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May 19, 2020: CDA Update

CDA Update

The CDA update dated May 15 contains some useful information on the announced Federal subsidy programs, mental wellness and cautions around non-approved PPE, particularly KN95 masks. Click here to read the full update.

May 15, 2020: Things to consider

As Alberta dentists return to full practice, please think about your new environment and the messaging to your patients and the public.

The Alberta Dental Association and College is here to help you engage with your patients! It starts with your website and your voice mail message. Take a look at your website and listen to your voicemail message.

Consider the information on your website and voice mail message:

  • Does it present your current hours?
  • Have you listed the names of the dentists who are currently working at the practice?
  • Does the public know if you are accepting new patients?
  • Do your patients know you are contacting them to schedule recall appointments?
  • Let your patients know if the dentists at the practice are providing hygiene services.
  • Have you decided whether you have returned to full provision of services or are providing a specific range of services?
  • If you have not returned to full practice, let your patients know how they can contact you.

Remember, some things never change. The ADA&C Guide for Advertising and Promotional Activities continues to be your go-to reference for your advertising and marketing. Watch out for claims of superiority and misleading information if you are advertising your IPC practices and PPE.

Do you have a new ad you would like to run past the ADA&C? We are here to help! Please contact Katherine at kgibson@adaandc.com if you wish to have an advertisement reviewed.

Guidance for Flushing Water Systems

If your practice has been closed or you have questions about your water systems, Alberta Health has provided Guidance for Flushing Water Systems. Depending on the complexity of the system, it may be helpful to consult with your dental supply maintenance company, a plumber or building system engineer to assist with flushing procedures.

5 Ways Leaders Accidentally Stress Out Their Employees

There’s a good article recently published in the Harvard Business Review, 5 Ways Leaders Accidentally Stress Out Their Employees by Tomas Chamorro-Premuzic, that’s a good reminder of how to deal with the people around you.

Thank you

Thank you again for your patience and for continuing to meet the dental needs of Albertans during this time. 

May 13, 2020: Alberta Health Announcement and Thank you

Alberta Health Announcement – May 13

The ADA&C wants to ensure dentists of Alberta that with the phased launch approach in Calgary and Brooks, dentists are still permitted to open if they feel comfortable. Regulated health professionals were permitted to return to safe practice (on May 4) subject to guidelines approved by their respective regulatory colleges.

The ADA&C released Expectations and Pathway for Patient Care during the COVID-19 Pandemic document yesterday with the information that Alberta dentists are permitted to return to their full provisions of services on May 14. This includes dentists in Calgary and Brooks.

All dentists may choose to delay returning to full provision of services to allow for more time to prepare before doing so. When you proceed with opening, daily screenings of staff and patients are of utmost importance.

A special thank you to all members of the Alberta Dental Association and College for their patience and understanding as we have navigated the past 2 months of this COVID-19 pandemic. These have been challenging times for all Albertans. Dentists have not been excluded from this challenge.

You allowed time for the Covid-19 Response Team to develop guidelines for use during this pandemic. Because of this time, Alberta dentists are in a good position to resume providing full treatment to their patients. The ADA&C’s existing Standards of Practice that are now supported by the enhanced guidelines for COVID-19 times, will serve Alberta dentists well as we continue to provide a full range of dental procedures. They allow provision of treatment that is safe for dentists, team members and patients.

Thank you again for being a valued part of healthcare in Alberta. The ADA&C will continue to support the work of dentists as they resume their full scope of treatment.

Sincerely,
Dr. Troy Basarab
President

May 12, 2020: Expectations and Pathway for Patient Care during the COVID-19 Pandemic

Correction Notice: Required PPE

In the Expectations and Pathway for Patient Care during the COVID-19 Pandemic document released earlier today, we have corrected the heading Recommended PPE to Required PPE in Table 2, page 7.

Expectations and Pathway for Patient Care during the COVID-19 Pandemic document is now available

On May 14, 2020, Alberta dentists are permitted to return to full provision of services. These oral healthcare services are included in Stage 1 of Alberta’s Relaunch Strategy.

The Expectations and Pathway for Patient Care during the COVID-19 Pandemic provides interim considerations for Alberta dental offices, specific to the COVID-19 pandemic. It is designed for use by Alberta dentists and the dental team and should be read in conjunction with relevant provincial legislation, regulations and policies.

Alberta dentists are reminded that registered dental hygienists, registered dental assistants, registered denturists and registered dental technologists are governed by their own independent Colleges. Although we dialogue regularly, these governing bodies will make their own decisions with respect to their members’ return to practice.

May 11, 2020: Expansion of Services Thursday, May 14

On May 14, 2020, Alberta dentists are permitted to return to full provision of services. These oral healthcare services are included in Stage 1 of Alberta’s Relaunch Strategy.

The Expectations and Pathway for Patient Care during the COVID-19 Pandemic document will provide interim considerations for Alberta dental offices, specific to the COVID-19 pandemic. It is designed for use by Alberta dentists and the dental team and should be read in conjunction with relevant provincial legislation, regulations and policies.

Alberta dentists are reminded that registered dental hygienists, registered dental assistants, registered denturists and registered dental technologists are governed by their own independent Colleges. Although we dialogue regularly, these governing bodies will make their own decisions with respect to their members’ return to practice.

The document is informed by the best available scientific evidence and expert opinion available at this time and is subject to revision as additional information and data becomes available. As new evidence becomes available, the document will be updated accordingly.

The full Expectations and Pathway for Patient Care during the COVID-19 Pandemic document will be released on Tuesday, May 12, 2020.

May 8, 2020: Medical Grade Masks

The ADA&C have further information about medical grade and commercial grade N95 masks for members delivering Aerosol Generating Medical Procedures.

Medical Grade Masks

The following masks can be used in place of an N95:

  • FFP2 respirators meeting the European Committee for Standardization (CEN) Standard (EN 149:2001+Al:2009)
  • KN95 respirators meeting the National Standard of the People’s Republic of China (GB2626-2006)
  • P2 respirators meeting the standards of the Council of Standards Australia/Council of Standards New Zealand (AS/NZA 1716:2012)
  • Korea 1st class respirators meeting the standards of Korean Food and Drug Administration (KMOEL – 2017-64)
  • DS respirators meeting the standards of the Japanese Ministry of Health, Labour and Welfare (Japan JMHLW-Notification 214, 2018)

The kinds of masks dentists may use in Alberta have expanded because of a May 3, 2020 Order from the Alberta Minister of Labour and Immigration (MO Order 2020-2021). The masks listed above and referenced in the MO Order 2020-2021 meet the Health Canada interim order. Health Canada has expanded equivalent alternate standards so that respirators approved under standards used in other countries that are similar to NIOSH-approved N95 respirators may be used.

This Ministerial Order 2020-2021 is in effect for a very specific time period in relation to the State of Public Health Emergency.

Commercial Grade N95 Masks

Health Canada has allowed the use of commercial-grade N95 masks in a health care setting during the COVID-19 outbreak if alternatives are not available.

Level 3 Mask + Face Shield
If a respirator is not available, use a combination of a level 3 surgical mask and full-face shield.

Dentists are to use their appropriate clinical judgment and risk assessment.

Facility Requirements
The ADA&C does not require dental practices to make major air filtration technology purchases or change existing office designs.

Dentists are providing an essential service. Therefore, dentists may have more than 15 people in the dental office at one time. However, dentists are required to follow Workplace Guidance for Community Health Care Settings, as outlined by Alberta Health Services. We recommend that dentists carefully manage patient and staff flow and contact.

