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.
MDS Board of Trustees Policy
The combination of the seasonal flu and the COVID-19 pandemic has the potential to overwhelm the health care system. If this happens, the United States could see key supplies diverted to hospitals, reintroduced prohibition on non-emergency dental care, and another complete shutdown of the Massachusetts economy.
“A seasonal influenza outbreak could have devastating effects on our already taxed health care system and the state economy,” said MDS President Dr. MaryJane Hanlon. “As a profession, it is imperative that we do all we can to ensure Massachusetts does not roll back to Phases 1 or 2, which could force dental practices to revert to providing only emergency care.
“We urge the dental community to do their part in trying to minimize the dual impact of flu season and the COVID-19 pandemic on our patients, our communities, and the health care system," she continued. "As essential health care workers, dental professionals should protect themselves and their patients by getting a flu shot.”
The U.S. Centers for Disease Control and Prevention (CDC) recommend that “all U.S. health care workers get vaccinated annually against influenza” as well as an annual flu vaccination for “everyone 6 months of age and older, with rare exceptions, because it is an effective way to decrease flu illnesses, hospitalizations, and deaths.”
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.
Interim Dental Practice Guidance
Updated Interim Guidance
On August 4, 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
Resources for PPE Supplies
Need help finding sources for personal protective equipment (PPE)? Every day you no doubt receive emails from companies with names you’ve never heard of before offering to sell you the PPE you need or other COVID-19-related services. How do you know if these companies and the products they offer are legitimate and not a scam? The Massachusetts Dental Society (MDS) has vetted following companies to help members avoid spending time researching or inadvertently falling for a scam. Be sure to identify yourself as an MDS member.
Performs respirator fit testing and provides full OSHA-compliant documentation for each person
Contact: Valerie Clayton (scheduling) or Fred Myerson (technical assistance)
Products: gloves, face shields, KN95s, and non-contact thermometers. PureLife Dental is an MDS Member Savings Program partner. Mention the MDS and receive a 10% discount.
Contact: Carmella Hanoon
Phone: 877.777.3303, ext. 92121
Products: N95 respirators, procedure face masks, face shields and non-contact infrared thermometers
TPC Advanced Technology, Inc.
Products: face shields, KN95 masks; limited gown, non-contact infrared thermometer
Contact: Scott Beckley, vice president
The Centers for Disease Control and Prevention (CDC) has compiled a table of NIOSH-approved N95 respirators, listed alphabetically by manufacturer. You can select a particular manufacturer by clicking on the first letter of their name on the index.
Additional Resources for Reopening
Pearl Studio 82 Inc.
Social distancing safety signage and hygiene barriers for all around the office, entrance, lobbies, hallways, bathrooms, common areas, offices, etc.
Contact: Stephen Pinette, president
Planning Ahead for PPE
As of August 2020, there is still a limited supply of personal protective equipment (PPE) available to dental practices. The MDS is in ongoing communication 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 suggests dental practices reach out to your PPE suppliers to determine their inventory status and if they are fulfilling orders at this time.
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 running 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 6/19/2020)
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 6/19/2020)
- 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.
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.
Dentists 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
Deadline to Apply for HHS Provider Relief Fund Extended to August 28, 2020
Note that both Medicaid and non-Medicaid dental providers can apply for funding through the Enhanced Provider Relief Fund Payment Portal.
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.
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.
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, 2020, Massachusetts launched the Pandemic Unemployment Assistance (PUA) program, which provides up to 46 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 included a $600 weekly increase for up to four months in addition to the standard unemployment benefit through July 25, 2020, which varies by state and by individuals' record of previous earnings. The Massachusetts Department of Unemployment Assistance is awaiting federal guidance on whether the program will be renewed. 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.