Q: Does the CDC’s guidance supersede Texas’ authority to open dental practices for non-emergency care?
A: No. The CDC does not have regulatory authority over the operation of dental practices. CDC guidance issued on April 27 is a non-binding recommendation. Final decisions about how dental practices operate in Texas are made by our governmental authorities. CDC guidance includes that, “Dental health care professionals should regularly consult their state dental boards or other regulating agencies for requirements specific to their jurisdictions.”
Q: Does OSHA’s guidance supersede Texas’ authority to open dental practice for non-emergency care?
A: No. OSHA guidance is just that, guidance. Final decisions about how dental practices operate in Texas are made by our governmental authorities. For example, according to OSHA’s Guidance on Preparing Workplaces for COVID-19 —"This guidance is not a standard or regulation, and it creates no new legal obligations.”
Guidance for Dentistry Workers and Employers issued on May 1, 2020, is a guidance document does NOT establish new requirements. It is offered as guidance only.
Q: What is the difference between OSHA guidance and OSHA standards? Must dentists comply with applicable OSHA standards?
A: According to the ADA, an OSHA standard equates to a regulation for enforcement purposes. OSHA standards are published by the agency to serve as “criteria for measuring whether employers follow OSHA laws.” Employers must comply with all applicable OSHA standards. OSHA standards are enforced in Texas by federal OSHA.
Q: Is a properly fitted surgical mask substantially equivalent to N-95 respirator masks/KN-95 masks?
A: No: According to the TSBDE, “Equipment that qualifies as a substantial equivalent to a N-95/KN-95 mask DOES NOT include the combination of a surgical mask and a face shield. CDC provides guidance on equipment that qualifies as a "substantial equivalent" to a N-95/KN-95 mask."
Q: Do DHCP have to wear N95/KN95 or their substantial equivalent masks when delivering all types of dental care?
A: No. DHCP must only wear an N95 respirator mask, KN95 mask, or their substantial equivalent if DHCP will be within 6 feet of any and all procedures likely to involve aerosols.
Q: How long will the TSBDE’s emergency rule (22 Texas Administrative Code §108.7(16)) remain in effect?
A: State emergency rules can remain in effect for up to 120 days and can be extended for an additional 60 days if needed—Texas Government Code §2001.034, Emergency Rulemaking. This is the standard for state agency emergency rule making regardless of the subject of the emergency rule or the agency issuing the emergency rule. Emergency rules are not created to go on indefinitely, but they are designed to be flexible so that state agencies can make changes without having to go through an entirely new emergency rule-making process.
Dentistry’s emergency rule will remain in place until Governor Abbott’s COVID-19 disaster declaration is terminated at which time the dental board would rescind the emergency rule. The TSBDE could amend dentistry’s emergency rule if Governor Abbott issues a new executive order governing dentistry or modifies GA-19.
Q: Is an ultrasonic scaler used on a low setting (eg, Cavitron) the same as a low-speed polishing tool for hygiene services as required by the TSBDE’s COVID-19 emergency rule?
No. Although ultrasonic scalers (eg, Cavitron) have a range of settings, it is not considered a low-speed polishing tool for hygiene services according to academic literature including: G. JS, SR, SD. Revised Reprint Fundamentals of Periodontal Instrumentation & Advanced Root Instrumentation, eighth edition. Examples of hand tools and low speed instruments are included HERE
Q: Are DHCP limited to using only hand instruments and low speed polishing to provide hygiene services?
A: Yes. According to the TSBDE’s COVID-19 emergency rule, “DHCP shall use only hand instruments and low speed polishing tools for hygiene services.“ Hygiene services include routine/general cleanings (adult or child prophylaxis).
Resource: 22 Texas Administrative Code §108.7(16)(B)(vi)
Q: Are DHCP limited to only using hand instruments and low speed polishing tools to provide periodontal procedures/treatment to patients?
A: No. According to the TSBDE’s COVID-19 emergency rule, DHCP are prohibited from using ultrasonic devices for routine/general cleanings (adult or child prophylaxis) but are permitted to use ultrasonic devices for periodontal treatment procedures when deemed medically necessary as part of a dental treatment plan.
Resource: 22 Texas Administrative Code §108.7(16)(B)(vi)
Q: If an N95 respirator is worn and a level 2/3 mask is placed over the N95 respirator, can the N95 respirator be worn for more than one patient if the level 2/3 mask covering is changed between patients?
Q: Can a gown be worn for more than one patient if there was no aerosol/splash/splatter generated and the gown is not visibly soiled?
Specifically, “Crisis Capacity Strategies—Extended Use of Isolations Gowns, Re-use of Cloth Isolations Gowns, and Prioritize Gowns.”
Q: Is a gown necessary for patients where there will be no aerosol/splash/spatter, like a typical hygiene check or emergency exam where no treatment is being performed?
Q: Under the dental board’s COVID-19 emergency rule, can I leave the treatment room of one patient to treat a different patient? For example, can a dentist check hygiene patients’ in-between treatment they are performing on other patients?
A: No. The dental board’s emergency rule clearly states that DHCP must complete the full treatment of one patient before leaving the treatment area to treat another patient.
TDA understands that this current standard differs from typical patient workflow prior to COVID-19. However, the Governor and the Strike Force are utilizing a phased approach to opening Texas. Dentistry was fortunate to be part of Phase 1. The focus remains on safely delivering dental care to Texans and at this stage it includes following the TSBDE’s minimum standards for safe practice during COVID-19 as approved by the governor’s office. Right now, this means fully completing the treatment of one patient before leaving the treatment area to treat another patient. If the state’s COVID-19 data progresses favorably, then TDA will ask Governor Abbott to revisit this standard, and others, as part of his continuing phased approach to reopening Texas.
Q: Does the dental board’s COVID-19 emergency rule require fit-testing of respirators?
A: Fit testing is not a requirement per the TSBDE’s COVID-19 emergency rule—22 Texas Administrative Code §108.7(16) and the dental board does not have authority to issue sanctions for violations of OSHA standards. OSHA is a federal regulation.
Regarding fit-testing masks, dentists are required to comply with OSHA’s respiratory protection standard
. Dentist employers have always been required to comply with this standard.
Dentist employers must conduct hazard assessments identifying the hazards DHCP may face, evaluate that risk, and select, implement and ensure DHCP use the controls you put in place to minimize risk. Refer to the
OSHA Guidance for Dentistry Workers and Employers
for guidance in performing a hazard assessment.
Q. Is TDA pursuing the ability for dentists to perform point-of-care COVID-19 testing?
A. No. Not at this time. TDA consulted with the Texas State Board of Dental Examiners and their position right now is that the Dental Practice Act does not give dentists the ability to administer medical tests such as the serology test for immunity and the molecular test for the virus itself. Both are considered medical tests. Separate from the current regulatory environment, there are concerns about the accuracy of at least one rapid point-of-care molecular test—FDA informs public about possible accuracy concerns with Abbott ID-NOW point-of-care test. The ADA advises dentists to stay away from “so-called ‘gray market’ point-of-care tests for COVID-19 and “recommends dentists follow direction issued by the FDA regarding testing procedures in dental practices.”
TDA is closely watching the point-of-care testing debate and agrees that dentists need a fast point-of-care test that accurately predicts the presence or absence of COVID-19 virus in real time. If COVID-19 point-of-care testing becomes scientifically sound and readily available, TDA will advocate that dentists be able to use COVID-19 point-of-care testing to screen patients for COVID-19 as it is not a diagnostic test for dentists, since dentists aren’t treating COVID-19 as an illness.