Weitzman ECHO September 23, 2020

1. National Conversation on Dental Care:
Reflections & Looking Forward
September 23, 2020

2. CME Credit
• Bridgeport Hospital Yale New Haven Health is accredited by the Connecticut State
Medical Society to sponsor continuing medical education for physicians. The
Bridgeport Hospital Yale New Haven Health designates this live activity for a
maximum of one (1) AMA PRA Category 1 CreditsTM. Physicians should claim only
credits commensurate with the extent of their participation in the various
activities.
• This activity has been planned and implemented in accordance with the Essential
Areas and policies of the Accreditation Council for Continuing Medical Education
through the joint sponsorship of Bridgeport Hospital Yale New Haven Health and
the Weitzman Institute. Bridgeport Hospital Yale New Haven Health is accredited
by the Connecticut State Medical Society to provide continuing medical education
for physicians.
• The content of this activity is not related to products or services of an ACCME-
defined commercial interest; therefore, no one in control of content has a relevant
financial relationship to disclose and there is no potential for conflicts of interest.

3. National Conversation on Dental Care:
Reflections & Looking Forward

4. COVID-19 in the United States
6,895,549 cases on 9/22/20 up from 6,604,355 cases on 9/16/20 200,768 deaths
https://coronavirus.jhu.edu/map.html

5. Last week:

6. COVID-19 News updates
• Miami-Dade County, FL, one of the largest
school districts in the U.S., will reopen
classrooms to students next month
– 350,000 students, the largest in the country to
have students in their classrooms full-time
• NYC only attending part-time
• Los Angeles and Chicago, the second and third-largest
systems, -remote classes

7. Ready for the ‘Fall’?
• Dr. Fauci:
“I’d like to see us go into [October-November] at such
a low level that when you have the inevitable cases
you can handle them”
“Get a flu shot now – reduce the strain on health care
systems responding to the COVID-19 pandemic.”
• FDA:
promising excellence with vaccine vetting process
vaccine safety; long term efficacy

8. Halloween ?
• The CDC discouraged traditional trick-or-
treating

9. Resources
• Nuvance health ~1200 articles reviewed:
https://spark.adobe.com/page/usNN4WCpWhNOy/
• CDC:
https://www.cdc.gov/coronavirus/2019-ncov/index.html
https://emergency.cdc.gov/coca/calls/2020/
• WHO:
https://www.who.int/emergencies/diseases/novel-coronavirus-2019
• Johns Hopkins:
https://coronavirus.jhu.edu/map.html
• Others
https://www.thelancet.com/coronavirus
https://covidactnow.org/

10. National Conversation on Dental Care:
Reflections & Looking Forward
Community Health Center Inc.
Sheela Tummala, DDS, MPH; Chief Dental Officer,
Community Health Center
10

11. Community Health Center, Inc., CT
Response to Dental Care During COVID-19
• Closed on March 18th to regular service but
remained open for emergencies
– Reduced burden on hospital
– Provided access for our patients
• Emergency triage
– One core dental team at each site
– Simple, non-aerosolized procedures (e.g., extractions)
– Patients referred to specialists as needed after being
seen

12. Community Health Center, Inc., CT
Response to Dental Care During COVID-19
• CHC is a major COVID testing site as requested
by the State of CT; dental supporting this
needed effort
• Other dental staff deployed to multiple roles in
agency; no furloughs or lay-offs
– COVID screening and testing
– Telehealth Outreach Team
– Telemedicine assistance for other disciplines

13. Community Health Center, Inc., CT
Response to Dental Care During COVID-19
• State recently passed legislation allowing
teledentistry, but DSS codes needed
• Task force working on a phased reopening plan
– Beginning with opening for non-aerosolizing
procedures, phasing into aerosolizing based on Joint
Commission recommendations of COVID testing
– Detailed document outlining best practices from
patient arrival to patient dismissal.

