More Malpractice Insurance Questions During the COVID-19 Crisis
Richard C. Engar, DDS, FAGD, is CEO of Professional Insurance Exchange Mutual Inc., a Utah-based professional liability insurance carrier created by Utah dentists in 1978. He currently maintains a faculty position with the University of Utah School of Dentistry. He is the author of the AGD Impact Risk Management column and took time to share some of the more common questions he is receiving during the COVID-19 pandemic. You can find the first round of questions and answers from April 6 here.
1. What procedures are most risky as far as transmission of COVID-19?
Any procedure that generates an aerosol spray is more likely to facilitate the spread of the COVID-19 virus than a non-aerosol-producing procedure. Specifically, routine dental hygiene procedures with an ultrasonic scaler or pressing both buttons of an air/water syringe will generate plenty of aerosol spray, and using a high-speed handpiece with water spray will generate aerosol droplets. For these reasons, many hygienists are concerned about seeing patients for hygiene, and the best alternative is to refrain from using ultrasonic scalers and other aerosol-generating tools and revert to the method they learned in school — scaling and curettage with sharp instruments only.
Some hospital clinics are prohibiting the use of any dental procedure that generates an aerosol spray. This means no cavities prepared with a high-speed handpiece and water spray. It means no water with the handpiece during endodontic access. And if any etchant or similar material is used, the air/water syringe should only be used to deliver water, and careful suction must be performed to avoid the generation of any aerosol spray.
Even in the hospital environment with negative pressure ventilation systems, procedures known to generate aerosols are being banned. Furthermore, even with such ventilation systems, the recommendation is that the room be swabbed and cleaned and then left vacant for at least 20 minutes. If a room has no negative pressure ventilation, the recommended time between cleaning and the next patient being seated is 45 minutes.
In summary, hospitals will have the strictest protocols that do not necessarily have to be followed in a dental office. However, adequate cleaning protocols must be followed and sufficient time left between patients to allow any ambient air that might contain the COVID-19 virus be cleared out as much as possible.
2. I am planning on hiring a new associate who is supposed to graduate from dental school this year but social distancing will preclude standard board exams. Will new graduates be allowed to practice?
The answer depends on state or provincial requirements. Some states will use the option of granting a temporary license, which will be valid until the new graduate, whether it be a dental associate or dental hygienist, is able to take the applicable licensing examination. Other states will use manikin-based examinations using teeth designed to simulate enamel and with built-in “caries” to enable examiners to evaluate the graduating student’s ability to remove decay. Questions about your state or province can usually be answered by contacting the applicable board to determine the specific protocols and paths to licensure.
In any event, the senior or owner dentist should assess the new dentist’s procedures initially to ensure that he/she is up to speed and able to practice safely. Restrictions in most states and provinces since mid-March may have limited the ability of some graduates to complete the normal number of requirements. Mentoring will be beneficial to both senior/owner and rookie/associate dentists.
If you need more answers to malpractice coverage questions, connect with Dentist’s Advantage, an AGD Exclusive Benefits provider. Don’t forget there are special discounts for AGD Masters (save 20%), AGD Fellows (save 15%) and other AGD members (save 10%).
1. What procedures are most risky as far as transmission of COVID-19?
Any procedure that generates an aerosol spray is more likely to facilitate the spread of the COVID-19 virus than a non-aerosol-producing procedure. Specifically, routine dental hygiene procedures with an ultrasonic scaler or pressing both buttons of an air/water syringe will generate plenty of aerosol spray, and using a high-speed handpiece with water spray will generate aerosol droplets. For these reasons, many hygienists are concerned about seeing patients for hygiene, and the best alternative is to refrain from using ultrasonic scalers and other aerosol-generating tools and revert to the method they learned in school — scaling and curettage with sharp instruments only.
Some hospital clinics are prohibiting the use of any dental procedure that generates an aerosol spray. This means no cavities prepared with a high-speed handpiece and water spray. It means no water with the handpiece during endodontic access. And if any etchant or similar material is used, the air/water syringe should only be used to deliver water, and careful suction must be performed to avoid the generation of any aerosol spray.
Even in the hospital environment with negative pressure ventilation systems, procedures known to generate aerosols are being banned. Furthermore, even with such ventilation systems, the recommendation is that the room be swabbed and cleaned and then left vacant for at least 20 minutes. If a room has no negative pressure ventilation, the recommended time between cleaning and the next patient being seated is 45 minutes.
In summary, hospitals will have the strictest protocols that do not necessarily have to be followed in a dental office. However, adequate cleaning protocols must be followed and sufficient time left between patients to allow any ambient air that might contain the COVID-19 virus be cleared out as much as possible.
2. I am planning on hiring a new associate who is supposed to graduate from dental school this year but social distancing will preclude standard board exams. Will new graduates be allowed to practice?
The answer depends on state or provincial requirements. Some states will use the option of granting a temporary license, which will be valid until the new graduate, whether it be a dental associate or dental hygienist, is able to take the applicable licensing examination. Other states will use manikin-based examinations using teeth designed to simulate enamel and with built-in “caries” to enable examiners to evaluate the graduating student’s ability to remove decay. Questions about your state or province can usually be answered by contacting the applicable board to determine the specific protocols and paths to licensure.
In any event, the senior or owner dentist should assess the new dentist’s procedures initially to ensure that he/she is up to speed and able to practice safely. Restrictions in most states and provinces since mid-March may have limited the ability of some graduates to complete the normal number of requirements. Mentoring will be beneficial to both senior/owner and rookie/associate dentists.
If you need more answers to malpractice coverage questions, connect with Dentist’s Advantage, an AGD Exclusive Benefits provider. Don’t forget there are special discounts for AGD Masters (save 20%), AGD Fellows (save 15%) and other AGD members (save 10%).