The MDS continues to monitor the outbreak of the coronavirus and COVID-19 and will keep members informed of any new developments and recommendations. Please be sure to read all the communications we send you and continue to check the Centers for Disease Control and Prevention, American Dental Association, and Massachusetts Department of Public Health websites for the most current information and updated guidelines.
The Massachusetts Dental Society (MDS) has been sharing COVID-19 information through email and website updates with all dentists in Massachusetts to keep you informed about the constantly changing environment.This content is usually exclusive to MDS members, but during these unprecedented times it is important to keep all dental professionals aware of updates. Learn more about The Value of Membership or Become A Member.
Return to Practice Roadmap Questions and Answers
With much uncertainty surrounding reopening dental practices in the wake of COVID-19, it’s understandable that dentists have many questions. To help members navigate the reopening process, the MDS has compiled a list and is providing answers to the most frequently asked questions from members about COVID-19 concerns and reopening. This listing will be updated and revised as the situation changes, so please continue to check back.
Have a question you don't see answered? Contact us.
Preparing for Practice Reopening
MDS Board of Trustees Updates Guidance on COVID-19 Office Closures
This week, Governor Charlie Baker announced his administration’s four-phase approach to reopening Massachusetts. In preparation for this phased reopening, the Massachusetts Dental Society (MDS) Executive Committee and Board of Trustees met last night to discuss its COVID-19 guidance for dentists practicing in the Commonwealth. Based on recommendations from the state’s Reopening Advisory Board, the MDS will be participating in a workgroup convened by the administration to inform guidance applicable to dental practices and other non-hospital providers.
Taking into consideration guidance from the Centers for Disease Control and Prevention (CDC), American Dental Association (ADA), Massachusetts Department of Public Health (DPH), and the Baker Administration, the MDS recommends that at the start of Phase 1—the “Start” phase—dentists may treat emergent and likely to become emergent cases. The state will be establishing criteria that providers must meet and attest to in order to resume such services in Phase 1. Dentists that satisfy this criteria may begin offering services for emergent—or at risk of becoming emergent—cases based on the provider’s clinical judgment. High-risk patients should be prioritized as providers begin setting appointment schedules. This recommendation supersedes the MDS’s previous guidance that dental practices close to all but emergency care until May 18.
Prior to the start of Phase 1: Dentists in Massachusetts should continue to only see emergency and urgent cases. During Phase 1: Dental offices will continue to see patients with underlying health risks and defer elective care as determined appropriate for those who present without underlying health risks. Dentists are expected to use their professional judgment when determining which procedures should occur during Phase 1. The MDS will be issuing further guidance on these items prior to members expanding their services.
The MDS will continue to closely monitor the CDC, ADA, state DPH, and Governor Baker’s guidelines as we offer additional guidance and resources.
Why is this information only coming out a few days before May 18? How did the MDS Board reach this decision?
Since the beginning of the COVID-19 pandemic, the state’s focus has been on stopping/slowing the spread of the disease. Now that the data shows a consistent downward trajectory, the state has been able to turn its attention to reopening the Commonwealth, first by appointing a Reopening Advisory Board on April 28. This Reopening Advisory Board has met with more than 40 stakeholder organizations, including the MDS.
These stakeholder meetings led to the Reopening Advisory Board's recommendation that industry-specific work groups be assigned to set specific guidance and criteria for broad industries. The MDS has two representatives on one of the work groups, which will inform guidance applicable to dental practices and other non-hospital providers.
This work group is expected to meet daily for as long as necessary to determine further guidance for dental offices as we move through Governor Baker’s four-phase reopening plan.
Tips for Talking to Your Team Members About COVID-19 Concerns
Many dental practice staff members are expressing concerns returning to work as practices look to begin to expand care beyond only emergency care. These are trying times, and as the dental team leader, you need to communicate with your staff well in advance of our practice reopening to acknowledge and address their concerns, and discuss the changes to your practice due to COVID-19. The Massachusetts Dental Society (MDS) has developed a set of talking points that dentists can use during these important conversations with ensure you are all on the same page.
