May 26, 2020

 

Dear Governor Sisolak and Director Whitley:

 

Thank you for your continued commitment to the health of all Nevadans and for the time your Administration has dedicated to protecting our communities. I appreciate your commitment to guide Nevada through these unprecedented times.  As a hygienist and front-line healthcare provider in Nevada, I prioritize the safety and well-being of my patients and our dental teams.

 

As of Monday May 22nd, Nevada is one of forty-two states that will resume non-emergency dental care.  As a Nevada hygienist, I’d like to share that the opinions of the Nevada Dental Hygiene Association (NDHA) who represent merely 11% of all Nevada Dental Hygienists are not reflective of the majority of the hygiene profession in Nevada. We are committed to serving the millions of Nevada residents in order to maintain their oral health.

 

Regarding the following:

 

o   Safety for the public and dental team: The ADA has met with scientists, epidemiologists, and nationally recognized experts in every field. After doing so, the Association made the difficult decision to recommend that dentists refrain from elective procedures. The decision was made in order to: conserve PPE, reduce the number of patients going to emergency rooms; and mitigate the spread of SARS-CoV-2, the virus responsible for COVID-19. The ADA's recommendation to postpone all but urgent/emergency procedures ended on April 30, 2020, and was not renewed. Currently, the ADA advises dentists to follow state and local mandates.

 

For the forty-two states that have or are in the process of reopening, the ADA's Return to Work Interim Guidance Toolkit is a science-based resource for dentists. These toolkits which have been released by the American Dental Association and the American Dental Hygiene Association illustrate the importance of oral health and ensure the safety of our patients and our dental teams.  It has been reported that the ADA toolkit has been downloaded over 100,000 times by dental health care professionals with comprehensive, evolving science-based resources that have helped guide the profession of dentistry. The recommendations have provided guidance on a new set of precautions dentists are taking to ensure their patients and their dental teams are safe while receiving dental care for active diseases that exist in patient’s mouths. 

 

While we recognize, that each individual is different, we respect the fact that some hygienists and dental health care professionals may choose not to return to the profession at this time or in the future.  We believe that is a choice for each individual, not the Nevada Dental Hygiene Association and its leadership who represent approximately 11% of Nevada Hygienists.

 

o   Availability of Personal Protective Equipment (PPE): We feel confident that our doctors have taken steps to ensure our safety and the safety of our patients by providing the highest level of PPE. As our profession has always done, we use universal precautions and treat every patient as if they have an infectious disease.  COVID-19 is no different. Providing PPE recommendations for every dental code/procedure is simply demeaning and unnecessary to the protocols and precautions we take each day to ensure the safety of our patients and our teams prior to the existence of COVID-19. The ADA has already provided the profession with  Interim Mask and Face Shield Guidelines and the American Dental Hygienists’ Association (ADHA) has already provided Frequently Asked Questions to Return to Work. I feel that the PPE that has been provided enables me to treat patients with active oral disease safely rather than neglect and abandon their oral health needs. I also trust that the Board of Dental Examiner’s will continue to protect the public and ensure the proper infection control practices are being adhered to in dental health facilities.

 

While we recognize PPE may be difficult to procure at this time, we understand that there is an increase in production of legitimate sources of PPE.  We commend the ADA for providing Tips to Identify Counterfeit Masks in order to ensure our safety and that of our patients. We are also grateful that we are able to disinfect N95 masks while we await the increase supply and are appreciative for the Battelle CCDS Critical Care Decontamination System that has been offered to the profession of dentistry in Nevada. Additionally, less PPE is being utilized by the profession daily in order to meet the social distancing mandate in Nevada.

 

o   CDC Recommendations: Contrary to the NDHA letter to the Governor and Department of Health and Human Services on May 19th, the CDC had updated it’s Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings on May 18th and the “The prior recommendation that all elective procedures be postponed has been removed and key considerations for performing non-COVID-19 clinical care during the COVID-19 pandemic, including potential for patient harm if care is deferred and level of community transmission, are summarized in the Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic”

 

As you know, forty-two other states, like Nevada, continue to care for the oral health needs of our community.  Oral health is the foundation to overall systemic health.  Systemic diseases are often found based upon changes in the oral cavity.   Periodontitis is a chronic bacterial infection of the dental supporting structures: teeth, gums, and bone.   Researchers have found positive associations between periodontitis and lung disease, heart disease, diabetes, hypertension, and obesity.   These are the top five underlying health conditions that are found in patients dying from COVID-19.  Treatment of periodontal disease and routine dental cleanings by hygienists is critical to long-term dental and systemic health.   Patients with active periodontitis need our expertise to maintain their oral health but also to decrease their inflammatory markers which contribute to the diseases mentioned above. For those of us who have all the proper personal protective equipment and who are ready to work, we should be allowed to continue to fight oral disease. We provide critical care that contributes to the overall health and wellness of our patients. In instances where there is a discrepancy in the protocols, we support and encourage a dialogue between the doctor and the dental team rather than inflammatory conversations or opportunities to slander the profession in the public forums, a common practice of NDHA.

 

During this first phase, Nevada is taking a conservative approach to allow patients that are on the verge of a dental health crisis to receive care while avoiding unnecessary risk.  By allowing patients to receive essential services such as fillings, crowns and cleanings, Nevadans will save thousands of dollars by preventing the need for more invasive, expensive treatment in the future. With Nevada unemployment reaching unprecedented numbers, Nevadans cannot afford to neglect procedures that would otherwise have an affordable treatment option.

 

We are requesting that you acknowledge that their voice, although loud and persistent, does not represent the sentiments of myself and most hygienists in Nevada. Thank you for recognizing the importance of oral health, for allowing us to continue to treat our patients rather than abandon them and for supporting oral health leadership at the state level to advocate for our patients and our profession.

 

As a final note, contrary to the NDHA claims, this statement has not been coerced and my job has not been threatened by my employer dentist as a result of my statements.  It’s shameful that the bullying that the NDHA leadership speaks of by dentists is actually the tactic utilized by the NDHA in order to disseminate false information and scare tactics among legislators and patients.

 

Sincerely,

 

 

Adrien Little R.D.H.

 

Cc: Nevada State Board of Dental Examiners

Dr. Ihsan Azzam

Dr. Antonina Capurro

Nevada Dental Hygiene Association