May 6, 2020: Grey Market PPE

Grey Market PPE

The ADA&C is aware of the shortages and concerns members are having procuring PPE. We are actively working with both AHS and dental suppliers on the issues of PPE.

It is critical that PPE be Dental Industry Association of Canada (DIAC) compliant.

To be compliant, a product must have a Health Canada product licence and be sold by a dealer with a Health Canada establishment licence.

Noncompliant products can look very similar to compliant products, but are generally sold at a much lower price. Side-by-side comparisons of compliant and noncompliant versions of product are almost impossible to distinguish.

Follow the DIAC checklist to help avoid the use of noncompliant products.

DIAC Checklist

• Is it the same product that you ordered?
• Does it have the same name as advertised?
• Does it have the same product number?
• Are the contents the same as advertised? (quantity, shapes, sizes, colors, etc)
• Is the package in English and French?
• Have any markings been scratched out?
• Is the product in it’s original package? (or a zip lock bag or other substitute container)
• Do the lot number and expiry date on the package match those on the container?
• Does the package or contents have markings that indicate it may have been rerouted? (e.g. ‘Not for sale in North America’)
• Is equipment CSA approved or equivalent?

May 5, 2020: Revised Guidelines on Emergency & Urgent Treatment

We have updated the Guidelines on Emergency and Urgent Treatment to include the Workplace Guidance for Community Health Care Settings, as per Alberta Health.

We have also included a link to Alberta Health’s Workplace Guidance For Business Owners – this document highlights employer responsibilities. For a comprehensive list of Employment Standards, see the Alberta Health Workplace guidance for Alberta’s relaunch.

Alberta dentists are reminded that registered dental hygienists and registered dental assistants are governed by their own independent Colleges. Although we dialogue regularly, these governing bodies will make their own decisions with respect to their members’ return to practice.

College of Registered Dental Hygienists of Alberta: COVID-19 Return to Work Guidelines

The College of Alberta Dental Assistants Return to Work Plans include a link to our Guidelines on Emergency and Urgent Treatment.

The ADA&C will have further information as it’s finalized regarding the expansion of services to include non-urgent dental care. This is subject to the Chief Medical Officer’s orders and the anticipated stage 1 Alberta Relaunch Plan.

May 4, 2020: CDA update and April/May Updater

April/May Updater
The ADA&C created a COVID-19 Special Edition Updater for the months of April/May. The hard copy of this Updater will be delivered this week, as per your regular Updater mailing address. An electronic copy of this Updater is available on the members’ website.

PLEASE NOTE: Due to the timelines of designing, printing and delivering the Updater, three documents have been revised online. You can find the updated Guidelines on Emergency and Urgent Treatment, Patient Consent Form and Guidelines on Remote Dentistry to reflect the changes that went into effect today, Monday, May 4, on the COVID-19 Info page.

CDA Update
The CDA has released an update on the work that they and the Provincial Dental Associations have been doing. Click here to read the full update from the week of May 1.

Mental Health Resources
Through CDSPI’s Members’ Assistance Program, Morneau Shepell has been providing additional COVID related resources such as articles and webinars. They have the most up to date information posted on their COVID-19 web page so that members can easily access these resources. It also feature wellness related articles on their Insights Hub. There’s a tag for health and wellness on the right.

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 8:00 a.m. to 5:00 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.

May 1, 2020: Guidelines on Emergency and Urgent Treatment - Effective May 4, 2020

On Monday, May 4, dentists of Alberta will be able to provide urgent dental care in addition to emergent care. The Guidelines on Emergency and Urgent Treatment, have been updated.

Other documents that have been updated include:
Patient Consent Form
Guidelines on Remote Dentistry

At this time the ADA&C does not anticipate requiring dental practices to make major air filtration technology purchases or change existing office designs.

May 1 COVID-19 Update: Return to Work and Monday, May 4

On Monday, May 4, dentists of Alberta will be able to provide urgent dental care in addition to emergent care.

The Guidelines on Emergency Treatment will be updated later today and posted for your use. There are no major changes anticipated.

As of May 14, provided the Alberta Relaunch Strategy remains on track, dentists of Alberta will be able to provide further services. It is anticipated this will expand to include non-urgent dental services. We will communicate with members when the guidelines for this have been posted.

April 30, 2020: Alberta's Phased Relaunch Strategy

Alberta’s Phased Relaunch Strategy

At 4 p.m. today Alberta Health announcement Alberta’s Phased Relaunch Strategy, with stage one starting May 14. As part of this strategy, all regulated health professionals may return to safe practice subject to guidelines approved by their respective regulatory colleges.

The current suspension on non-emergent dental care remains in place.

The finalization of these guidelines is being undertaken and will be released by May 4 to facilitate the gradual progression to return to a full scope of practice. We understand that membership would like as much notice as possible to plan for the updated guidelines. The ADA&C continues to review the best science currently available. We are focusing on Albertan’s access to care, protection and safety of the dental team.

Thank you for playing an important role in helping stop the spread of COVID-19 while continuing to provide essential oral health services.

April 30, 2020: Dental Supplier Deliveries

The ADA&C met the three major dental supply companies earlier this week. While PPE continues to have stock shortages, we have been assured that the supply chains are fluid and as stock comes in orders will be fulfilled.

Dentists are asked to only order what is needed for a two-week supply, for yourselves and your staff that are in the dental operatory. Stockpiling of PPE is not helpful in these times – we want as many dentists to be able to access PPE as is needed.

The suppliers mentioned that there have been some deliveries of supplies returned to them, as Purolator has been unable to deliver packages to practices. If you place an order, be sure to track the parcel with the Purolator tracking number supplied to you and be available at your practice on the day of delivery. You may also want to review the Purolator Changes in Service in Response to COVID-19 notice.

Continue to reach out to your dental supply representatives regarding your PPE needs and any orders that you have with them.

April 28, 2020: Application of USC&LS Code 05201 'Consultation with Client’ during the Pandemic

Application of USC&LS Code 05201 ‘Consultation with Client’ during the Pandemic

In response to the current COVID-19 pandemic, and to facilitate the emergency management and triage of patients’ acute oral health care needs, the Non-Insured Health Benefits (NIHB) Program has included a code temporarily under Schedule A to be used when providing consultation services by phone or other virtual methods.

NIHB has included code 05201 temporarily under their Schedule A (does not require predetermination section), and the code is retroactive to March 15.

Return to Work Task Force

The CDA has developed a Return to Work task force and two members of the Alberta Dental Association and College are representing Alberta on this task force.

The ADA&C and the CDA are monitoring the research and evidence from around the world related to what is required to keep dentists, staff and patients safe as we go back to work. Any changes in requirements will be based on scientific evidence and practicality.

At this time there have been no specific decisions for post-COVID equipment or facility requirements of dental offices in Alberta. The ADA&C does not recommend making expensive purchases of any forms of equipment or any changes to office designs until there has been an evaluation of what is needed.

The ADA&C will continue to follow the direction of Dr. Hinshaw, Chief Medical Officer of Alberta, and Premier Kenney. They have not announced relaxation of ministerial orders as of yet.

The ADA&C will communicate any updates regarding Return to work Guidelines as soon as possible.

CDA update from the week of April 24, 2020

Please see the CDA Update; this document has some valuable resources including federal funding information specific to dental practices.

