the Employment and Office Closures FAQ for common questions regarding your responsibilities as an employer.  

How do I notify my patients of the shift in provision of dental services for the time being? 

Contact patients via phone, email and text and reschedule their appointments for a later date. Explain the reason for the change. Identify how you’ll communicate with patients during the office closures, whether it will be via email, your practice website or social media, and let your patients know which channel you’ll be using for communication. Be sure to make you and/or members of your staff available to them via phone, for consultation regarding possible emergencies or to make patient records available. 

Additionally, a sample announcement is provided below which you may mail, email and text to your patients in addition to posting on your website and social media pages is available to download below./p>

How do I ensure my patients can receive emergency care during this time? 

You are obligated to make reasonable arrangements for the emergency care of your patients of record. A charge of patient abandonment may result from a failure to make reasonable arrangements. Also, dental benefit plans require contracted providers to make arrangements for after-hours emergency care for their patients.  

Examples of reasonable arrangements include: 

  • Arranging for emergency coverage with one or more colleagues in the event that you are unable to provide treatment to due incapacitation. Notify your patients in advance and provide your colleagues’ contact information or that of your answering service. 
  • Leave an outgoing message on your telephone answering system that provides instructions on how a patient can contact you or the colleague who is providing emergency coverage.  
  • If using an answering service, instruct the operator to collect information from the patient that includes full name, date seen by the dentist, complaint and a phone number.  
  • Ensure you have a method of verifying patients of record or verifying patients of colleagues for whom you are providing emergency coverage. 

If a patient has reached out for urgent or emergency care, triage the patient over the telephone as you normally would. However, implement the additional COVID-19 patient screening questions to assess whether the patient should be seen in your practice or referred to their medical provider for potential COVID-19 testing or treatment. In the event the patient has COVID-19 symptoms or has been recently exposed to the virus, direct the patient to contact their physician immediately or arrange to be seen at the local hospital.  

You are not required to see an emergency patient in the middle of the night. If a patient in pain contacts you in the middle of the night, refer the patient to a hospital emergency room or urgent care facility for pain relief and direct the patient to present at your office at the earliest possible time. 

Be sure to keep a record of these after-hours consultations. 

Patients not of record: When consulted in an emergency by a patient not of record, you are obligated to make reasonable arrangements for emergency care of that patient, including screening for COVID-19 symptoms. Consulting with a patient for the first time in an emergency does not make the individual a patient of record. 

Do not leave an outgoing message directing emergency patients to contact the local dental society, unless the dental society has agreed to handle and has implemented a plan for handling such calls. Check with your dental society for more information. 

You cannot advise patients to call 911 only, with no other options available to them. This is a misuse of the 911 system (refer to Penal Code section 653y). If the patient thinks they are having a medical emergency, you can tell them to call 911, but you must provide other alternatives for the patient to receive emergency dental care. If you need assistance finding options for your patients, reach out to colleagues to see if they are available to assist your patient base, ask what their methods are for these situations or consider hiring an answering service. A Google search will provide you with some options. If using an answering service, be certain the service signs a HIPAA business associate agreement. 

CDA Code of Ethics 

Section 8: Emergency Service 

A dentist has the obligation to make reasonable arrangements for the emergency care of his or her patients of record. 

A dentist has the obligation, when consulted in an emergency by a patient not of record, to make reasonable arrangements for emergency care of that patient. 

Advisory Opinion: 

8.A.1. Continuity of care: In the interest of preserving the patient’s continuity of care, a dentist who treats a patient not of record shall recommend to the patient to continue treatment with the original treating dentist unless the patient expressly reveals a different preference. 

Other considerations for practice interruption:  

  • Arrange for security at the dental office to ensure patient records, financial documents, contracts, etc., are safely stored.  
  • Forward postal service if someone is not regularly at the office to check for incoming mail. 
  • Notify mutual aid organization, if applicable. 
  • If applicable, notify landlord or tenants of temporary office closure per terms of any agreement. 
  • Notify suppliers and service providers of shifts in office hours.  
  • Ensure proper disposal of hazardous and medical waste.  

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