Originally published in: WPXI

The experience with the first wave of the pandemic, coupled with new research, provides helpful findings and data that governors, legislators, and other policymakers can use to decide which businesses can remain open even in the event of a future shutdown, and how they can do so in the safest manner possible. Some states have taken it a step further, passing legislation identifying businesses that not only are so essential that they should remain open even in the event of a future shutdown, but also granting them additional authority to help mitigate the spread of Covid-19. A great example of this can be found in Oregon, where a law was enacted that authorizes dentists for administer vaccinations.

Not much passes in Oregon’s Democratic-run state legislature that even red, Republican-controlled states would be inclined to take up. But an exception to that general rule is Oregon’s first-in-nation law authorizing dentists to administer vaccines. Lawmakers in other states, both Democratic and Republican-led, are now looking to Oregon’s reform as a model to adopt in the coming months.

House Bill 2220, legislation permitting dentists to administer vaccinations of any kind, was signed into law by Oregon Governor Kate Brown (D) on May 6, 2019. The fact that this reform was enacted prior to the pandemic underscores that many view it as smart policy even in normal times, and one that is particularly helpful during a national health emergency like the Covid-19 pandemic.

“We sponsored House Bill 2220 to increase access to care, providing additional opportunities for patients to receive life-saving vaccines from highly trained practitioners they already know and trust,” said Oregon Dental Association President James McMahan.

“If you have a routine dental cleaning in the fall, just as the flu season typically starts, you can also get vaccinated at the same time,” said Dr. Philip Marucha, who is dean of the OHSU School of Dentistry and helped write HB 2220. “This simple convenience can help bridge gaps in care and prevent the spread of infectious disease. We’re offering Oregonians another option that can make it easier to stay healthy.”

One reason dentists are so well equipped to administer vaccines, explains Dr. Marucha, is that they already routinely provide injections to a particularly sensitive part of the body. Dr. Marucha also points to dentists’ extensive training in microbiology, autoimmune response, and general anatomy.

Lawmakers in other states have taken similar steps as Oregon, but to a more limited degree. Illinois and Minnesota, have had bipartisan passed laws on the books for more than half a decade that permit dentists to administer influenza vaccines. On Friday, November 13, the Arkansas Dental Board approved dentists to provide Covid-19 vaccinations. The list of states where dentists are permitted to administer vaccinations is likely to grow in the coming months and years.

Oral Health Is Critical To Overall Health, Can Affect The Spread Of Infection

Expect lawmakers and governors in more states to take up this Oregon reform in 2021, as expanding access to vaccinations is at the forefront of policy debates. Not only that; there is new research from the British Dental Journal, the Journal of the California Dental Association, and DentaQuest indicating that good oral health can increase the likelihood that an infected person will survive Covid-19.

“There is evidence out there that patients with periodontal disease may be much more likely to have negative outcomes with COVID-19,” explains Michael Glogauer, professor at the University of Toronto’s Faculty of Dentistry.

That dentists are so well-trained and situated to fight the spread of Covid-19 by providing testing and vaccinations is far from the only reason why health experts want dentists to remain open even in the event of any future shutdowns. The fact that oral health is so critical to overall health is seen as another reason why dentists should be allowed to continue providing care throughout the pandemic.

“Taking care of your oral health is an investment in your overall health,” notes the Mayo Clinic website. The Mayo Clinic points out that “without proper oral hygiene, bacteria can reach levels that might lead to oral infections, such as tooth decay and gum disease.”

Poor oral health is also associated with more threatening but less intuitive ailments. The Mayo Clinic notes that there are a host of serious diseases and conditions linked to oral health, including cardiovascular diseases, respiratory diseases, certain cancers, and also pregnancy complications. The impact on overall health, coupled with a track record of safely providing care throughout the pandemic, is why it is likely state officials will ensure that dentists are allowed to continue treating patients, even in the event of future pandemic-related shutdowns.

“Dentists across the country have been treating patients for months. There is no evidence that routine dental care has contributed to the spread of this virus,” said Dr. Andrew Matta, co-founder and chief medical officer at North American Dental Group. “Routine care is often preventive care and it is extremely important in helping to avoid oral infections and diseases, which could impact a person’s quality of life…This pandemic has proven that it is time for dentistry to be recognized as a form of essential health care.”

It is widely recognized that dental practices can operate safely during the pandemic. Covid-19 transmission in the dental setting has proven to be rare, thanks to the precautions that clinics have been taking. Not only will state officials want to keep dentists in business throughout the pandemic because of this track record, we can expect lawmakers to look to the Oregon model as a way to further empower dentists to help fight the spread of Covid-19 in the coming weeks and months.