April 24, 2020 COVID-19 Update: Privacy, Canada Emergency Commercial Rent Assistance and more

As mentioned by Premier Jason Kenney on Wednesday, April 22 Alberta continues doing well because Albertans have risen to the challenge of physical distancing. Testing has expanded to anyone with symptoms and everyone in outbreak areas. Alberta leads the per capita in COVID testing.

The ADA&C will continue to follow the direction of Dr. Hinshaw, Chief Medical Officer of Alberta, and Premier Kenney. They have not announced relaxation of ministerial orders as of yet. We will update membership when we know more. 

Premier Kenney also called on all Albertans to volunteer with non-profits. Observing the Public Health measures does not mean you are unable to help others – healthy people can volunteer and are needed to volunteer, as long as they follow the public health guidelines.

Privacy and Remote Care

As a requirement of the Health Information Act, a health custodian must take reasonable steps to maintain administrative, technical and physical safeguards to protect the individuals’ health information.

There is also a requirement to notify the Office of the Information Privacy Commissioner (OIPC) if you are implementing new administrative practices like the provision of services via remote care. This new administrative practice will allow patients to remain at home and yet have contact with their dental provider. You are still responsible for the protection of the patient’s health information.

To meet the obligation of informing the OIPC, the ADA&C has notified them of this new administrative practice and the development of Guidelines on Remote Dentistry on your behalf. Dentists must continue to maintain the privacy of their patients’ health information as they would in a dental clinic setting.

Canada Emergency Commercial Rent Assistance (CECRA)

This morning, the Government of Canada announced further details on the Canada Emergency Commercial Rent Assistance (CECRA) for small businesses. This program aims to lower rent by 75 per cent for small businesses that have been affected by COVID-19.

The program will work as follows:

  • The program will provide forgivable loans to qualifying commercial property owners to cover 50 per cent of three monthly rent payments that are payable by eligible small business tenants who are experiencing financial hardship during April, May, and June.
  • The loans will be forgiven if the mortgaged property owner agrees to reduce the eligible small business tenants’ rent by at least 75 per cent for the three corresponding months under a rent forgiveness agreement, which will include a term not to evict the tenant while the agreement is in place. The small business tenant would cover the remainder, up to 25 per cent of the rent.
  • Impacted small business tenants are businesses paying less than $50,000 per month in rent and who have temporarily ceased operations or have experienced at least a 70 per cent drop in pre-COVID-19 revenues. This support will also be available to non-profit and charitable organizations.

The Canada Mortgage and Housing Corporation will administer and deliver the CECRA, a collaboration between the federal government and provincial and territorial governments, which are responsible for property owner-tenant relationships.

It is expected that CECRA will be operational by mid-May, with commercial property owners lowering the rents of their small business tenant’s payable for the months of April and May, retroactively, and for June.

April 23, 2020 COVID-19 Update: Revised PPE ordering via AHS

The ADA&C have heard concerns over the ordering of PPE through the AHS link. We brought these concerns to AHS and they have modified the form to make it more user friendly. Additionally, submitted orders should now recieve a confirmation email.

Requests for PPE are to be submitted online at https://xnet.gov.ab.ca/ppe

  • Submitted requests for PPE must be for a maximum of a two week supply for you and your staff.
  • Please note that fulfillment of any and all requests is subject to available stock. Orders should be filled as stock is received.

The ADA&C will continue to work with AHS and dental suppliers on PPE. We will update members as we have information.

April 22, 2020 Covid-19 Update: CDA help desk and request for your stories

The CDA has released an update on the work that they and the Provincial Dental Associations have been doing. Click here to read the full update from the week of April 17.

CDA Help Desk:

Launched on April 6, 2020, CDA’s Help Desk remains available to assist dentists and dental office employees on how to navigate and access federal government support programs.

The Help Desk service can be reached by calling 1-866-232-0385, M-F, 7:30 a.m. – 8:00 p.m. EDT. CDA’s website is also available to users for more information about:

We want to hear from you!

As we continue physical distancing it’s important to maintain connections – so we want to hear from you!

If you have a story of how you or a colleague are demonstrating leadership and compassion during COVID-19 we’d like to share your story in the June Updater and/or out on the ADA&C social media channels.

To submit, email Sarah at svantassel@adaandc.com

April 20, 2020 COVID-19 Update: What we're working on

Our thoughts and prayers go out to the families and friends of the victims as well as all of the citizens of Nova Scotia as they mourn this horrendous tragedy. #NovaScotiaStrong

Our deepest condolences,
Dr. Troy Basarab
President

Thank you to our members that continue to screen, triage and treat dental emergencies during the pandemic. Like much of our population, dentists are concerned about when they will return to a full range of work. Dentists are further concerned about what the pandemic may do to the requirements for Infection, Prevention and Control in Alberta. The ADA&C and the Canadian Dental Association are monitoring the research and evidence from around the world related to what is required to keep dentists, staff and patients safe as we go back to work. Any changes in requirements must be based on scientific evidence and practicality.

At this time there have been no specific decisions for post-COVID equipment or facility requirements of dental offices in Alberta.

The ADA&C does not recommend making expensive purchases of any forms of equipment or any changes to office designs until there has been an evaluation of what is needed. The ADA&C will communicate any updates to requirements at the soonest possible time to allow facility owners to make adaptations.

The ADA&C continues to collaborate with CDA on return to practice plans and guidelines; all of which will be dependent on direction from Dr. Hinshaw, Chief Medical Officer of Health for Alberta.

April 17, 2020 COVID-19 Update: Ordering PPE through Alberta Heath

The ADA&C has been working hard to source personal protective equipment (PPE) for distribution to our members. As a result of Tuesday’s announcement by Premier Jason Kenny that addressed the ordering of PPE for front-line services, the ADA&C has made a request for PPE on behalf of the dentists of Alberta.

Dentists of Alberta are now able to order PPE through the Provincial Emergency Social Services (PESS).

The request is divided into three sections and it is important that you complete all mandatory fields.

  • The first section is your basic information
    • This is where you will fill in your practice information, including contact and mailing address
  • The second sections is PPE required for the COVID-19 specific response
    • This is where you will fill in what items you and your staff require for a two week period (hand sanitizer, gowns, gloves, etc.)
  • The third section is PPE required for daily usage
    • This is where you will fill in what items you and your staff require for a two week period (3M – N95, boot covers, face shields, etc.)
    • It is important to note that in this section they offer different sizes and styles of 3M-N95 – it’s important to consider the correct selection of size and style of masks and to have N95s fit tested for you and your staff. You may wish to consult with your local First Aid/Safety Services organization
    • Be sure to order enough quantities for your staff that will be working on the patient with you

You should evaluate your needs and be sure to order only what you need to be able to handle emergency procedures.

To complete your request, fill out the PPE Request Form: https://ppe.sp.alberta.ca/Lists/Requests/New.aspx?IsDlg=1 

When filling out the form, please ensure you complete all mandatory fields. It is very important that you only order for a two week period. We understand your urgency and will work to procure items to meet your submitted requests. If your request meets the Alberta Health Guidelines and there is available stock, the request will be filled. Due to the volume of requests we cannot provide an ETA on your order at this time, however, you will be contacted once your goods are ready for shipment. 

April 15, 2020 COVID-19 Update: Taking care of yourself

During crises it’s important to check in with fellow colleagues, staff, neighbours, and families – from a safe distance, of course. If you’re struggling, or know someone who is, the ADA&C has resources that can help.

The Members’ Assistance Program provides confidential counselling and related support services to all dentists, their extended families and staff members at no cost.

The Wellness Program committee members are your colleagues and will talk or confidentially assist you in getting the help that you need. The 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.

