On March 16, the American Dental Association (ADA) and the New York State Dental Association (NYSDA) issued statements recommending that dentists postpone elective dental procedures for three weeks in order to mitigate the spread of COVID-19. On March 18, The Center for Medicare and Medicaid services also issued a recommendation that all nonessential dental exams and procedures be postponed until further notice due to the close proximity of the healthcare provider to the patient.  Both the professional associations and CMS recommend that dentists offer emergency dental care only during this time period to alleviate the burden that dental emergencies would place on hospital emergency departments.

On March 20, 2020, Gov. Cuomo issued an Executive Order changing the recommendations to a mandate.  As of Monday, March 23 you will be in violation if you are treating anything but emergencies in your office and can be subject to a fine. Here is a link to that order: executive order

Governor Andrew Cuomo’s announcement that dental practices across New York State may reopen to perform all dental care, the New York State Department of Health (DOH) has issued minimum safety and social distancing standards in its “Interim Guidance for Dentistry During the COVID-19 Public Health Emergency.” Here is a link to that Interim Guidance: “Interim Guidance for Dentistry During the COVID-19 Public Health Emergency.”

The Interim Guidance applies to all dental care, including both emergency and non-emergency or elective care, and will remain in effect until it is rescinded or amended by DOH. All dentists must implement the standards upon reopening and submit an affirmation to DOH stating that they have reviewed the Standards and will implement them.

The Interim Guidance provides:

No dentistry activities can occur without meeting the … Standards, as well as applicable federal requirements, including but not limited to such minimum standards of the Centers for Disease Control and Prevention (CDC), Environmental Protection Agency (EPA), and United States Department of Labor’s Occupational Safety and Health Administration (OSHA).

Recognizing the dynamic and fluid nature of state and federal guidance on preventing the spread of COVID-19, the Interim Guidance notes that the Standards are based on the “best-known public health practices” and cautions all dental practices to understand that such practices — and presumably the Standards themselves — “change frequently.” Therefore, dentists should regularly monitor the DOH website for any updates to the Interim Guidance.

The Standards include practices that are well known to reduce the spread of COVID-19, such as:

• Requiring physical distancing of at least six feet in every direction in all waiting areas, reception areas, and elevator entrances and other spaces where individuals tend to congregate.
• Installing physical barriers when adequate distancing is not possible;
• Limiting elevator density; and
• Using signage to reduce bi-directional traffic and to otherwise remind all employees, patients, and visitors to engage in best practices (g., social distancing, face coverings and hand washing) to reduce the spread of the disease.

The Standards further require that providers:

• Limit gatherings in enclosed spaces (g., restrooms and break rooms);
• Take measures to reduce interpersonal contact and congregation (g., limiting in-person staff present, adequate time between patients, and limiting the number of patients on the schedule); and
• Limit on-site interactions (e.g., require employees to remain near their workstations).

On cleaning and disinfection, the Standards require that dental practices “wait at least 15 minutes” after completion of a dental visit to allow potential contagious droplets to fall from the air prior to disinfecting. Inasmuch as dental practices are required to clean and disinfect between each patient visit, this requirement will limit significantly the capacity to service patients.

According to the Standards, dental practices “must ensure that patients and visitors wear face coverings at all times, except when undergoing a dental procedure,” and require all employees to wear appropriate personal protective equipment when providing care in accordance with OSHA standards. For aerosol-generating procedures, the provider’s personnel must wear a properly fit-tested, NIOSH-certified, disposable N95 or higher rated respirator, as well as eye protection, gloves, and gowns.

On screening and testing, dental practices must implement mandatory health screening practices of employees, patients, and visitors, including through remote (e.g., telephone or text) processes. Dental practices must notify the local health department of confirmed positive cases COVID-19 and be prepared to cooperate with the local health department’s contact tracing efforts.

While dental practices are accustomed to taking precautions, they should become familiar with the added DOH requirements by reviewing the Interim Guidance and continuing to monitor for changes to the Standards.

Reopening orders contain extensive requirements creating compliance issues that can vary significantly depending on the specific state or local jurisdiction.

As of June 15, 2021 these COVID restrictions were lifted for most businesses, but not for dentistry.  It was not until Thursday February 10, 2022, that Gov Hochul lifted this mandate for dental offices.  However, the NYSDOH Interim Guidance for Dentistry during the Covid- 19 Public Health Emergency, which includes face coverings, continues to be the recommended best practice for dental settings. The Centers for Disease Control (CDC) still recommends masking for all people in a healthcare setting as well.  Here is a link to that interim guidance: NYSDOH Interim Guidance for Dentistry during the Covid- 19 Public Health Emergency