Regional Phase Reopening
On April 16, President Donald Trump announced a new three-phase guideline for how the United States will return to business and suspend the various stay-at-home orders. In his address, Trump indicated that the authority to reopen businesses would rest with individual states, specifically directing that our nation’s governors would be responsible to monitor, inform and ultimately end stay-at-home orders. The AAO recommends that its members follow all applicable federal, provincial, state and local authorities’ guidance concerning closure recommendations for non-emergency care. To that end, the AAO defines emergency orthodontic care as care that will relieve pain and/or infection, is trauma-related, or is critically necessary to prevent harm to the patient.
AAO Statement on Recent WHO Guidance to Delay Routine Dental Care
The American Association of Orthodontists (AAO) is aware of the World Health Organization’s (WHO) recently issued interim guidance recommending the delay of routine dental care in certain situations due to COVID-19.
AAO members have been responsible professionals throughout the COVID-19 pandemic. They closed their practices, except for emergencies, at the beginning of the outbreak. The WHO interim guidance speaks to following “official recommendations at the national, sub-national or local level”. This is exactly what AAO members have done. When national, state and local government experts declared it safe for orthodontists to reopen their offices, AAO members did so with the health and safety of their staff and their patients at the forefront. AAO members are following all guidance including the use of PPE, social distancing and taking extra safety precautions for procedures that use aerosols. Further, the AAO created a COVID-19 Task Force to empanel a group of experts to focus on the science and safety so that we could educate our members on the best practices. This Task Force will continue to meet and confer to ensure that science guides safe orthodontic treatment.
WHEN YOUR OFFICE REOPENS
The COVID-19 pandemic has affected AAO members in numerous ways. We remain confident that you will be returning to your practices in the near future but in the meanwhile, you are presented with a series of challenges. Among those challenges are the decisions about:
- When to reopen
- Personal protective equipment (PPE)
- Developing a scripting and scheduling plan
- Operational guidance
- Infection control
- Virtual consultations
- Updated Informed Consent forms
- Patient intake forms
- Patient communications for reopening
- Helpful information from our consumer blog
- State & Local Toolkit Provided to Constituents and Components
- More helpful links from the AAO
When to reopen
Before deciding to reopen your office, check with any federal, state, and local regulations, as well as applicable dental boards. For your reference, the ADA has developed and is maintaining a database of State Mandates and Recommendations.
Interim Orthodontic PPE Summary Based on Current CDC and OSHA Guidelines
In response to the current COVID-19 pandemic, the AAO has formed an AAO COVID-19 Task Force. The COVID-19 Task Force, comprised of a diverse and experienced group of individuals, includes orthodontists, orthodontic educators, members of the AAO Legal Department, and experts in the areas of infection control, infectious diseases, and office design. The Task Force is reviewing all pertinent literature in regards to a variety of topics, including aerosolization in practice and PPE recommendations from the CDC, OSHA, and ADA. While final recommendations from the Task Force are forthcoming, some interim suggestions are indicated as orthodontic offices start to reopen.
AAO is not a legislative body and does not produce regulations that require adherence. These can only come from the regulatory bodies in the United States and Canada. However, the AAO does have a duty to inform, educate and protect members of the public, clinicians and staff during the delivery of orthodontic care.
These suggestions are based on current CDC and OSHA guidelines and may be helpful as practices start to reopen. The professional judgment of the orthodontist should be used to determine how to best apply these in practice.
Purchasing PPE: Get an Inside Track on Sources
The AAO has been communicating with our industry suppliers in order to identify those best-positioned and willing to fulfill large orders from AAO members in a cost-efficient and time-efficient manner. PPE availability includes masks, face shields, gowns and gloves. Some suppliers also offer office supplies such as thermometers and sneeze guards.
N95 face masks are regulated by the National Institute for Occupational Safety and Health (NIOSH) and the Centers for Disease Control and Prevention (CDC). Concerns have been raised about counterfeit versions of N95 masks entering the market. The CDC has outlined signs that a product may be counterfeit in its guide, “Counterfeit Respirators / Misrepresentation of NIOSH-Approval.”
In addition, recommend expanding the article to read:
View Information from PPE Suppliers and Updates on KN95 Mask Authorization
(Exclusive to members; log-in is required.)
PPE Protocols for the Orthodontic Team: Reuse of Respirator Masks
Infection control expert Jackie Dorst, who serves on the AAO COVID-19 Task Force, provided the guide linked below for members and their teams who may have questions about the use of PPE. In particular, Ms. Dorst addresses the use of respirator masks when aerosol-generating procedures are being performed, including recommended protocols for extended use of the masks.
