This page is intended to be a resource for dentists and their staff regarding COVID-19 (coronavirus). We are committed to keeping our community of dental healthcare professionals abreast of the evolving pandemic and will update this page as the situation changes and will continue adding information as it comes to us. We are not responsible for the content on sites linked from this page, but we hope they will serve as additional resources to you during this challenging time. The COVID-19 situation continues to change rapidly, so while we are doing our best to keep this page accurate, all information is subject to change.
- NEW for 2021 Vaccine Resources
- COVID-19 FAQs
- General Resource Links
- Our Resources (Consent Forms, Re-opening Practice Guide, etc.)
- Financial Resources
- COVID-19 Webinars
- CDC website
- ProAssurance website
- OSHA Guidance
- California Guidance for Resuming Deferred and Preventive Dental Care
- COVID-19 Sterilizers, Disinfectants, Purifiers Guidance
- Understanding the Difference: Surgical Mask/N95 Respirator
- ADA Diagnostic Testing Options for COVID-19
- Updated CDC Guidelines On Airborne Transmission
- Submit General COVID-19 Questions and Concerns
- Download Sample Teledentistry Consent Form
- Download Sample Letter to Patients
- Sample COVID-19 Request for Treatment Representations and Consent Form
- COVID-19 Reopening Practice PDF
- Economic Injury Disaster loans
- Paycheck Protection Program
- CARES Act: Tax
- CARES Act: Helping Small Business
- FAQ: Coronavirus Legislation
- Coronavirus (COVID-19): Small Business Guidance & Loan Resources
- Coronavirus Tax Relief
- Let's Get Back to Work: Suggestions for Reopening Your Office
- Strings Attached: What Doctors Need to Know About the CARES Act Provider Relief Fund
In general, teledentistry services can be covered under a DentistCare policy. Our policy mandates appropriate state licensure and adherence to scope of practice, state and federal laws for their specialty, as well as any teledentistry laws or regulation. Additionally, we recommend dentists do the following:
- Consider your practice and patient mix to decide what services can be provided via teledentistry technology
- Any interaction using teledentistry technology be appropriately documented in the patient’s record
- Use of appropriate informed consent for teledentistry services
It is a good idea to limit teledentistry to only established patients. If you are planning on seeing new patients, starting a new business, or providing wound care, please call your agent. You do not need to notify us if it's in the case of an expansion of services for existing patients.
Coverage and Premiums
We recognize this is a difficult time for dentists, so we are suspending cancelations due to non-payment through June 30, 2020. If you are able to make your regular premium payment on schedule, we will accept payments as planned.
Additionally, we will remain in compliance with the Departments of Insurance (DOI) for individual states which have guidance beginning before or ending after our own grace period. NOTE: Invoice mailing/automated payment plan debits already established will proceed as normal unless there is specific direction from your state’s DOI; this is simply a notice your policy will not be canceled due to non-payment during the grace period.
On March 16, the ADA recommended postponing all elective procedures for at least three weeks. In addition, some state and local health departments have made similar recommendations. It is important for all policyholders to be sure that they are keeping up to date on these recommendations and mandates. An element of coverage on our professional liability policy is that an insured dentist must be acting within the scope of their license.
While we encourage all dentists to comply with ADA recommendations, regardless of whether your physical office has been mandated to be closed or not, your coverage is dependent on performing services which are within your particular state dental practice act’s rules and regulations defining the scope of dentistry, subject to all other policy provision and conditions. It is the responsibility of all individual dentists to be aware of the rules and regulations of the dental practice act for the states in which they operate.
For further guidance from the ADA, see the ADA Statement on Third Party Payer Reimbursement for Temporary Procedures
The decision to treat or NOT treat a patient based upon concerns of COVID-19 spread is one of balancing the harm to the individual patient versus that of others in the office and the community at large. If a patient appointment is cancelled due to circumstances out of the control of the office, like staffing issues due to the virus, it is unlikely to create an issue – even if it is alleged that the condition worsened due to the cancellation. This most likely would not be considered abandonment.