14. Community Health Center, Inc., CT
Response to Dental Care During COVID-19
• Taking “pulse” of dental staff through personal site
by site conversations; eager to go back to normal,
but understand the needed work and that we’re
doing the best we can
• Opportunities
– Rapid COVID test before dental appointment
– Using teledentistry to monitor patients
– Drive-through fluoride varnish
– Fluoride offered alongside flu vaccine and COVID testing

15. Community Health Center, Inc., CT
Response to Dental Care During COVID-19
The Future of Dentistry
• Getting closer to “normal”
• Focusing on preventative care
• Integration
– CHC received grant for increased medical/dental
integration that connects children at high risk of
obesity to medical, nutritional counseling, and pre-
screening for diabetes

16. National Conversation on Dental Care:
Reflections & Looking Forward
NYU Langone
Margaret Mason, DMD; Vice President of Dental
Medicine, Family Health Centers at NYU Langone
16

17. NYU LANGONE HEALTH
DENTAL DIVISION SERVICES
17
DENTAL
SERVICES
PRE
and POST
COVID
SCHOOL
HEALTH
DENTAL
SERVICES
41 SITES
Serving 9000* Children
(2019)
• Brooklyn
• Manhattan
• Staten Island
• Bronx
GENERAL
DENTISTRY
PEDIATIC
DENTISTRY
ENDODONTICS
PERIODONTICS
ORAL FACIAL
PAIN
6 Sites
Serving 28,000* patients
(2019)
ORAL
SURGERY
DENTAL
ANESTHESIA
TELEDENT
Post
Covid

18. NYU LANGONE HEALTH
DENTAL DIVISION SERVICES
18
TELEDENTISTRY
URGENT AND
EMERGENT
CARE
DENTAL
SERVICES
DURING
COVID
March to June
2020

19. NYU LANGONE HEALTH
DENTAL DIVISION SERVICES
19
Services reduced to
Urgent and
Emergent due to
COVID 19
1 2 3 4 5 6 7 8
Series1 7,845 7,920 8,568 8,564 7,970 8,075 8,381 8,405
Series2 8,375 8,097 4,578 573 2,276 5,224 6,458 7,027
7,845 7,920
8,568 8,564
7,970 8,075
8,381 8,4058,375
8,097
4,578
573
2,276
5,224
6,458
7,027
Visits
FHC Clinics Visits '20
Services reduced to
Urgent and Emergent
due to COVID 19
Opened services, limited
hours.

20. Family Health Centers at NYU Langone
Response to Dental Care During COVID-19
• First week of March: The pandemic would change
how we could practice; began utilizing contingency
plan for “inability to provide service”
• March 20th: Decision was made to close all sites
except one for urgent/emergency care
• Assigned team to begin calling patients to remind
them of importance of dental care – telephonic
teledentistry
• Deployed staff to support other areas of
hospital

21. Family Health Centers at NYU Langone
Response to Dental Care During COVID-19
• Planning for reopening
– Small team looked at the science of providing safe care
– Considered CDC and dental society guidance
– Started ordering supplies
• Met with the dental team to discuss what types of care
were truly urgent/emergent and created workflows for
each type of care
– Team was frightened, but we could agree on necessary
procedures
– Not only emergencies, but treating urgent cases that could
progress to emergency status
21

22. Family Health Centers at NYU Langone
Response to Dental Care During COVID-19
• Dental became a “Second Arm” of the emergency
room
• Patients would call first and be assessed
telephonically or by video before being brought in
• If an invasive procedure was needed, patients would
have COVID test
• To maintain social distancing, patients were given
long-range pagers and dispersed around the
environment
22

23. Family Health Centers at NYU Langone
Response to Dental Care During COVID-19
• By June 1st NY had permission to re-open dental
• A flood of patients wanted to be seen
• Patients were color-coded by priority
– Red: Urgent
– Yellow: Priority
– Green: Recall
• Aerosolizing procedures are avoided if possible;
patient must have negative COVID test prior to more
invasive procedures
23