Article author: Patrick Gleason

Originally appeared in: Forbes

In an initial survey commissioned by the North American Dental Group, which released findings in April, 71% of respondents said they felt “uncomfortable” visiting their dentists during the COVID-19 pandemic. Similarly, 77% of respondents cited their own personal health and safety as a concern due to the pandemic, while only 42% of participants were confident in their dentist’s ability to reduce or prevent the spread of the novel coronavirus in the office.

But a follow-up survey in July showed significantly shifting attitudes, thanks in part to education efforts from dentists and groups representing the profession. Compared to the April findings, 60% of respondents said they were comfortable now with visiting a dentist for a routine cleaning or check-up.

In a report from the Dentist trade publication “Dental IQ,” Dr. Frank Nia attributes the shift to the trust people have put in their dentist.

“Dentists have not taken lightly the immense responsibility we have to our patients during this current crisis,” added Nia, who works at the McDonough Center for Family Dentistry in Georgia.

Findings from the July survey also found that 64% of respondents believed their dentists knew how to prevent the spread of COVID-19, up from 42% in April. Similarly, 65% of respondents were planning to schedule a visit with a dentist within the next six months.

How did dentists make offices safe?

As more people learned about coronavirus, and after Gov. Andrew Cuomo announced that dental offices could reopen June 1, employees at Victor Dental Care have seen a return to normal, according to Eileene Trace, office manager for the practice.

However, it did take some time to adjust to the new procedures to control possible infectious spread of the novel coronavirus.

Once the practice received the news that it could reopen, “It was really a kind of wild weekend,” Trace said. While the New York State Dental Association said patients could be received on May 30, announcements that went back-and-forth between Cuomo’s office and the association meant it took some time before things became more clear, with announcements being made that practices could open June 1. Practices could see patients as early as June 2.

But that didn’t mean the practice would be ready to accept any patients yet, Trace said. “It’s hard to be nimble and see a group of patients that fast.”

So instead, all staff at the practice began working on implementing a reopening plan which had been developed in Zoom meetings for six to eight weeks before reopening. Staff were broken up into groups, which would handle different aspects of the reopening process, according to Trace. These groups included infection control, social media messaging and an innovation team which would be responsible for developing new workflows to reduce possible infection.

“By bringing the team together like that,” the dental practice was “prepared for the day we would actually reopen.”

Trace also emphasized how, much like everywhere else, there was a learning curve for staff.

“In the beginning, it was hard because we didn’t walk through it or have the practice. But now it’s kind of routine.”

Patients who come to the office now must fill out an eight-question electronic form, which asks if they’ve exhibited any of the common COVID-19 symptoms, including a fever, shortness of breath, or flu-like symptoms, which is in accordance with recommendations from the American Dental Association. Patients also must fill out a form on whether they’ve traveled to one of the states which has a higher infection rate for COVID-19, which could affect the date of their appointment. Trace also said staff can make calls to patients if they don’t fill out the electronic screening in advance or are unable to before their appointment.

When a patient arrives, Trace said they typically like to call in advance to make sure they’re the only ones aside from staff in the office, although the waiting room is now spaced out and can only be seated at half capacity.

The dental assistant working at the front desk also works as a concierge, greeting patients and giving them hand sanitizer before escorting them to the treatment room for their appointment. Clinical staff working on a patient are dressed in two different kinds of face masks, along with face shields and washable gowns. HEPA filtration units have also been installed in each room.

“We’re just trying to create less touch points, so to speak,” Trace said, adding how the office has also reorganized the flow of patients so they can exit through the employee entrance without having to backtrack.

So far, Trace says that patients have been accommodating with all the changes.

“For the most part our patients are great, very understanding for the most part.”

However, while extensive precautions have been set up, there are older patients who haven’t made the visit yet, Trace said.

“I think we find it more in the older population: ‘We haven’t gone anywhere, we’re not going anywhere. Or my kids won’t let me go anywhere.’ ”

Dental clinic steps in for emergencies

While private practices are up and running again, that hasn’t necessarily slowed down the Eastman Institute of Oral Health in Rochester, which has seen a massive increase in the number of patients, according to Courtney Speers, associate quality and compliance Officer at the institute.

Having worked in this position for three years, with additional experience as a nurse, Speers has always been focused on patient safety and complaints, something which changed dramatically with COVID-19.

“With COVID, there’s been a fast switch,” she said, describing how the reaction meant the institute “wanted to make sure everything was in place,” to prevent possible spread.

Once all the private practices were closed due to COVID-19 concerns in the spring, “we started to see a lot of emergency patients,” Speers said, with people coming from out of the county and across the state in some cases.

“We’ve seen over 5,000 patients over 48 counties,” Speers said, with daily totals at about 100 patients a day, in addition to their regular patients.

“Now we’re kind of in a crisis mode, in a sense, to make sure people feel safe.”

