On May 18, Governor Baker announced the results of the Reopening Advisory Board’s report regarding the phased reopening of the state. During the Reopening Advisory Board’s stakeholder meetings, Massachusetts Dental Society (MDS) representatives presented information on how dental facilities could safely and slowly begin expanding care. The first phase, which is currently expected to begin Monday, May 25, includes an increase in allowable dental procedures for those providers who are able to meet key public health criteria as set by the Provider Advisory Committee.
The beginning of Phase 1 hinges on the overall management of the COVID-19 pandemic. This has been the primary focus for the governor and the state’s COVID-19 Response Command Center. In order to move into Phase 1, it is critical that the state maintain greater than 30% capacity of ICUs. The state has been unable to move into a phased reopening because this and other critical benchmarks have remained elusive until recently. As the governor noted, if the data begin to show a backwards trend, it is possible that care will again become limited to emergencies only.
In order to prepare providers for Phase 1 as the state approached the key ICU benchmark, the Reopening Advisory Board formed a Provider Advisory Committee comprised of key provider groups, including representatives from the MDS. The Provider Advisory Committee was tasked with outlining necessary criteria and guidelines to enable non-hospital-based providers to open. Individual providers must meet the following criteria prior to beginning Phase 1 services:
- Have current adequate supply of PPE and maintain adequate supply on an ongoing basis without support from the state stockpile
- Meet public health and safety standards in the domains of workforce safety, patient safety, and infection control
- Designate a compliance leader at the highest level of the organization
- Attest to and maintain the attestation form acknowledging that they meet all of the requirements in PPE, health and safety standards, and compliance standards (practices must retain this attestation for inspection upon request by the Department of Public Health)
When Phase 1 begins, dental practices will be able to treat patients with emergent or likely to become emergent if care is deferred symptoms. Dental practices should continue only treating emergency and urgent care patients until Phase 1 begins. In preparation for this expansion of dental treatment, the MDS, in collaboration with leaders of each of the Massachusetts specialty organizations, has created a resource document to assist providers in identifying situations that are likely to become emergent if care is deferred. Ultimately, providers must use their own clinical judgment in determining which procedures for which patients may continue being deferred during Phase 1.
Dentists are expected to use their professional judgment to provide emergent and likely to become emergent if deferred care within parameters set forth by the state. It is up to the doctor to determine that treatment is emergent or likely to become emergent. Dentists have well-trained professional judgment. The MDS is here only to offer broad guidance and point to official state guidelines. Any dentist providing care during Phase 1 should consider documenting in the clinical record why the treatment being prescribed during the phase is not simply routine or elective care and record your Centers for Disease Control and Prevention (CDC) compliant protocols and PPE usage.
We understand this can be a confusing time for staff and patients. Again, the dentist, as the leader of the dental team, is best positioned to assure staff and patients that the work being done is appropriate under the current guidelines and that the dental team is strong, compliant, and following all safety measures.
The MDS has compiled the following questions and answers to offer general guidance to members. You should continue to rely on your best professional judgment. We will continue to update this section as more information becomes available or as information changes.