24. Family Health Centers at NYU Langone
Response to Dental Care During COVID-19
• Keeping staff and patients safe
– High level of PPE use for staff – n95 respirator (fit
tested) and face shields
– Air quality and proper ventilation
– Schedule alternating aerosolize and non-aerosolize
procedures
– Stage when patients enter and exit
– Ensure patients social distance and wear masks
24

25. Family Health Centers at NYU Langone
Response to Dental Care During COVID-19
• Preparing for the next wave
– Re-reviewing contingency plans
– Considering implication of cold weather on where
patients can wait
• Future implications on dentistry
– Interprofessional team work needed more than
ever
– Thinking creatively about teledentistry
25

26. National Conversation on Dental Care:
Reflections & Looking Forward
Chiricahua Community Health Centers, Inc.
Brianna Hillier, DMD; Director of Dental Services,
Chiricahua Community Health Centers
26

27. Chiricahua Community Health Centers
Response to Dental Care During COVID-19
• Overview of CCHCI Dental Services
– Full scope dental services: pediatric to adult
– Provided at 3 fixed sites and 2 mobile units in rural
area of Southeast Arizona
– Dental staff of ~30 (dentists, dental hygienists, and
dental assistants)

28. Chiricahua Community Health Centers
Response to Dental Care During COVID-19
• Initial Change in March
– March 15th dental services closed
– Furloughed majority of staff
– Two dentists per week still providing emergency services
– Medicaid teledentistry approved April 2020
• Mid-May staff brought back, some re-assigned to other
areas of the clinic
– Still providing emergency services
– Staff serving supporting front desk and as greeters

29. Chiricahua Community Health Centers
Response to Dental Care During COVID-19
• In June, began phased re-opening, in accordance with
CDC guidance
– Providing emergency, restorative, and basic prevention
– Currently operating at ~60% capacity
• Current challenges
– Maintaining a supply of PPE
– Workforce challenges
• Losing staff for different reasons (child care, concerned about risk, etc.)
• Continued concern about keeping staff safe

30. Chiricahua Community Health Centers
Response to Dental Care During COVID-19
Long term implications on the dental field
• More reliance on integrated care for preventive dental
care
• Reconsidering the amount of chairside time needed for
each member of the dental team
• Revisiting aerosol procedures

31. National Conversation on Dental Care:
Reflections & Looking Forward
National Network of Oral Health
Access
31
Irene V. Hilton, DDS, MPH; Dental Consultant,
National Network of Oral Health Access

32. •Dental Workforce & COVID-19
• Presentation on Workforce Innovation during COVID-
19: http://www.nnoha.org/covid-19-coronavirus/covid-
19-webinar-slides-and-recordings/
•NNOHA's COVID-19 Resources
• Series of webinars: http://www.nnoha.org/covid-19-
coronavirus/covid-19-webinar-slides-and-recordings/
• Teledentistry Resources: http://www.nnoha.org/covid-
19-coronavirus/teledentistry-resources/

33. Upcoming Opportunities
• Integrating Diabetes and Oral Health Learning
Collaborative
• 8-month quality improvement collaborative focusing on
integration of primary care and oral health for people
with diabetes
• Apply by October 9th at: http://www.nnoha.org/call-for-
applications-integrating-diabetes-and-oral-health-
learning-collaborative/
• NNOHA Virtual Conference: Oct 25-28, 2020
• A virtual conference for health center dental programs
with clinical, practice management, and innovative
practice sessions.
• Register at: https://web.cvent.com/event/93ce3f8b-ea23-
41c9-96fc-40f4a3154203/summary

34. Contact Us!
Irene V. Hilton, DDS, MPH, FACD
NNOHA Dental Consultant
irene@nnoha.org
National Network for Oral Health Access
181 E 56th Avenue, Suite 401
Denver, CO 80216
Phone: (303) 957-0635
Fax: (866) 316-4995
info@nnoha.org

35. 35 * This initiative is supported by

36. Thank You!
www.WeitzmanLearning.org/the-path-forward/
www.WeitzmanLearning.org/coranavirus