Resources for dental professionals

During the COVID-19 pandemic additional guidelines have been designed to keep yourself, your team and your patients safe. These include looking at the whole practice and implementing measures to minimise the risk of spreading COVID-19. In addition to the Guidelines, the levels of restriction on dental practice will change according to the current environmental risk assessment and it's important to understand what each of these levels mean for you and your practice. 

Risk Management Principles for Dentistry

Dental practices will need to consider what they need to do to maintain a safe working environment for staff and patients during the continued COVID-19 pandemic. To support dental practitioners, the ADA’s Infection Control Committee has developed the “Risk Management Principles for Dentistry" as a guideline for managing risk in this new environment. This resource replaces the ADA Restrictions Levels framework.
  Risk Management Principles for Dentistry

Resource outlining how to apply evidence-informed infection control measures within a broader risk-based approach.

  Understanding the new Risk Management Principles for Dentistry Webinar

Webinar that explains and guides you through the new Risk Management Principles for Dentistry.

Critical Information & Resources for Members

  ADA Dental Service Restrictions in COVID-19

A framework outlining the ADA's recommendations in relation to the continuation of dental services.

  ADA Guidelines for Teledentistry

Last updated: 26 October 2021

In an exceptional circumstance where a patient is seeking urgent care from a dentist but is unable to attend a dental clinic in person, it may be necessary to conduct a consultation by audio or through a videoconferencing platform such as Microsoft Teams, Skype, Google Meet or Zoom. Videoconference services are the preferred approach for substituting a face-to-face consultation. Regardless of the application used, practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws.
 
It should be noted that a service may only be provided by teledentistry where it is safe and clinically appropriate to do so. This item number is not intended to be used for offering routine assessments, advice or oral health instructions. It is a patient-led service.
 
Ideally teledentistry services should only be offered to existing patients or those referred by another practice.
 
The appropriate item number to use from the Australian Schedule of Dental Services and Glossary is:

919 Teleconsultation

The remote provision of a consultation to a patient in exceptional circumstances which prevent face to face consultation. It may include the provision of oral health or treatment information and referral.


The item number may be used with other relevant item numbers, e.g. 019 Letter of referral.

What steps should I take in conducting a teleconsultation appointment?

• Patient suitability for teleconsultation should first be assessed (see: “Which patients are most suited to a teleconsultation?” and “When would a teleconsultation be appropriate?” below). Triage using the clinic phone, or a secure secondary phone, is recommended over email.

• The teleconsultation appointment may be booked as a normal appointment in your clinic’s practice management software. The patient should also be sent teleconsult joining instructions via SMS or email. Most videoconferencing platforms will send this information automatically. If not, this information should include:

o Date and time of the teleconsult
o Meeting link and joining instructions
o Additional relevant information, such as a legal disclaimer (see the next point).

• The patient should be made aware, over the phone, at the meeting confirmation and at the start of the meeting, of the limitations of teledentistry and that dentists are providing the best advice possible in the absence of face–to–face consultation.

• Patient consent for the consultation must be attained prior to the meeting either verbally or in written format.

• At the start of the meeting, the identity of the patient should be confirmed using at least three patient identifiers such as name, date of birth, and address.

• The patient’s current clinical records should be available for reference. You may therefore choose to either conduct the teleconsult at your clinic, or by accessing your practice management software through a remote secure channel.

• A detailed record of the consultation should be written contemporaneously in the patient’s clinical records, including:

o Confirmation of identity
o Consent to consultation
o Updates to medical and medication history
o Presenting symptoms
o Recommended treatment

• This applies whether a consult fee was charged.

What security is required when conducting a teleconsultation appointment?

Choose a secure platform

Dental healthcare providers should use one of the following videoconferencing systems which are listed in order of security level preference:

1. Microsoft Teams 
2. Skype for Business
3. Google Meet
4. CISCO Webex or Jabber
5. VIMED Teledoc (Victorian Stroke Telemedicine program)
6. Zoom

Do not use ‘social media’ platforms such as Facebook, Twitter or WhatsApp. These platforms, as the name implies, are designed for social interactions and are not secured for clinical consultations or discussions.

Manage your attendee list

• When using video conferencing keep your meetings small and short to control security and privacy. 

• Ensure you invite only people you know and need for the meeting, do not allow on-forwarding of your invitation to third parties.

