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AAO Task Force and COGA Obtain OSHA Clarification Regarding Guidance for Dentistry

During the week of May 4, 2020, the Occupational Safety and Health Administration issued a document providing guidance for Dentistry Workers and Employers. A copy of that document can be viewed on OSHA’s website here. On May 11, 2020, a team of AAO representatives met by phone with representatives of OSHA to obtain clarification regarding the OSHA guidance. OSHA was represented in the meeting by Krisann Pearce, OSHA Chief of Staff, and Dr. Chris Brown, OSHA Health Scientist. Representing the AAO in the meeting were Dr. Mike Durbin (AAO Trustee and Chair of AAO COVID-19 Task Force), Dr. Dale Anne Featheringham (Chair of COGA), Dr. Phil Mansour (member of COGA and COVID-19 Task Force), Kaitlyn Martin (AAO lobbyist Cozen O’Connor Public Strategies), and AAO Legal and Advocacy staff members Rob Kent, Trey Lawrence and Gianna Hartwig.

First, by way of overall summary, the OSHA representatives stated that this guidance document is intended as a framework with tips for dentists, and OSHA is not intending to set new requirements with this document.

One section of the OSHA guidance in particular raised concern with some AAO members because it appeared to contradict guidance from state and local officials permitting dental offices to reopen. That section states, “Only patients needing urgent and emergency procedures should be seen during the pandemic. Consistent with CDC recommendations, all elective dental procedures should be postponed. Limiting services to urgent or emergency treatment will help control dental workers’ possible exposure to sick patients.”

OSHA representatives confirmed that this statement is not intended to recommend closure of offices where state and local officials are permitting reopening. OSHA representatives clarified that if a practitioner is in an area where state and local officials are permitting practices to reopen for non-emergency procedures, you may reopen in compliance with those officials’ guidance. Furthermore, they stated that your job as an employer is to remain alert to the changing number of cases, and adapt your practice to suit the evolving risk levels that you see in your area as your state reopens. The OSHA representatives confirmed that OSHA’s guidance should not be interpreted as a mandate that prohibits an orthodontic practice from opening in any location where state and local officials have authorized reopening for non-emergency procedures.

The OSHA guidance document also contained discussion regarding suggested PPE for procedures based upon (a) whether a patient has suspected or confirmed COVID-19 or is confirmed well, and (b) whether the procedure is aerosol-generating or not. The AAO expressed its support for an approach in which guidance is based on whether procedures are aerosol-generating, but expressed concern because some members are having difficulty obtaining recommended PPE.

The OSHA representatives indicated that they recognize that all PPE may not be available in all locations. They explained that OSHA has laid out on its website alternative PPE use recommendations when certain PPE is not available in your area (that guidance can be found here). The OSHA representatives further expressed agreement that orthodontists and dentists are in the best position to determine safe practice and are best able to adapt to the environmental changes and as states start to implement their own reopening guidance.

Lastly, the AAO team shared with OSHA a summary of the work of the AAO’s COVID-19 Task Force, including the review of scientific evidence undertaken by the Task Force and the Task Force’s interim guidance for orthodontists. The AAO team offered to share this information with OSHA and asked to be able to participate in any future discussions about any permanent regulations that OSHA may consider in the future.

The AAO appreciates OSHA’s willingness to discuss and clarify the guidance document with the AAO team. The AAO will continue to advocate on behalf of its members with respect to federal and state matters pertaining to the COVID-19 pandemic and members’ practices.