Alert: FDA Issues Warning About Hand Sanitizers Containing Methanol
The U.S. Food and Drug Administration (FDA) is warning consumers and health care professionals to avoid alcohol-based hand sanitizers that contain methanol (wood alcohol). This substance, a common ingredient in fuel and antifreeze, can be toxic if absorbed through the skin and life-threatening if ingested.
The FDA encourages individuals to look for identifiers on product labels, including: manufacturer name, product name and National Drug Code number.
Prior to scheduling the patient’s first visit back in your office, it is recommended that you develop scripting that suit both the orthodontist and the team, to best communicate your new scheduling plan. Scripting goals should revolve around helping the patient realize that they remain important to you and your team.
Consider keeping all patients first post-quarantine appointments as short as possible so that all patients may be seen in the office within a reasonable amount of time. Patients that had been previously scheduled with lengthy visits, such as debond appointments, should be advised that, prior to rescheduling their long visit, a cursory brief evaluation is necessary and in their best interest.
Seeing all of your patients without too long of a delay will allow them to recognize that they are important to you and will be cared for in a timely manner.
Planning for Recovery: Operational Guidance from Mary Beth Kirkpatrick
Among the experts who have offered in-depth recommendations for AAO members is Mary Beth Kirkpatrick, managing partner of Impact360 Consulting and founder and president of Gaidge, a cloud-based business analytics dashboard for orthodontists.
Ms. Kirkpatrick’s webinar from 4/23, “Doctors, Start Your Engine: A Roadmap for Re-Opening,” has been archived and is available at no cost to AAO members. Click on the title to access the webinar (exclusive to members, so log-in is required). Please note CE is not available.
Taking the perspective that the current situation, while extremely challenging for orthodontic practices, also will bring opportunities, the webinar takes a deep dive into every aspect of re-opening planning. Topics addressed include:
- Overall re-opening planning
View the handout, “Prepare Final Plans for a Strong Recovery”
- Physical planning for the COVID-19 office: Reception area furniture arrangements to reduce risk, removal of as many sources of infection as possible, reception desk sneeze guards, and social distancing floor decals may all be helpful;
- Clinic area changes: Separate locations for aerosol-generating procedures, partitions between treatment chairs;
- Staff preparation: Training, assigning roles, scripting and rehearsing;
- Infection control basics;
- Planning patient entry and triage processes;
- Communicating with returning patients about what to expect.
What to Do if An Employee Tests Positive for COVID-19
CEDR HR Solutions has produced a video about employees testing positive for COVID-19, featuring company founder Paul Edwards.
The video reviews current CDC guidance and offers risk assessment recommendations. To support the risk assessment process, CEDR HR encourages employers to bookmark the following websites:
- Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19
- Criteria for Return to Work for Healthcare Personnel with Suspected or Confirmed COVID-19
CEDR HR has also compiled step-by-step recommendations on what to do if there is a potential exposure in your office:
Handling Ongoing Concerns About Employees Contracting the Coronavirus.
Additionally, the ADA has released Protocols to Follow if COVID-19 Positive.
Handling COVID-19 Concerns Impacting Your Team and Patients
If you, an employee or a patient experience a known COVID-19 exposure, are symptomatic or test positive for COVID-19, what steps should you take? Resources compiled by the AAO address topics such as handling of symptomatic employees awaiting test results, asking employees to self-report potential or definite exposures, paying employees who need to quarantine, travel concerns, and more. Many of the recommendations involve decision-making processes that might lead to different outcomes from one orthodontic practice to another, and in some cases from one situation to another within a practice.
Break Room Safety Flier Offers Timely Reminders for Your Team
Is your team complying with all of your office’s COVID-19 protocols during patient treatment, but the break room at lunchtime looks like a pre-pandemic scene? The AAO has prepared a break room safety flier with reminders from infection control expert Jackie Dorst. Practice owners and office managers are invited to download, print and post the flier where team members may view it.
Track Your Team’s Health with the AAO Daily Employees Screening Form
The AAO has developed a fillable PDF, “COVID-19 Daily Employees Screening Form” for member use in tracking temperatures and symptoms being experienced by team members.
After using all of the rows in the chart:
▪ Simply save the form if you wish to maintain a long-term record; then,
▪ Save under a different filename and use the CLEAR FORM button at the bottom to clear all fields and re-use the form.
A six-page portfolio version of the form is also available for those who prefer to keep records in one large document.
AND, COMING SOON: Two patient temperature/symptom tracking forms, each offering a different approach for varying preferences:
▪ One PDF will provide a fillable chart to enter each patient’s information upon arrival on a specific day;
▪ The second form will be patient-specific and include fields to enter the patient’s information at each appointment.