• Always set up unique conference Identification (ID) and Password for each session, where the application supports this functionality.

• Keep attendees in a ‘waiting room’ or ’lobby’. Admit only when they are verified.

• Keep an eye on the attendees throughout the session, watch for ‘rogue attendees’.

• Terminate session immediately if you suspect there is an unverified attendee.

• Reschedule with new conference ID and Password. 

Manage what you share

• Allow file sharing from the host only. Attendees should forward files to be shared to the host prior to the meeting.

• Avoid sharing classified information on screen. 

• Close all unnecessary windows to avoid accidental sharing.

• Share patients’ clinical documents only, when necessary and not by default.

• Remove any sensitive information in your background for video calls, for example, whiteboards, documents and computer screens.

If you are using Zoom

Although Zoom is not recommended for patient-care provider interactions, we recognise its increasing popularity in accessibility and ease of use. If there is no viable alternative to using Zoom, follow the steps below when setting up each session. The following may also be used as a general guide to setting up videoconferencing. 

1. Use a randomly generated ‘Meeting ID’

Using an automatically generated code (ID) means you have a different link for each meeting, which increases security: 



2. Add a Meeting Password

You can add a password when scheduling your meeting in the Meeting Password section: 



This means even if someone manages to guess or steal your Meeting ID, they are unable to easily join without your Meeting Password. It changes the meeting link you send with an encrypted password, for example:

• it changes your direct link from this: https://agencyx.zoom.us/j/518730239

• to this, with the password encrypted: 
https://agencyx.zoom.us/j/518730239?pwd=UndycENZS2lQbGRrZ25nOWhIVWQyQT09

The session invite must be sent with the Meeting ID and the Meeting Password together.

3. Utilise the ‘waiting room’

When scheduling your Zoom session, you can also use a ‘waiting room’. Anyone attempting to enter your session will be sent to a waiting or holding area. You will need to manually allow them entry into the session. To manually allow entry into the session you must be logged into Zoom as the host. 



4. Do not use ‘Enable join before host’

The ‘Enable join before host’, Zoom tick box allows sessions to be scheduled by another person in your organisation. This leaves the Zoom Meeting ID open outside of the session time. If you must use this option, make sure you use risk mitigation steps 1, 2 and 3 above. 

Do not use this function as a general practice: 



5. Check your background

Ensure there is no sensitive information in your background. Zoom allows you to have a virtual background for increased privacy.

To learn how to enable virtual backgrounds click on the link below: 
https://support.zoom.us/hc/en-us/articles/210707503-Virtual-Background

In summary

Stay cyber safe by staying alert in your sessions:

• know who is in the meeting
• limit what you share
• do not leave the session open after the call
• end the session immediately upon evidence of an intruder

Do I need to conduct the teleconsultation from my normal clinic?

No, you do not need to be in the dental practice to provide telehealth services, but you should ensure you have secure access to patients’ clinical records.

You may use your provider number for your primary location and must provide safe services in accordance with normal professional standards.

Can I delegate responsibility for conducting a teleconsultation to another staff member?


Only if the person who conducts the consultation is the holder of a provider number.

Which patients are most suited to a teleconsultation?

Any patient who has recently undergone a dental procedure and requires follow up or has concerns with their recovery after the procedure or is presenting with an acute dental problem:

• Outside of normal practising hours,
• Who are unable to attend the clinic due to illness, isolation or quarantine. Such as:
• aged 70 years or older
• identify as being of Aboriginal or Torres Strait Islander descent
• pregnant; or
• the parent of a child aged under 12 months; or
• being treated for a chronic health condition; or
• immune-compromised; or

When would a teleconsultation be appropriate?

Outlined below is a series of examples where it would be appropriate to conduct a consultation remotely.

Toothache

The following suggested questions may help you to determine if it is an acute odontogenic infection.

• Is this new or recurrent?
• Has the patient recently undergone a dental procedure?
• Have they been prescribed antibiotics for this problem before?
• Do they have an elevated temperature?
• Do they have facial swelling and pain, trismus, neck swelling, difficulty swallowing, difficulty breathing or a compromised airway? If the patient has a spreading infection/cellulitis, they should present to the nearest emergency department and the dentist should call the hospital and provide details of the referral.
• If an existing patient, do they have any changes to their medical history, including allergies, medications. If new patient, detail full medical history.
• Determine the site of the pain
• Determine how long the patient has had the pain
• Determine the nature of the pain. E.g. Stabbing, throbbing, etc.
• Determine if the pain radiates
• Any other signs and symptoms.