Outside of the ADA&C there are many other resources for people struggling, whether it’s with addition, depression or violence at home.

First and foremost, if you are in urgent need of assistance, call 911 or go to an emergency department. AHS has a dedicated Addiction Helpline that can be reached at 1-866-332-2322. They also have a Mental Health Helpline at 1-877-303-2642. Both lines are available 24/7.

Take care of yourselves.

Personal Protective Equipment 

The ADA&C has been working hard to source personal protective equipment (PPE) and expedite distribution to our members. As a result of today’s announcement by Premier Jason Kenny that addressed the ordering of PPE for front-line services, the ADA&C has made a request for PPE on behalf of the dentists of Alberta.

April 14, 2020 COVID-19 Update: AHS modelling, CPR and CDA update

AHS Modelling

Last week Premier Kenney and Dr. Hinshaw, Chief Medical Officer, presented COVID-19 modelling for Alberta.

This modelling is designed for the purpose of advising Albertans about what they can expect as the pandemic unfolds.

COVID-19 and CPR

In this unusual time of the COVID-19 pandemic, there is concern about the risk of a public responder contracting COVID-19 from a person when providing CPR or using an AED.

Please see the Heart and Stroke Foundation’s resource for Modification to Hands-Only CPR during the COVID-19 pandemic.

CDA COVID-19 Update

Here is a link to a summary of the Canadian Dental Association’s (CDA) pandemic-related work-in-progress for the week ending April 9, 2020.

April 9, 2020 COVID-19 Update: CDA Help Desk and more

Today I want to thank our members that are doing great things during these trying times. There are members that continue to be the glue that keep their staff together. They are arranging Zoom parties that ensure that people get some of the socialization that they need. They continue to give to their favorite charities. They are delivering meals for foodbanks. They are looking after elderly neighbors. They are husbands, wives, partners, siblings, children. They continue to be human. These are all very important roles.

I think of our suppliers that are still working to source PPE for practices and are already preparing for the future as we come out of this pandemic.

I think of the staff at the ADA&C and the CDA that have adapted to working at home and taking work life balance to a whole new level. I think of committee members that have spent countless hours reviewing research and providing tough advice. Our ADA&C members see the result of these decisions in the form of an e-advisory that takes minutes to read. Each one of these pieces of correspondence is the result of many hours of work by a number of people.

This weekend is one of religious significance for many members. Whether you practice a religion or not, I encourage you to spend some time reflecting this weekend. Consider that this very tough situation will come to an end. Over time our world will return to some level of normalcy. Think of how this time has changed you. Think of what your contribution was to flatten the curve and help countless others. Spend time reflecting on what is truly important to you. Have a great weekend.

Dr. Troy Basarab,
President

Patient Consent Form

We received a few questions on the revisions to the Patient Consent Form, specifically updates to high risk categories. These were included to be consistent with AHS. We have updated the form to add further clarity to this section.

CDA Help Desk

The ADA&C is committed to doing all that it can to support our members in these most challenging times. Together with the Canadian Dental Association, we want to ensure that you have access to information you need for the Federal support programs. CDA’s Help Desk team is now available to provide you with information on the COVID-19 Federal Economic Response Programs. These programs are available to Businesses (Dental Offices) and Individuals (Dental Office Employees & Associates).

If you have questions about these support programs, the CDA Help Desk team will have resources to guide you through the available programs, eligibility requirements and information on how to apply.

Call the CDA Help Desk at 1-866-232-0385 (M-F, 7:30 a.m.-8:00 p.m. EDT) or visit the CDA COVID-19 webpage for more information.

CDA Scam Alert! Phishing Campaign Targeting Stimulus Package:

  • The Canadian Cyber Threat Exchange advised CDA that a massive phishing campaign is underway targeting individuals who are seeking funds from the Canadian government’s stimulus package.
  • Scammers are crafting fake government websites, sending emails and text messages to individuals to exploit prevalent fears and needs.
  • The Federal Government is not sending text messages regarding the new Canada Emergency Response Benefit and is warning individuals that if you receive a text message regarding the benefit, to not click the link.
  • Scammers will attempt to seek social insurance or banking information or try to trick victims to transfer upfront payments by claiming a small fee is required to process a COVID-19 benefit cheque.
  • CDA encourages PDAs to remind dentists to be vigilant of such phishing campaigns as the consequences could include financial loss and identity theft.
  • Tips to avoid scams:
    • verify emails with senders;
    • avoid clicking suspicious links in email; and
    • keep your software updated.
April 8, 2020 COVID-19 Update: New and updated COVID-19 resources

The ADA&C is committed to keeping our members, your staff and patients healthy and safe. As we continue to learn more about COVID-19 we have developed the Guidelines on Remote Dentistry.

Remote dentistry is patient care provided by using communications technologies such as telephone, email, apps, and video-conference, where the patient and provider are in different locations.

Following these guidelines will help not only keep you safe but also your staff and your patients. We thank you for your continued care of the people of Alberta.

As we continue to learn more about COVID-19 we will continue to refine the resources for members.

  • We have revised the definition of Emergency Treatment: Emergency dental treatment includes treatment of oral-facial trauma, significant infection, prolonged bleeding, pain which cannot be managed by over the counter medications, or management of known/high risk malignancy.
  • We have updated the list of symptoms for COVID-19 to align with AHS: Fever > 38C, Cough, Sore Throat, Shortness of Breath, Difficulty Breathing, Flu-like symptoms, Runny Nose
  • We have updated the high risk category to include: diabetes, cardiovascular disease, hypertension, lung diseases including moderate to severe asthma, being immunocompromised, having active malignancy, age > 65
  • We have added AHS’ return to work guidelines for anyone who tested positive for COVID-19.

Please carefully review these updated documents: 

If you are using the staff and patient consent forms, please replace them with these updated versions:

April 7, 2020 COVID-19 Update: Letter from the Registrar about Emergency Treatment

Members,

As the COVID-19 crisis continues, the correctness of our early actions is evident. Through restricting treatment to ensure physical distancing, staying home, significantly reducing aerosol generating medical procedures (AGMP) and so on, we adapted and therefore protected our patients, staff, families and ourselves. These swift and appropriate measures have reduced Emergency Room hospital attendance and saved lives. Our members are to be commended.​

Despite this commitment to saving lives, the ADA&C continues to receive reports from dental laboratories, dental benefits’ companies and fellow dentists that some Alberta dentists may be providing dental services and procedures that are not emergency treatment. If accurate, these actions are not in compliance with the mandated suspension of all non-emergency dental services and procedures. This is alarming as it sacrifices the actions others have taken to save lives.

If the treatment and services you are providing do not fit into emergency treatments as described in the Guidelines on Emergency Treatment, STOP. Right now. These non-emergent treatments and services must stop.

If you are aware of another dentist providing these services, consider contacting your colleague directly to discuss your concerns. If this does not resolve it, contact me at the ADA&C. If you are delivering non-emergency treatment, think about your patients, staff and families who are at risk. Think about the risk of unnecessary AGMP.

If you are delivering non-emergency treatment, consider whether you will have malpractice insurance coverage in the unfortunate event that something goes wrong. Questions may arise about whether you will be covered for services outside of the Guidelines on Emergency Treatment and the orders made during the State of Public Health Emergency.

In an effort to save lives, we are actively making a request to the Canadian Life and Health Insurance Association (CLHIA) for information from practices about possible claims submitted for non-emergency dental treatments being provided at this time.

