Earlier this week, the American Dental Association (ADA) urged dental professionals to stop performing elective procedures for the next three weeks and to only treat emergency patients as the country tries to contain the spread of coronavirus. Now, the organization is giving guidance on what exactly an emergency patient is.
According to the guidance, “dental emergencies are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding, alleviate severe pain or infection.”
This includes:
-Uncontrolled bleeding
-Cellulitis or a diffuse soft tissue bacterial infection with intraoral or extraoral swelling that potentially compromise the patient’s airway
-Trauma involving facial bones, potentially compromising the patient’s airway
Urgent care “focuses on the management of conditions that require immediate attention to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments,” according to the guidance. These conditions should be treated as minimally invasively as possible and include:
-Severe dental pain from pulpal inflammation
-Pericoronitis or third-molar pain
-Surgical post-operative osteitis, dry socket dressing changes
-Abscess, or localized bacterial infection resulting in localized pain and swelling
-Tooth fracture resulting in pain or causing soft tissue trauma
-Dental trauma with avulsion/luxation
-Dental treatment required before critical medical procedures
-Final crown/bridge cementation if the temporary restoration is lost, broken or causing gingival irritation
-Biopsy of abnormal tissue
Other urgent care includes:
-Extensive dental caries or defective restorations causing pain. Manage these cases with interim restorative techniques when possible (silver diamine fluoride, glass ionomers)
-Suture removal
-Denture adjustment on radiation/oncology patients
-Denture adjustments or repairs when function impeded
-Replacing temporary filling on endo access openings in patients experiencing pain
-Snipping or adjustment of an orthodontic wire or appliances piercing or ulcerating the oral mucosa
The guidance also lists care that isn’t considered an emergency and that can be delayed. This includes:
-Initial or periodic oral examinations and recall visits, including routine radiographs
-Routine dental cleaning and preventive therapies
-Orthodontic procedures other than those to address acute issues (e.g. pain, infection, trauma)
-Extraction of asymptomatic teeth
-Restorative dentistry including treatment of asymptomatic carious lesions
-Aesthetic dental procedures
This guidance may change as the situation with COVID-19 continues to unfold, but dentists should use their professional judgment when determining if emergency care is needed. While the ADA recommends not performing elective procedures for the next three weeks, state governments and state dental associations may have other guidance depending on the situation in your area.