The National Association of Dental Laboratories released the following statement on March 20:
The National Association of Dental Laboratories is keenly aware of the business challenges and confusion that our members are facing relative to the COVID-19 pandemic.
NADL has created an ever-growing list of focused resource links to help members with questions on a variety of issues. NADL is working as carefully as possible to only post resource links from validated sources.
NADL continues to post new information primarily on its NADL Facebook Page and What's In Your Mouth Facebook Page, as those mediums facilitate faster distribution across various audiences. If you have not liked these pages or are not a follower of these Facebook pages, please do so, as NADL can post the most up-to-date information more frequently on those communication mediums. NADL has been posting updates on Facebook sometimes 4-5 times a day.
NADL's Board of Directors has discussed the COVID-19 pandemic on a recent conference call, and NADL staff is in frequent communication with the NADL Executive Committee Officers within the Board. NADL staff is in communication daily with the American Dental Association and is also in communication with various federal government agencies.
NADL as an association, recognizes that dental laboratory owners, managers, and technicians are extremely concerned with what has already occurred in our profession as a result of the COVID-19 pandemic. These concerns are primarily focused on infection control (for work that may be coming in, although cases are certainly declining daily) based on Executive Orders of State Governors or State Boards of Dentistry.
The other primary areas of focus are on the impact of lack of work on operating revenue for the business and resulting paths that owners are facing relative to short and long term human resource decisions on layoffs, furloughs, reductions in pay, and reduction in working hours.
More and more state governors are passing executive orders for hospitals, ambulatory surgery centers, and dental offices on restrictions of care. These actions are twofold: 1) to mitigate what is expected to be a shortage in the supply chains of personal protective equipment and 2) to facilitate social distancing. The executive orders also vary in length with some states extending these requirements into June 2020. These orders and the duration of these orders can be reduced or extended based on conditions in a specific state.
To help dental laboratories understand how most states are addressing dental office requirement, the following list illustrates what dentists are allowed to perform. Again, each state may modify this general list based on conditions, and the number of cases in their state. For the most up-to-date information on dental office requirements in a specific state, visit the website of the State Board of Dentistry or state dental association in your state.
The following is a statement from the American Dental Association.
Dental emergencies, according to the ADA, “are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding [or to] alleviate severe pain or infection.” Conditions include uncontrolled bleeding; cellulitis or a diffuse soft tissue bacterial infection with intraoral or extraoral swelling that potentially compromises the patient’s airway; or trauma involving facial bones that potentially compromises the patient’s airway.
“The guidance may change as the COVID-19 pandemic progresses,” according to the Association. “Dentists should use their professional judgment in determining a patient’s need for urgent or emergency care.”
As part of the emergency guidance, the Association added urgent dental care which “focuses on the management of conditions that require immediate attention to relieve sever pain and/or risk of infection and to alleviate the burden on hospital emergency departments.”
Examples of urgent dental care treatments, which should be treated as minimally invasively as possible, include:
• Severe dental pain from pulpal inflammation.
• Pericoronitis or third-molar pain.
• Surgical postoperative osteitis or dry socket dressing changes.
• Abscess or localized bacterial infection resulting in localized pain and swelling.
• Tooth fracture resulting in pain or causing soft tissue trauma.
• Dental trauma with avulsion/luxation.
• Dental treatment cementation if the temporary restoration is lost, broken or causing gingival irritation.
Other emergency dental care includes extensive caries or defective restorations causing pain; suture removal; denture adjustments on radiation/oncology patients; denture adjustments or repairs when function impeded; replacing temporary filling on endo access openings in patients experiencing pain; and snipping or adjustments of an orthodontic wire or appliances piercing or ulcerating the oral mucosa.
“The American Dental Association recognizes the unprecedented and extraordinary circumstances dentists and all health care professionals face related to growing concern about COVID-19,” according to the March 16 statement from ADA President Chad P. Gehani. “Concentrating on emergency dental care will allow us to care for our emergency patients and alleviate the burden that dental emergencies would place on hospital emergency departments.”
Nonemergency dental procedures, according to the Association, include but are not limited to:
• Initial or periodic oral examinations and recall visits, including routine radiographs.
• Routine dental cleaning and other preventive therapies.
• Orthodontic procedures other than those to address acute issues (e.g., pain, infection, trauma).
• Extraction of asymptomatic teeth.
• Restorative dentistry including treatment of asymptomatic carious lesions.
• Aesthetic dental procedures.
