Pfizer BioNTech and Moderna have each released an updated COVID-19 booster shot, known as a bivalent vaccine booster, that offers protection against multiple virus variants. The bivalent vaccine booster will replace the original monovalent booster moving ahead. Children and adults, ages 12 and up, are authorized for the Pfizer bivalent booster, while children and adults, ages 18 and up, have the option to get the Moderna bivalent shot. To learn more about how COVID-19 vaccines and booster shots are changing visit FDA.gov's COVID-19 Vaccines website. Visit the FDA's short Q&A on the bivalent vaccine here.

The CDC announced today the recommendation of another primary series COVID-19 vaccine for children and adolescents ages 12-17. The Food and Drug Administration (FDA) authorized the adjuvanted vaccine series for adults in mid-July. Further testing showed the vaccine was effective for adolescents as well. For more information on the new vaccine series for adolescents, visit Vaccines for Children and Teens and for a fact sheet on Novavax, visit Novavax COVID-19 Vaccine, Adjuvanted. Click here to read the full announcement.

Dentists who recieved Provider Relief Fund (PRF) payments of over $10,000 between January 1, 2021 to June 30, 2021 (Period 3) can now report their use of funds in the PRF Reporting Portal. Reporting for this period has a deadline of September 30, 2022 at 11:59 p.m. ET. Technical webinars are available for new reporters on Tuesday, July 12th and returning reporters on Wednesday, July 13th.

Providers who received Period 4 payments between July 1, 2021 to December 31, 2021  have until December 31, 2022 to use their PRF funds. For other important dates and details on reporting use of funds visit HRSA's "Provider Relief Fund Reporting Requirements and Auditing" website and to access the PRF Reporting Portal, click here. The ADA has reported on the upcoming webinars. Click here to visit "Provider Relief Fund Reporting Requirements Webinar Set for July 12".

 

The CDC has signed off on a recommendation  that children over the age of 6 months old receive a COVID-19 vaccine, stressing that children who have already had a COVID-19 infection will have added protection when also getting vaccinated. 

The recommendation followed the Food and Drug Administration authorization of two long-awaited COVID-19 vaccines for children under the age of 5 years old. 

 

The two vaccines include the Pfizer-BioNTech COVID-19 vaccine for ages 6 months to 4 years old and the Moderna COVID-19 vaccine for ages 6 months to 17 years old. The Pfizer-BioNTech vaccine is given in a three shot primary series while the Moderna vaccine has a two dose primary series and a third primary dose for children who are immunocompromised.

 

The new CDC recommendation for children can be found here.  More information on the newly authorized vaccines can be found in Coronavirus (COVID-19) Update: FDA Authorizes Moderna and Pfizer-BioNTech COVID-19 Vaccines for Children Down to 6 Months of Age.

 

Following a recent FDA authorization, people age 50 and older, and those with immunocompromise are now eligible and recommended to recieve a second dose of the COVID-19 vaccine booster to extend protection from COVID-19 infection. Those eligible include the following groups:

 

• People age 50 plus are eligible to receive the Pfizer-BioNTech or Moderna second booster

• People age 12 and older with specific types of immunocompromisethe are eligible for the Pfizer-BioNTech second booster

• People age 18 and older with immunocompromise are eligable for the Moderna second booster

 

They note that the second dose should follow the first no earlier than 4 months after the first booster shot. To read Coronavirus (COVID-19) Update: FDA Authorizes Second Booster Dose of Two COVID-19 Vaccines for Older and Immunocompromised Individuals, click here. To read the CDC's statement on the new recommendation, click here.

With state indoor mask mandates lifting in regions across the U.S., there is currently an abundance of news circulating on changes to mask recommendations and requirements. Despite the revision to mask recommendations for indoor settings by the Centers for Disease Control and Prevention (CDC), universal mask recommendations for most healthcare settings remain in place.

The recommendation for healthcare settings, including dental practices, still advises that practices employ source control and physical distancing for all in the healthcare facility for the safest visit at this time, particularly where communitry transmission levels are higher and patients may be unvaccinated. Further, they suggest dentists check with their localities, state dental boards, or local health departments for guidance close to home for the most relevant information for their practice. Visit "Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic" for more information on current infection control recommendations.

The American Dental Association has created a new resource called "Indoor Masking in Dental Practice Public Space" to help dental practices make informed decisions when designing policies for masking. Click here to view this new resource for dentists.

Originally posted February 28, 2022

The COVID-19 pandemic continues to change with new rules and recommendations that are based on data emerging on the variants, testing accuracy and availability, and risks of transmission to name a few areas. AAPD encourages members to weigh postings on this site against local information and recommendations to best protect patients and staff and families. 

These selected resources may be helpful keeping on top of the latest:

• Healthcare Workers: Information on COVID-19 | CDC. New guidance related to the omicron variant, including updated isolation and work restriction recommendations for health care personnel, isolation recommendations for the public, and updated recommendations for healthcare worker shortages.

• Science Brief: Transmission of SARS-CoV-2 in K-12 Schools and Early Care and Education Programs – Updated. Information on the current COVID-19 situation impacting children and schools.

• COVID-19 Treatment Guidelines: Special Populations: Children. An overview of COVID-19 infection and treatment options for children and adolescents from the National Institutes for Health.

• NIH COVID-19 Treatment Guidelines: Therapies. A list of therapeutic recommendations for people with COVID-19 infections from the National Institutes for Health. The latest updates to treatment guidelines can be found here on the webpage, "What's New in the Guidelines".

• A Community Toolkit for Addressing Health Misinformation. Tips on addressing miscommunication within your patient community.

• SARS-CoV-2 Viral Mutations: Impact on COVID-19 Tests. Important information about how testing accuracy has changed with the evolution of the virus.

The Supreme Court has upheld a CMS rule that requires vaccination of workers employed by facilities funded by the Centers for Medicare and Medicaid. Private practices are not included in the groups affected by the requirement. However, the employees at Federally Qualified Health Centers (FQHC), Indian Health Services (HIS), hospitals and those with hospital privileges and who provide care in nursing homes that receive funding from CMS will be impacted by the rule. This is part of the ongoing efforts by the Centers for Medicare and Medicaid Services to mitigate COVID-19 transmission within health care among staff and patients. The rule was originally issued in November 5, 2021.

The American Academy of Pediatric Dentistry (AAPD) continues to strongly support vaccination but does not endorse vaccine mandates. Click here to read "Supreme Court Upholds CMS Vaccine Requirement".

The Centers for Disease Control and Prevention (CDC) is recommending the Pfizer-BioNTech COVID-19 booster shot for everyone age 12 and older to extend the protection offered by the vaccine and strengthen protection against the Omicron variant of SARS-CoV-2.  Additionally, they now recommend a third dose of the vaccine for 5-11 year olds who are immunocompromised, noting that kids ages 12-15 who are immunocompromised should receive their third dose of vaccine prior to getting their booster. 

Click here to read the FDA press release on authorization of the booster shot for 12-15 year olds. Click here to read COVID-19 Vaccines for Children and Teens and here to read the media statement from the CDC on the newly authorized booster shot for kids. To learn more about the COVID-19 vaccine and booster shot, visit COVID-19 Vaccine Booster Shots.

The Food and Drug Administration (FDA) has authorized the Pfizer BioNTech COVID-19 Vaccine Booster for 16-17 year olds to extend the protection offered by the vaccine, especially for those who may need the booster due to their higher risk of serious illness following a COVID-19 infection. Both, the Pfizer and Moderna booster are available to adults over the age of 18.

The deadline for SBA COVID-19 EIDL Loans is approaching, and the Small Business Administration is encouraging all eligible to apply ASAP, especially for the Supplemental Targeted Advance. Applications for the up to $5,000 Supplemental Targeted Advance loan will be processed until the end of day, December 31st and no later so applicants are encouraged to apply by December 10th. Those applying for the up to $10,000 Targeted EIDL Advance and COVID-19 Economic Injury Disaster Loan (EIDL) have until December 31st. These loans will continue to be processed after that date. Applicants may apply for all three loans if eligible, but should note that “advances” do not have to be repaid while the COVID-19 EIDL is not forgivable. These loans are distributed on a first-come, first-served basis. To view the COVID-19 EIDL Loan FAQ, click here. Click here to apply.