ADA Releases Return to Work Interim Guidance Toolkit
Dental practitioners across the country have expressed concern about how to safely reopen their dental practices when the stay-at-home bans are lifted. The American Dental Association (ADA) Advisory Task Force for Dental Practice Recovery has developed the Return to Work Interim Guidance Toolkit, a complimentary resource that recommends measures to take to help protect patients, staff, and dentists from COVID-19 as dental practices reopen and begin to provide more than emergency and urgent care. The toolkit includes:
- Sample letter to patients
- Guidance on pre-appointment screening
- In-office patient registration procedures
- Reception area preparation strategies
- Chairside checklist
- Staff protection strategies
- Supplies shopping list
Since our knowledge about COVID-19 continues to evolve, the toolkit and its offerings will be continually reviewed and updated by the ADA as new information becomes available.
In addition, the MDS is developing supplemental resources to help dental practitioners prepare to reopen their practices, so stay tuned for more updates from us.
- NEW: Back to Business: Returning to the Workplace
- NEW: PANDEMIC Back-to-Practice Plan of Action
- Metrics to Measure for Recovery
Communicating with Patients on Temporary Office Closures
To help dentists notify their patients of temporary office closings during this public health crisis, we have created a sample letter that dentists can personalize and post on websites or social media channels.
Emergency and Urgent Care Dental Practice Guidance
As dental practitioners transition to an emergency treatment–focused dental practice following the MDS’s strong recommendation that Massachusetts dental offices close to patients seeking elective or non-urgent care, the MDS has provided interim guidelines to help dentists determine which procedures are emergent or urgent and which are elective and non-urgent.
- Download MDS Updated Guidance
- Download Emergency Dental Practice Triage and Applicable Teledentistry Checklist
- Infection Control Guidance for Dental Health Care Settings: COVID-19 Webinar
The ADA has also released Interim Guidance for Minimizing Risk of COVID-19 Transmission.
On May 19, the Centers for Disease Control and Prevention (CDC) updated its Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response to provide recommendations for dental practices resuming non-emergency dental care during the pandemic. The CDC has added new information regarding facility and equipment considerations, sterilization and disinfection, and considerations for the use of test-based strategies to inform patient care. It also offers expanded recommendations for the provision of dental care to both patients with COVID-19 and patients without COVID-19.
With dental practices in Massachusetts closed to all but emergency procedures, dentists have been utilizing teledentistry to triage patients. The MDS has created the following resources to help dentists:
ADA COVID-19 Coding and Billing Interim Guidance
The ADA has released a guide intended to help dental offices navigate issues related to coding and billing for virtual check-ins in the midst of the COVID-19 outbreak. Available on the ADA Center for Professional Success, the guide was created because telecommunication technology can be leveraged to support dental evaluations during this national effort to reduce non-emergency services.
Dental practitioners are facing many unknowns as a result of the coronavirus pandemic, including potential risk management issues. Massachusetts Dental Society (MDS) Member Savings Program Partner Eastern Dentists Insurance Company (EDIC), the malpractice insurance provider founded by the MDS and member dentists, has shared answers to some risk management questions posed by its dentist clients.
COVID-19 Patient Waiver
The MDS recommends obtaining a signed consent waiver when treating patients during this time. To assist dental practices in developing their own waiver forms, the MDS has developed a sample consent waiver for patients. Be sure to check with your own legal counsel or risk management insurer to confirm that any waiver meets your specific needs.
Personal Protective Equipment
Planning Ahead for PPE
The significantly limited supply of personal protective equipment (PPE) available to dental practices is an area of growing concern, both for dentists currently providing emergency care and practitioners planning ahead to reopen their offices. The MDS is in communication daily with the major PPE suppliers and continues to explore options for members regarding the shortage. We will provide updated information on PPE as it becomes available. In the meantime, the MDS urges dental practices to reach out to your PPE suppliers to determine their inventory status and if they are fulfilling orders at this time. If you are able to order any PPE (e.g., masks, face shields, goggles, gloves, etc.) at this point, we recommend that you do so to start preparing your inventory in anticipation of your practice’s reopening.