Watch your in-box for more information.
AJO-DO Article Examines Evidence Regarding Aerosol-Generating Procedures
The AJO-DO has published a special article addressing scientific issues and recommendations pertaining to aerosol-generating procedures in orthodontic offices during the COVID-19 pandemic. The article, “Minimizing the Aerosol-Generating Procedures in Orthodontic in the Era of a Pandemic: Current Evidence on the Reduction of Hazardous Effects for the Treatment Team and Patients,” (July 16, 2020) is by Drs. Theodore Eliades and Despina Koletsi.
The authors reference more than 25 years of research on pathogen loads resulting from aerosol forming dental procedures, including some studies that addressed orthodontic debonding. In their article they detail current approaches to reducing pathogens potentially released into the air during bonding and debonding, address the use of preprocedural mouth rinses and examine handpiece usage concerns, among other issues.
Frontload Your Practice’s Recovery with Proactive Recall Management
Ms. Kirkpatrick also addresses marketing the re-opened office. To build new revenue from starts, she recommends that orthodontists initially focus on those who have been in monitoring/recall status, so as to quickly ramp up new starts following re-opening.
Handouts include Proactive Recall Management guides covering five of the major orthodontic software companies. These guides outline each step for identifying a practice’s monitoring/recall patients in the respective systems. Click below to access this information for:
Find Answers to Many of Your Infection Control Questions
Click on the title to access the free webinar from 4/21, “Coronavirus: Getting Back to Work after Closure ,” by Jackie Dorst, RDH, BS. In this free webinar Ms. Dorst, an infection control and OSHA expert, provided a comprehensive COVID-19 Infection Control plan for patient and orthodontic team safety for reopening orthodontic practices. (Non-CE webinar)
The Virtual Consultation Option: Is It Right for Your Practice
Prior to re-opening and even after your office has re-opened, virtual consultations may offer an efficient opportunity for initial interaction with prospective patients. A Trapezio webinar included in our article on this topic provides a comprehensive how-to guide.
Updated Informed Consent Forms
The AAO has updated the informed consent form adding a new section covering transmission of communicable diseases. This form represents sample informed consent provisions offered as a service to AAO members. It is not intended to serve as legal advice, and each state may require unique provisions. You are encouraged to have this form reviewed and approved by counsel in your state prior to using it. Any such items should be included by you in the space provided. The AAO accepts no liability for any modifications you may make to this form. LEARN MORE >
Two Intake Form Options Available for Check-in Documentation
Screening patients for fever and other symptoms as they check in for appointments may be easier with a choice of two patient intake forms formatted as fillable PDFs. Depending on your preferences, either form may work well for documentation in your practice:
- The Daily Patients Screening Log: Track information on each patient who checks in for an appointment on a specific date.
After completing daily input or using all of the rows in the chart:
- Simply save the form if you wish to maintain a long-term record to observe trends in your practice over time; then,
- Save again under a different filename and use the CLEAR FORM button at the bottom to clear all fields and re-use the form.
- The Individual Patient Log: Track each patient’s check-in health status from one appointment to the next with an individual patient log that may be kept in his or her chart.
Patient Communications for Reopening Your Practice
You have been busy planning for re-opening, acquiring PPE and preparing your team to return to work. While individual timetables vary by state and practice, you may be ready to let patients know about your reopening plans.
To help ensure that all important information is communicated, our guide provides recommended points to cover and sample letters shared for AAO members by Mary Beth Kirkpatrick. Also included are suggestions for reinforcing information via social media between the reopening soon and welcome back communications.
Helpful Information from Our Consumer Blog
We will soon provide templates for patient communications announcing re-opening. In the meantime, to help patients understand the changes they may find upon returning to your office, you may want to share the following on your social media:
State & Local Toolkit Provided to Constituents and Components
As you are likely aware, parts of the United States and Canada are experiencing a resurgence in COVID-19 positive tests and hospitalization numbers. This development is causing state and/or local governmental authorities to consider (or in some cases, impose) a second round of business closure requirements. As with the first round of business closings, the AAO continues to recommend that members monitor and abide by any business closing restrictions imposed by your state and/or local authorities.
However, the AAO also recognizes the extreme burden that these restrictions may have on members’ practices and patients as in-person appointments have experienced interruptions for an extended period of time. The AAO has provided members with a wide range of resources to minimize the disruption, including the AAO’s COVID-19 resource webpage and the work of the AAO’s COVID-19 Task Force.
As part of our ongoing effort to assist members during COVID-19-related closures, the AAO is equipping component and constituent leadership with resources for advocating before governmental authorities regarding additional business closures.