On Thursday, September 9th, a COVID-19 vaccine mandate was announced for federal workers and government contract workers. In addition to the federal worker rules, there have been several other directives out of U.S Health and Human Services (HHS) and the Labor Department, including a mandate from the Centers for Medicare and Medicaid Services (CMS) and another from the Occupational Safety and Health Administration (OSHA).

Under the rules from HHS, CMS is requiring that workers employed by Medicare and Medicaid-certified healthcare organizations get vaccinated with a COVID-19 vaccine. Additionally, OSHA has issued an emergency temporary standard that is requiring employees in work settings with over 100 workers to be vaccinated with a COVID-19 vaccine or be tested weekly.  On November 4, 2021 CMS issued an emergency regulation implementing the vaccine mandate. According to the American Dental Association (ADA), "the CMS rule will apply to dentists working in Medicare or Medicaid facilities such as hospitals, ambulatory surgical centers, nursing homes and federally qualified health centers, but not private dental offices". They further note that employers are required to allow for paid time off for vaccination and recovery. State mandates for health care workers may be broader than the federal vaccine mandate. The AAPD concurs with the ADA that dental professionals are strongly encouraged to be vaccinated, but that vaccinations should not be mandated.

Check out these selected resources to keep up to date on the new mandates and more: 

Vaccine Mandates by State: Who is, Who isn't, and How?

State Immunization Laws for Healthcare Workers and Patients: Immunization Administration Requirements For Hospital Employees

Tracking COVID-19 Vaccination Among Dentists

Guidance for Documenting Employee COVID-19 Vaccinations (ADA login required)

AAPD COVID-19 Status and Vaccines

Originally published September 16, 2021

Children ages 5-11 years old can now get the Pfizer-BioNTech COVID-19 Vaccine following the vaccine’s FDA authorization and review by the Advisory Committee on Immunization Practices (ACIP) of the CDC. The CDC continues to endorse a layered approach to prevention during the COVID-19 pandemic that includes vaccination, physical distancing, mask-wearing among other precautions for health care facilities. 

To learn more about the new vaccine recommendation, click here to read COVID-19 Vaccines for Children and Teens. To read the FDA press announcement on the COVID-19 Vaccine authorization for children age 5-11, click here.

 

The U.S. Health and Human Services (HHS) has announced the availability of 25.5 billion dollars of additional Provider Relief Funds (PRF) for health care providers for lost revenue and costs related to the COVID-19 pandemic. Phase 4 payments to providers, including a bonus payment to those serving Medicaid/CHIP and Medicare patients, are based on the losses and expenditures between July 1, 2020, and March 31, 2021. Additional funds are available through the American Rescue Plan (ARP) for providers serving rural patients on Medicaid/CHIP and Medicare, and these funds can be applied for on the same application. The application opens on September 29th. 

 

HHS has also announced that there will be a 60 day reporting grace period  for period 1 reporting for providers impacted by recent disasters. To read the the Phase 4 Provider Relief Funds announcement from HHS, click here. Click here to visit the Provider Relief Fund Application and Attestation Portal, and here to access the PRF Reporting Portal.

 

The American Dental Association created a detailed FAQ to help guide dentists through the phase 4 funding process. The resource includes information on eligibility, application and reporting processes, but also explains what to do if your 3rd payment was calculated incorrectly, provides a list of expenses and revenues lost that qualify for reimbursement, addresses a common tax-related question, and more. Click here to view Frequently Asked Questions: HHS Provider Relief Fund.

The Urban Institute reports that as of April 2021 many parents are delaying bringing their children to medical and dental appointments because of worries that their child(ren) may be exposed to COVID-19. Dental appointments topped the list with 5.3% of parents reporting they hadn’t brought their child in for appointments that they would have in normal circumstances. Parents in low-income households were more likely than higher income households to delay or avoid scheduling. The authors suggest that scheduling may pick up once children under the age of 12 become eligible for the vaccine and recommend an across-the-board effort by government, payers and providers to help children make up postponed care.

This motto led the AAPD through the first waves of the COVID-19 pandemic and our initial uncertainty. Many things have changed since March 2020, but the guiding principles that emerged early on remain a top priority. The motto holds true in August 2021 – and beyond. While we are reassured by the low levels of transmission in dental practices, we must continue to stay on top of local infection rates and local directives, while maintaining safe and accessible care. 

Schools will be resuming in-person learning this fall, the timing of which may coincide with the current rise of infection rates in some parts of the country. Patients younger than 12 years old in school will experience varying degrees of exposure to SARS-CoV-2, depending on local cases, policies and vaccine eligibility. Pediatric dentists should continue to be aware of and adhere to the evolving screening, testing, masking and vaccine recommendations from governmental and professional organizations. Check out these resources for the latest trends and guidance - and come back frequently for ongoing updates!

COVID-19 Data Tracker

Updated Healthcare Infection Prevention and Control Recommendations in Response to COVID-19 Vaccination

COVID-19 Guidance for Safe Schools

COVID-19 Status and Vaccines

Guidance for Dental Settings

Update to Office Procedures During COVID-19 corresponds to the key reference from the American Dental Association (ADA), Return to Work Interim Guidance Toolkit., adding to it a number of new considerations from hazard assessment and staff protection to screening protocols following the recent release of new and revised infection control recommendations and requirements, such as OSHA’s Emergency Temporary Standard for Healthcare Settings and Guidance for Dental Settings: Interim Infection Prevention and Control Guidance for Dental Settings During the Coronavirus Disease 2019 (COVID-19) Pandemic. This short checklist of considerations makes practice during the pandemic a little bit easier and it will surely be another indispensable part of your COVID-19 toolkit. Click here to read Update to Office Procedures During COVID-19.

Guidance for Dental Settings, a key infection control resource for dentists practicing during the COVID-19 pandemic, has been updated to reflect the current understanding of the risks involved with COVID-19 transmission and aerosol-generating procedures. The CDC removed the recommendation for all patients to avoid aerosol-generating procedures following the observation that, to date, dentistry has demonstrated a high level of safety for patients and clinicians. The guidance still advises that dentists avoid aerosol-generating procedures for patients with suspected or confirmed SARS-CoV-2 infection. Click here to view the updated Summary of CDC COVID-19 Guidance for Dental Settings.

Patients experiencing lingering symptoms for four months or longer after initial infection or symptom presentation fall into a category called post-covid conditions, otherwise known commonly as "long COVID" and "COVID long haulers", or clinically as post-acute sequalae of SARS-COV-2 infection (PASC). Unfortunately, the specter of long-term health consequences from coronavirus can be as haunting to children as to adults. Top symptoms for children experiencing post-Covid conditions include gastrointestinal issues, chest pain, headaches, fatigue, joint/muscle pain/weakness, sore throat, dizziness, rashes, mood changes and nausea.

The NIH has undertaken a research initiative called RECOVER to understand PASC and aid in the recovery of those who are impacted longer term because of infection with the virus. Clinicians who would like more information this topic can look to these two excellent resources from the Centers for Disease Control and Prevention: Post-COVID Conditions: Information for Healthcare Providers  and Evaluating and Caring for Patients with Post-COVID Conditions: Interim Guidance. 

The Provider Relief Fund (PRF) Reporting Portal opened today, July 1, 2021 for first period reporting. Period 1 reporting can be completed between now and September 30, 2021. HRSA announced revisions to reporting requirements for recipients of PRF including those distributed from The Coronavirus Aid, Relief, and Economic Security (CARES) Act, the Paycheck Protection Program (PPP) and Health Care Enhancement Act, and the Coronavirus Response and Relief Supplemental Appropriations (CRRSA) Act. The updates include adjustments to timelines to use and report on funds in the Provider Relief Fund Reporting Portal. For assistance getting started with registration, click here. Reporting is only mandatory for providers who received $10,000 or more cumulatively. For more information on PRF, visit Frequently Asked Questions: HHS Provider Relief Funds from the American Dental Association.

