Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 1

Re-emergence Pediatric Dentistry

PRACTICE CHECKLIST

A guide for re-entry into practice for pediatric dentists during the

COVID-19 pandemic

Updated 4/28/2020

2 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST

TABLE OF CONTENTS

PRE-EMERGENCE PROCESSES4 Supplychainverification4 General 4 Employeecalibrationprocesses5 Teledentistry5 Staffandemploymentconsiderations5 Testingandresearch5 Physicalspace/officemodifications6 Pre-closure/closurepatientstatus

PRACTICE RAMP UP SCHEDULE CONSIDERATIONS7 Addressingfamilyunitbehavior7 Gettingreadytostartupagain

SITUATIONS UNIQUE TO THE SPECIALTY OF PEDIATRIC DENTISTRY8 Childrenrequiringbehaviorguidance(BG)withenhancedphysical contact8 Childrenwithcompromisedimmuneillnessorwithcomplex medicalcareneeds8 Immediatecareforhighcariesindexpatients/emergencies9 Patientsfromgrouplivingsites9 Traumaticinjury9 In-officeanesthesiatreatment9 Hospitaldentalcases

POINT-OF-CARE CONSIDERATIONS/OPERATORY ENVIRONMENT10 Ventilation10 Useof highcapacityevacuationdevices10 PPEandinfectioncontrolenhancement11 Viralnumbersandaerosols11 UVC 11 HEPA 11 SingleUseEquipment11 Nitrousoxidesterilization11 Miscellaneous

PRACTICE MANAGEMENT CONSIDERATIONS13 If anownerof apractice13 If youareassociatedwithlocalhospitals13 Insuranceandpayerconsiderations14 Medicaidandpublicconsiderations14 If youareanassociateoremployeedentist14 Forpendinggradsandnewgrads14 Thirdpartycomplianceoversight

PREFACE

DearColleagues,

ThetremendouschallengeswearefacingduetotheCOVID-19crisisareunprecedentedinmostof ourlifetimes.Ourhealthcaresystem,oureconomy,andournation’speoplewerenotreadyfortheimpactof thisvirus.Andweandourpracticeswerenotpre-paredforthefar-reachingeffectsof thepandemicandonlynowarebeginningtolookatre-emergencefromclosuresandemer-gency-onlyoperationtogetbacktocaringforchildren.

Re-emergencefromthedepthsof thepandemicwilltaketimeanddefininga“newnormal”forourlivesandourpractices.Nooneisreallysureof whattheendof thispandemicwilllooklike,sowecanonlytrytodoourbesttocraftasafeandeffectivepracticeenvironment.Further,becauseof thenoveltyof thiscrisis,howweapproachrenewalof ourpracticeswillbeamixof applicationof existingscience,interpretationof newfindings,andcreativityandcommonsense.Untilmoreisknownabouttransmission,testing,andimmunity,aswellastheeffectivenessof mitigationefforts,theserecommendationsare,atbest,merelyguideposts,notadefinitiveroadmap.

Becauseof uncertaintiesandtheevolvingunderstandingof thevirus,wefeltitwouldbelessvaluable,andinfact,counterpro-ductivetobeprescriptivethantodirectmembersindirectionsthatseemimportanttoconsiderintheresumptionof practice.Becauseof competinginformationandsignificantdifferencesinstates’approachestoreestablishingtheireconomieswhilestillcontrollingthevirus,wefeltitbesttodirectpediatricdentiststolooktoreliablelocalandnationalsourcesof informationtogetspecificinformationinthecategoriesinthischecklist.

Thechecklistoffersdocumentsandlinksthatwereavailableatthetimeof itsconception,butthosecanchangeandsomeal-readyhave,butareincludedbecauseof theirhistoricalreference.

Wehopethatthisdocumentprovesusefulasstatesopenuprestrictionsandweallbegintogetbacktocaringforchildreninwaysthataresafeforthem,theirfamilies,ourstaffandourselves.

Sincerely,

The Safety Committee

Casamassimo, P., Castellano, J., Conte, C., Czerepak, C., Jacobson, B., Lee, J., Miller, J., Younger, L.

Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 3

INTRODUCTION Thischecklistismeanttobeaguideforre-entryintopracticeforpediatricdentists.

