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National Conversation on Dental Care: Reflections & Looking Forward

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Weitzman ECHO September 23, 2020

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National Conversation on Dental Care: Reflections & Looking Forward

  1. 1. National Conversation on Dental Care: Reflections & Looking Forward September 23, 2020
  2. 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. 3. National Conversation on Dental Care: Reflections & Looking Forward
  4. 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. 5. Last week:
  6. 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. 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. 8. Halloween ? • The CDC discouraged traditional trick-or- treating
  9. 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. 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. 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. 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. 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. 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. 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. 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. 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. 18. NYU LANGONE HEALTH DENTAL DIVISION SERVICES 18 TELEDENTISTRY URGENT AND EMERGENT CARE DENTAL SERVICES DURING COVID March to June 2020
  19. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 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. 35 * This initiative is supported by
  36. 36. Thank You! www.WeitzmanLearning.org/the-path-forward/ www.WeitzmanLearning.org/coranavirus

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