The MDS also wants to warn dentists against ordering PPE from unknown sources, including the growing number of international vendors that claim to have proven and effective PPE supplies. The PPE being sold by these “gray market” vendors have not been tested or verified and their claimed effectiveness can not be guaranteed. Do not put yourself, your staff, or your patients at risk with ineffective PPE.
Extending the Use of N95 Respirators
Given the challenges in obtaining supplies of personal protective equipment (PPE), it’s critical that dental professionals understand when and how to extend the use of N95 masks and other respirators without compromising their infection control performance. The ADA guide “Extending the Use of N95 Masks” offers guidance to dental professionals for the extended use or reuse of these respirators, and includes links to resources from the National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention (CDC) on safely extending the use of N95s.
Another option for dentists to consider is utilization of a decontamination system, like the Battelle CCDS Critical Care Decontamination System, which was issued an Emergency Use Authorization (EUA) by the U.S. Food and Drug Administration in late March. Under this EUA, health care personnel—including dentists—can sign up for complimentary decontamination of N95 masks, a service funded entirely by the federal government.
The MDS is working with Battelle’s Somerville location to make it easier for dentists to sign up for the service. To streamline the process, the MDS has set up a master account with Battelle. Dentists simply need to identify a contact person in your organization and submit your contact information through this online form and Battelle will contact you via email within a week to relay the program details and next steps, such as sending you no-cost Fedex shipping labels. (You will need to log in to your MDS account to access the form.)
With several options available for dentists to safely extend the use of respirators, it’s important that each provider carefully review the options and evaluate which method is best for your practice.
3M Data Sheet Offers Comparison of Filtering Facepiece Respirators
One of the many facets of reopening your dental practice amidst the COVID-19 pandemic is ensuring that you not only have an adequate supply of PPE but also that you have equipment that meets required performance standards. St. Paul, MN-based 3M, which manufactures N95 masks, has created a data sheet offering a comparison of the performance standards of filtering facepiece respirator (FFP) classes including N95, KN95, and FFP2.
Resources to Help Identify Approved Manufacturers of Respirators (Updated 5/12/2020)
The Centers for Disease Control and Prevention (CDC) has created resources to help dentists identify approved manufacturers of respirators, as well as N95 masks:
- NIOSH-approved particulate filtering facepiece respirators (updated 5/12/2020)
- If you have a product not listed on the provided tables, please use the CDC’s searchable certified equipment list
Also, the U.S. Food and Drug Administration has provided a list of authorized, imported, non-NIOSH-approved respirators manufactured in China.
Massachusetts DPH Updates PPE Guidance
On April 5, the Massachusetts Department of Public Health (DPH) announced updated comprehensive personal protective equipment (PPE) guidance, based on recommendations from the Centers for Disease Control and Prevention (CDC) for all health care personnel (HCP) in clinical care settings. With this guidance, the DPH is adopting a universal facemask use policy for all health care personnel. Also, due to PPE shortages and the need to conserve supplies during the COVID-19 pandemic, the DPH is now supporting the extended use of facemasks, which is the practice of wearing the same facemask for repeated close contact encounters with several different patients, without removing the facemask between patient encounters. The DPH supports the extended use of facemasks under the following conditions:
- The facemask should be removed and discarded if soiled or damaged.
- HCPs must take care not to touch their facemask. If they touch or adjust their facemask, they must immediately perform hand hygiene.
- HCPs should leave the clinical care area if they need to remove the facemask.
- Facemasks should be carefully folded so that the outer surface is held inward and against itself to reduce contact with the outer surface during storage. The folded facemask can be stored between uses in a clean sealable paper bag or breathable container.
- The DPH also recommends that a facemask, eye protection, isolation gowns, and gloves be used when caring for an individual who is presumed or confirmed to be infected with COVID-19.