NADL is submitting a letter to the U.S. Department of Labor advocating for clarity on how businesses, including dental laboratories under 50 employees, can demonstrate that meeting current federal laws on "paid leave" and "FMLA" can result in actual closure/shutting of the doors of some businesses.
NADL staff is on the phone in some cases over ten hours a day, working with individual dental laboratories to help direct them to appropriate outside legal, human resource, and tax service providers that can assist them in their specific situation. Each scenario is different given the size of the dental laboratory, demographics of that laboratory's workforce, and geographic location (based on local or state guidance or mandates).
NADL is working diligently to assist as many people as it can in a quickly changing economic and regulatory environment. Please continue to visit NADL's news page on https://www.nadl.org and its social media platforms for the most up to date information.
These resources are categorized by subject matter.
General Business Links
https://www.insperity.com/blog/covid-19-pandemic/
From NADL’s Business Services Affinity Partner
https://www.insperity.com/blog/3-steps-dealing-workplace-tension-caused-current-events/
From NADL’s Business Services Affinity Partner
https://www.insperity.com/blog/motivating-employees-in-uncertain-times/
From NADL’s Business Services Affinity Partner
From NADL’s Outside Law Firm
From NADL’s Outside Law Firm
https://www.covid19.polsinelli.com/
From NADL’s Outside Law Firm
State by State Summary of Board of Dentistry Actions on Practice Closures and Procedures
https://www.nnoha.org/download/covid-19-coronavirus-resources/
American Dental Association Guidance on COVID-19
https://success.ada.org/en/practice-management/patients/coronavirus-frequently-asked-questions
Business Links Related to Wage and Hour; Disaster Relief Programs
https://disasterloan.sba.gov/ela/Declarations/Index - The U.S. Small Business Administration is offering designated states and territories low-interest federal disaster loans for working capital to small businesses suffering substantial economic injury as a result of the Coronavirus (COVID-19). Upon a request received from a state’s or territory’s Governor, SBA will issue under its own authority, as provided by the Coronavirus Preparedness and Response Supplemental Appropriations Act that was recently signed by the President, an Economic Injury Disaster Loan declaration.
https://www.sba.gov/local-assistance/find/?type=SBA%20Regional%20Office&pageNumber=1
Contact List of Regional SBA Offices
https://www.sba.gov/local-assistance/find/?type=SBA%20District%20Office&pageNumber=1
Contact List of District SBA Offices
Some states may offer state business loan assistance outside of the SBA national program. To determine if your state has such resources, look for local programs at:
https://www.economicdevelopmenthq.com/economic-development-agencies/united-states/
https://www.ready.gov/business-impact-analysis
https://www.ready.gov/pandemic
https://www.dol.gov/agencies/whd/fact-sheets/70-flsa-furloughs
Wage and Hour Guidance
Employee Pay and the Coronavirus
From NADL’s Outside HR Firm
Business Guidance on COVID-19 from OSHA and CDC (including infection control)
https://www.cdc.gov/coronavirus/2019-ncov/about/index.html
https://www.osha.gov/Publications/OSHA3990.pdf
https://dentallabs.org/managing-the-coronavirus-in-a-dental-lab-or-dental-practice-setting/
State and Local COVID-19 Response Information
Footnote:
Many NADL members have had questions on “non-essential vs. essential businesses”. To NADL’s knowledge there is no federal guidance, definition or checklist that has been established to define how dental laboratories are classified. These classifications are being left to states or local (counties and cities) to make those determinations. NADL members should sign up for alerts from their state and local government entities to get the most real time local information on this subject.
Many NADL members have had questions on ADA’s role with dental practices. ADA is a nonprofit organization just like NADL. ADA is a not a government agency, it has no authority to mandate its members to do anything as it relates to guidance. It can only provide recommendations.
Only government entities, at the federal, state or local level, including State Boards of Dentistry can put forth mandates that direct dental offices relative to full or partial closure, providing only urgent or emergency care, etc.
Dental laboratories are faced with making tough decisions relative to business continuity, considering layoffs, furloughs, reduction in pay for employees. Each situation is case specific and dental laboratory owners/managers should consult with outside Human Resource professionals if you do not have an inside/in house Human Resource department or personnel. These types of significant decisions should be measured for both short and long term implications.
NADL will continue to update this document with additional resources as we are able to. Have an additional resource that would be helpful to include or have additional questions? Please contact NADL by phone at (800) 950-1150 or by email at nadl@nadl.org.