If the office is concerned after questioning and examining a patient (taking their temperature) that the patient is showing signs of the virus or has been exposed, it is perfectly acceptable to cancel or reschedule them unless it is a true acute emergency – in that case, the doctor should utilize universal precautions and limit the patient’s exposure to other patients and unnecessary staff.
Abandonment occurs when you terminate a patient relationship without giving the patient adequate notice or time to locate another practitioner. Therefore, under the unprecedented circumstances we all face right now, a mandate by a state or federal authority to temporarily close your office and limit treatment to emergency care only, is not a termination of the relationship, and there can be no “abandonment.” Moreover, you are to use clinical judgement to determine level of risk. If the patient is high risk, in acute phase of treatment, post-operative, or wounds need to be assessed regularly, you would be able to see them in the office under emergency or essential care.
It is our commitment to remain in compliance with Departments of Insurance (DOI) for individual states which may provide specific guidance on deferring non-renewal underwriting actions.
We are continuing to renew without premium 45 days in advance of the renewal date. If you do not want to renew your policy, please contact your agent.
Here are several ways you can prepare your office for COVID-19, including (but not limited to):
- Hold a staff meeting to educate employees on COVID-19 and what they can do to prepare.
- Prepare to contact patients who may have been exposed in your office. Should it be later disclosed/discovered that a patient infected with COVID-19 was in your office, all patients and others who were in the office the same day should be notified.
- During appointment confirmation calls, ask if the patient, close family members, co-workers, or the person(s) accompanying them to their appointment have any symptoms of acute respiratory illness (e.g., fever, cough, sore throat, recent difficulty breathing), or have recently traveled internationally, especially to currently identified hot zones for the infection.
- If so, cancel the appointment, unless the patient is experiencing an acute emergency. Depending on the patient’s reported flu-like symptoms, it may be advisable to refer them to an emergency room. Strongly advise them to report their symptoms to their healthcare provider, and the local health department.
- If not, instruct the patient that if their respiratory health changes prior to their appointment, please call to cancel and request that they contact their primary care physician for further evaluation.
NOTE: if you handle appointment confirmations via pre-recorded messages, you should also consider updating those recordings to include information regarding COVID-19.
Establish a plan for what to do when you encounter a confirmed or suspected exposure to COVID-19 in your office, including:
- Review all applicable guidance and specific jurisdictional legal mandates. The most conservative mitigation step would be to request exposed staff self-quarantine.
- If you are able, remain open and thoroughly disinfecting the space with alternative staff. If quarantine of staff becomes necessary, consult with appropriate counsel regarding Employment Law issues.
- Review CDC guidance daily to understand the specific facts surrounding the exposure event. There may be other options based on current guidance, subject to state mandates. At a minimum, from a reputational and ethical perspective (notwithstanding state by state legal mandates), notify those exposed to the infected individual.
State and Local Authority
Carefully study or retain local counsel to gain a full understanding of the mandate/order which allowed your office to reopen – it may provide specific guidance on this issue. It may also reveal particular conditions for reopening and remaining open under certain events. Look in particular for advice regarding contact tracing and notification requirements, etc.
Federal and State Agencies
- CDC (as of May 13, 2020 the CDC has not provided industry specific guidance in this area for dental practices)
Consider utilizing a disclosure/consent form to educate your patients about the probability of contracting the virus while visiting the office. For example, see Sample COVID-19 Request for Treatment Representations and Consent Form.
- Patient exposure at your practice: Your professional liability policy may defend and indemnify you against claims by patients who allege they contracted COVID-19 at your office depending on the nature of the allegations. Negligent acts and omissions are generally covered, while liability for intentional conduct is excluded. For example, if a patient contracts COVID-19 at an insured’s office despite an insured’s best efforts to follow current guidelines, such a claim could fall within the coverage of the policy. Alternatively, if an insured continues to treat patients after the insured knows he or a staff member is contagious with the virus, this could lead to a claim of intentional conduct, which is excluded by the policy.
Download and use our Sample COVID-19 Request for Treatment Representations and Consent Form.
Note: We cannot provide a coverage opinion or confirm coverage as to hypothetical claims. Coverage opinions are provided only after analyzing the specific allegations of an actual claim together with the applicable policy. The information here is general in nature and should not be interpreted to mean any given claim or actions by an insured will be covered by our policy. Rather, we will adhere strictly to the provisions of our policy, which is the only statement of our coverage obligations.