Dental Practice Protocols and ResourcesTo protect against transmission of the novel coronavirus and the disease it causes, COVID-19, it’s important that your practice's infection control procedures and protocols are up-to-date and enforced.
The DPH and BORID issued a recommendation stating that dentists who keep their dental practices open are required to practice in compliance with the U.S. Centers for Disease Control (CDC) Guidelines for Infection Control in the Dental Healthcare Setting per the BORID’s regulations at 234 CMR. Additionally, if a dentist is treating a patient diagnosed with COVID-19 or suspected of having been exposed to the virus, then the treating dentist and any auxiliary staff involved in that treatment should follow the CDC’s Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease (COVID-19) in Healthcare Settings and utilize N95 respirators and surgical face masks/gowns per the recommendations of the U.S. Food and Drug Administration, the CDC, the National Institute for Occupational Safety and Health, and the Occupational Safety and Health Administration.
Continue to visit the following websites for additional preventive measures and COVID-19 resources:
- U.S. Centers for Disease Control and Prevention
- Massachusetts Department of Public Health
- American Dental Association (ADA)
Financial Resources for Small Businesses
Paycheck Protection Program Loan Forgiveness Application Available
On May 15, the Small Business Administration (SBA) and the U.S Department of the Treasury released the Paycheck Protection Program (PPP) loan forgiveness application and the SBA issued guidance to further assist borrowers and lenders.
The SBA’s guidance provides four broad categories of costs that are eligible for forgiveness: payroll costs, business mortgage interest payments, business rent or lease payments, and business utility payments. At least 75% of the forgiven amount must be attributable to payroll costs during the eight-week period that began on the date the PPP loan was disbursed to the borrower. The ADA continues to advocate to extend the eight-week requirement.
The PPP loan forgiveness application and instructions inform borrowers how to apply for forgiveness of their PPP loans. Access the form here.
SBA Resumes PPP Loan Processing
Late Friday, the Small Business Administration (SBA) released a joint statement from SBA Administrator Jovita Carranza and U.S. Treasury Secretary Steven T. Mnuchin stating that the SBA will resume accepting Payroll Protection Program (PPP) loan applications today, Monday, April 27, at 10:30 a.m. EDT from approved lenders on behalf of any eligible borrower. This will ensure that the SBA has properly coded the system to account for changes made by the legislation.
“We encourage all approved lenders to process loan applications previously submitted by eligible borrowers and disburse funds expeditiously,” said Carranza and Mnuchin. “All eligible borrowers who need these funds should work with an approved lender to apply. Borrowers should carefully review [PPP] regulations and guidance and the certifications required to obtain a loan.”
The MDS recommends any practice owners who has yet to apply for a PPP loan, to contact your lender or financial institution immediately. If you previously applied and your application was put on hold when SBA funding ran out in mid-April, you should contact your lender to ask about your application status. If your loan application was rejected, we recommend that you contact your lender to discuss amending your application so you can reapply.
MDS Financial Impact Survey Results
- When practices will reopen
- How they can reopen safely
- How to protect their patients and staff
- Recovering from the significant financial impact of the pandemic
Read more of the survey results in detail.
Senate, House Approve Additional $370 Billion for PPP, EIDL Programs
The U.S. Senate and House of Representatives have just passed the Paycheck Protection Program and Health Care Enhancement Act, new legislation that will add $370 billion into the Paycheck Protection Program (PPP), Economic Injury Disaster Loans (EIDL), and emergency EIDL grants for struggling Americans and small businesses. This includes more than $250 billion in unrestricted funds for PPP loans, $50 billion for EIDL loans, and an additional $10 billion for EIDL advance grants. On April 16, the SBA announced that the initial $350 billion funding for the loan programs had been exhausted, so this additional funding could be good news for many small business owners—including member dentists—who have expressed frustration regarding the SBA loans. The bill will now go before President Trump, who is expected to sign it into law imminently.