HHS Summary of Reporting Requirements Time Periods

Period	Payment Received Period (Payments Exceeding $10,000 in Aggregate Received)	Deadline to Use Funds	Reporting Time Period
1	April 10, 2020 to June 30, 2020	June 30, 2021	July 1, 2021 to September 30, 2021
2	July 1, 2020 to December 31, 2020	December 31, 2021	January 1, 2022 to March 31, 2022
3	January 1, 2021 to June 30, 2021	June 30, 2022	July 1, 2022 to September 30, 2022
4	July 1, 2021 to December 31, 2021	December 31, 2022	January 1, 2023 to March 31, 2023

The U.S. Equal Employment Opportunity Commission (EEOC) reports that it is within the rights of the employer to create mandatory vaccination policies in the recently updated technical guide and FAQ, What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws. The guide explains how equal opportunity (EEO) laws apply to workplace COVID-19 vaccination policies, especially mandatory vaccination and incentive programs, stressing that policies must adhere to anti-discrimination and accommodation principles of EEO laws such as the Americans with Disabilities Act (ADA), Title VII of the Civil Rights Act, and the Genetic Information Nondiscrimination Act (GINA). Because some employees face greater difficulty accessing vaccines, the EEOC advises that employers consider the impact of their policies on protected groups of the Civil Rights Act. Click here to read What You Should Know About COVID-19 and the ADA, the Rehabilitation Act, and Other EEO Laws. This updates Litch's Law Log May 2021 article, Legal Issues Related to Dental Staff and COVID-19 Vaccine. Click here to read.

The Pfizer-BioNTech COVID-19 Vaccine is now available for 12-15 year-olds after the FDA expanded the Emergency Use Authorization (EUA) to include the adolescent age group for the vaccine. The Centers for Disease Control and Prevention (CDC) is recommending the Pfizer-BioNTech vaccine for everyone age 12 and older. Click here to visit COVID-19 Vaccines for Children and Teens to read the new guidance for adolescents age 12-15. To learn about enrolling as a COVID-19 vaccine provider, click here.

The Centers for Disease Control and Prevention (CDC) have released a joint statement with the Food and Drug Administration (FDA) to announce the resumption of the administration of the Johnson & Johnson/Janssen COVID-19 vaccine after taking a cautious pause due to the identification of several rare cases of a type of blood clot following vaccination. The stoppage was being used to study the cases involving the blood clot, cerebral venous sinus thrombosis (CVST) also known as  thrombosis-thrombocytopenia syndrome (TTS). Since the pause, the CDC and FDA have determined that the vaccine is safe and effective in preventing COVID-19 but emphasize that clinicians should be aware of the adverse events associated with the Janssen Vaccine and recognize the symptoms associated with TTS. To read the press release, click here. To access the Janssen COVID-19 Vaccine fact sheet for providers, click here, and for patients and caregivers, click here.

Newly approved CDT 2021 codes to report COVID-19 vaccines allow dentists to document and reportvaccination services in their practices. The American Dental Association (ADA) and Centers for Medicare & Medicaid Services (CMMS) have established eight new CDT codes. Mentioned in a recent ADA News piece, the new codes include all doses needed to complete vaccination and one new code for molecular diagnostic testing:

• D1701   Pfizer-BioNTech COVID-19 vaccine administration – first dose.
• D1702   Pfizer-BioNTech COVID-19 vaccine administration – second dose.
• D1703   Moderna COVID-19 vaccine administration – first dose.
• D1704   Moderna COVID-19 vaccine administration – second dose
• D1705   AstraZeneca COVID-19 vaccine administration – first dose.
• D1706   AstraZeneca COVID-19 vaccine administration – second dose.
• D1707   Janssen (Johnson & Johnson) COVID-19 vaccine administration.
• D0606   Molecular testing for a public health related pathogen, including coronavirus.

To read more about the new codes, click here.

According to a notice of the Federal Register, a new amendment of the U.S. Health and Human Services' (HHS) Public Readiness and Emergency Preparedness Act (PREP Act) for Medical Countermeasures Against COVID–19, qualifies licensed dentists to administer the COVID-19 vaccine to patients. The announcement, published on March 16, supersedes any state-specific legislation on vaccination by dentists during the COVID-19 pandemic in pursuit of unified action to end the COVID-19 pandemic in the U.S. To read the new declaration, click here.

The Centers for the Disease Control and Prevention has published their latest guidance on safe post-vaccination activities during the COVID-19 pandemic. This webpage answers pressing questions on how you can go about your daily activities and resume being in close contact with others when you have been fully vaccinated. Can you visit with family who are not vaccinated? Do you still need to wear a mask in public? The website is helpfully outlined with three key topics so you can find the information you need with ease:

• What’s changed,
• What hasn’t changed, and
• What we know and what we’re still learning.

Click here to visit When You’ve Been Fully Vaccinated. For more in-depth guidance on the fully vaccinated, click here.

The Provider Relief Fund (PRF) Reporting Portal is now open for registration of post-payment reporting of funds over $10,000 from one or more Provider Relief Fund (PRF) payments. A Registration User Guide, and Portal FAQ from the Department of Health and Human Services (HHS) are available to help navigate this first step of the reporting process.

To complete registration, users will need the following information: 

• Tax ID Number (TIN) or other number submitted during the application process (Social Security Number, Employer Identification Number)
• Business name as it appears on a W-9
• Contact information (name, phone number, email)
• Address (street, city, state, zip code) as it appears on a W-9
• TIN(s) of subsidiaries
• Payment information including TIN of entity that received the payment, payment amount, mode of payment (check or direct deposit ACH), and check number or ACH settlement date 

To register through the Provider Relief Fund Reporting Portal, click here.

The Small Business Administration (SBA) Paycheck Protection Program (PPP) will continue to offer funding for loans through March 31, 2021, or until resources have been exhausted. Those who have applied or will be applying for $150,000 or less will be happy to know that the SBA is offering a streamlined version of the loan forgiveness application. The new one-page form can be viewed here. Borrowers can also receive the document from their lender. 

The SBA advises following these steps to successfully apply for loan forgiveness: 

1. Contact your PPP Lender and complete the correct form
2. Compile your documentation for payroll and nonpayroll expenses
3. Submit the forgiveness form and documentation to your PPP Lender​
4. Continue to communicate with your lender throughout the process

To learn more about applying for Paycheck Protection Program (PPP) loan forgiveness, click here.

The AAPD has joined other dental and medical organizations in a letter to the Centers for Disease Control and Prevention (CDC) to endorse the inclusion of dental, laboratory and autopsy personnel in the recommendation of the Advisory Committee on Immunization Practices to give health care personnel priority access to COVID-19 vaccines. The letter strongly urges that this clarification be reflected in the Vaccination Playbook for Jurisdictional Operations, a guidance document on the national strategy for vaccine response during the COVID-19 pandemic. Click here to read more.

Update: The Centers for Disease Control and Prevention (CDC) clarified the definition of healthcare personnel in a new guidance document on vaccine allocation to healthcare workers. The definition includes dentists, dental assistants and dental hygienists, as well as all other healthcare workers who have direct contact with patients and potentially infectious materials. Click here for more information.

The U.S. Department of Health and Human Services (HHS) is providing more than $24 billion in new relief to more than 70,000 healthcare providers, according to a December 16 news release, which can be accessed here. 

The HHS has completed its review of Phase 3 applications from the Provider Relief Fund program, and the next round of payment distributions is now underway and will continue through January, 2021. Up from the $20 billion originally planned, the addition of another $4.5 billion in funding is being used to satisfy close to 90 percent of each applicant’s reported lost revenues and net change in expenses caused by the coronavirus pandemic in the first half of 2020.

The HHS provides a state-by-state breakdown on the first batch of Phase 3 payments that will be updated until distribution closes at the end of January. 

The AAPD has worked closely with the ADA and other dental organizations to ensure dentists were included in the Provider Relief Fund through HHS and the Health Resources and Services Administration, which administers the fund. For more information on the Phase 3 distributions and advocacy efforts, view the ADA News article here.