If the patient does not meet admission criteria for hospital, consider if the patient needs pharmaceuticals and/or if their management can be deferred. Please refer to the Therapeutic Guidelines Oral and Dental V3 for the appropriate prescription of analgesia and/or antibiotics.

Broken or loose tooth

Ascertain from the patient the degree of mobility of their tooth or teeth. If there is no pain and the tooth is not mobile enough to be aspirated, management may be deferred.

If the tooth has broken, the patient should be asked if there is any pain or hot/cold sensitivity. Treatment should be deferred if the tooth is asymptomatic.

If the tooth is broken or chipped, or causing soft tissue irritation, patients may be directed to file it down themselves with some sandpaper or a nail file. Orthodontic wax might also be suggested.

Trauma

In cases of dental trauma, determine if the management of this may be deferred or if urgent visual inspection is required. You may wish to ask some or all of the following questions to help in determining the extent of the injuries.

• Which area of the face was there trauma to?
• Is the tooth sore to touch?
• How loose is it?
• Is the tooth broken?
• Is the gum around the tooth bleeding?
• Is there bleeding from the lips, gums or other tissues?

Please refer to the International Dental Trauma Guide: https://dentaltraumaguide.org/free-dental- guides/permanent-teeth/

Orthodontics

Ascertain if this is a situation for which the management may be deferred.

The patient can contact their orthodontist if their arch wire has come loose, or the bracket has come loose for advice.

If there is soft tissue irritation, the patient may be directed to place some orthodontic wax or sponge (from a makeup remover pad) over the sharp area.
Broken dentures/crowns/bridges
Broken dentures should not be worn if they are an aspiration risk.

Management of broken crowns and bridges should be deferred. Broken or loose crowns should be kept safely until treatment can be provided in the clinic.

Patients should not be encouraged to recement any of these due to an aspiration risk.

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  Covid-19 Decision Trees

A decision tree for patient management during COVID-19 Level 1 restrictions.

  Correct Use of PPE

Resources to help you correctly use and conserve your PPE stock.

Vaccination Information

  Can a dental practice mandate the COVID-19 Vaccine?

Information prepeared by ADA HR on mandating the COVID-19 Vaccine for staff.

  Mandatory COVID-19 Vaccination Templates

Resources to help support you successfully implement COVID-19 Vaccination policies.

  VIC Mandatory COVID-19 Vaccination for Healthcare Workers
  QLD Mandatory COVID-19 Vaccination for Healthcare Workers
  WA Mandatory COVID-19 Vaccination for Healthcare Workers
  SA Mandatory COVID-19 Vaccination for Healthcare Workers
  NT Mandatory COVID-19 Vaccination for Healthcare Workers
  Vaccination FAQs

Answers to some of your most frequently asked questions. This page will be updated regularly as information becomes available.

  HR Vaccination FAQs

Answers to some of your most frequently asked HR questions around vaccinations. This page will be updated regularly as information becomes available.

  Proof of Employment Letter for Priority Groups - Member Only Resource

Tempate letter to support dental practices to ensure staff are eligible for the COVID-19 vaccine in the appropriate phase of the national vaccine rollout.                                                                                 
 

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Critical Information & Resources

  ADA Dental Service Restrictions in COVID-19

A framework outlining the ADA's recommendations in relation to the continuation of dental services.

  Covid-19 Decision Trees

Decision trees for patient management during COVID-19 restrictions.

  Managing PPE Resources

Key Resources for managing PPE during COVID-19.

  Managing COVID-19 in the Practice

The key resources for managing COVID-19 in your practice.

Infection Control

Infection control in dental practice has always been a cornerstone of ensuring your practice is safe. This is the responsibility of the treating practitioner. Below are some general infection control resources as well as some additional measures to be mindful of during the COVID-19 pandemic. 
  Practising Through Covid

The key documents to help you keep practising during the COVID-19 pandemic.

  Infection Control FAQs

Answers to some of your most frequently asked questions.

  Environmental Cleaning

Guides on keeping your Dental environment clean.