The MDS strongly urges dental practice owners who have yet to apply to reach out to your lender or financial institution today and apply both both loans now. And if you had previously applied for an SBA loan and were rejected, we recommend that you go back to your lender to see if there is anything you can do to amend your application that can increase your chances of approval and reapply.
Small Business Administration (SBA) Loans Information
On April 16, the Small Business Administration (SBA) announced that it is unable to accept new applications at this time for Paycheck Protection Program (PPP) loans or the Economic Injury Disaster Loan (EIDL) COVID-19 related assistance program (including EIDL Advances) based on available appropriations funding. The SBA says that EIDL applicants who have already submitted their applications will continue to be processed on a first-come, first-served basis. Treasury Secretary Steven Mnuchin asked Congress for an additional $250 billion in funding, which Congress and the Trump administration are currently trying to come to an agreement on. The ADA continues to work with the SBA to help dental practice owners impacted by the COVID-19 pandemic, and will provide updates if Congress makes any announcements in regard to additional funding. You should check with your financial institution to see what their process is during this period.
CARES Act Small Business Loans
The Coronavirus Aid, Relief, and Economic Security (CARES) Act allocated $350 billion to help small businesses keep workers employed amid the pandemic and economic downturn. Known as the Paycheck Protection Program, the initiative provides 100% federally guaranteed loans to small businesses that maintain their payroll during the COVID-19 emergency. These loans may be forgiven if borrowers maintain their payrolls during the crisis or restore their payrolls afterward. The administration will release more details, including the list of lenders offering loans under the program. In the meantime, the U.S. Chamber of Commerce has issued a guide to help small businesses and self-employed individuals prepare to file for a loan.
SBA and Treasury Department Answer PPP Loan Questions
There’s been much confusion surrounding the Small Business Administration’s (SBA) Paycheck Protection Program (PPP) loans, especially for small business owners such as dental practices, who are in much need of this economic relief. The SBA is working with the U.S. Department of the Treasury to provide additional guidance to address borrower and lender PPP questions and they have developed a Frequently Asked Questions (FAQs) document that will be updated on a regular basis (the latest version was released April 17). Per the U.S. Treasury, borrowers and lenders may rely on the guidance provided in this document as the SBA’s interpretation of the Coronavirus Aid, Relief, and Economic Security (CARES) Act and of the PPP Interim Final Rule.
Small Employers May Be Exempt from FFCRA
On April 1, the U.S. Department of Labor (DOL) issued a temporary rule regarding the Families First Coronavirus Response Act (FFCRA) provision that that requires employers to provide emergency paid sick leave and expanded medical leave to employees in certain COVID-19 circumstances. The DOL temporary rule states that employers with fewer than 50 employees—including dental practices—may be eligible for exemption from this provision. The DOL’s temporary rule states that small employers with less than 50 employees may be exempt if they meet certain criteria showing that providing the leave will be a burden on the business. In an alert issued today, the American Dental Association (ADA) said that it has checked with the DOL and they have confirmed that dental office owners are not required to pay paid sick leave or extended family leave—if the employee has a child whose school or daycare is closed due to COVID-19—as long as they meet certain criteria.
Financial Resources for Individuals
Independent Contractors, Self-Employed Workers Can Now Apply for Pandemic Unemployment Assistance
On April 21, Massachusetts launched the Pandemic Unemployment Assistance (PUA) program, which provides up to 39 weeks of unemployment benefits to those individuals who are unable to work due to a COVID-19-related reason and who are ineligible for regular or extended unemployment benefits. Eligible entities include self-employed workers and independent contractors.
Learn about unemployment assistance and apply for benefits. The CARES Act includes a $600 weekly increase for up to four months in addition to the standard unemployment benefit, which varies by state and by individuals' record of previous earnings. Learn more about how your MA unemployment benefits are calculated.
MDS Unemployment Insurance Q&A
To help dental offices navigate various unemployment resources, the MDS has compiled a memo summarizing available information and providing answers to questions received by member dentists.
