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Shaping Our Future Together

An ODA Return to Practice Working Group update

May 14, 2020

Dear Colleagues:

The ODA and our members watch with great interest as other provinces and countries cautiously reopen their communities. Generally, dental office doors aren’t wide open, as everyone adjusts to staged approaches and fluctuations in what is "normal" – if such a thing can truly exist right now.

Different jurisdictions are at different stages of the pandemic. Some have seen little spread lately and are more confident about reopening. In Ontario, there are numerous new cases of COVID-19 each day, although the rates appear to be stabilizing. This week, Ontario has seen about 300 new cases daily, compared to less than 80 cases daily in all the Western provinces combined. The provincial government is reopening our communities later, more slowly and with greater caution as a result.

At some point though, more dental care will be permitted. We do not know exactly when, or exactly how we will do it. It’s frustrating. We are now nine weeks into the crisis and it has been tough. We are concerned about our patients’ oral health; their access to care; their, our staff’s and our own safety; and the sustainability of our practices.

But there are opportunities in not being first. We can, and are, learning a lot from experiences elsewhere. Timing, protocols and restrictions that make sense elsewhere may not work for Ontario, so we are combining others’ experiences with our local realities to come up with the solutions our members, our patients, and our communities deserve now and in the post-pandemic period.

This is what the ODA’s Return-to-Practice Working Group (RTPWG) is trying to help resolve. And, you are helping us do it. A sincere thank you to the more than 3,600 ODA members who responded to our survey last week. You are not alone, and your responses help us act quickly and give credible information when we advocate to decision-makers such as the Ministry of Health. The survey shows:

  • Barriers to accessing care
    About four in 10 dentists were not able to see any of their own emergency patients in April, with 75 per cent citing the lack of appropriate PPE as the cause.
  • Significant PPE shortages
    Fifty-six per cent of dental practice owners do not have any N95 masks. Most dentists and dental staff need access to fit testing. We are now looking at how to help members access that service so that you are ready when these masks become available.
  • In-office structural challenges
    About 80 per cent of Ontario dental practices do not have a closed treatment room available. This makes it tough to meet potential guidelines for aerosol generating procedures. We are looking for solutions to this issue as well.

Dentistry does not just include aerosol generating procedures – it is an aerosol-generating profession. The survey makes it clear that access to care and sustainability are at huge risk if more than typical droplet precautions are required.

But the potential spread of COVID-19 through aerosols also places dentists, our staff, and our patients at risk. We cannot use the same protocols as other professions or businesses. More will be expected of us. More than ever, it is apparent that dentistry is largely surgical, and therefore we need similar protocols to our medical colleagues. However, there is simply not yet definitive evidence pertaining to COVID-19 in dental settings. This creates significant unknowns, and it isn’t easy for any of us. While we wait for the science to develop, our approach is still informed by whatever limited evidence exists, so that we can reopen our practices as safely as we can for ourselves, our staff and the patients who need our care.

What we’re working on now

Ramping up our practices will not be easy. The ODA is now building resources and guidance to help members return to practice. We are bringing our perspective to the RCDSO as it establishes its recommendations and standards for returning to practice as well.

The global PPE shortage has also created major barriers to accessing safe and trusted PPE for healthcare workers. Together with the RCDSO, we are strongly advocating to the Government of Ontario for dentists to be prioritized for access to PPE. We are talking with some dental suppliers about our shared concern for the enormity of dentists’ needs. At the same time, the ODA is attempting to secure other sources of safe, sustainable PPE that meets Canadian regulations. We are looking to use the ODA Supply Hub or alternate channels to get reliable delivery for members.

The ODA is also working on a toolkit for members that reflects the Ontario situation. When it is ready, it will be a starting point for all members’ individual circumstances. We will adapt the toolkit as the pandemic changes. While our guidance will be for the short term, it will nonetheless prepare our members to deal with changing regulatory requirements, the next wave, or an altogether different pandemic. We must form a foundation for the future.

Early advice to dentists

Your biggest concerns include having to make significant, costly permanent structural changes to your practices and lengthy wait times between patients. The RTPWG is looking at multiple ways to minimize these difficulties while maintaining safety for everyone. Some early tips we can share:

  1. We don’t know exactly what structural changes will be needed yet. A plexiglass barrier to protect the reception area is pretty much a given so this may be a place to start.
  2. Wait times between patients are related to the efficiency of our HVAC systems and the number of air changes per hour. As a starting point, we suggest you bring an HVAC specialist into your office to check your specific situation and provide advice. There may be air filtration strategies that can help. But be cautious about making major investments now until we have more information about what will be required. You should balance whether the possibly unnecessary expense is worth it, and whether it will help you open more quickly or safely.
  3. Be a trusted leader to your team and your patients. Reassure them that the current measures are for everyone’s safety and that you will be following the guidance of regulatory authorities.

We will get through this, and we will do it together! Your participation in the survey has helped the RTPWG prioritize your most pressing questions. We will need even more of your help soon. We are working on another survey to fill in knowledge gaps that have come up over the last week. Please keep an eye on your email.

And in the meantime, please keep reaching out with your questions at member@oda.ca or by calling 416-922-3900 (toll-free at 800-387-1393). We’ll keep trying to find you the answers you need.

Take care and be well.

Dr. David Stevenson Dr. David Stevenson sgntr
Dr. David M. Stevenson
Chair, Return to Practice Working Group
Dr. Kim Hansen Dr. Kim Hansen sgntr
Dr. Kim Hansen
Chair, Board of Directors and President
Ontario Dental Association
4 New Street, Toronto, Ontario M5R 1P6
416-922-3900   |   1-800-387-1393
www.oda.ca
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