Along with over 500 national and state/regional trade associations, the AAPD has urged Congress to take action to reverse an IRS technical rule, IRS Notice 2020-32 to preserve the original intent of the Paycheck Protection Program (PPP) through the Coronavirus Aid, Relief, and Economic Security (CARES) Act. The rule being challenged indicates, “no deduction is allowed under the Internal Revenue Code…if the payment of the expense results in forgiveness of a covered loan pursuant to section 1106(b) of the [CARES ACT].” In effect, the surprise notice alters the original agreement that PPE loans will be forgiven in a tax-free manner. Click here to read the letter.

Results from the latest ADA HPI COVID-19 poll show that dentists are experiencing an economic and emotional toll from the COVID-19 pandemic as practices report lower patient volumes, decreases in profitability and moderate to substantial increases in the costs of operations. The survey has an accompanying webinar for curious dentists and practice managers on the significance of these results. This week’s topics include an update on the latest data, potential retirement trends, the COVID-19 impact on profitability, strategies to reduce aerosols, student loan repayment and more. Click here to watch.

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced $20 billion in new funding for providers on the frontlines of the coronavirus pandemic. Under this Phase 3 General Distribution allocation, providers who have already received Provider Relief Fund payments are invited to apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing January 1 – March 30, 2020, are also invited to apply. Read more here. 

Along with the newly eligible providers, all providers who previously received, rejected or accepted a General Distribution Provider Relief Fund payment will be able to submit more information to become eligible for an additional payment. This additional “equitable add-on payment” will be based on a provider’s change in operating expenses from patient care, including expenses incurred related to coronavirus, as well as payments already received through prior Provider Relief Fund distributions. Providers who believe they did not receive the full payment based on two percent of patient revenue will have the opportunity to submit additional information. These providers will receive this amount consistent with prior general distributions, plus a Phase 3 allocation. This applies to all dental providers who believe they received incorrect payments. 

Providers will have from October 5, 2020 through November 6, 2020to apply for Phase 3 General Distribution funding. The HHS is urging all eligible providers to apply early; this last $20 billion in the fund will be distributed on a first-come, first-serve basis. Applying early will help to expedite the distribution of payments.Please note that providers will need to submit a new application, even if they previously submitted for a prior distribution.The updated application requests additional data to calculate payment based on financial impact of COVID-19.

 To learn more about the Phase 3 General Distribution Provider Relief Program, visit here.

When you are ready to apply, login here.

The ADA announcement of the Phase 3 General Distribution funding can be found here.  

Newly released data from the Centers for Medicare & Medicaid Services (CMS) provide a snapshot of the impact of COVID-19 on service utilization for children enrolled in Medicaid and the Children’s Health Insurance Program (CHIP). The preliminary findings show that services for children have dropped across a number of health care fields, including oral health.

While enrollment in Medicaid and CHIP has increased, the data show a decline in service use among children in March through May of this year compared to the same period last year in the following key domains:

• 69 percent fewer (7.6 million) dental services
• 44 percent fewer (3.2 million) child screening services
• 22 percent fewer (1.7 million) vaccinations for children under age 2
• 44 percent fewer (6.9 million) outpatient mental health services 

Medicaid and CHIP cover nearly 40 million children, including those living in low-income families and those with special health care needs. More information on the newly released CMS data can be found here.

On August 28, the Centers for Disease Control and Prevention (CDC) updated its Guidance for Dental Settings: Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19.

The AAPD and ADA engage in ongoing communications with the CDC to help ensure consistency between the CDC guidance, ADA toolkit and AAPD practice re-emergence checklist.

The recent changes to the update are summarized as follows: 

• The definition of fever was updated to either measured temperature ≥100.0°F or subjective fever to align with CDC’s Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 Pandemic.
• In areas with moderate to substantial community transmission, during patient encounters with patients not suspected of SARS-CoV-2 infection, the CDC recommends that dental healthcare personnel use an N95 respirator or a respirator that offers an equivalent or higher level of protection during aerosol generating procedures; and wear eye protection in addition to their facemask to ensure the eyes, nose, and mouth are all protected from exposure to respiratory secretions during patient care encounters, including those where splashes and sprays are not anticipated.
• New language states that protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glasses and the face likely do not protect eyes from all splashes and sprays.
• The update includes additional guidance on physical distancing and how to respond to SARS-CoV-2 exposures among DHCP and others.

This updated guidance complements the following CDC guidance documents:

• Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic
• Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic

The U.S. Department of Health and Human Services (HHS)  has announced the deadline to apply for Phase 2 General Distribution Funding has been extended to September 13, 2020. This deadline applies to:

• Dentists who have directly billed their state Medicaid/Children’s Health Insurance Programs or Medicaid managed care plans for oral health care services
• Dentists who have directly billed health insurance companies for oral health care services
• Dentists who do not accept insurance and have directly billed patients for oral health care services

Dentists are eligible for these relief funds even if previously receiving Small Business Administration EIDL and/or PPP loans. These have no impact on the HHS relief funds.

For more information on the application deadline extension click here.

The AAPD and ADA recommend that dentists who participate in Medicaid and CHIP programs apply for the Medicaid and CHIP Distribution.  A fact sheet is available here.

For dentists who don’t participate in Medicaid/CHIP, the AAPD and ADA recommend application through the Enhanced Provider Relief Payment Portal. 

Note that for either application, the same portal is used.

HHS has updated its FAQs to address common questions, including expanded information on eligibility, application, payment process, and more.  HHS also offers webinar recordings,  available here: HHS Webinar Recordings 

For help with the application process, HHS has set up a Provider Support Line, 866- 569-3522, to assist with questions. The hours of operation are 7 a.m. to 10 p.m. CST, Monday – Friday.

The ADA has also prepared a FAQ for dentists concerning the relief funds.

The American Academy of Pediatric Dentistry (AAPD) opposes the August 3rd World Health Organization’s (WHO) recommendation to delay “routine” oral health care – including dental check-ups, cleanings and preventive care – until there has been further reduction in COVID-19 transmissions. 

“Now more than ever, we want our patients’ families to know that dental care for children is a medical necessity,” stated AAPD President Jessica Y. Lee, DDS, MPH, PhD. “We continue to provide the highest quality of care possible while keeping children, staff and ourselves safe.”  

The American Dental Association (ADA) respectfully yet strong disagrees with the WHO recommendation, as do other U.S. dental organizations. “Oral health is integral to overall health. Dentistry is essential health care because of its role in evaluating, diagnosing, preventing or treating oral diseases, which can affect systemic health,” according to ADA President Chad P. Gehani, D.D.S. “Millions of patients have safely visited their dentists in the past few months for the full range of dental services. With appropriate PPE, dental care should continue to be delivered during global pandemics or other disaster situations.” Read more here.

In a responding email to global leaders on August 13, WHO Chief Dental Officer Benoit Varenne, Ph.D., expressed his concerns about media coverage of the interim guidance: "A number of media headlines…did not mention that the recommendation to delay routine oral health care is only suggested in an intense uncontrolled community transmission scenario. A scenario that [does] not fit with the current situation of [most countries] around the world. Please be aware of the missing information sometimes disseminated by the media that could increase fear and concern of patients seeking oral health care."

“Pediatric dentistry has an impeccable history of evidence-based knowledge and practice in infection control, and we continue working hard to reduce the spread of germs among our patients in our office,” Lee said. “During this pandemic, we have stepped up our cleaning practices along with our personal protective equipment to protect patients and staff from potential exposure to COVID-19.”

The AAPD urges pediatric dentists to follow the highest level of infection control guidance from the U.S. Centers for Disease Control and Prevention (CDC).  Pediatric oral health providers must provide necessary services while minimizing risk to patients and personnel, as well as consult their state dental boards and health departments for local practice requirements. Learn more here.

The AAPD offers continual updates on the impact of COVID-19 on pediatric practice, and its Re-emergence Pediatric Dentistry Practice Checklist, a comprehensive online publication features up-to-the-minute information on how to protect patients, families and staff from COVID-19. 