With a number of locations patients can visit, including the main site next to Strong Memorial Hospital, education around COVID-19 happens across all sites, Speers said. Mask-wearing for patients is a must, and if someone doesn’t have one, they receive one from a staff member.

“That’s where that education component comes from, being able to talk to them. We see so many people. We want to make sure we talk to them and educate them.”

The Institute has also implemented temperature checks and screening tables for patients to answer questions. At the main site a tent has been set up to create an outdoor waiting room for patients, along with pre-appointment mouthwash. Staff also have extensive protections in place, Speers said, with employees wearing PPE, including medical gowns, masks, face shields and gloves, along with adjustable glasses, which are also worn by a patient on occasion. If there’s a patient with a suspected or confirmed case of COVID-19, staff can wear fitted N95 masks. HEPA filters are also in place for each exam room, along with an increase in cleaning procedures.

The result? No viral spread, according to Speers, with staff and patients continuing to be safe.

“There was that fear at the beginning, but we’ve really been able to decrease that.”

With winter on its way, Speers said the institute is planning how to accommodate patients while continuing to make use of outdoor, well-ventilated spaces. Two plans are being developed, with the first one involving a heated waiting room, while the second will be space to serve patients.

“If we don’t have enough room in the building, we’ll have enough space by setting that up.”

Infection control past and present

Given the nature of the novel coronavirus and how it’s transmitted, the virus had a “significant impact on dental practices, not just nationally, but worldwide,” according to Dr. YanFang Ren. As a dentist, professor and clinical chief of the institute’s Howitt Urgent Dental Care clinic in Rochester, Ren found that, as the American Dental Association issued guidance on halting elective dental care between March and June, it severely impacted patients all over, including New York.

“With no cleaning for a long period of time, two and a half months in New York, that was a major disruption of dental care, as most dental offices were closed.”

The result of not making regular appointments or being able to see their usual dentist is what led to an increase in patients for Ren’s clinic and the Eastman Institute as a whole. While the number has gone down, Ren admits that they’re still seeing double the number of patients they saw from before the pandemic, due to missing or not making regular check-ups.

“They did not get preventative care, so now there’s an increase.”

And while people may still have concerns about going to the dentist, Ren believes the profession is uniquely suited to handling the pandemic.

“This is one of the things that a dentist can do very well in terms of infection control,” he said, noting that certain procedures in place before the pandemic were originally pioneered during the height of the AIDS epidemic.

“There were a lot of unknowns there as well, working with people and their saliva. There’s a lot of blood.”

As a result, Ren said, dentist offices around the world in the 1980s started to implement specific infection-control measures to reduce the likelihood of transmission.

“Before the 1980s, dentists didn’t wear gloves. A lot of people used to not wear masks either,” Ren said, although following concerns around how HIV and AIDS were spread, the profession started to implement stricter use of masks, surgical gloves, plastic goggles and gowns.

“That started in the 1980s. That has proven really effective to use in a dental setting,” Ren said, adding that hand-washing and sterilizing dental instruments also went into effect.

“Compared to other health care settings, dentists have been at the forefront of infection control measures.”

Now with the implementation of HEPA filters in offices to increase air filtration and ventilation, Ren believes dentists will be able to continue reducing and preventing infection from COVID-19, and that more people will feel comfortable going to the dentist for regular check-ups and cleaning appointments.

“Dental health is very important, preventative care is very important. Brush your teeth and go to the dentist as much as you can. If you delay preventative measures, you might end up in pain and in emergency.”

Article author: Patrick Harney

Originally published in: Daily Messenger 

Article author: Ricchard Gawel

Originally published in: Dentistry Today

While challenges mounted for the DSO, which supports over 230 practices across 15 states and employs thousands of employees, NADG CEO and co-founder Kenneth Cooper shifted his focus to helping workers cope with the pandemic – switching to remote work as a safety precaution and creating a fund to help others suffering economic hardship.

His servant leadership approach of putting team members first is just one of the reasons why Cooper was named one of the 25 Highest Rated CEOs During the COVID-19 Crisis by Glassdoor, one of the world’s largest job and recruiting sites. Cooper was the only dental industry leader – and one of only three healthcare CEOs – to be featured in the report.

“The fact that this honor comes solely as a result of NADG team members sharing their personal thoughts, beliefs and experiences makes this acknowledgement truly special for me. I have tremendous gratitude for the men and women who make NADG a wonderful place to work,” said Cooper, who helped coin NADG’s familiar maxim, ‘Caring people, caring for people.’

To compile the list, Glassdoor reviewed posts from current and former employees at U.S.-based American companies with a workforce of at least 1,000 employees between March 1 and July 31. In addition, Glassdoor rated CEOs on several leadership characteristics and traits, including how employees rated their overall effectiveness during the pandemic.