- Business Interruption Toolkit
- Guidance for Dental Practices from CDC
- Guidance from the ADA on Emergent Care
More Helpful Links from the AAO COVID-19 Resource Center
Along with your regular financial advisors, these sources may be helpful for addressing financial issues related to re-opening:
Bringing your team back to work will require some basic steps. See the following resources for recommendations.
ONLINE LEARNING RESOURCES
AAO members can access live and recorded education anytime, anyplace, and on any device. Our recorded lecture archives give you access to over 500 doctor and team clinical lectures, as well as the complimentary Business of Orthodontics series
The recorded lectures library covers a wide range of clinical and practice management topics. Presentations are viewable on your computer or mobile device, or through the AAO mobile app.
CE credit varies by lecture and requires completion of a test or evaluation after viewing.
To register your entire orthodontic team for online lecture access and our Orthodontic Staff Club Facebook group, click here to access the OSC application. Each OSC member will receive an individual login.
The American Association of Orthodontists is an ADA CERP Recognized Provider. ADA CERP is a service of the American Dental Association to assist dental professionals in identifying quality providers of continuing dental education. ADA CERP does not approve or endorse individual courses or instructors, nor does it imply acceptance of credit hours by boards of dentistry.
American Association of Orthodontists designates for all CE activities, 0.25 credit hours will be awarded for each 15 minutes of activity time unless otherwise noted.
Concerns or complaints about a CE provider may be directed to the provider or to the Commission for Continuing Education Provider Recognition at www.ada.org/cerp.
WEBINARS: ALL THINGS COVID-19
Catch up on CE with webinars on all things COVID-19:
April 3 | Recorded Webinar | 1.25 CE
April 20 | Recorded Webinar | 1.25 CE
April 27 | Recorded Webinar | 1.25 CE
Listen to the AAO Townhall Featuring Expert Advice for COVID-19 Issues
In case you missed it on Tuesday, July 28, listen to the recording of AAO’s COVID-19 Townhall. AAO President, Dr. Chris Roberts, hosted a panel of subject matter experts on COVID-19 issues for AAO members. A recorded version of this event is now available to view in its entirety. Tune in for COVID-19 analysis, guidance and information from Dr. Mike Durbin (Chair, AAO COVID-19 Task Force), Paul Edwards (CEDR Human Resources), Dan Wicker, CPA (Cain Watters & Associates), and Jackie Dorst, RDH, BS. Please note that this program is not for CE.
Coronavirus Issues for Orthodontic Practices
On March 24 an AAO featured speaker on sterilization, infection prevention, and OSHA safety, Jackie Dorst, RDH, BS presented “Today’s Coronavirus: Management in the Ortho Practice.” This free event aired with a special introduction by AAO President, Dr. Gary Inman.
Resurrecting Your Practice after the Shutdown
Paul Edwards with CEDR HR Solutions presented “Resurrecting Your Practice after the Shutdown” on Monday, April 13th at 12:00pm CT. Edwards fielded Q&A from AAO members and covered how to handle Coronavirus as an employer with practical solutions for the impact that the outbreak may have on your business. *Non-CE webinar*
Using Virtual Appointments to Maintain Continuity of Patient Care During a Crisis and Set Yourself up for ‘Normalcy’ Upon Return
On April 9, Dr. Michelle Neal presented “Using Virtual Appointments to Maintain Continuity of Patient Care During a Crisis and Set Yourself up for ‘Normalcy’” Upon Return.” Dr. Neal answered questions on the topic of utilizing virtual appointments to remotely monitor patients in active treatment and identify potential emergencies.*Non-CE webinar*
CARES Act: What It Means for Small Businesses
On Monday, March 30, 2020, Steven Dickerson and James Van Orden from Cozen O’Connor Public Strategies presented a webinar for AAO members on what the CARES Act means to small businesses and their employees. AAO members can access this video below for an update on how to navigate small business issues during COVID-19 related closures and restrictions. *Non-CE webinar*
YOU, YOUR TEAM, YOUR PATIENTS: IS ANYONE EXPERIENCING CORONAVIRUS-RELATED STRESS?
Emotional Check-Up: Taking Care of Our Mental Health during COVID-19
As we try to manage necessary tasks and support others, it is important to take time to process our own reactions and truly take care of ourselves emotionally as well as physically. Here are some resources that can help: aaoinfo.org/emotional-check-up-taking-care-of-our-mental-health-during-covid-19/
The entire AAO team wishes you well and we will strive to help as best we can.
More COVID-19 related questions? Let us know
Please also recognize that we are here to serve you. If there are additional assets or guidance that would be useful for your practice,
please make us aware by sharing it with us at Coronavirus@aaortho.org.