The ADA’s Advisory Task Force for Dental Practice Recovery has developed a free toolkit for members offering interim guidance on measures to help protect patients, staff and dentists from COVID-19 as dental practices re-engage in providing the full range of oral health care. The toolkit includes:

• Sample letter to patients
• Guidance on pre-appointment screening
• In-office patient registration procedures
• Reception area preparation strategies
• Chairside checklist
• Staff protection strategies
• Supplies shopping list

To receive a copy, visit this ADA site and fill out the form for a link to the toolkit.

The AAPD has joined the Organized Dentistry Coalition in a letter to the leaders of the U.S. Senate and House of Representatives that outlines policy priorities to be included in the next COVID-19 relief package. The letter can be accessed here. This request for important support to dental practices includes:

• Tax credits to small businesses for the purchase of additional personal protective equipment (PPE) and safety improvements
• Temporary and targeted liability protection to small businesses 
• Additional flexibility for the Paycheck Protection Program (PPP) loans 
• Incentives for health care practitioners to work in health-disadvantaged communities that have been further undermined by COVID-19 

In view of the success of previous advocacy efforts, the AAPD predicts a positive step forward in Congressional efforts to combat the challenging effects of the COVID-19 pandemic on pediatric dentistry.

The Enhanced Provider Portal from the U.S. Department of Health and Human Services (HHS) is now accepting applications for the Provider Relief Fund from eligible providers who participate in state Medicaid and Children's Health Insurance Programs (CHIP).The payment to each provider will be at least 2 percent of reported gross revenue from patient care; the final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers serve.The portal allows dental providers to attest to relief fund payments made for healthcare-related expenses or lost revenue attributable to COVID-19. The deadline for submissions is July 20, 2020.

To apply, please access the portal here. Before you apply, be sure to:

• read the Medicaid Provider Distribution Instructions, and 
• download the Medicaid Provider Distribution Application Form. 

The $15 billion will be distributed to eligible providers who have not received a payment from the Provider Relief Fund General Allocation and have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, and May 31, 2020. These funds are not loans, and are not first come, first served. All eligible providers who apply can expect to receive funds.
 
Additional information on the announcement can be found in the ADA News here.

HHS has also provided a number of FAQs on the Medicaid Targeted Distribution.

Pediatric dentists who were previously ineligible for relief can now apply for the Provider Relief Fund from the U.S. Department of Health and Human Services (HHS). In late June, the Enhanced Provider Portal from the HHS began accepting applications for the $15 billion Provider Relief Fund from eligible providers who participate in state Medicaid and Children's Health Insurance Programs (CHIP). Now, Provider Relief Funds are available to all dentists even if they don’t participate in Medicaid/CHIP.  

If your practice accepts Medicaid programs, apple for the Medicaid/CHIP Provider Relief Fund. The deadline for submissions is July 20, 2020. If your practice does not, apply through the Enhanced Payment Portal. The deadline for funding applications is July 24.  

Information on how to apply for either source of funding can be found here.

Access the application submission portal here.

HHS has updated its FAQs to address common questions, including those submitted during the previous webcasts. The FAQs include expanded information on eligibility, application, payment process, and more. For help with the application process, HHS has also set up a Provider Support Line (866) 569-3522 to assist with questions.

The Enhanced Provider Portal from the U.S. Department of Health and Human Services (HHS) is now accepting applications for the $15 billion Provider Relief Fund from eligible providers who participate in state Medicaid and Children's Health Insurance Programs (CHIP). The deadline for submissions is July 20, 2020.

HHS is offering a webinar on July 8, 2020 at 4pm ET to guide providers through the application process, including the attestation process, eligibility and reporting requirements. Pre-register here to reserve a spot. 

A recording of the June 25 webcast is now available for viewing here.

For more information, please access the portal here. Before you apply for the fund, be sure to:

• read the Medicaid Provider Distribution Instructions, and 
• download the Medicaid Provider Distribution Application Form.  

To address important concerns, HHS has updated its FAQs to address common questions, including those submitted during the previous webcasts. The FAQs include expanded information on eligibility, application, payment process, and more.

On June 5, the President signed into law the Paycheck Protection Program Flexibility Act, which will reform the Paycheck Protection Program (PPP) to give small businesses more time and flexibility to use their funds. Advocated by the AAPD and the Organized Dentistry Coalition, the bipartisan legislation passed the House on May 28 and the Senate on June 3. The new act applies to pediatric dentists who have or will receive funds from the PPP — a loan established by the Coronavirus Aid, Relief, and Economic Security Act. This act will extend the following benefits:  

• Increase the Paycheck Protection Program loan forgiveness coverage period from eight weeks to 24 weeks
• Defer payroll tax for borrowers
• Deferring Paycheck Protection Program loan repayment for 10 months instead of 6 months
• Allowing borrowers to use 40 percent of PPP funds to pay for non-payroll expenses 
• Extending the rehiring deadline for dental practice employees

Learn more from the ADA here, and Congress here.

PEDIATRIC DENTISTS WHO TREAT MEDICAID/CHIP PATIENTS SHOULD APPLY

The U.S. Department of Health and Human Services (HHS), announced additional distributions from the Provider Relief Fund to eligible providers who participate in state Medicaid and Children's Health Insurance Programs (CHIP). The $15 billion will be distributed to eligible providers who have not received a payment from the Provider Relief Fund General Allocation and have directly billed their state Medicaid/CHIP programs or Medicaid managed care plans for healthcare-related services between January 1, 2018, and May 31, 2020. Click here to learn more. 

Scheduled for today, HHS will launch an enhanced Provider Relief Fund Payment Portal that will allow eligible Medicaid and CHIP providers to report their annual patient revenue, which will be used as a factor in determining their Provider Relief Fund payment. Please note that the HHS Portal is not yet open for Provider Relief Fund Payment. We will keep you posted about when it is available and provide guidance about how to apply. 

The payment to each provider will be at least two percent of reported gross revenue from patient care. The final amount each provider receives will be determined after the data is submitted, including information about the number of Medicaid patients providers served. These funds are not first come, first served. All eligible providers who apply can expect to receive funds. For updated information and data on the Provider Relief Fund, visit hhs.gov/providerrelief

As noted in the ADA’s announcement, the AAPD was part of a coalition of dental stakeholders that advocated to HHS that Medicaid and CHIP dentists should have priority access to the Provider Relief Fund.

Please join the APPD on Tuesday 6/9 at 9:00am (CST) for the upcoming Pedo Teeth Talk, Taking care of Yourself, Your Mental Health and Wellbeing. In this exceptionally important podcast, Dr. Sheela Raja, Clinical Psychologist, and expert on post-traumatic stress, talks with us about doing a survey of ourselves and our well-being, helping us deal with difficult feelings and times, and how to get help for ourselves and others.  We ARE all in this together and Dr. Raja is here to help us get through some of the most challenging times in generations. Join us on Tuesday or listen any time after at your convenience. Click here to listen.

Helpful Resources:

Substance Abuse and Mental Health Services Administration National Helpline, 1-800-662-HELP (4357), or TTY: 1-800-487-4889

Anxiety and Depression Association of America

The National Center for PTSD

Centers for Disease Control: Coping with Stress

Web MD: Coping with Stress

At this live webinar/call on Wednesday, 6/3 from 2:00pm-3:00pm (ET), a panel from the CDC Division of Oral Health, the Infection Control Team and Worker Safety Team will review the updated guidance for dental offices that includes non-emergency dental care guidelines. Participants can engage with the panel through a Q&A session following the discussion. Slides will be available following the webinar/call, and interested parties who are not available for the live discussion can also find it recorded on the Clinician Outreach and Communication Activity (COCA) webpage, here.

The Centers for Disease Control and Prevention (CDC) released new Guidance for Dental Settings: Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response on May 21, 2020.  The AAPD and ADA have engaged in ongoing communications with the CDC to help ensure consistency between the CDC guidance, ADA toolkit and AAPD practice re-emergence checklist.

The recent changes are summarized as follows: 

• Recommendations are provided for resuming non-emergency dental care during the COVID-19 pandemic.
• New information is included regarding facility and equipment considerations, sterilization and disinfection, and considerations for the use of test-based strategies to inform patient care.
• Expanded recommendations for provision of dental care to both patients with COVID-19 and patients without COVID-19.

