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COVID-19 Updates from Executive

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.

CDSPI Update

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.

March 31, 2020 COVID-19 Update: Walk-through of dental emergency care

We understand the challenges our members are facing during this pandemic. We have fielded many calls from individual members around a variety of clinical situations, where the member is seeking direction from the ADA&C on appropriate steps to take in managing the care for their patient.

We would encourage members to use their good clinical judgment in all cases. Assistance to guide you through the process can be found within the Dental Emergency Protocol document.

To provide more clarity and direction for you, the expectation is that you, the dentist, would speak directly with the patient to triage for symptoms and risk factors and to determine whether a dental emergency exists. As a reminder, for the purposes of the environment in which we are currently under (i.e., a state of public health emergency), those conditions would include trauma, significant infection, prolonged bleeding and pain that cannot be managed by over the counter medications.

Often this direct patient-dentist contact will resolve the problem or determine that in your good clinical judgment it is a condition that can be observed or monitored. Sometimes the concern of the patient will be managed by pharmaceutical management. We have provided both adult and child pharmaceutical flowcharts to assist you with decisions on pharmaceutical management for your patients.

IF it is determined at this stage that you require a physical face-face visit with your patient to better assess their condition, you would assess whether there are symptoms or risk factors present. For your patients that you have triaged and assessed, if there are no risk factors, they can be treated within your own office. If you are performing non-aerosol generating procedures, using PPE that includes gloves, eyewear protection, a surgical mask (it does NOT have to be a N95 to treat an asymptomatic patient with non-aerosol generating procedures) you will meet current IPC standards.

If you are generating aerosols, and the ADA&C has strongly recommended that those procedures be limited, you are required to use enhanced PPE for all staff doing the procedure. This includes enhanced PPE such as protective clothing, gloves, fitted N95 masks, protective eyewear or face shield (due to the aerosol being created). Follow donning and doffing of all PPE.

As per your usual decision making for all patients, continued use of your good clinical judgment remains paramount. You may decide that this patient who has no symptoms or risk factors requires a referral. Your first point of contact should be to your regular referral base. Call your pediatric dentist, endodontist or oral surgeon to ascertain whether they can see your patient. Follow your regular referral process and have the care needs of your patient addressed.

The ADA&C is continuing to work on where to send a COVID-19 positive or patient with symptoms or risk factors.

​We hope you have found this “walk-through” of the basics helpful and reassuring that you can continue to provide care for your patients. An additional valuable resource is the Guideline on Emergency Treatment document. Please refer to this and the other resources outlined above to assist you in your clinical decision making and exercising of your good clinical judgment.

We would like to thank our members for their desire and ability to provide safe dental care, while continuing to protect themselves and their staff as they provide care to their patients.

March 30, 2020 COVID-19 Update: Health Canada controlled substance changes

At the ADA&C we know that in times of high anxiety and stress, it’s more important than ever to safeguard your mental wellness.

You, your families and your staff, even those who have been temporarily laid off, are able to contact CDSPI Members’ Assistance Program (MAP) for support to help you navigate through this challenging time. MAP can be contacted at 1-844-578-4040 or visit: worklifehealth.com. Click here for the Member Assistance Program brochure.

Shepell have released a series of podcasts on a variety of topics, including: what we currently know about coronavirus, how to manage your emotional well-being during a pandemic, talking to children about COVID-19, and more.

The ADA&C Wellness Program Committee (formerly CAP) provides professional and confidential assistance from your colleagues to all members and their immediate family members.

The ADA&C Wellness Program also offers clinical counselling, accessed by telephone, for dentists and their family members that are experiencing problems – and the ADA&C will pay for the first six appointments. The clinical counselling is done through the independent counselling firm Canniff and Associates.

Canniff and Associates’ main office is open from 8 a.m. to 5 p.m. Monday to Friday. You may also call their 24 hour answering service and be connected to the on-call therapist in the event of a crisis situation: Toll Free: 1-800-CANNIFF (226-6433) or email:  jim@canniff.ca.

As always, if you become aware of signs or incidents of domestic or child abuse, you have a duty to report. These are sad realities, but, these are things that we need to be aware of and sensitive to as health care professionals and as caring citizens.

  • Family Violence Info Line: 310-1818 to get help anonymously in more than 170 languages or find other supports.
  • Kids Help Phone is Canada’s only 24/7 national service offering bilingual (English and French) professional counselling, information and referrals.

The ADA&C is continually working to monitor the COVID-19 crisis and develop resources for the membership. We have formal lines of communication with AHS and Alberta Health. We are also maintaining contact with national dental organizations and other provincial partners.

This ongoing environmental scan allows us to be proactive, and reactive, as this health crisis evolves. Your health and safety, the health and safety of your staff as well as your patients is our overarching goal.

Please look for this daily communique as further information and resources are shared. Thank you for your ongoing commitment to your patients and the citizens of Alberta.

Health Canada issued exemptions to maintain Canadians’ access to controlled substances for the treatment of pain and other medical conditions, while they adhere to physical distancing guidance from public health professionals or if they need to self-isolate.

The exemptions are:

  • Permit pharmacists to extend prescriptions;
  • Permit pharmacists to transfer prescriptions to other pharmacists;
  • Permit prescribers to issue verbal orders (i.e., over the phone) to extend or refill a prescription; and
  • Permit pharmacy employees to deliver prescriptions of controlled substances to patient’s homes or other locations where they may be (i.e., self isolating).

More information, guidance and responses to frequently asked questions are available at abpharmacy.ca/CDSA_Exemption_and_interpretive_guide_for_controlled_substances.pdf 

To read past advisories we’ve sent visit: ADA&C Communications