CDA letter to Gov. Newsom calls for immediate alignment of return-to-work directives

Unaligned state and county orders disrupting provision of oral health care, letter states

As some dental practices in California begin to resume the provision of deferred and preventive care following updated state guidance issued specifically for dental health care personnel, dentists throughout the state remain confused about how to open their offices, what preventive measures they must implement and what services they can provide, writes Richard Nagy, DDS, CDA president, in a letter sent May 18 to Gov. Gavin Newsom. 

That lack of clarity “has left dental team members unsure if they can return to work and patients uneasy about receiving oral health care, including urgent care,” writes Dr. Nagy on behalf of CDA’s 27,000 member dentists.

State and local directives are unaligned, causing confusion

Conflicting county directives, particularly those that are more stringent than the state guidance issued May 7, are the primary cause for confusion.

Some of those directives, such as the San Francisco County directive issued last week, require that certain patient testing measures be achieved before the dental team can perform an aerosolizing or surgical procedure, despite the current unavailability of such testing. Rapid COVID-19 tests with reliable results do not yet exist on the market, for example, and testing as a primary method of screening is also unreliable given the dayslong processing time needed for the most accurate testing technology.

Los Angeles, Ventura and Sacramento counties have issued local directives that similarly conflict with the state guidance.

Instead of requiring that dentists provide nonexistent or unreliable patient testing prior to providing treatment, the state guidance prioritizes the availability of adequate personal protective equipment and sanitation supplies. The state guidance strongly recommends that “dental practices have a minimum 2-week supply of PPE for dentists and staff” prior to resuming deferred and preventive care, for example. 

The state guidance also clearly covers screening and testing ― with a focus on screening patients for COVID-19 before they enter the dental facility and consulting with a patient’s physician to obtain COVID-19 infection tests for any symptomatic patient “when adequate testing capability is established.”

Infection rates across the state will vary and may warrant different preventive measures, but any guidance that is more restrictive than the state guidance should not produce an “artificial barrier to care,” Dr. Nagy writes. “Local directives cannot get ahead of the science of testing, otherwise the ability to execute directives will be significantly impacted.”

Unaligned state and county guidance can also lead patients to seek health care in less restrictive neighboring counties, which could quickly erode the state’s progress on disease mitigation and the state’s economic recovery.

Dr. Nagy closes his letter:

I respectfully urge your administration to develop and immediately implement a standardized process by which local public health directives are vetted for alignment with current policy. I also urge that when more restrictive orders are deemed necessary, those orders reveal in plain language the supporting rationale and do not conflate the real issues at hand.

Read the full letter from Dr. Nagy to Gov. Newsom. 

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