Thechecklistisbasedonbestinformationatthetimeof itscreation.Theevolvingnatureof theCOVID-19pandemic,scientificdiscoveriesrelatedtovirustransmission,anddataoneffectivemitigationeffortsandtreatmentsmakeanysetof recommendationsandareasof con-siderationtime-sensitive.Usersof thisguideshouldcontinuetoconsultwithreliablenationalandlocalsourcesregularlyandadheretorecommendeddirectivesthatapplytotheirlocusof practice.

Inaddition,sourcesof informationprovidedintheresourcesectionof thisdocumentmaybecomeoutdatedwithnewinformationovertime.Adherencetorecommendationsbygovern-mentandprofessionalorganizationsshouldbebasedonmostcurrentversionsof advice.

Forthelongerterm,untilimmunityagainstCOVID-19isachieved,ouractionsaspediatricdentistsshouldbealignedtoachievethefollowing:

1. EnsuretheU.S.healthcareworkforcehasabilitytocareforthesickwithinourhospitals,

2. Preventinfectionwiththeviruspersonallyandprofessionally,

3. Buildcapacitytoprotectthehealthandwell-beingof thepublicandpediatricdentalworkforce,

4. Reducesocial,emotionalandeconomicdisruption,

5. Optimizeoralhealthof childrenwecarefor.

Becauseof impactsonhealthcare,povertyandeconomy,thecurrentpracticestateof onlyemergencydentalcarethatmanystatesandprofessionalorganizationshaverecommendedorrequiredinattemptstomitigatethespreadof COVID-19isunsustainableinthelongterm.Thus,thischecklistisdesignedtoaddresssignificantareasof practicethatmayneedattentionpriortoresumptionof pre-pandemiclevelsof care.Italsotakesintoconsiderationnewandpossiblechangesasaresultof thepandemicanditslingeringeffectsandretrospectiveactionstoreturnpracticestooptimalfunction.

4 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST

PRE-EMERGENCE PROCESS

Inordertobegintogetbacktopatientcare,anumberof stepsshouldbetakentoprepareafacilityforre-openingandstafftobeabletofunctioninthe“newnormal”environment.Thisfirstsectionreflectsguidelinesaswellasmember-drivenideastofacilitatetherestartof apractice,aimedmainlyatpersonnelpreparationandphysicalchanges.ThesuggestionsofferedhereareaimedatsafetyaswellasoperationalchangesconsistentwithwhatisknownandstillemergingabouttheCOVID-19pandemic.

Supply chain verification:

• PPEguidelinesastheyapply

• Newdisposablerecommendations(egN2O)

• Stayinconstantcontactwithdentalsupplyrepsforavailabilityof PPE

• Bewaryof graymarketPPE

TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.

• AmericanDentalAccessories

• AMSystems:RespiratoryandAnesthesiaEquipment:ViroMaxViralandBacterialFilter

• TheADA’sAdvisoryTaskForceforDentalPracticeRe-coveryhasdevelopedafreetoolkitformembersofferinginterimguidanceonmeasurestohelpprotectpatients,staffanddentistsfromCOVID-19asdentalpracticesre-engageinprovidingthefullrangeof oralhealthcare.Toreceiveacopy,visitthisADAsiteandfillouttheformforalinktothetoolkit.

• ADAInterimGuidanceandMinimizingRiskCompre-hensiveResource

• ADAGuidetoUnderstandingandDocumentingTeledentistryEvents

• ADA:WhatConstitutesaDentalEmergency

• ADAWebinar:COVID-19:WhatToDoIf aPatientorDentalStaffTestsPositive

• ADA:WhattoDoif SomeoneonYourStaffTestsPosi-tiveforCOVID-19

• ADA COVID-19CodingandBillingInterimGuidance

• CDCCOVID-19GuidanceforHealthcare Professionals

• CDC:InterimInfectionPreventionandControlGuidanceforDentalSettingsDuringtheCOVID-19Response

• CDCPoster:PPETrainingforStaff

• CDC UsingPPEWhenCaringforPeoplewithCon-firmedorSuspectedCOVID-19

• DoxyTelemedicineTool

General:

• Reviewcurrentinfectioncontrolpractices

• Pediatricriskislow

Employee calibration on processes:

• Considerdevelopingarespiratoryprotectionprogram:

1. Youmusthaveaprogramadministratorthatisqual-ifiedbyappropriatetrainingorexperience(DDSalonedoesnotqualify)

2. RespiratoryProtectionProgramElements: a. Selection b. Medevaluation c. Fittesting d. Use e. Maintenanceandcare f. Breathingairqualityanduse g. Training h. ProgramEvaluation

• Patienttriagefororalhealthneed

• Developascriptforfrontofficescreeningof patientsforbothdaybeforeanddayof appointment

• Assessment of COVID-19 risk

• Referraloptionsidentifiedforpatientswhohaveaposi-tiveCOVID-19testresults

Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 5

• EPA:DisinfectantsforUseAgainstSARS-CoV-2

• HowtoChooseandUseEnvironmentalSurface Disinfectants

• MMWRHospitalizationRatesandCharacteristicsof PatientsHospitalizedwithLaboratory-ConfirmedCoronavirusDisease2019

• SocialDistancingProtocolfromSanMateo County,CA

• StandardandTransmission-BasedPrecautionsin Dentistry

• Sampling:Adult

• Sampling:Pediatric

• Test:LoopMediated

• Test:RT-PCR

Hospitalization Rates and Characteristics of Patients Hospitalized with Laboratory-Confirmed Coronavirus Disease 2019, COVID-NET, 14 states March,4-30, 2020, MMWR April 8, 2020

Pediatric COVID –19 Imaging

Reference: Lu et al, Letter to the Editor, March 18, 2020 NEJM, Xia et al Pediatric Pulmonology, 2020:1-6

If you use teledentistry:

• Describethetriageprocess

• Describetheexpansion/reductionof theuseof teledentistry,if implementedduringcrisis

Staff and employment considerations:

• Untiltesting,considerriskreductionmeasures:takingtemperatures

• Non-contactrolesforstaff

• Managinglaundry

• Abtiterswhenutilityisestablishedonlimitinginfection

• Considervaccinerequirementwhenavailable

• Whattodoif someoneonstafftestspositiveforCOVID-19

• Protocolfor“non-returntowork”employees

• Checkinregularlyonstaffstatusandmorale

Testing (when available), some types to research are:

• Reversetranscriptionpolymerasechainreaction(RT-PCR)test

• Loop-mediatedisothermalamplification(lamp)

• Sampling:adultandchild

• Knowthedifferencebetweenantibodyvsvirustestsand accuracy

Physical space/office modification:

• Usecommontermsusedbygovernment,publichealthdepartments,andCDC(socialdistancing)

• Considerbarriersinbay

• Considerhavingdrapesinstalledbetweenchairs

• Removehard-to-disinfectitemsfromoperatoriesandwaitingrooms(toys,decorations,books,magazines)

• Createcleaningscheduleforefficiency

• Considernewsignageinofficetopreventpatientsfromwalkingthroughthewrongareas.

• Planwaitingarealayoutforsocialdistancingwhilemaximizingexperienceduringreception

• Considerleavingfrontdoortoofficeopenorinstallationof electronicdooropeners

• Considerwhatasafenumberof peopleisandif therearedistancesthatneedtobemaintainedwhilethepatientswaitforappointment

• Isthereaneedtoplaceairpurifiersinthesehighvol-ume/trafficareas?

TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.

ForCOVID-19

resourcesfromthe

AAPD,visitthe

AAPDCOVID-19

UpdateCenterat

aapd.org.

6 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST

• Contactarchitectorheatingconstructiontodeterminerateof airturnoverinoperatoriesand/oropenbays

• Aerosolevacuationunits(notadvisedatthistime,butfollowscientificadviceasitchanges)

• If possible,closedoortotreatmentroomduringtherapy

• Considerreducingtheamountof potentialinfectiouscontactpointsandpatientinteractiontouchpoints.Forexamplewipingdownof pensandcreditcardprocess-ingmachines(orprocessors),lessenpenandformtrans-ferswithcontactlesssolutionsorself-servicesolutions(forms,records,etc)

• Identifyprocedure-specificoperatory/rooms/spaces/andattempttolimitlengthof appointments

• ConsidertreatingCOVID-19positivepatientsattheendof theday

• ConsiderhavingaCOVID-19assignedteamforposi-tivepatients

• Receptionstaffprotection/barriers/PPE

• Inopenreceptiondeskconsiderplacingtemporaryacrylicbarrierstoprotectreceptionist