This guidance is a supporting document for these earlier CDC recommendations:

• Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings
• Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic.

Many children are at a greater risk for child abuse and neglect (CAN) due to stay-at-home orders. As each state resumes dental care, pediatric dentists are in a unique position to identify CAN. In fact, two to three out of four CAN cases involve trauma to mouth, face, and head. This report by Dr. Homa Amini, DDS, MPH, MS of The Ohio State University and Nationwide Children’s Hospital illustrates a severe case of CAN.

Please click here to read the report.

What to say to families coming back to your practice? This new AAPD resource gives concise positive answers to parent questions about treatment, appointments, dental emergencies and other topics related to the oral health care of their children. It lets families know that even though the office may look a bit different, you continue to provide the highest quality of care possible while keeping children safe and comfortable during the dental visit. You can use the fact sheet in conversations with parents, email it to families, and post it on your website and Facebook page. It can be adopted as is or modified to suit your practice. And don’t forget to share it with your referring dental and medical offices.

Click here to view the Parent FAQ

Click here to personalize the Parent FAQ for your office

On April 23, the House of Representatives passed a new coronavirus relief bill calling for additional funding for federal loan programs to help dental practices, as well as other businesses, recover from the economic fallout of the pandemic, which was signed into law by the President the following day. The Paycheck Protection Program and Health Care Enhancement Act infuses $370 billion into the Paycheck Protection Program, Economic Injury Disaster Loans, and emergency Economic Injury Disaster Loans grants. Learn more here.

Visit the SBA website here to determine the current status for new applications for the Paycheck Protection Program and the Economic Injury Disaster Loan (including Advances) based on available appropriations funding. Applicants who have already submitted their applications will continue to be processed on a first-come, first-served basis.

The following article summarizes the two Small Business Administration (SBA) loans available to dental practices. View the article here.

Immediately after passage of the CARES Act both ADA and AAPD strongly urged dentists to apply quickly for the SBA EIDL and then PPP loan, because funding was on a first come/first serve basis, and funds might runs out. This was emphasized in the April 1 AAPD podcast of Pedo Teeth Talk where Dr. Joel Berg interviewed Mike Graham, head of the ADA Washington D.C. office. 

The AAPD continues to participate in efforts with the ADA to modify the PPP legislation to provide additional funding, streamline the SBA loan application process and allow dental practices to choose the 8-week period for which they can seek loan forgiveness and rehire staff. Learn more about the letter sent by a strong dental coalition consisting of the AAPD and many of our state pediatric dentistry chapters here.

In related news, the AAPD joined a strong coalition of dental organizations in a request for immediate financial assistance for dentists across the country from the Department of Health and Human Services (HHS) and Centers for Medicare and Medicaid Services. The letter strongly recommends that HHS provide immediate access to capital by releasing funding from the CARES Act Provider Relief Fund to dentists that are Medicaid providers and serve as critical access points for oral health care to lower income Americans. Learn more here.

The AAPD Safety Committee is proud to offer its new guide for re-entry into practice uniquely designed for pediatric dentists. This comprehensive online publication will answer many of your most pressing questions to protect patients, families and staff from COVID-19 – including recommendations about personal protective equipment. It will help you prepare for re-emergence in view of the far-reaching effects of the pandemic. Topics:

• Pre-Emergence Processes
• Practice Ramp Up Schedule Considerations
• Situations Unique to the Specialty of Pediatric Dentistry
• Point-of-Care Considerations/Operatory Environment
• Business and Practice Administration Considerations

Follow this checklist to get back to caring for children in ways that are safe for them, their families, your staff and yourselves. Click here to view the checklist.

The Coronavirus Aid, Relief and Economic Security (CARES) Act includes a significant increase in funding of $349 billion to the Small Business Administration (SBA) to guarantee loans to small businesses to help alleviate economic injury directly caused by the coronavirus. These loans may be used to pay for employees’ COVID-19-related sick leave, mortgage or rent, and other overhead expenses. For the latest information from the ADA about these loans and the circumstances in which they must be utilized, click here.

The SBA COVID-19 Economic Injury Disaster Loan (EIDL) is now available to employers in all U.S. states, Washington D.C., and territories. It offers small business owners impacted by COVID-19 the opportunity to obtain up to a $10,000 Advance on their EIDL. To ensure that the greatest number of applicants can receive assistance, Advance amounts will be determined by the number of employees as of January 31, 2020. The Advance will provide $1,000 per employee up to a maximum of $10,000.

Since the EIDL 7(b) loans are awarded on a first-come, first-served basis, online applications should be completed promptly. You will find the updated EIDL Application page here. 

The CARES Act also created a new Paycheck Protection Program (PPP) Loan. Starting April 3, 2020, small businesses and sole proprietorships can apply for and receive PPA loans to cover their payroll and other certain expenses through existing SBA lenders. Understanding these options and determining what is best for your practice can be confusing. We strongly encourage that you review this fact sheet prepared by the ADA and Academy of Dental CPAs. In addition, the SBA has released the loan application for the PPP. Comprehensive information from the SBA on loan opportunities can be found here.

Any information you may have seen suggesting that both EIDL and the PPP Loan cannot both be applied for is incorrect. A former draft of the CARES Act would have prohibited this, but last minute negotiations changed that prohibition. Further, the ADA understands that you can roll your EIDL loan into the PPP loan. An EIDL grant/advance of up to $10,000 will be deducted from any loan forgiveness someone receives if they roll the EIDL into the PPP, but not the full EIDL amount. ADA encourages dentists to get both and then roll in the EIDL for better loan terms on any of the remaining balance from the combined loan after receiving assistance.

The AAPD also supports efforts by the ADA to modify the PPP legislation to allow for more flexibility in timing for use of the funds. Click here to learn more.

The U.S. Chamber of Commerce has also provided a Coronavirus Emergency Loans Small Business Guide and Checklist, which can be accessed here.

The AAPD continues to strongly recommend that you should also contact your main practice lender bank for other sources of relief from current loan payments such as deferred payment, interest-only payments, and/or short-term low interest loans. Pediatric dentists have reported favorable outcomes utilizing this approach. 

A revised guidance statement from the Centers for Disease Control and Prevention (CDC) recommends that dental facilities postpone elective procedures and non-urgent dental visits, and prioritize urgent and emergency visits and procedures, now and for the coming several weeks.

On April 7, 2020, the CDC made revisions to the Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response. This guidance provides recommendations for providing emergency dental care and a description of risk to dental health care personnel when providing emergency care during the COVID-19 pandemic.

According to the ADA’s interim recommendations, dentists should limit their practices only to urgent and emergency procedures until April 30. Read more here.

In addition, guidance from the Centers for Medicare and Medicaid Services (CMS) recommends that all non-essential dental exams and procedures be postponed until further notice. Read more here.

UPDATE: THIS EFFORT WAS SUCCESSFUL. The SBA has clarified that dentists can apply for both economic injury disaster and paycheck protection program loans. Click here to learn more.

The AAPD has been regularly updating membership regarding on this page regarding Small Business Administration (SBA) loan opportunities, both the Economic Injury Disaster Loan (EIDL) and the new Paycheck Protection Program (PPP). The PPP officially opened on April 3, 2020.
 
Unfortunately, interim guidance released by the SBA concerning EIDL and PPP prompted the ADA to send out an Action Alert.

This latest SBA guidance appears to indicate that small businesses will now be ineligible to apply for a PPP loan if they received EIDL dollars after April 3, 2020.  Many small businesses that have applied for the EIDL were under the impression that they could also apply for PPP loans in the future if they chose to do so.  All of the guidance from the various Congressional committees and other sources have stated that a small business can apply for both, with no deadline beyond the covered period in the legislation. The guidance also seems to contradict legislative language from the CARES Act. Further, the SBA has been accepting the EIDL applications with no caveat that it might make someone ineligible for PPP. 
 
The AAPD also sent the ADA Action Alert to our Grass Roots Network yesterday urging a response. 

