AUSTIN — Just hours before Texas dentists could resume providing nonemergency care, the state dental board late Thursday required that advanced surgical masks be worn within six feet of patients to capture “aerosols” that might carry the novel coronavirus.
However, the licensing board ignored a dental hygienist group’s plea that routine visits be delayed further, until at least May 18.
After prodding from Gov. Greg Abbott, the State Board of Dental Examiners hastily approved a revised emergency rule that, starting at 12:01 a.m. Friday, allows dental offices to resume elective procedures and surgeries and non-urgent care.
That assumes Abbott’s office signed off on the final version. It could not be determined late Thursday if that would happen.
The rewritten rule continues to go against the federal Centers on Disease Control and Prevention’s recommendation that because dental care is risky in the age of COVID-19, all nonemergency procedures and surgeries should be postponed indefinitely.
That conflicts with many dentists’ desire to reopen their practices, which have suffered financially during the virus outbreak. On Monday, Abbott said dentists “need” to get back to work.
On masks, Abbott’s office directed the board — and it agreed — to grant a concession sought by dental hygienists. Many hygienists say they fear for their safety after dental offices reopen.
The board bolstered the quality of personal protective equipment that offices must supply during procedures in which drills, electric brushes, scalers and suction devices can spew patients’ saliva, mucus and blood into the air.
The dental health care provider “shall implement Transmission-Based Precautions, including N-95 respirator masks, KN-95 masks, or their substantial equivalent for all [personnel] who will be within six (6) feet of any and all procedures likely to involve aerosols,” the revised rule says.
KN-95 masks are N-95 masks that are made in China. The National Institute for Occupational Safety and Health lists the types of masks that are their “substantial equivalents” on its website, said board member Lois Palermo, a dental hygienist from League City.
On Wednesday, she had pleaded unsuccessfully for the board to require Level 3 masks during “aerosol-producing procedures.”
Level 3 masks provide the maximum level of fluid resistance. COVID-19 is believed to spread primarily through respiratory droplets floating through the air.
In another change ordered by Abbott, the board scrapped what it had envisioned as a “guidance” document and turned it into a highly detailed emergency regulation.
For instance, a statement that dental offices “should” create COVID-19 procedures and train their personnel about them became a requirement. In three other places, the phrase “if possible” disappeared, replaced with a command.
“I appreciate the governor’s office for their direction,” said board member Robert G. McNeill, an oral and maxillofacial surgeon from Dallas. “This is an appropriate balance of caring for the patients and protection of the office staff.”
Among other things, the rule would require regular hand-washing, wearing of personal protective equipment, spacing of appointments to reduce patient contact in waiting rooms and the taking of employees’ temperatures twice a day.
“We are very pleased to see the governor’s office thought it was prudent to have specific PPE temporarily required through this pandemic,” Janessa Bock of Sugar Land, president-elect of the Texas Dental Hygienists’ Association, said of the more stringent mask requirement.
“However, we are seeking some clarification as to some language that was changed from [what] the governor’s office” had recommended earlier Thursday, she said.
The hygienists’ group had sought a further postponement of “hygiene” care, such as the evaluations, X-rays, cleanings and fluoride treatments that her members provide, Bock explained.
The board’s revised rule included a provision, which Bock said was “rushed through” by the dentist-dominated board, that temporarily bans the use of high-speed rotary equipment during routine care. The provision says a dental health care provider “shall use only hand instruments and low speed tools for hygiene services and procedures.”
Because the coronavirus can linger in the air for hours, many hygienists think only staggered appointments and renovation of workplaces — to install new ventilation systems and get rid of open bays — will keep them safe.