- Office staff exposure at your practice: In general, our policies exclude coverage for any claim made by an employee, unless the claim arises from the employee’s status as a patient of the practice.
In regard to patients:
Dentists ALWAYS have a duty to utilize "universal precautions" notwithstanding the current crisis. Universal precautions, standard precautions, and contact precautions should ALWAYS be utilized with all patients – those are the standards to prevent cross contamination. To the extent a dentist is not following current generally accepted guidelines, they may be held liable to a patient or staff member.
Office should already have policies in place to aid in prevention of all respiratory diseases, but if not, the office should immediately put into effect strict respiratory hygiene/cough etiquette guidelines.
More on the CDC website:
- Infection Control Basics
- Isolation Precautions
- Respiratory Hygiene/Cough Etiquette
- Infection Prevention & Control in Dental Settings
In regard to staff:
OSHA’s General Duty Clause, Section 5(a)(1) of the Act, requires an employer to protect its employees against “recognized hazards” to safety or health which may cause serious injury or death. While there is no specific regulation dealing with COVID-19, it is the General Duty Clause which mandates that you must act to protect your employees.
You are obligated under OSHA to develop a written plan to protect your employees from this risk. The plan assessing the “hazard” should include, but is not limited to:
- Training employees with regard to the hazard
- Revisiting the procedures utilized with personal protective equipment (PPE)
- Recording (logging) any illness which are occupationally related
- Documenting all efforts and training on this hazard
More information from OSHA:
Examples of emergency situations:
- Facial trauma involving loss or fracture of a tooth or a facial bone fracture
- A severe infection such as a cellulitis, or other diffuse soft tissue swelling within the oral cavity or extra-orally that has a potential to compromise the patient’s airway
- Uncontrolled bleeding
Examples of urgent care situations:
- Severe and intractable pain from pulpal inflammation, infection or other dental condition
- Third molar pericoronitis
- Post extraction dry-socket
- Localized abscess
- Dental treatment required prior to a critical medical procedure
- In the event a temporary restoration, or crown has been lost, and it needs to be re-cemented/replaced due to pain, potential for infection, or other significant harm to the patient
- Gross carious lesion
- Suture removal
- Denture adjustment when acute pain or irritation (ulceration) is present, especially in those who have had radiation treatment
- Orthodontic wires piercing tissue or ulcerating mucosa
Specific CDC guidance now includes two options – a time-based strategy and a test-based strategy as such:
- Time-based strategy: Persons with laboratory-confirmed COVID-19 who have not hadany symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:
- At least 10 days have passed since the date of their first positive COVID-19 diagnostic test assuming they have not subsequently developed symptoms since their positive test. If they develop symptoms, then the symptom-based or test-based strategy should be used.
Note: because symptoms cannot be used to gauge where these individuals are in the course of their illness, it is possible that the duration of viral shedding could be longer or shorter than 10 days after their first positive test.
- Test-based strategy:A test-based strategy is contingent on the availability of ample testing supplies and laboratory capacity as well as convenient access to testing.
Persons with laboratory-confirmed COVID-19 who have not had any symptoms and were directed to care for themselves at home may discontinue isolation under the following conditions:
- Negative results of an FDA Emergency Use Authorized COVID-19 molecular assay for detection of SARS-CoV-2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens). See Discontinuation of Isolation for Persons with COVID -19 Not in Healthcare Settings and Interim Guidelines for Collecting, Handling, and Testing Clinical Specimens from Persons for Coronavirus Disease 2019 (COVID-19).
Note: because of the absence of symptoms, it is not possible to gauge where these individuals are in the course of their illness. There have been reports of prolonged detection of RNA without direct correlation to viral culture.
Legal Notice and Disclaimer: Please note that the information contained in these resources does not establish a standard of care, nor does it constitute legal advice. The information is for general informational purposes only and is written from a risk management perspective to aid in reducing professional liability exposure. Please review these documents for applicability to your specific practice. You are encouraged to consult with your personal attorney for legal advice, as specific legal requirements may vary from state to state.