Tuesday, May 26, 2020

The CDC has *Finally* Updated Treatment Protocols for Dentistry


First of all, if you are reading this and involved in dentistry, you NEED to read the updated CDC Guidelines.  You can come back and finish reading my post after you’ve read through the pertinent info from the CDC.  The Guidelines are here.  

I’m sure that most of you like to keep bookmarks in your web browser for subjects or sites that you have an interest in.  That just makes everything so much easier.  I have a Bookmark folder called “Dental” and under it I have nested folders for things like “Pharmacology”, “3D Printing”, “Intraoral Scanners”, as others.  That way I don’t have to think or search online when I need to go to a site that has the information I need.

When the SARS-CoV-2 virus began to be big news in late February I promptly created a folder nested under “Dental” that I called “Covid”.  Information was changing so rapidly, that it greatly simplified my life to have all the important websites I was perusing on a regular basis available in a couple of clicks.  

One of the sites I bookmarked and kept in that “Covid” folder was the CDC page titled “Guidance for Dental Settings”.  When it comes to guidance on handling any type of infectious process from a clinical perspective I have always turned to the CDC.  The group has always been at the forefront on how to handle these types of scenarios and situations.

Yet, this time, CDC dropped the ball in a big way.  Now first let me state, that I understand the pressure that CDC is under.  They are being inundated with questions and requests from civilians, government officials, and every type of healthcare provider in the United States.  What they are being asked to do difficult.  They only have so many employees and some many hours in the day.  I am sure that their system is stressed to the breaking point on a continual basis.  I salute the job they have done.

However, at the same time I feel it is the right thing to do to evaluate the current situation and the mistakes that have been made, in an effort to improve things for the next pandemic situation.  And trust me when I say *next*.  There will always be a next when it comes to fighting diseases that affect the human race.

My complaint is the amount of time it took CDC to get us these updated guidelines.  In mid-March, the ADA had asked all dentists to cease treating patients for elective procedures.  The ADA promptly released a decision matrix with guidelines for what constituted a dental emergency so dentists could make informed decisions.  This was a threefold recommendation.  The first was to reduce chances for exposure and spread of the disease.  The second was to keep patients with dental emergencies out of hospital emergency rooms.  This kept ERs available to treat Covid-19 patients as well as reducing the risk of dental emergency patients contracting Covid-19 in the ER.  The third was to conserve PPE so that it was more readily available for hospitals and those treating Covid-19 patients.  The supply chain, by that time, was already stressed and the last thing needed was even more demand for N-95 masks, gowns, and the like.

Once dentistry, for all intents and purposes “shut down” everyone knew that eventually dentistry would “start up” again.  There was no doubt that when it *did* start up, things would be different.  The start up would need guidance on how to proceed with treatment.

An example of this can be made in my own dental office.  The city of Kansas City as well as the surrounding counties in Missouri and Kansas agreed to the same quarantine schedule.  Thus, I knew that my office would be opening for elective procedures on May 18th.  I began to plan for that opening several weeks in advance and began looking for guidance on how to keep my patients, my team, and myself safe.  Some offices, due to the quarantine schedule of their jurisdictions actually opened 2 weeks before I did.

Those that opened in the first week of May did so with NO recommendations from the CDC.  The ADA released their "Return to Work Interim Guidance Toolkit” on, I believe, April 24th, which was a week before many offices opened.  However there was no update on recommendations from the CDC.  In an attempt to get an update from the CDC, the ADA wrote a letter to the CDC requesting guidance.  This letter, dated May 6th, 2020 is addressed to Robert Redfield, M.D. who is the director of the CDC.  This letter was written the week that many offices were reopening.  At that point in time, the CDC guidelines were dated April 27th.

Dental offices continued to open.  They had no choice but to use their best professional judgement regarding how to treat.  On May 18th, my office reopened.  I had been seeing emergencies only since March 18th.  By that point in time, I had managed to stabilize as many patients as possible, but many of them required definitive treatment.  You can only provide palliative care for so long...

The problem was that on May 18th, the CDC still had not updated their guidelines since April 27th.

Finally on May 21st, nearly a month since the last update, CDC posted new and improved guidelines.  As a profession we depend heavily on the advice of experts when something outside the normal scope raises its ugly head.  I completely get the idea that SARS-CoV-2 caught the world by surprise, however an organization such as the CDC should shine in moments of crisis and confusion, but in this case they promoted confusion.

I’m afraid that as the world has changed and seemingly become more “blame oriented” no one wanted to accept the heat if something wrong was advised.  My hope is that smart minds at the CDC are already working on ways to improve their response in times of a crisis like this.  We depend on them and I support them.  I just don’t want this situation repeated in the future.

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