Information for Employers Regarding UI Login Information
Before you can file for unemployment benefits, check with your employer regarding the following:
Dental practice owners who have laid off or furloughed staff, or who plan to, should make sure to know their business’s Unemployment Insurance (UI) login information or otherwise obtain it from their payroll person/business manager. In the process of closing an office, the dentist should change that designated person to himself or herself in order to receive timely notification of any claims. Email notifications will come from the UI system to the designated individual informing them of a furloughed or laid-off employee’s unemployment claim filing. The individual who receives the email will then be required to log in and respond to the Department of Unemployment Assistance’s (DUA) information requests.
If you have employees and have been paying into UI, you should already be registered as an employer with the DUA. If you are an employer and have not registered as an employer with the DUA, you will need the following information to complete your registration:
- Doing business as (DBA) name
- Federal Employer Identification Number (FEIN)
- State and date of formation or incorporation
- Date that employees first began work in Massachusetts
- Owner/officer information including: Social Security number (SSN), FEIN, and percent of ownership
- North American Industry Classification System (NAICS) code: Dentists should use NAICS Code 621210 – Offices of Dentists (DMD DDS)
- Principal business activity performed in Massachusetts
- Quarterly gross summary of wages paid to date
- Number of employees currently on payroll
There are a couple of ways for you to get your Employer UI username.
- Do you have an outside service company that processes your payroll – they may have the number.
- At least annually your practice should receive a letter from unemployment notifying you of your experience rating for the year. Your UI number should be on those letters. Find out where those letters have been filed. Once you have the UI number you can reset your password via the instructions below.
- Go the unemployment website https://uionline.detma.org/Claimant/Core/Login.ASPX to get your UI User ID. Click on the drop down menu under LOG IN TO you will come to a page with the following box:
Staffing Concerns and Notifications
Tips for Talking to Your Team Members About COVID-19 Concerns
Many dental practice staff members are expressing concerns returning to work as practices look to begin treating patients for elective and non-urgent care. These are trying times, and as the dental team leader, you need to communicate with your staff well in advance of our practice reopening to acknowledge and address their concerns, and discuss the changes to your practice due to COVID-19. The Massachusetts Dental Society (MDS) has developed a set of talking points that dentists can use during these important conversations with ensure you are all on the same page.
Answers to Your Questions About Furloughs and Layoffs
To help members and their staff better understand the impact of COVID-19-related staffing decisions, the MDS has produced a resource that details the differences between layoffs and furloughs, and provides answers to common questions.
Answers to Paid Sick and Expanded Family and Medical Leave Questions
The Families First Coronavirus Response Act (FFCRA) requires certain employers to provide their employees with paid sick leave and expanded family and medical leave for specified reasons related to the COVID-19 pandemic. The provisions took effect April 1, 2020, and run through December 31, 2020. To help our members understand these new leave benefits, the MDS has created a document outlining the FFCRA provisions that may pertain to dental professionals. Note that any employee placed on furlough or leave prior to April 1 is not eligible for benefits under FFCRA.
Answers to Staffing Questions
To help answer your staffing questions related to dental office closures as a result of COVID-19, the MDS has developed a resource summarizing answers to frequently asked questions. Please note that this guidance is not a substitute for legal advice, and we recommend that you seek appropriate legal counsel for answers to more specific questions.
Sample Furlough Letter
To help dentist practice owners notify their staff of a furlough due to the COVID-19 pandemic, the MDS created a sample letter that dentists can personalize. Please note that employers and their furloughed employees are required to check in with each other weekly pursuant to Department of Unemployment Assistance regulations.
Sick Leave Poster Requirement
All employers are required to post a notice of the FFCRA requirements in a conspicuous place on the premises where notices to employees are customarily kept. Given dental practice closures, we recommend that dental practices email this notice to all employees, including those on furlough. Although employees are not eligible for the benefit while on furlough, that could change as they resume work.
- NEW: Back to Business: Returning to the Workplace
- Staffing Questions in Connection with a Temporary Office Closure