  Posters/Signage for your Practice

Posters/Signage to place in your waiting room and in other publicly visible areas in your practice so that patients and staff are aware of what behaviour and symptoms to be mindful of. 

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  Information/Guidelines + Resources

The key Information/Guidelines & Resources for Infection Control.

  Working in Domiciliary Care

Resources for dental practitioners working in domiciliary care during COVID-19.

  Rapid Antigen Testing in Dental Practices

Webinar to help members unpack what impact the introduction of rapid antigen testing will have on dental practices.

  Ozonated Water

Answers to some of your most frequently asked questions.

PPE and Stock

There's some confusion surrounding the requirements of PPE during the COVID-19 pandemic. Understanding the precautions and whether you need to consider droplet or aerosol-based precautions will depend on the patients COVID-19 risk and the type of procedure being performed. Worldwide, PPE supply is diminished due to an unprecedented demand. It's important to be mindful of the PPE you require in the context of your practice and in the wider environment.
  PPE & Stock FAQs

Answers to some of your most frequently asked questions.

  Where to find PPE

Information regarding which suppliers stock each item of PPE and access to the ADA emergency supply of masks.

  Correct Use of PPE

Resources to help you correctly use and conserve your PPE stock.

HR Support

HR Resources are available to ADA Members Only.

We understand that restrictions on the services you can provide will profoundly affect your cash-flow and the staffing requirements of your practice, and may result in the practice temporarily closing. It is a difficult and uncertain time for everybody and ensuring that the practice team are treated fairly and with respect is important and will aid in our efforts to return to business as the restriction levels lower. 

The ADA's HR Advisory Service is available to members and provides individual advice to guide you through any changes you need to make.
  HR FAQs

Answers to some of your most frequently asked questions.

  Legislation + Fair Work Act Information

The most up to date changes to legislation & Fair Work Act during the COVID-19 pandemic.

  Information for WA members

Relevant HR advice for Western Australia State System employers and employees regarding COVID-19.

  Information for Practice Owners/Employers

Information and templates for practices not qualified for the JobKeeper scheme provided by the ADA HR Advisory Service team to assist practice owners in responding to potential changes in practice operations due to the COVID-19 health crisis.

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  Information for Employees

Information provided by the ADA HR Advisory Service team to assist employees in responding to potential changes in practice operations due to the COVID-19 health crisis.

  Jobs

View current employment opportunites in the dental industry.

Practice Resources

In order to implement the newly established guidelines, practice policies should be developed so that staff and clinicians understand how to practically implement these changes. These policies look at how staff and clinicians can determine the COVID-19 risk of each patient, the other risk factors that should be considered and the ways to operate in a consistently safe manner. Each practice should also have an exposure response plan so that all team members know how to behave and react in the situation where there is a COVID-19 exposure. 
  ADA Guidelines for Teledentistry

A guide on the appropriate use of teledentistry to provide urgent dental consultation. 

  COVID-19 Practice Templates

Templates to assist with returning to work and preventing the further spread of COVID-19.

  Practice Closure + Reopening Resources

Resources to assist you if you're in the process of temporarily closing down or starting up a practice following hibernation due to the COVID-19 pandemic.

  Marketing and Patient Communication - MEMBER RESOURCE

The Covid-19 pandemic has been an unprecedented situation for dental practices and our patients. With most of the restrictions on dental practices now lifted, it's important to let patients know that practice doors are open and they can safely return to see their dentist.

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Financial Support

Changes to working arrangements will directly affect your finances. The ADA have included links below to a range of resources to help manage your finances for the weeks and months ahead. We also advise that you contact your accountant and financial adviser so that you can have direct advice during this time.  Additionally, the government is releasing different packages to support members of the community and we will update you as they become available.
  Practice Owner/Employer

Information for practice owners/employers on available financial support.

  Employee

Information for employees on available financial support.

Mental Health Support

The COVID-19 pandemic affects everybody and their ability to earn an income, have security and socialise. As a result, there are many members of our community who are struggling with their mental health. Below is a link to resources and advice that are available. The ADA understands that we are all part of a wider community and now more than ever it is important to reach out to your colleagues, check-in and stay connected.
  Mental Health Services

Information on mental health services available to Dentists.

  Mental Health Resources

Key Mental Health resources for Dentists.

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