• Negativepressurerooms(notadvisedatthistime)

Pre-closure/closure patient status:

• Followuponemergencypatientsseen:describebacklogof urgentoremergentcasesneededtotreatandthechangesinseverityof thecasesandwherepatientswentforcare

• FollowuponpendingsedationandGAcases

• Stagingof missedrecall/newpatients

• Websiteupdates

• Officecompliancenoticesforpatients(howtheofficeiscomplyingwithfederal,state,localmandatesandguid-anceinregardtodentalpracticeandCOVID-19)

• Phonemessagingupdates

• Giveadequatetimetoreviewcoverageandact

TOPICS AND CONSIDERATIONS

Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 7

PRACTICE RAMP UP SCHEDULE CONSIDERATIONS

Restartingpracticeshashumanelementsaswellasphysicalconsiderations.Thelevelof patientconcernaboutrenewingdentalcareisunknownandapartof theprocessistheneedforpatientassuranceandmakingsurethatstaffareabletocommunicatewithfamiliesaboutstepstakenandshowothermeasurestoassuretheirsafety.

TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.Addressing family unit behavior:

• Lookatspacingandotherinfectioncontrolmeasures(barriers,staggeringappointments,carwaiting,useof pre-screeningviaphone,oneguardian,nosiblings,no-touchsignin,notoys/books/magazines)

• Balanceexposureriskandpatientseparationwithsim-ple,cost-effectivepatientflowpoliciesandprocedures

• Maximizetreatmentandaccessandincorporateacutepandemicperioddisplaced/rescheduledpatients

• PPEsustainablestrategies:considermasksandsanitiz-ersatdoorforfamilies

• DuetoPPEshortageconsiderrequiringpatientstoar-riveatofficewitha“facecover”andprovidemaskonlyif/whennecessary

• Inadditiontocurrentadviceonfeverandsymptomscreening,evaluateanddevelopadditionalscreeningproceduresthatwillimproveidentifyingpatientswithinfection,whoareasymptomatic,includingchildren

• ADA:COVID-19FrequentlyAskedQuestions

• ADA:OSHAGuidanceSummaryforPreparingWork-placesforCOVID-19

• ADAScreeningandRiskMitigationAlgorithms

• ADAStateDentalMandatesandRecommendations

• AmericanDentalAccessoriesDentalPracticeAdvice

• CDC:InterimGuidanceforBusinessesandEmployers

• Clinician’sReportfromGordonChristiensen

• CoronavirusBlog:DropletvsAirborneTransmissionWarning

• CoronavirusDisease2019(COVID-19):EmergingandFutureChallengesforDentalandOralMedicine

• Dimensionsof DentalHygiene:ProtectingYourself

• FDA:SurgicalMaskandGownConservationStrategies-LettertoHealthcareProviders

• FederalGuidance:OpeningUpAmericaAgainGetting ready to start up again:

• Utilizereal-timeCOVID-19diseaseprogressionre-sourcesthatgivestate/countydatatobestunderstandyourcommunity’sdiseasestatus

• UtilizeResourcesforIndustryReopeningGuidance

• Knowindividualstatemandatesrelatedtopracticeof dentistryduringCOVID-19

• Understandthedifferencebetweendropletandaerosolcontamination

• Understandingdentalaerosolsandsplatterandmitiga-tionapproaches

• Developastart-upplanforyouroffice

• Createapost-crisisSOPManualorrevisecurrentofficemanual

• JADA:AerosolsandSplatterinDentistry

• JohnsHopkinsCOVID-19U.S.CasesbyCounty

• JohnHopkins:PublicHealthPrinciplesforaPhasedReopeningDuringCOVID-19:GuidanceforGover-nors

• N-95RespiratorsandSurgicalMasks,FDA

• NIOSH:Slideshow,AerosolGenerationandBehavior

• Return-to-practiceroadmapfordentistsinpost-COVID-19pandemic

8 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST

SITUATIONS UNIQUE TO THE SPECIALTY OF PEDIATRIC DENTISTRY

Theuniquepatientmixof pediatricdentalpracticechallengesustoprepareforsituationsthatmaynotoccurforgeneraldentalpracticesorotherspecialties.Thissectioncoversdifferentpatientgroupsweaspediatricden-tistsseeregularlyandstepsthatcanbeconsideredtomaketheirtreatmentsafeandeffective.

TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.Children requiring behavior guidance (BG) with

enhanced physical contact and multiple personnel:

• DelayphysicalBGpatients

• Considertreatingpatientwhileonparent’slapwithpar-entwearingmaskandhavingpassednegativescreeningcriteria

• Specialhours

• Prepareforpossiblereferralspriortocontamination

• Scrubchangefrequencyandlaundering

• Restraintdevicecleaning

• EnhancedPPEuseif recommendedwithPPEgearedtospecificroles/likelihoodof exposure

Children with compromised immune illness or with complex medical care needs:

• Considerpreparingprotocolsandreferralsources

• HaveMDandhospitalprotocolsonhand

• ConsultwithMDaboutsafetyof childbeingseenatclinic

• AAAASF’sguidetore-openingyourAAAASF-accredit-edfacilityafterclosureduetoCOVID-19

• AmericanCollegeof Surgeons:LocalResumptionof ElectiveSurgeryGuidance

• AAPD:Managementof DentalPatientswithSpecialHealthCareNeeds AmericanCollegeof Surgeons:ClinicalIssuesandGuidance_COVID-19

• AmericanCollegeof Surgeons:LocalResumptionof ElectiveSurgeryGuidance

• ASDAInterimGuidanceForDentistAnesthesiologistsPracticingInTheOffice-BasedSettingDuringTheCOVID-19Pandemic

• ASHRAE:NewVentilationGuidelines

• CariesManagementStrategiesforPrimaryMolars

• CDC:CaringforChildren_COVID-19

• Effectof sensoryadaptationonanxietyof childrenwithdevelopmentaldisabilities:anewapproach.• Considerhospitalbaseddentalclinicsif available

• Considerthetimingof theappointmentintheschedule(1stappointmentsorspecialhours/days)

• Considerbuildingaroomthatmeetshospitalstandardsforinfectioncontrolandairturnover

Immediate care for high caries index patients/ emergencies:

• Maximizingtreatmentpervisittoreducenumbersof visits

• Establishprotocolsforpainandreferrals

• Developariskbasedscaleforschedulinggeneral anesthesiapatients

Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 9

TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.• Determinewhenthehospital/surgicalcenterwillbe

schedulingelectivedentalpatients

• Developstrategiestotemporizecariousteeth:useof IRM,glassionomer

Patients from group living sites:

• Considerpre-screeningforsymptoms

• Teledentistrytriage

• Specialhourstomaximizeaccessandtreatment/reduceexposurelikelihood

• Developacommunicationlinkwiththeproviderre-sponsibleforthehealthof thepatient

Traumatic injury:

• Considerdedicatedafter-hoursroom

• Pre-screeningforsymptoms

• Consideringageof patients,toothstatus,occlusionandmedicalandviralstatusof patient

• Teledentistrytriage

• After-hoursteamhazardpay

• Knowwhatcanwait

• GuidanceonPreparingWorkplacesforCOVID-19

• PlanningAdvice:Designdistinctionsforexam, procedureandoperatingrooms

• RoadmapforResumingElectiveSurgeryAfterCOVID-19Pandemic,JointStatement

• StrategiesforOptimizingtheSupplyof IsolationGowns

In-office anesthesia treatment:

• ConsiderPPErequirementsforadditionalstaff

• Implementdisinfectionprotocolforequipment

• Considerschedulingtoreducetransmissionlikelihood

• RefertoASDArecommendations

• Considerdisposablevsclothgarmentsforstaffinanes-thesiapatients

Hospital Dental Cases:

• Morestringentpre-andintra-operativestepsforhospi-talcases

• Considerreferraloptionsandpre-optimeframe

• Complywithscreeningandmanagementprotocolsoutsideof theoffice

• BefamiliarwithDepartmentof SurgeryGuidelinesforelectivecases

• Determineif thehospitalsystemwillallowdentiststousesatellitecenters

• ConsiderreviewingoptionsforORandspecialtyrefer-ralsources

• Complywithincreasedscreeningandmanagementprototcolsoutsideof theoffice

10 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST

POINT-OF-CARE CONSIDERATIONS/ OPERATORY ENVIRONMENT

Muchof thefocusof areturntodentalpracticehasbeenoninfectioncontrol,andmuchof thatrelatedtothedentist-patientinterface.Todate,nostudiesconfirmthebenefitsof additionalprecautionsontransmission.Theideasandresourcespresentedinthissectionarereiterationof provenandtrustedapproaches,thebestguessesof experts,andsomecommonsenserecommendationsof dentistswhoarefamiliarwiththetreatmenttriadandtheuniqueaspectsof deliveryof careinapediatricdentalpractice.Theresourcesofferedaretime-limitedsousersshouldattendtodatesandrelayonmorecurrentinformationasitbecomesavailable.

TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.Ventilation:

• Considerpartneringwithlocalhospitalorsurgerycen-terbasedonavailability

• Considertheuseof disposable/sterilizablenitroustubing

• Determinewhichdentalprocedurescanbeaccom-plishedwithoutcreatinganaerosolanddesignatetheseas“dryappointments”allotherappointmentswouldbeconsidered“wet”andhigherrisk

• ConsiderwearingaregulardentalmaskoveryourN95maskstopreservetheN95masks

• Considerthatairexchanges,filteringandexhaustfanscanimproveflow,socheckwithcontractor/buildingmanager

• ADACOVID-19WebinarsonTransmissionand Emergency

• ADA:InterimMaskandFaceShieldGuidelines

• ADA:UnderstandingMasks

• ADSExtraoralDentalSuctionSystem

• ASHRAEStandard:VentilationforAcceptableIndoorAirQuality

• BentleyCD,BurkhartNW,CrawfordJJ.Evaluatingspatterandaerosolcontaminationduringdentalproce-dures.JAmDentAssoc.1994;12:579-584.

• CaliforniaCodeof Regulations:IndoorAirQuality

• CDC:BloodbornePathogensandAerosolsinDentistry

• CALOSHA:CaliforniaWorkplaceGuidetoAerosolTransmissibleDiseases

• CDC:DecontaminationandReuseof FilteringFacepieceRespirators

• CDC:GuidelinesforEnvironmentalInfectionControlinHealth-CareFacilities(2003)pg.1

• CDC GuidelinesforEnvironmentalInfectionControlinHealth-CareFacilities(2003)Pg.2

• CDC:StrategizingforOptimizationtheSupplyof IsolationGowns

• CDC:SterilizingPractices

• Comparisonof suctiondevicewithsalivaejectorforaerosolandspatterreductionduringultrasonicscaling

• Considerhavingschedulingseparateaerosolproceduredaysandnon-aerosolproceduredaystoallowcleaning/disinfectiontimeforaerosolproducingprocedures

Use of high capacity evacuation devices:

• Considermultiplesuctionunits

• Referralstohospitalorsurgerycenterasneeded

PPE and infection control enhancement:

• ConsidercleaninganddisinfectionprotocolstoadjustforCOVID-19

• Followrecommendedchangesinpoint-of-contactpa-tientcarefromreliablesources

• Considerscreeninglogsandtemperaturetakingforstaffandadultsaccompanyingpatients(benefitnotprovenatthistime)

• Reuseof N-95masksif necessary

Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 11

TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.

• ConsumerHealthReports:WhattoknowaboutAirPurifiersandtheCoronavirus

• ConsumerLab:UltravioletLightSanitizersand Coronavirus

• COVID-19EvidenceService|AddressingCOVID-19FaceMaskShortages[v1.1]

• CPAC:RHN95DecontaminationSystem

• Crosstex:InstructionsforUseof AxessRFSNasalMaskSystem

• Crosstex:Reprocessingof ScavengingCircuitsandMulti-UseNasalMasks

• Crosstex:TheRightMaskfortheRightTask

• ECRI:Safetyof ExtendedUseandReuseof N95Respirators

• Efficacyof preproceduralmouthrinsesinthereductionof microorganismsinaerosol:Asystematicreview

• FDA,N-95RespiratorsandSurgicalMasks

• HowtoProperlyPutonandRemoveaDisposableRespirator

• IMC:Canmasksbesterilizedwhileretainingprotectivefunction

• Theefficacyof therubberdamasabarriertothespreadof microorganismsduringdentaltreatment

• JacksM.Alaboratorycomparisonof evacuation devicesonaerosolreduction.JDentHyg. 2002;76:202-206.