We are contacting the College of Dental Technologists of Alberta (CDTA) to request that they message their members that accepting cases that are not directly following the intent of the currently mandated suspension is not appropriate. We are asking CDTA to report to the ADA&C if they are receiving these laboratory cases from dentists.

We will continue to work with the Chief Medical Officer (CMO) on the message that non-emergency services are suspended. We will continue to work with the CMO to enforce this provincially mandated directive.

Proper record keeping remains extremely important in terms of documenting rationale for triaging, diagnosing and treatment decisions, including pharmacological management. Your obligations have not changed regarding patient records as this is an ongoing requirement.

If Alberta dentists are providing services that are non-emergency, they will be investigated. Dentists continue to have an on-going duty to report to the ADA&C any behaviour that endangers public health and safety.

Thank you for your commitments to your patients and quality emergency dental care during the COVID-19 crisis.​

Dr. Randall Croutze,
Registrar, Alberta Dental Association and College

April 6, 2020 COVID-19 Update: Member Resources

Updated Pharmacological Flow Charts

We have updated the pharmacological management charts for Adults and Children.

Dentist are required to prescribe within their scope of practice, and must have knowledge of the medications they are prescribing. If required, update yourself before prescribing or consult with an appropriate allied health professional.

Updated Resources on COVID-19 Info for patients & practitioners page

Appropriate use of Personal Protective Equipment (PPE) saves lives. This includes putting it on and taking it off. We have added the AHS Donning & Doffing of PPE (Video) and Guide to PPE (Narrated Slide Show). Please review this information.

Check out the CDA Business Roadmap for the programs the Federal Government has available to help mitigate the current business disruption for dental offices, their associates and employees due to the COVID-19 outbreak.

We will continue to update this page with valuable resources for you and your staff. Be sure to check it often!

As Prime Minister Trudeau recently announced new supports for families and vulnerable populations, it’s a good reminder that physical distancing and economic pressures are adding stressors to those who were already struggling.

If you become aware of signs or incidents of domestic or child abuse, please report to the appropriate authorities. 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.

April 3, 2020 COVID-19 Update: Personal Protective Equipment

The procurement of Personal Protective Equipment (PPE) is still a concern. However, we have heard from suppliers that supply chains are fluid – if they don’t have specific PPE now, we are told they expect to receive it soon. Keep communicating with all suppliers.

We are also encouraging members to share your PPE resources. If you are closed, or if you are referring a patient to another provider, consider that the practice has adequate PPE. If you are able to share resources, please do so. Reach out to your colleagues and arrange for the appropriate PPE to be sent or transferred to practices who continue to see emergency patients and who may be running low on appropriate PPE.

N95s are only needed for AGMPs. If you determine you need to do an aerosol generating procedure, and you do not have the proper PPE, our suggestion is for you to reach out to other providers or your normal referral sources to see if they can accept the patient. As a reminder to members, IF you are delivering an emergency aerosol generating procedure (AGMP) on a COVID risk-free patient there are enhanced PPE requirements to minimize the risk to you, your staff and your patients. Review the Guidelines on Emergency Treatment for PPE requirements.

Health Canada accepts the NIOSH certification as an appropriate quality standard for N95 masks used by health care providers. It also accepts that equivalent alternate standards are also acceptable. See: Optimizing the use of masks and respirators during the COVID-19 outbreak.

We would like to thank our members again, for providing safe emergency dental care to patients while continuing to protect yourselves and your staff.

April 1, 2020 COVID-19 Update: Pandemic coverage and more

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 

March 28, 2020 COVID-19 Update: Premiers update on emergency care

On Friday, March 27 Premier Jason Kenney issued public health orders that have been implemented on certain businesses and workplace closures to protect Albertans’ health and limit the spread of COVID-19.

Albertans are prohibited from accessing close contact personal services and non-emergency and non-critical health services provided by regulated health professionals or registered professionals including dentistry.

These orders affirm the direction the ADA&C shared earlier this week.

Members can continue to provide emergency care, and if so, should be providing telephone screening and triage for appropriate management, including pharmacologic management, as per the Guidelines on Emergency Treatment.

We would also like to thank all of our members for being on the front line treating patients. We know this is a high-stress environment with a lot of changes happening over a short period of time.

Your continued dedication to the health and well-being of Albertans is appreciated by the Council and staff of the ADA&C and by the patients that you serve. Thank you

March 27, 2020 COVID-19 Update: Clarity on COVID-19 Consent and Pharmacological Management

It is a dentist’s responsibility to provide initial telephone triage to patients of record. Any “generic” or “broad” message directing patients to hospitals or specialists will be considered by the ADA&C as a possible breach of the Code of Ethics.

Direct Doctor to Doctor referral/consultation is expected.

Any patients identifying an imminently life threatening condition should of course be directed to the emergency department immediately.

It is still the dentist’s responsibility to follow up on patients directly referred to an emergency department.

Clarity on COVID-19 Consent
Members are asking questions about the sentence in the Guidelines on Emergency Treatment:
“The COVID-19 Patient Consent and COVID-19 Staff Consent forms must be filled out for each visit.”

The intent is to ensure members receive specific COVID-19 consent from patients and staff prior to delivering treatment. Verbal consent meets the minimum standard, but the ADA&C strongly recommends that it be in writing.

You may use your own forms or use the sample forms linked above to obtain consent.

Pharmacological management for adults and children
As we continue to work through the COVID-19 Pandemic, how we treat our dental patients continues to evolve. The need for continuity of care for patients of record should continue to be the primary goal of each dentist.

The first line of care should be over the telephone. Telephone triage should always begin with evaluating your patient’s general health. Review the Guidelines on Emergency Treatment for the phone triage and assessment of patients.

Depending on the patient’s response of their symptoms, the first dental treatment should involve the use of antibiotic and/or analgesics. To help you with this pathway, we have enclosed Pharmacological flow charts for adults and children.

If there are medications that you are unsure of or have never used, update yourself before prescribing or consult with an appropriate health professional.

If you have concerns about the patient’s health history, contact the patient’s pharmacist or physician. They have access to NetCare which allows them to see health concerns and current medications.

Reminder about proper Donning and Doffing
There is a high risk of transmission of COVID-19 during Aerosol Generating Medical Procedures (AGMP). The risk of contamination during doffing of PPE is especially high.

Following the Guidelines on Emergency Treatment:
• if after proper telephone screening
• if you have determined that it is an emergency patient, and;
• if you are going to deliver emergency treatment in your dental practice

Be sure to follow the proper donning and doffing requirements 

March 26, 2020 Revised Guidelines on Emergency Treatment and the Dental Emergency Protocol

Effective immediately we have changed the definition of what emergency dental care consists of.

Emergency dental treatment includes treatment of oral-facial trauma, significant infection, prolonged bleeding or pain which cannot be managed by over-the-counter medications.

Members are not to provide routine or urgent care to patients. Only emergency care that fits within this description.

In addition to this change, IF you deem it necessary to perform any treatment that involves an Aerosol Generating Medical Procedure, it is now a requirement that you wear enhanced PPE such as; protective clothing, gloves, fitted N-95 masks, protective eyewear and face shield (due to the aerosol being created).

These measures are necessary to protect you, your staff and the public from known routes of COVID-19 disease transmission.

Refer to the attached and updated Guidelines on Emergency Treatment and the new Dental Emergency Protocol document.

March 25, 2020 COVID-19 Update: Member Services

During a crisis it is more important than ever that we put first things first. Initially, the ADA&C COVID19 Response Team focused on issues related to doing our part to flatten the curve of spread of this viral infection.

