Throughout this, symptomatic refers to patients having one or more of the following: Fever >38*C, cough, sore throat, shortness of breath, flu like symptoms. Risk factors refer to close personal contact (w/o PPE) with a suspected or lab confirmed COVID-19 patient within the past 2 weeks, and/or travel outside of Canada (by air, car, bus or otherwise) in the past 2 weeks.
The ADA&C is continuing to develop guidelines and requirements for facilities that can treat symptomatic and/or risk factor identified patients who require in person emergency care. At present these patients should only be treated after direct Dr to Dr consultation; this may be to an endodontist, an OMFS or a Pediatric dentist.
Refer to the COVID-19 Dental Emergency Protocol. We are developing guidelines for facilities that can treat patients that fall into Category F.
Fortunately the demand for this specialized care has been able to be met within current capacity. Thus we have had time to have thorough consultations with experts as we work on expanding this capacity. The overarching goal being healthcare provider and patient safety.
There are treatment strategies that can be considered to possibly bring Category F patients down into lower risk categories. It all depends on the nature of the dental emergency and what symptoms and/or risk factors have put the patient in the high risk category (category F). The variety of clinical presentations can be endless and thus it is difficult to give you direction on each specific scenario. Once again the reinforcement is that members need to use good clinical judgement.
Some possible treatment strategies to assist you in getting patients into lower risk categories:
- Maintain contact with the patient and manage them with antibiotics and analgesics while they are in any mandatory isolation period. After the isolation period ends, and no further symptoms or risk factors are identified, then the patient falls into a lower risk category and can be managed with the appropriate PPE in your office.
- The patient requires emergency care that can initially be managed pharmaceutically. Consider asking the patient to go into a voluntary 14 day isolation period. At the end of that time you can be more confident of the patient’s health status and thus once again they will be in a lower risk category for their emergency dental management.
- A patient is having symptoms. Manage them with pharmaceuticals if possible and then, as per AHS guidelines, have them self isolate for 10 days from the onset of symptoms (and/or until symptoms clear up, whichever is longer). At the end of that time if they are asymptomatic then they may be in a lower risk category.
The above examples are only meant to be that. Assess your patients and their individual presentation as the unique situations they are. What causes them to be in the highest risk category? What initiatives can you undertake to get them into a lower risk category? Thus protecting you, your staff and your other patients.
We understand the pressures members are operating under. There is demand for treatment from patients and our internal desire to provide an exceptional level of care utilizing all of our knowledge and resources. But these are unique times and require patient education on expectations. It requires us to be clinical problem solvers within a framework of our own health protection, as well as the health of our teams and patients.
On Wednesday, April 1, the ADA&C has been informed by CDSPI that there is positive news coming regarding TripleGuard Pandemic Insurance. Please look to your CDSPI representative for more information.
Duty to report
As professionals, there are specific obligations you have because of what you do and who you are to your patients. Self-reporting and reporting a colleague in specific situations are two of these obligations.
On March 15, 2020, these two duties were communicated to members in an e-Advisory. As a recap of the March 15, 2020 e-advisory, members must self-report a positive test for COVID-19. If you have tested positive, you must report this even if you are now healthy and clear of the virus.
Members have an obligation to report a colleague if they know they have tested positive and did not self-isolate; or otherwise are not self-isolating because of travel outside of Canada within the last 14 days or confirmed contact with someone who has tested positive.
The ADA&C is here to fully support any members who may find themselves testing positive for COVID-19. For any questions or to discuss the duty to report, please contact Colleen Wetter at 780-432-1012.