• MinnesotaDeptof HealthOfficeof Emergency Preparedness:AirbornInfectiousDisease Management_MethodsforTemporaryNegative PressureIsolation

• NAFA:TalkingAirFiltration

• NAFA:TalkingAirFiltrationwithDr.JeffSiegel Universityof Toronto:COVID-19FAQsandAir

• NAFA:COVID-19andAirFiltrationFrequently AskedQuestions

• NIOSH:UnderstandingtheDifferenceBetween MaskandRespirator

• OSHAGuidanceonPreparingWorkplacesforCOVID-19

• OSHA:FitTestingProceduresforRespirators

• OSHA:HealthandSafetyTopics_IndoorAirQuality

• OSHA:HowtoPerformaUserSealCheckwithanN95Respirator

• Continuetotestanddocumenttheeffectivenessof officesterilizers

• Lookatwaterlinesafetyafterpracticereduction

• Considerbathroomcleanliness

• Forrewards:havelistandhavestaffretrieveandgivetochild–notoybins

Viral numbers and aerosols:

• Considermouthrinsetoreduceviralload

• Rubberdamusetoreducepathogentransmission

• N95maskuseandotherPPEfordentistandstaffbasedonproceduresandproximity

• SalivaejectorvsIsolitetypesuctions

• Possiblywearastandardsurgicalmaskoverthen95masktopreservethen95mask

• Wearafaceshieldovermask

UVC:

• Considerultravioletlightsanitizers

HEPA:

• ConsiderHEPAairpurifiers

Single Use Equipment:

• Identifyonetimedisposablearmamentariumthathassterilizableandmulti-usecounterpartsandsolutionssuchasnitrousoxidecircuits/masksandlaunderedgowns.

• Newdisposablerecommendations(egN2O)

Nitrous Oxide Sterilization:

• Tubes,masks,bags

• If sterilizing,verifyyourtubing/bagscanbesterilized

Miscellaneous:

• Identifyandevaluatepotentialdeficienciesininfectioncontrolandthenmitigatethroughdevelopmentof interimbestpracticesuntilformalfederalguidelinesareestablished(e.gaerosolsandnitrousoxidebreathingcircuits)

ForCOVID-19

resourcesfromthe

AAPD,visitthe

AAPDCOVID-19

UpdateCenterat

aapd.org.

12 Re-emergence Pediatric Dentistry PRACTICE CHECKLIST

• OSHA:IndoorAirQualityinCommercialandInstitu-tionalBuildings

• OSHA:LetteronRegulationonRespiratoryProtectionforM.tuberculosis

• OSHA:TemporaryEnforcementGuidance-Health-careRespiratoryProtectionAnnualFit-TestingforN95FilteringFacepiecesDuringtheCOVID-19Outbreak

• OSHATraining:MedicalEvaluationforWorkersWhoUseRespirators

• OSHATraining:RespiratorFitTesting

• NIH:Decontaminationof N-95Masks

• NIOSH:Aerosols

• NIOSH:HealthcareRespiratoryProtectionResources

• NIOSH:IndoorEnvironmentalQuality

• NIOSH:TBInfectionControlPractices

• 2020COVID-19CoronavirusUltravioletSusceptibility

• PorterInstrument_NitrousOxideScavengerSystem:DoubleMaskBreathingCircuit

• PorterScavengerRubberGoodsSystemUserInstruc-tionsforAssembly,InstallationandCleaning

• ThePorterDisposableSilhouetteNasalMaskImprovesInfectionControlSafety

• TurbulentGasCloudsandRespiratoryPathogenEmis-sions

• RAMedicalServicesLtd:InfectionControlGuidetoCareof InhalationSedation

• RDH:HighVolumeEvacuation:Aerosols-It’swhatyoucan’tseethatcanhurtyou

• TimmermanMF,MensoL,SteinfortJ,vanWinkel-hoffAJ,vanderWeijenGA.Atmosphericcontami-nationduringultrasonicscaling.JClinPeriodontol.2004;31:458-462

• Transmissionroutesof 2019-nCoVandcontrolsindentalpractice

• WHO:NaturalVentilationforInfectionControlinHealthCareSettings

RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.