While we still have several big items on our list of things to do to ensure that Albertans continue to have access to emergency dental care, we are beginning to have time to turn our attention to other concerns that our members have.

The financial impact on Canadians as a result of this pandemic will be immense. To think that dentists will escape the pandemic without financial pain would be naïve. We have heard the frustration of Alberta dentists that have purchased pandemic insurance and are not clear on whether that coverage will pay out on claims. While we have not made this the focus of our communication, we want you to know that the ADA&C has continued to be a part of the conversation and to express the concerns of our members. As some of the urgent issues of early management of the pandemic response have started to subside, I would like to take an opportunity to provide you with updates from the information that we have to date.

First, it is important to understand that CDSPI is the broker. The primary insurer in this situation is AVIVA. Due to the magnitude of the coverage in place it would be normal for AVIVA to share some of the risk by utilizing what is referred to as re-insurers. These are essentially other insurance companies. The discussion about paying out on claims involves AVIVA and these other insurance companies. Ed Dermit, President of CDSPI and Lyle Best, Chairman of the Board of CDSPI are your greatest advocates in this discussion. As your broker, they represent you, their client, in this matter.

Over the past week there have been communications from CDSPI informing you that they are working on this issue. Yesterday, both the CDA and ADA&C heard from Ed and Lyle. They have expressed that they have been making progress with AVIVA. They highlighted that at this time the insurer has not decided to deny claims. Ed and Lyle are both expressing optimism that a satisfactory result will be reached for dentists. Please understand that these people are the voice for the dentists in the conversation. They have been in this place before with multiple wildfires and floods that have impacted Alberta dentists. They are experienced, connected and knowledgeable. They know the issues. They are the very people we want as our advocates.

Although we do not have any firm answers yet, I would urge you to be supportive of CDSPI and to be patient. Allow them to do their work.

Please know that your ADA&C COVID Response Team consists of people that run dental practices. They are impacted much like you are. From the vantage point of seeing what is going on behind the scenes, please let the work continue. Be patient. Be respectful. Be kind. CDSPI is working on it. We are working on it. We do share your pain in this regard.

Dr. Troy Basarab,
President

Member Resources

We know that a lot of members are keeping up-to-date on these e-Advisories and sharing the information with your staff. We appreciate your dedication to your patients, your staff and your communities – keeping informed is critical when information changes as rapidly as it is. We will continue to post e-Advisories online, as well as important member resources.

Here are a few resource quick links:

Guidelines on Emergency Treatment
The ADA&C is providing this information for members to use as a resource in addition to good clinical judgment on making decisions to provide care for emergency treatment.

Canada Emergency Response Benefit (CERB)
The new CERB will cover Canadians who have lost their job, are sick, quarantined, or taking care of someone who is sick with COVID-19, as well as working parents who must stay home without pay to care for children who are sick or at home because of school and daycare closures. The CERB would apply to wage earners, as well as contract workers and self-employed individuals who would not otherwise be eligible for Employment Insurance (EI).

Alberta Emergency Isolation Support
Eligible working Albertans can receive a one-time emergency isolation support payment of $1,146 if they are required to self-isolate or are the sole caregiver of someone in self-isolation and they have no other source of pay or compensation.

Information for AHS Staff & Health Professionals
Latest information for healthcare professionals about novel coronavirus (COVID-19) and actions being taken to protect the health of Albertans.

Remember to do the daily self-assessment of yourself, your staff and all emergency patients. If you display any symptoms, self-isolate and go to the AHS self-assessment tool.

We remind you of the mandate to stop all non-emergency treatment. The Guidelines for Emergency Dental Treatment (updated: March 24, 2020) are your tools to assess yourself, your staff, your patients and your treatment protocols. Remember that every day and throughout the day you and your staff can take a minute or two to monitor yourselves for any of the symptoms of COVID-19.

Continuity of Care means that patients of record have access to their primary care provider for guidance on emergency care.

You continue to be your patients’ dentist of record. You are obliged to address their ongoing emergency questions. Core elements of care to asymptomatic patients include that you have arranged for these patients to have availability to you or another dentist that you have asked to do this. This other dentist is essentially stepping into your shoes as the patients’ care provider.

Your voice mail and email messaging to patients must include information about how a patient can contact you or another dentist, including a telephone number. You must ensure their calls or emails are returned in a timely way. Being available by phone or email is the essential element.

It is NOT appropriate to refer your patients to an emergency room for a dental emergency when you or the other dentist can reasonably assess that patient in a dental setting or over the telephone. Pharmacological care may be your first level of management. Use your clinical judgment.

March 24, 2020 COVID-19 Update: Personal Protective Equipment (PPE)

Personal Protective Equipment (PPE)

  • Asymptomatic patient & non-aerosol: Current IPC standards apply and proper PPE. This includes proper PPE such as gloves, surgical masks, protective eyewear.
  • Asymptomatic patient & aerosol generating: Aerosol Generating Medical Procedures (AGMP) require current IPC and enhanced PPE. This includes enhanced PPE such as protective clothing, gloves, surgical masks, protective eyewear or face shield (due to the aerosol being created).

Protective clothing includes gowns and lab-coats, and is meant to be worn over regular clinic clothing, such as uniforms, scrubs or street clothing. Long-sleeved, fluid resistant, protective clothing, extending to the wrist if dental procedures may create splash or spray. Follow donning and doffing of all PPE.

N95 are not required if the patient is Asymptomatic. Clinical judgement should be exercised in the decision to use N95s or not when treating asyptomatic patients.

To determine if a patient is asymptomatic, refer to the pre-screening questions from the Guidelines on Emergency Treatment.

Review pages 61-63 of the Standard of Practice Infection Prevention and Control and Risk Management for Dentists.

Further guidelines on PPE are being considered and will be communicated as they are developed.

As a resource, for your information, please see this Guide to Face Mask Selection and Use.

March 23, 2020 COVID-19 Update: Requirements for treating Asymptomatic patients requiring Emergency Care and more

Requirements for treating Asymptomatic patients requiring Emergency Care
After you have conducted your pre-screening of a patient and determined that there is a need for emergency treatment AND that the patient is asymptomatic please follow these guidelines:

Aerosol Generating Medical Procedures (AGMP) present the biggest risk in dental practices for cross contamination. Therefore the ADA&C strongly recommends that dentists limit these procedures thus protecting patients, staff and themselves. Aerosols are generated by all handpieces, ultrasonic devices, high volume suction, air water syringe and to a lesser extent, low volume suction.

    • Asymptomatic patient & non-aerosol: Current IPC standards apply and proper PPE.
    • Asymptomatic patient & aerosol generating: AGMPs require current IPC and enhanced PPE.

Further guidelines on PPE are being considered and will be communicated as they are developed.

Information on Personal Protective Equipment is section 4.0 in the Standard of Practice Infection Prevention and Control. Also, see AHS Contact and Droplet Precautions.

We want to stress again that there is a mandatory suspension of all non-emergency dental treatment and services.

Dentists may continue to provide emergency treatment. At a minimum you must provide telephone access to address patients’ continuity of care.

Please refer to the Guidelines on Emergency Treatment.

Further self-isolation guidelines
AHS has indicated that if you are feeling symptoms such as a cold or runny nose, you should self-isolate for 10 days from the onset of symptoms (and/or until symptoms clear up).

If you are already in self-isolation for 14 days due to travel or an AHS recommendation, and you start having symptoms, you must add a minimum of 10 days to wherever you are in the process. For example, if you are on day 8 of your isolation, and you get a runny nose, you are to add the additional 10 days to your isolation from the start of their symptoms, or until symptoms resolve, whichever is longer.