THERE IS GOOD NEWS TO REPORT THIS MORNING FROM THE ADA:

Thank you for your interest in sending a grassroots alert on this issue. Due to the overwhelming response from ADA members across the country, SBA reached out this morning to inform the ADA that they will be clarifying the rule. Until we receive that clarification, we will be holding off on sending any additional communications to regulators and legislators. Thank you again for being an advocate!

~ The ADA Grassroots Team 

If you have any questions contact COO and General Counsel C. Scott Litch at 312-337-2169 ext. 29 or slitch@aapd.org.

New PEDO Teeth Talk Episodes regarding COVID-19 are now available.

Leadership, Ethics and Managing through a Crisis that we Never Imagined Would Happen
This inspiring and informative podcast with Professor Timothy Feddersen of the Kellogg School of Management guides us through the steps for right actions in managing the pandemic.  You will learn protocols for managing today, as well as planning for the future, with empathy and “lean out” leadership.
 
One Pediatric Dentist’s Observations and Actions to date in early response to COVID-19
In this interview with Dr. Ron Hsu of Vancouver, WA, you will hear how one practitioner respondedin a location hit early and hard by the COVID-19 crisis. With experience in DSOs and private practice, Dr. Hsu discusses his strategic actions throughout the crisis, from the beginning until today.

Subscribe to Pedo Teeth Talk so you don’t miss any COVID-19 specific episodes being released. Listen on aapd.org.
 
Dentist Volunteer Opportunities During Pandemic
The Emergency System for Advance Registration of Volunteer Health Professionals (ESAR-VHP) is a federal program created to support states and territories in establishing standardized volunteer registration programs for public health emergencies. As a pediatric dentist, your time and expertise could be invaluable. To volunteer, you can register online with ESAR-VHP and be ready to serve. Since volunteer registration differs from state to state, visit this site here and click on your state of residence.
 
SBA PPP Loan Program Opens Today
See our update from earlier this week on April 1, 2020 and the PEDO Teeth Talk Podcast Episode featuring Mike Graham, the ADA’s Senior Vice President for Government and Public Affairs, as he quickly and simply breaks down the meaning of the CARES Act for dentists and their practices.  He explains the different loans/grants and the timing for application, what may come next, and clarifies some of the confusion regarding the meaning of the CARES Act. Mike is connected to the pulse of activity in Congress regarding this package and conversations regarding future possible funding. Listen here.

• The American Dental Association (ADA) issued a new interim recommendation that dentists limit their practices only to urgent and emergency procedures until April 30, in keeping with the recent recommendations from the U.S. Centers for Disease Control and Prevention. Learn more here.

  ADA New Interim Guidelines for Minimizing Risk of COVID-19 Transmission

  CDC Guidelines

  According to the statement, “The ADA recognizes that existing and future local or state government mandates supersede ADA recommendations. In addition, state dental associations may best understand local challenges being faced and make recommendations appropriate to members in their areas.”

  ADA’s interactive state-by-state map with regulations, recommendations and mandates regarding the safe practice of dentistry during the COVID-19 pandemic and number of cases in each state.

  The recommendations encourage individual dentists to “exercise professional judgment and carefully consider the risks outlined in the ADA’s interim guidance and weigh those risks against any possible benefit to the patient, the practice employees, the community at large, and the practitioner.” The recommendations also emphasize the high risk of transmission for dentists, staff and patients due to the proximity of individuals during dental procedures, and the critical importance of the availability of appropriate personal protective equipment (PPE) during emergency and urgent care.

•  

In keeping with our attempts to apprise our membership of important changes and clarifications in the midst of the COVID-19 pandemic, we want to provide the latest from the CDC. Our previous communications have tried to advise members to look to reliable sources for information and advice. The CDC continues to represent the best information, derived from national and international surveillance and analysis by our country’s best epidemiologists and dental analysts. 

Also in keeping with the AAPD’s position, we encourage members to seek current information from local and state authorities that may more directly affect efforts in your location. Because of the changing nature of this pandemic and strategies to address it, regular scrutiny of reliable resources will be the best way to provide for patients, insure their safety and protect you and your staff.

The Centers for Disease Control and Prevention (CDC) released Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response on March 26, 2020. These guidelines offer worthwhile direction to pediatric dentists nationwide and may serve to influence state-level decisions regarding the safe practice of dentistry during the pandemic.

Recommendations Summary

Postpone Elective Procedures, Surgeries, and Non-urgent Dental Visits.
Services should be limited to urgent and emergency visits only during this period of the pandemic. 

Stay at Home if Sick.
Ask employees to stay home if they have symptoms of respiratory infection and send staff home if they develop symptoms while at work.

Contact Patients Prior to Clinically Urgent/Emergency Dental Treatment.
Call all patients before their scheduled appointments and screen for symptoms of respiratory illness over the phone. If the patient reports signs or symptoms of fever or respiratory illness, dental and medical providers should work together to determine the appropriate facility for emergency treatment.

Know Actions to Take if a Patient Has Suspected/Confirmed COVID-19.
Clean and disinfect the room and equipment according to the Guidelines for Infection Control in Dental Health-Care Settings. Clean, disinfect, or discard the surface, supplies, or equipment located within 6 feet of symptomatic patients, and use EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program from use against SARS-CoV-2. 

The AAPD urges its members to review the newly posted guidelines in their entirety, found here. 

Additional information from the AAPD on Infection Control can be found here.  

As AAPD Chief Policy Officer, I wanted to touch on two areas of particular importance for our pediatric dental practices: Treating emergencies, as well as managing hospital and office-based general anesthesia cases. Both require triage and possible re-prioritization in this time of limited access and potential infectivity.

1.  Emergency care of patients. Pediatric dentists around the country have taken different approaches to the management of dental emergencies in children. An algorithmic approach to determining medical and dental emergencies is one proposed by Meyer et al and may be helpful to pediatric dentists seeking to provide humane care in this time of crisis, yet minimize possible exposures to the COVID-19 virus. Click here to view the article.
   
   We suggest that each practice determine the best approach to emergency management and take into consideration the needs of children, the health and safety of staff, their own safety and that of loved ones. No one size fits all. In addition, local and state health authorities may provide guidance for management and/or referral, and members are encouraged to check those sources for advice.  
   
   
2. General anesthesia cases. Hospitals across the country are looking at elective surgeries and encouraging or mandating providers to triage those cases so that operating room resources are not stressed and OR personnel are not unnecessarily exposed to COVID-19. Pediatric dentists are encouraged to review pending cases to determine if children can be delayed access to the operating room until this crisis abates. Clearly, children in pain, with acute facial swelling, or with significant traumatic injury may require treatment under general anesthesia. Again, the decision to provide care is dependent on patient need, local restrictions and available alternative care approaches, such as antibiotics and pain medication.

We will continue to keep you apprised of new updates as they arise.
 
Dr. Paul S. Casamassimo, Chief Policy Officer

Since yesterday’s AAPD statement (3-16-20), the ADA has recommended that dentists postpone elective procedures for the next three weeks. A number of states have strongly recommended that dentists postpone non-emergency care as well. These ADA and state recommendations are consistent with AAPD’s statement of March 16. Children in need of urgent/emergency care should be treated, while elective care can be postponed. Urgent/emergency care means treatment of pain, swelling, trauma, and infection. Hygiene and prophylaxis visits, cosmetic, and elective operative procedures should be considered non-urgent/non-emergency.

Dr. Kevin J. Donly, President 
Dr. Paul S. Casamassimo, Chief Policy Officer

The landscape continues to change as the pandemic continues and we learn more about it—and are challenged to understand transmission and translate knowledge into mitigation strategies.

At present, neither the Centers for Disease Control and Prevention (CDC) nor the ADA have made a recommendation that all dental practices be closed. That would entail a significant impact on access to care.

Pediatric dentists are on the front lines of oral health and will continue to be challenged to address significant oral infection that can’t wait and to care for patients with significant medical issues making them at risk and fragile. While certainly some dental visits and treatments can be safely postponed as discussed below, being a “dental home” for families means being available when urgent or emergency dental care is required. We will all be similarly challenged to make decisions without a playbook or experience. Our training, compassion, and experience in infection control will guide us when the path isn’t clear.