Re-emergence Pediatric Dentistry PRACTICE CHECKLIST 13

PRACTICE MANAGEMENT CONSIDERATIONS

Nooneisreallysurehowthepracticeof pediatricdentistrywillevolveastheresultof thepandemic,butthebestadviceistobepreparedbyvalidatingrelationshipsandfinancialpathwaysbeforebeginningareturntopractice.Theresourcesofferedreflectapointintimesetof suggestions,buttherealitiesof theeconomiceffectsof thepandemiconpersonal,industrial,andgovernmentfinancessuggestthatpracticereadinessincludesathoroughandon-goingconsiderationof thebusinessaspectsof pediatricdentistry.

TOPICS AND CONSIDERATIONS RESOURCESResourcesaremeantforbackgrounduseandarenotinchronologicalorder.Usersareadvisedtoverifyaccuracy.If an owner of a practice:

• Didyoulay-offorfurloughyourstaff?

• Estimatecostsof salariesnotpaid

• Howdidyouengagethestaffduringtheshutdown?

• Describetheestimatedoverheadcostlossesduringthisperiod

• Estimatetherevenuelossesduringthisperiod

• Estimateof incomenotrealizedfor:routineexams,restorative,allcarerendered?

• DidyouapplyforaSBAEIDL(EconomicInjuryDisas-terLoan)?

• DidyouapplyforaSBAPPPloan?

• Didyouaskyourmainpracticelenderbankforothersourcesof relief fromcurrentloanpaymentssuchasdeferredpayment,interest-onlypayments,and/orshort-termlowinterestloans?

• Didyoupetitionyourlandlordforadelayinrentpay-ments?

• Areyouconsideringdownsizingyourpractice?

• Willyouberehiringallof youremployees?

• AAOOfficeStaffandHRFAQ’s

• DeltaDentalmembercompaniesbeginofferingfinan-cialassistanceduringpandemic

• PaycheckProtectionProgram(PPP)Update[NEW4/24/20]

If you are associated with local hospitals, describe your role during the crisis:

• Didyoucontributeyourofficeresources(PPE)tothehospitalsduringthecrisis?

• Wereyouexcludedfromaccesstooperatingrooms?

Insurance and payer considerations:

• Becomefamiliarwithpotentialcoverageforteledentist-ry,andnewcodesforCOVID-19testing

• Followupwithinsurerswhomaybeassistingwithfinancialissuesfromcrisis

ForCOVID-19

resourcesfromthe

AAPD,visitthe

AAPDCOVID-19

UpdateCenterat

aapd.org.

• Follow-upwithinsurerswhomayprovidemoreflexibili-tyintermsof timingforsixthmonthrecallvisits

• Howtodealwithnewlyunemployedyetrecurringparentsoremployerswhosehealthbenefitshaveceasedduetheirliabilities

• Trackpossiblechangesimplementedby insurancecarriersinresponsetocrisis

Medicaid and public considerations:

• DidFQHCs,publichealthfacilities,orcorporate practicesrampupemployment?

• WillMedicaidrollsswellandswamppediatric practices?

• WillstatesmaintainPerMemberPerMonth(PMPM)toManagedCareOrganizations(MCO)toassurepayment?

• WilldecreasedstaterevenuesaffectMedicaiddentalcare?

• ShouldyoufileanyunsubmittedMedicaidclaims?

• Willpandemicbecomeanexcuseforproblems/delays?

• IsMedicaidinyourstateprovidingfinancialadvancesorgrants?

If you are an associate or employee dentist, describe the liability costs you incurred during this time:

• Incomenotrealized

• Educationalloans

• Refinanceloans

For pending grads and new grads:

• Didtheprogramconfercompletionof certificate despiteshortfallof tenureof theprogram?

• Weretherelicensingchallengespost-programinthestateyoumovedto?

• Werethereemploymentchallenges?(Underlyingassumption-existingprivatepracticesarecatchingupforlossessustainedandwouldminimizeadditionaloverhead)

• Whatwereyourloanliabilitiesoncompletionof yourresidency?

Private third party compliance oversight:

• Contractingoutsideconsultant(s)forspecifiedobjectives

• Doacross-disciplinepracticereview:legal,clinical,OSHA,accounting,insurance,andotherelementsasneeded

TOPICS AND CONSIDERATIONS