According to Glassdoor, common themes from employees of the highest-rated CEOs included respect for work-life balance and showing genuine care for workers. NADG’s culture is grounded in the core values of empathy, compassion and care. Cooper and his fellow NADG leaders were committed to showing those values aren’t just random words in a mission statement—they are words to live by.

“There is no question that this pandemic has created deep challenges for our company. But we never wavered from our servant leadership mindset, our culture and our values. We genuinely care for our patients and teammates. That has been our North Star as we navigate this current crisis.” -Kenneth Cooper, CEO, NADG

To support team members, NADG, led by its board of dentists known as the Professional Dental Alliance, focused on two key pillars that exemplified the company’s values: fostering a caring workplace environment and ensuring the health and safety of NADG team members when they returned to work.

From the onset of the pandemic, Cooper shared frequent and candid communications with NADG team members, sometimes penning a personal message to the team. He recognized it was more important than ever to be both transparent and human, as well as listen and respond to employee needs.

To protect the health and safety of its team members, NADG implemented an innovative “Essential Treatment Only” model and adopted advanced safety and infection control procedures across all supported practices early in the pandemic. Cooper shared these procedures with colleagues across the dental industry, providing guidance and insight to help other dentists navigate the crisis.

When local guidance allowed dental practices to fully reopen, Cooper left it up to individual practices to decide when they were comfortable and prepared to see patients for routine oral care and elective procedures again. Knowing that dentists, hygienists and other dental professionals are among the most vulnerable to coronavirus exposure, it was important that NADG team members choose what was best for themselves and their families. Many were still managing drastic changes in their daily lives, including home-schooling children or supporting elderly and at-risk loved ones.

Cooper helped to support those who were unable to or chose not to return to work by establishing a $340,000 employee relief fund. He also allowed team members to borrow up to two weeks of paid time off against a future balance to minimize economic hardship for NADG team members.

From securing advanced personal protective equipment for team members to introducing COVID-19 screenings for patients prior to appointments, many NADG team members have shared they feel safe in their practices due to these extra measures. Though the long-term impact of the pandemic is still unknown, Cooper will continue to roll up his sleeves to help the NADG team and broader dental industry through this crisis and beyond.

“As many of these employees are navigating major changes during the pandemic,” Glassdoor said in a statement announcing Cooper’s inclusion on the Highest Rated CEOs During the COVID-19 Crisis list, “It’s clear that frequent and transparent communication, as well as making the effort to listen to employees’ needs, is more important than ever.”

Article author: Group Dentistry Now

Originally published in: Group Dentistry Now 

While I do not question the WHO’s overall motive to promote personal safety and the adoption of protective habits during this pandemic, its recommendation does not consider the following three key points that have guided and refocused dentistry since the start of the pandemic.

First, oral care is essential health care. Research has shown that poor oral health can lead to other systemic health problems and a lesser quality of life. The routine care that the WHO is recommending patients delay is often preventive care, and it is vital to both diagnose early disease to improve clinical outcomes and help patients avoid oral infections and diseases.

Second, dentists are infectious disease control experts who have implemented extraordinary new measures to provide a safe environment designed to minimize the risk for everyone. Our company, North American Dental Group (NADG), supports 432 doctors at more than 230 dental practices in 15 states, where we, along with affiliated dentists, have introduced advanced personal protective equipment for team members and enhanced infection control procedures such as frequent sanitization of treatment rooms.

Third, our patients trust us to keep them safe. In July, NADG commissioned a national survey in which 60-percent of respondents said they were comfortable visiting a dentist for a routine cleaning or check-up. In that same survey, 64-percent of respondents said they believe their dentist knows how to prevent the spread of COVID-19.

Dentists have not taken lightly the immense responsibility we have to protect our patients. We are confident that we can safely care for all patients during this current crisis.

DR. ANDREW MATTA
Moon
The writer is founding partner and Chief Medical Officer at North American Dental Group.

Article author: Dr. Andrew Matta

Originally published in: Pittsburgh Post-Gazette

First, oral care is essential. You shouldn’t skip a visit with your primary care physician, and you shouldn’t miss a visit with your dentist. Poor oral health can lead to systemic health problems. Routine dental care now may prevent serious medical issues later.

Second, many dentists are infectious disease control experts and we have all implemented extraordinary safety measures. When you go, your dentist office will not look the same. We have put in place exhaustive new procedures — including advanced personal protective equipment and enhanced infection control procedures.

Third, patients trust us to keep them safe. In July, North American Dental Group, a dental service organization supporting more than 230 dental practices including ours, commissioned a national survey in which most patients indicated they trust their dentist to protect them from COVID-19.

We have not taken lightly the immense responsibility we have to protect our patients. We are confident that we can safely care for all patients during this crisis.

Jeremiah Long