The AAPD has taken the position of “Be advised and be wise,” which means follow and adhere to the recommendations of government and recognized professional bodies affecting your particular circumstances and locale. Until we learn more about this disease, there is no “one size fits all” approach, nor can we reliably predict the effectiveness of every mitigation effort. The AAPD is continuously reviewing all up-to-date recommendations of the CDC and the ADA. 

States, cities and local health departments have instituted a variety of steps to control the infection, based on their rates of infection, population demographics, and other factors. The cascade of recommendations continue and will likely ratchet down the likelihood of exposure to and infection by the virus. If you follow national media coverage, you know that even our best experts are learning on the job, and so we will likely continue to see modifications made in advice and directives as time passes.

Many states have already recommended or mandated that dentists confine their care to urgent and emergent situations and established what are considered non-essential or elective services. It is important that members follow the recommendations pertinent to their locale and situation, and keep apprised of changes in those recommendations.

The following are some suggestions that have emerged relative to dental practice which may or may not be applicable to your situation, but may help in the absence of definitive and proven directives. Again, please look to your state government public health system and state professional organizations for advice and recognize that as we learn more about transmission, some of these suggestions may not apply.

1. Consider whether a dental visit is necessary for any particular child, if your local authorities have not already done so, and manage accordingly. (See below one state’s list for dentistry in general.)
2. Make a determination for your own approach to seeing urgent and emergent patient needs such as pain, swelling or trauma.
3. Always use universal precautions.
4. Address your environment by removing toys, reading materials, and prizes. Thoroughly and frequently clean items that can be cleaned.
5. Clean common areas frequently, including furniture.
6. Try to reduce exposure by having patients wait in their cars until ready to be seen. Text or call them when ready. Ask  them to sanitize hands upon entry.
7. Take temperatures of children, exclude patients/parents with symptoms or known contact with COVID-19 exposed patients, and identify travel history of families. These steps can be taken at home before the family travels to your office.
8. Institute “telephone triage” when families call about dental issues or are reminded of impending appointments to determine if the visit is necessary. Consider selfies for oral conditions as a first level of triage.
9. Limit family members attending visits; minimize hand contact and unnecessary touching.
10. Review office policies related to staff members who become ill. Staff with respiratory illness or symptoms should remain home; consider temperature-taking before patient care begins.
11. Consider leave time for staff members with a medically compromising condition.
12. Try to minimize aerosol effects using rubber dam and high speed suction, consider oral rinsing prior to treatment, and disinfect surfaces.

Be advised that the above are suggestions that may be beneficial, but may not be possible, nor apply to your personal circumstances.

Dr. Kevin J. Donly, President

Dr. Paul S. Casamassimo, Chief Policy Officer

American Academy of Pediatric Dentistry

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Note that the Ohio State Dental Board just recently (03-16-20) suggested that the following are non-essential or elective procedures for patients in general dental care and these suggest a template for modification to pediatric dental practice:

•  Any cosmetic or aesthetic procedures, such as veneers, teeth bleaching, or cosmetic bonding
•  All routine hygiene appointments
•  Any orthodontic procedures not including those that relieve pain and infection or restore oral function or are trauma-related
•  Initiation of any crowns, bridges, or dentures that do not address or prevent pain or restore normal oral functioning
• Any periodontal plastic surgery
• Extraction of asymptomatic non-carious teeth
• Recall visits for periodontally healthy patients
• Delay all appointments for high risk patients, including ASA 2 and 3 patients, unless it is an emergency

Information on the COVID-19/Coronavirus changes almost daily and the American Academy of Pediatric Dentistry urges its members to keep current on the evolving science and best practices to protect themselves and the families they care for. The fast spread of this illness and the world’s inexperience with it make staying current even more important:

1. Keep abreast of changes in understanding and addressing the virus. This means following the course of the virus every day. Government and professional health organizations provide the most up-to-date and accurate information. Some sites you may find useful are:
   • Centers for Disease Control and Prevention (CDC)
   • American Dental Association
   • American Academy of Pediatrics
   • U.S. Department of Education
2.  Avoid claims and information from non-mainstream and non-reliable or unverified sources which may provide erroneous and even dangerous advice or recommendations. 
3. Evaluate the need for precautions and changes in your personal behavior based on sound information. Work, travel, meeting attendance, and other potential sources of exposure are usually addressed in guidance by reliable sources. AAPD will advise its members of changes and precautions related to meetings and other events, based on sound science and best practices in advance. We are looking to the CDC and WHO to provide recommendations on travel. At this time, there are no bans or suggestions not to travel within the U.S. Learn more here.
4. Practice-related precautions should follow the advice of recognized authorities. Members should keep abreast of recommendations at the local, state, and national level that relate directly to their individual circumstances. State and county health departments are good sources of information relative to local circumstances.
5. This virus has demonstrated the need for personal responsibility in controlling its spread. This means attention to your own risk status, current health, and the health of your family. This is especially important for those who are at greater risk of infection, such as the elderly and those with weakened immune systems. Taking recommended steps to minimize spread of infection while ensuring that you seek and receive the appropriate care is the best advice. Your personal physician and local health authorities remain the best sources of information should you have questions about or require care for suspected infection.

AAPD will closely monitor information as it emerges and when necessary, advise members of changes and recommendations that will protect them, their families and their patients, and help them plan for future events.

The U.S. Department of Health and Human Services (HHS), through the Health Resources and Services Administration (HRSA), announced $20 billion in new funding for providers on the frontlines of the coronavirus pandemic on October 6, 2020. Under this Phase 3 General Distribution allocation, providers who have already received Provider Relief Fund payments may apply for additional funding that considers financial losses and changes in operating expenses caused by the coronavirus. Previously ineligible providers, such as those who began practicing January 1 – March 30, 2020, are also invited to apply here. 

Along with the newly eligible providers, all providers who previously received, rejected or accepted a General Distribution Provider Relief Fund payment may submit more information to become eligible for an additional payment. This additional “equitable add-on payment” is based on a provider’s change in operating expenses from patient care, including expenses incurred related to coronavirus, as well as payments already received through prior Provider Relief Fund distributions. Even if a provider received the full two percent payment, this new phase allows for an additional payment if the practice experienced a decrease in operating income attributable to COVID-19. In addition, providers who believe they did not receive the full payment based on two percent of patient revenue will have the opportunity to submit additional information. These providers will receive this amount consistent with prior general distributions, plus a Phase 3 allocation. 

According to HHS, this new payment’s actual percentage depends in part on how many providers apply in Phase 3, and will be determined after the application deadline. This applies to all dental providers who believe they received incorrect payments. 

Providers will have until November 6, 2020 to apply for Phase 3 General Distribution funding. The HHS is urging all eligible providers to apply early; this last $20 billion in the fund will be distributed on a first-come, first-serve basis. Applying early will help to expedite the distribution of payments. Please note that providers need to submit a new application, even if they previously submitted for a prior distribution. The updated application requests additional data to calculate payment based on financial impact of COVID-19.

To learn more about the Phase 3 General Distribution Provider Relief Program, please visit here. 

 The website offers a Factsheet , Presentation, and Phase 3 FAQs.

The ADA also provides FAQs about the funds here.

When you are ready to apply, login here.

You have your finger on the pulse of your own practice, but how are your colleagues faring – within your own state as well as across the country? The AAPD Pediatric Oral Health Research and Policy Center is proud to offer Re-emergence: A Report on Pediatric Dental Practice Re-entry into Practice During the COVID-19 Pandemic. This visually appealing report is based on a survey to members of the AAPD Public Policy Advocate Initiative during the first wave of the COVID-19 pandemic. Intended to assess the pandemic’s impact on pediatric dental care, the survey honed in on significant questions of the moment to inform us on what we can expect looking forward. Click here to read.

 

Dentists who received payments from HRSA’s Provider Relief Fund between January 1, 20212 to June 30, 2021 have just over a month left to put them to use on expenses incurred due to the COVID-19 pandemic. If you’re wondering where the funds can be used, visit the Allowable Expenses fact sheet on the HRSA website. Directions for PRF fund reporting and auditing can also be found here - and for an up-to-date FAQ on PRF reporting, visit Reporting and Auditing Frequently Asked Questions.