Dentists are calling on the Trump administration to provide them with coronavirus tests before reopening, arguing that conditions in dental offices make patients and staff more susceptible to exposure.
The American Dental Association (ADA), which has more than 163,000 members, wants the Department of Health and Human Services (HHS) to supply testing kits to dentists so that they can swab patients once the economy reopens.
The high-speed instruments used by dental practices create aerosol clouds that can hold germs for up to three hours, increasing the odds of exposure for staff if a patient has the coronavirus.
The Labor Department’s Occupational Safety and Health Administration has identified dental professionals as at risk for exposure to the coronavirus due to various workplace hazards. Dentists have been advised to use either a negative pressure room or high input suction devices to remove the germs and reduce exposure once they reopen.
But many offices lack those tools, let alone effective facial protections, according to Steven Guttenberg, president of the District of Columbia Dental Society.
“Dentists typically wear a mask and wear eye protection. The mask is one of these simple throw-away things. Very few have N95 respirators and would have trouble getting them right now,” Guttenberg said, adding that many dentists have donated their personal protective equipment (PPE) to front-line workers during the pandemic.
Members of Congress who are dentists say it’s an issue the administration needs to take seriously.
Rep. Brian Babin (R-Texas) was among those who spoke to White House officials on Monday about getting testing kits in dental offices.
“I addressed this with White House officials that we would like to have the capacity to test our patients so we know who we are dealing with and the determination of what kind of procedures we should be doing and the precautions we can take,” Babin told The Hill. “It boiled down to how many of these testing kits and PPE are available, which will make the determination.”
Babin said he knows some dentists who are looking to install the suction devices that can eliminate the aerosols generated during certain procedures.
“Dentistry would be one of the most hazardous, and the reason being is we generate aerosols with our hand pieces, our drills,” he said. “In order to be victorious over this COVID-19, testing is the absolute answer to winning the war.”
Rep. Mike Simpson (R-Idaho), who is also a dentist, said he supports the push for testing kits in dental offices because it will help reopen the economy safely.
“[Dentists] are well-equipped to help our country reach the testing capacity needed to combat the spread of COVID-19. This will also help us carefully reopen the economy by keeping both patients and employees safe in the process,” he said.
Simpson said he hopes HHS will grant liability protections to dentists similar to the kind pharmacists already receive.
The ADA asked HHS for dentists to be classified as “covered persons” under the Public Readiness and Emergency Preparedness Act, which would extend protection from liability associated with the administration or use of authorized tests.
“I feel HHS has the authority to accomplish these goals,” Simpson said.
HHS did not respond to a request for comment.
A major concern among dentists is that patients seeking care after reopening could be asymptomatic, putting staff members at risk of contracting the disease and spreading it to more patients or others outside the workplace.
“The last thing we want to do in the dental industry is be a spreader of COVID-19. We want to be part of the solution,” Noelle Dunn, a dentist and owner of Dunn Dental Group in D.C., told The Hill.
Dunn said that if a patient tests positive for coronavirus, they would refer the patient to a physician and inform the Centers for Disease Control and Prevention to help map out hot spots.
“A way that could protect patients in a dental environment, and also protect staff, is to allow dentists to screen their well patients. When you go to the dentist, you’re not sick. We can do these rapid tests to see if there are people walking around out there who are asymptomatic and can control the spread of this,” Dunn said.
Dunn noted that dentists are already qualified to administer tests for other diseases, like HIV and diabetes.
“Enabling dentists to test patients prior to dental treatment will help lower the ‘very high exposure risk’ of dental personnel in contracting COVID-19 when treating infected but asymptomatic patients,” ADA President Chad Gehani wrote in his letter to HHS. “It would add a layer of safety for both dental personnel and the patients they treat.”
While securing testing kits from the federal government is likely to be an uphill battle, there’s also the question about how many tests each dental office would need.
According to Dunn, a test might be needed for every patient who walks through the door.
Testing kits are needed “until there’s an effective vaccination,” she said.
Dentists have experienced significant financial losses due to the coronavirus pandemic. Most offices are open only for emergency procedures, and many specialists have had to close entirely because they lack the necessary PPE.
For emergency procedures, dentists are first taking a patient’s temperature and going through their medical history, including asking if patients have traveled recently.
It “absolutely” has been risky, Guttenberg said.
“It’s created a huge backlog in dental needs in our population. We want to be able to treat them, but we want to be able to treat them in a safe way and a safe environment,” Dunn added.
Some dental practices have applied for the popular Paycheck Protection Program, which is poised to get a $310 billion injection as early as this week after the initial $349 billion was depleted last week.
“This definitely has been an extremely hard, trying time for dental practitioners all across the country. They are chomping at the bit. Most of them are not even doing 5 to 10 percent of what they normally did,” Babin said.
Guttenberg, who is an oral surgeon, said he normally sees eight to 10 patients a day. In the past five weeks, he has had only three, for emergency procedures.
“Staff has to be paid. Your rent has to be paid. If you have loans, like a lot of people do, those have to be paid,” he said. “I think there could be some people that go out of business.”
Salaries for dentists average about $151,000, followed by $74,000 for hygienists and $39,000 for dental assistants.
Dentists say they will keep pressing for testing kits, but many say that if they have to reopen without them or without the necessary tools to eliminate aerosol germs, they’ll feel obligated to disclose those shortcomings to patients.
“The general public deserves to know the risk. As a dentist, and any medical provider, I took a Hippocratic oath and that is to do no harm,” Dunn said.