See the Chief medical officer of health COVID-19 update – March 23, 2020

Reoccurring member questions
These are challenging times and we know that every member has questions. The staff at ADA&C and the Executive are working to address your concerns.

We do not currently know how long the practice restrictions will continue for. We will update you as we know more.

For Continuing Education – we want to remind members that you are able to access 40 hours of CE credit online. Refer to the Continuing Competence/Education Program Requirements. We do not encourage any hands-on course that will produce aerosols.

March 22, 2020 COVID-19 Update: What we are working on….

What we are working on…

As the COVID-19 pandemic is progressing the ADA&C has made announcements aimed at limiting contact in our dental offices. At the same time, we recognize you are continuing to provide emergency dental care. To date, patient screening on the phone has allowed offices to provide care to patients who are asymptomatic while delaying treatment and/or providing pharmacotherapy to patients who are potentially at a higher risk due to travel or community exposure or to those who are symptomatic.

Communication from the Chief Medical Officer of Alberta indicates that increased numbers of COVID-19 positive patients are anticipated in the coming weeks and beyond. It is only a matter of time before we have a COVID-19 positive patient with a significant dental emergency.

The ADA&C is working with the Hospital Dentistry Committee to develop a protocol for you to guide your care of these patients. The development of this strategy takes time. The nature of the pandemic is fluid. We recognize that and we are balancing the need for information with the concept that the message may and does change… sometimes within days or even hours.

Currently, the Hospital Dentistry Committee is developing a decision process for the triage and management of patients that may be COVID-19 positive. As that protocol becomes available it will be shared with members.

This protocol will guide the information that we provide to members on a number of other fronts including Personal Protective Equipment. The protocol will give information that will be useful in helping members decide what is the appropriate PPE for the care they are giving. Items of PPE that are not needed in individual practices can be redirected for better use.

I would remind members that the proper use of N95 masks should not be taken lightly. Like many things in our IPC standards, it is not the equipment that makes the difference but in its proper use. For proper effectiveness N95 masks should be fit tested. N95 masks used improperly are of limited usefulness.

One issue we can provide guidance on is Aerosol Generating Medical Procedures (AGMP). There are very few procedures that we do in dentistry that are not AGMPs. AGMP include the use of handpieces, sonic and ultrasonic instruments and also include the use of high volume suction and saliva injectors. It is important that these be limited to protect you, your staff, your patient and future patients. We will be re-evaluating the evidence around this in the next days.

There are currently guides on the public website. Please refer to these for guidance. More information will come to members as we can develop it.

I appreciate the efforts of committee members and Council. They have been available to provide input at all hours in an effort to keep members up to speed. A special recognition of the efforts of staff at the ADA&C that have fielded thousands of calls since the onset of the pandemic and have worked many extra hours to get members what they need.

Thank you,
Dr. Troy Basarab
President

Mental well-being

In times of uncertainty, like this pandemic, it’s normal to feel some stress and anxiety. We understand the pressures you’re under as healthcare professionals, caring business owners, parents, children and members of your community.

On one hand you are balancing the emergent dental needs of your patients in a new and often evolving manner. On the other, you are practising social distancing. It’s important to remember that this is the time to lean on each other and the resources available through the ADA&C. The Members’ Assistance Program provides confidential counselling and related support services to all dentists, their extended families and staff members at no cost. The Wellness Program Committee (formerly CAP) provides professional and confidential assistance from your colleagues to all members and their immediate family members. More information, including contact information for both programs can be found here.

Canadian Mental Health Association has some resources and suggestions to help support your mental health at this time of uncertainty.

We also know that there are societal issues of stress that will be exacerbated by the challenges that we face. 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.

We encourage everyone to practise social distancing, but that doesn’t mean we can’t be there for one another emotionally. So, stay in, stay in touch with each other, and reach out to the ADA&C if you need support.

Reminder on returning to practice

The mandatory PDC self-isolation period ends today, March 22. Whether or not you are planning to return to practice, please be sure to read the March 21 COVID-19 Update: PDC & Returning to Practice

March 21, 2020 COVID-19 Update: PDC & Returning to Practice

Pacific Dental Conference Updates
The ADA&C has been following the recommendations of the Chief Medical Officer.

We initially sent out messaging to all ADA&C members on Thursday, March 12 that if you attended PDC to monitor yourselves and if your became symptomatic to self-isolate and call 811. When new information from the Provincial Medical Officer of British Columbia came out on Monday, March 16 for all PDC attendees to self-isolate, we immediately directed all ADA&C members that attended PDC to self-isolate through to March 22, 2020.

While this self-isolation period is ending right away, we are still requesting that ADA&C members to continue monitoring yourselves and if you become symptomatic at any time to self-isolate and call 811.

Returning to Practice
The mandatory PDC self-isolation period ends on Sunday, March 22.

Asymptomatic dentists may be choosing to return to practise. If you do return to practise, ensure you are prepared to provide only emergency dental treatment to your patients. The public website dentalhealthalberta.ca is your go to source for current and relevant information for you and your staff.

We remind you of the mandate to stop all non-emergency treatment. The Guidelines for Emergency Dental Treatment (March 19, 2020) are your tools to assess yourself, your staff, your patients and your treatment protocols. Remember that every day and throughout the day you and your staff can take a minute or two to monitor yourselves for any of the symptoms of COVID-19.

If you display any symptoms, self-isolate and go to the AHS self-assessment tool.

If you have decided to remain closed, please contact Katherine at kgibson@adaandc.com to provide an update.

CDSPI Update
The ADA&C has been in conversation with management of CDSPI. Members are encouraged to speak directly with CDSPI with their coverage concerns.

March 20, 2020 COVID-19 Update: Continuity of Care

In this context, Continuity of Care means that patients of record have access to their primary care provider for guidance on emergency care.

You may have closed your dental practice. You may be unable to provide direct care to your patients right now. What should you do?

In this context, Continuity of Care means that patients of record have access to their primary care provider for guidance on emergency care.

You continue to be your patients’ dentist of record. You are obliged to address their ongoing emergency questions. Core elements of care to asymptomatic patients include that you have arranged for these patients to have availability to you or another dentist that you have asked to do this. This other dentist is essentially stepping into your shoes as the patients’ care provider.

Your voice mail and email messaging to patients must include information about how a patient can contact you or another dentist, including a telephone number. You must ensure their calls or emails are returned in a timely way. Being available by phone or email is the essential element.

It is NOT appropriate to refer your patients to an emergency room for a dental emergency when you or the other dentist can reasonably assess that patient in a dental setting or over the telephone. Pharmacological care may be your first level of management. Use your clinical judgment

March 19, 2020 COVID-19 Update: Guidelines on emergency treatment and more

The ADA&C has created Guidelines on Emergency Treatment.

The ADA&C has created Guidelines on Emergency Treatment 

March 19, 2020

This guide is information for members to use as a resource in addition to good clinical judgment on making decisions to provide care for emergency treatment.

This document defines:

  • Symptomatic patient care
  • Asymptomatic patient care
  • Scripting for phone calls
  • How to determine “emergency” versus “non-emergency”
      • Dental emergency procedures
      • Dental non-emergency procedures
      • Waiting room guidance
      • Considerations when providing treatment after proper screening

As always, the ADA&C expects members to use clinical judgement. These guidelines are current as of March 19, 2020 and will be updated and modified as needed.

