Lack of PPE, conflicting guidelines slow reopening of dental clinics

TORONTO - A lack of personal protective equipment and conflicting guidelines for COVID-19 practices between dentists and dental hygienists are delaying the reopening of many practices, the association representing dentists said as the province began the second stage of its reopening plan this week.

Dr. David Stevenson, a former president of the Ontario Dental Association who is now the head of the group's return to practice task force, said the resumption of services - permitted by the government in late May - has been slow.

Stevenson, who has been a dentist in the Ottawa-area for 35 years, said it has been difficult for dentists to find PPE, and many doctors gave away their supplies to hospitals early in the pandemic.

“We are getting access to a limited amount,” he said, adding that hospitals and long-term care homes are still getting priority access, which is appropriate. “I'm not going to say it's a complete barrier to treatment, but it is still the major impact.”

Conflicting guidelines for the resumption of practice from the colleges that regulate dentists and dental hygienists are also adding uncertainty to the reopening, he said.

“There's some confusion, there's no doubt about it,” Stevenson said. “Are dentists up and running? Are hygienists up and running? The answer to that question is 'No, we're not.”'

In mid-March, the province ordered all non-essential and elective health services to close or reduce operations as COVID-19 cases increased.

Under a new directive issued last month, the province is asked all regulatory colleges to develop guidance to ensure safe clinical care could be provided during the pandemic.

But the restart guidelines from the College of Dental Hygienists of Ontario and Royal College of Dental Surgeons of Ontario set different standards for each profession.

They take a different approaches to COVID-19 screening for patients and personal protective equipment use for dental hygienists and dentists, despite the fact that they work in the same offices and with the same patients.

The hygienist college standards include mandating N95s for aerosol generating procedures and mandatory wearing of gowns. The dentists' college guidelines only require that level of PPE use for COVID-positive patients.

Patients are to be screened before treatment, but with concern over asymptomatic transmission of the virus, some hygienists are worried the dental college's PPE requirements may not be stringent enough.

The executive director of the Ontario Dental Hygienists' Association said some of its members are anxious about their return to work because of the conflicting guidelines.

“I will acknowledge there is fear out there,” Margaret Carter said. “I think it's a reasonable fear that is driven by an understanding of just how devastating this virus is.”

Dental hygienists cannot physically distance from patients and their work makes them highly susceptible to the virus, she said.

“They are concerned about the potential for bringing things back into the home,” she said. “I think there are a lot of rethinks around what am I doing as a practitioner that I can change to reduce the risk, but it's also incumbent on employers to ensure a safe workplace.”

Whitney Foster, a dental hygienist in the Niagara Region, said the two regulatory colleges need to harmonize their guidelines so that everyone working in a dental office follows the same rules for patient screening and PPE use.

She has started an online petition calling on the government to work with the colleges to resolve the issue.

“I just want everyone to work together and collaborate for the patient safety,” she said.

Foster said if a dental hygienist works for a dentist who is not following stringent infection control guidelines, they have little recourse.

“Some of my friends been threatened with job loss,” she said.

Carter said she believes most dentists are stepping up their PPE use and infection control measures, but acknowledges she has heard complaints about some employers.

Stevenson said he believes the most important thing is for clear communication in each office and with patients.

“We've sat down and have a good long conversation and discussion with our, with our hygienists and assistants as well,” he said. “We've risen to the challenge of infection control protocols before and this is no different.”

The Royal College of Dental Surgeons of Ontario said Wednesday that it had met with the College of Dental Hygienists of Ontario to consider how they might align their guidelines.

Ontario's chief medical officer of health Dr. David Williams said Thursday that the province will leave it to the regulators to iron out the differences.

A spokeswoman for Health Minister Christine Elliott said the government relies on the colleges to govern their professions “in the public interest and ensure its members provide health care services in a professional, safe, and ethical manner.”

This report by The Canadian Press was first published June 11, 2020.