Member health during COVID-19
As health care providers, it is important that you take care of yourself.

If you are self-isolating for any of the following reasons:

  • are symptomatic,
  • have come in contact with someone presumed to be symptomatic,
  • have travelled outside of Canada within last 14 days, or
  • attended the Pacific Dental Conference (self-isolating until March 22, 2020)

If you become symptomatic please take the Alberta Health Services Self-Assessment and/or call 811. Please follow the directives of AHS.

If you have a colleague that is not dealing well, reach out, make a call. Know also that the ADA&C is here to provide support. We have excellent resources through our Wellness Program, through MAP, and through the staff at the office.

We also know that there are societal issues of stress that will be exacerbated by the challenges that we face. If you become aware of signs or incidents or 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.

Additional Member Resources
We are working diligently to ensure that member resources are kept up to date on this COVID-19 page.

Here you will find:

  • Guidelines on Emergency Treatment
  • Updates on COVID-19 from Executive
  • Continuity of Care information
  • Links to EI resources
  • and so much more
March 18, 2020: Update on suspension of non-emergency dental treatment and services

The Alberta Dental Association and College still expects the dentists of Alberta to provide treatment for dental emergencies.

March 17, 2020 the Alberta Dental Association and College announced a mandatory stoppage of all non-emergency dental treatment. The intent of this is to facilitate social distancing and help prevent people from contracting the COVID19 virus. By doing this we help to reduce the risk of a spike in severely ill patients in our hospitals. It is not a shut-down or closure of dental offices.

The Alberta Dental Association and College still expects the dentists of Alberta to provide treatment for dental emergencies. It also expects dentists in the province to provide access to care and continuity of care.

To have dental patients showing up in hospital emergency rooms for a dental emergency is the opposite of what is desirable. As the President of the ADA&C and a fellow practicing dentist I urge all of our membership to continue to fulfill their responsibilities in this time of pandemic crisis. It is the time for us to serve our patients and community and our fellow healthcare workers by doing our part.

Please continue to treat dental emergencies following the protocols that have been set out.

We will continue to send out information as it comes available.

Dr. Troy Basarab
President

March 17, 2020: Message to all Alberta dentists from Dr. R. Croutze, Registrar & CEO of the ADA&C – COVID-19

Effective immediately there is a mandatory suspension of all non-emergency dental treatment and services.

Dentists may continue to provide emergency treatment as outlined in this message. At a minimum you must provide telephone access to address patients’ continuity of care.

Emergency dental treatment may include treatment of oral-facial trauma, significant infection, prolonged bleeding or pain which cannot be managed by over-the-counter medications. It is appropriate to provide needed care that if left untreated becomes a more significant burden on our health care resources and significantly compromises patient health.

Pre-screening of patients by phone is strongly recommended. If a patient presents unannounced at the dental practice, please refer to AHS screening directions. Further dental specific pre-screening directions are being developed.

Dentists who are providing emergency care must perform a thorough pre-treatment risk assessment that includes risk to the patient, to the oral health care provider and to the greater community before any treatment is undertaken. Dentists in Alberta have a duty to prevent exposure to an infection from COVID-19. If risks are identified that cannot be immediately or succinctly mitigated, the determined care must be postponed or referred to an appropriate provider. ADA&C is in the process of developing a list of facilities capable of accepting symptomatic patients. More information will be provided to dentists about the list.

Care provided must be compliant with the existing ADA&C Standard of Practice: Infection Prevention and Control and Risk Management for Dentistry and guidance or the treatment must cease. Capacity to provide appropriate personal protective equipment (PPE) for all oral healthcare providers must be assessed before treatment can be initiated.

Further resources under development are:

  • Links and resources on employment considerations for your staff
  • Guidelines on treatment of emergent patients in office
  • List of facilities accepting patients
March 16, 2020 - PDC attendees to self-isolate

The ADA&C asks all members and any of their staff who attended PDC to self-isolate until March 22, 2020.

Dr. Bonnie Henry, Provincial Health Officer of British Columbia is asking anyone who attended to self-isolate until March 22, 2020.

The ADA&C asks all members and any of their staff who attended PDC to self-isolate until March 22, 2020.

If you will be closing your clinic due to COVID-19 we ask that you inform the ADA&C. Please contact Colleen Wetter or Katherine Gibson: kgibson@adaandc.com or call the office to be redirected: 780-432-1012.

Please provide the following information regarding office closures:

  • clinic name
  • location
  • anticipated closure dates
  • phone number for emergencies or questions.
March 15, 2020 - COVID-19 Update: addressing member concerns

As dentists, we are an important part of the health care system. Our training and professional judgement are a critical part of stopping the spread of COVID-19 as we provide care for the oral health of Albertans. Alberta has maintained an Infection Prevention standard that is amongst the highest in the world. A standard that centers around universal precautions. With proper screening and triage, and maintaining the standards that have been put in place by our regulations, it is possible to provide the dental care that our patients require in a safe manner. The application of professional judgement in case selection will allow the addition of another layer of public protection.

The ADA&C is working with Alberta Health Services as well as other departments of the Alberta government to ensure that ADA&C members are able to support the broader health care system. While it may not be the ideal time to take on significant elective treatment, it is appropriate to provide needed care that if left untreated becomes a more significant burden to our health care resources.

With the pandemic front of mind for most people it is not surprising that the ADA&C staff and Executive Council have fielded many questions regarding issues pertinent to continuing to provide dental care. In this e-Advisory and additional contact over the next days the ADA&C will provide information that will assist you as you continue to provide care. Further resources will be available on the members website. Please watch for updates and utilize the resources to help educate your teams and patients.

Dr. Troy Basarab
President

March 13, 2020 - Alberta Wellness Summit Cancelled

The Alberta Wellness Summit committee has been working diligently to produce our 2020 event and we know you were looking forward to participating.”

The Chief Medical Officer of Alberta has indefinitely cancelled all gatherings with over 250 people in attendance due to COVID-19. Given this clear direction, the 2020 Alberta Wellness Summit is cancelled. The health and wellness of the public and our members is our primary concern. As health care providers it is imperative we show leadership in this time of public health crisis.

In the next few weeks we will be exploring options to provide virtual CE content as an alternative. Further details regarding cancellation of all current registrations will be available within the next two weeks. Full refunds will be provided.

We appreciate your understanding and look forward to seeing you at the 2021 Alberta Wellness Summit happening May 27-29 in Calgary, AB.

March 12, 2020 Update: Coronavirus (COVID-19)

If you attended PDC but are asymptomatic, please self-monitor over the next few days. If you become symptomatic, self-isolate, and call 811.

The Pacific Dental Conference (PDC) has confirmed that a dentist has tested positive for COVID-19 after attending the PDC. The ADA&C has been gathering factual information on this situation. The person who has tested positive for COVID-19 attended the conference on March 6 between 2 p.m. and 4 p.m.

As a precaution only, we are advising participants who attended the Pacific Dental Conference during those hours to monitor themselves for the following symptoms for up to 14 days and call HealthLink at 811 for advice if they develop any of the symptoms:

  • Fever
  • Cough
  • Headache
  • Shortness of breath

If you attended PDC but are asymptomatic, please self-monitor over the next few days. If you become symptomatic, self-isolate, and call 811.

For reference, Vancouver Coastal has just released this statement: vch.ca/about-us/news/news-releases/covid-19-notification-for-attendees-of-pacific-dental-conference-2020

We will continue to update the members’ website and send out e-advisories in a timely manner, as the information is constantly evolving.