COVID-19_smallCOVID-19 

Updated May 29, 2020

At 2pm ET on June 3, 2020, CDC will host a Clinician Outreach and Communication Activity (COCA) call to discuss how the updated guidance addresses the unique characteristics of dental settings that warrant specific infection control considerations. The COCA network provides timely, accurate, and credible information to clinicians and other healthcare professionals related to emergency preparedness and response and emerging public health threats. During this COCA call, presenters will provide an overview of the updated guidance for dental settings before conducting a Q&A session.

This is CDC’s first-ever COCA call targeted specifically at the dental field. We ask that you share this announcement widely to your networks, as this is a unique opportunity for dental health care personnel to hear directly from CDC subject matter experts.


May 28, 2020
Some dentists may decide to pass on a portion of the increased costs for personal protective equipment (PPE) to patients. Those who do so should communicate with patients prior to their appointments about this delicate issue and why the circumstances demand a fee for PPE.

In addition, posting a sign such as this one could be used as an additional form of communicating with patients about the fee. 

Haga clic aquí para versión en español.




May 26, 2020
COVID-19 OSHA Respirator Wear Guide May 20



May 24, 2020
Some of the 3M masks that we received from the state have different model numbers.  However, all appear on the FDA approval list.

More information on the 3M masks are available here.



May 21, 2020
We have PPE!


DHHS PPE Truck-smallAs part of our continued dialogue with DHHS and the Governor's office, we continued to advocate for our member's needs for N95 masks and the inability to access sufficient sources. Dr. Deb West spoke with Matt Miltenberger, the Governor's Chief of Staff on Tuesday evening, reiterating the frustration of Nebraska dentists receiving kN95 masks. Matt confirmed our request with Dr. Charles Craft as to the reasonableness of the NDA's request. Yesterday, the Governor's Executive Strategic Advisor, Dustin Zabokrtsky called Cody Cade at DHHS and two hours later a truck showed up at the NDA office with 45,000 3M 9002 kN90 masks that are listed on the current FDA approved list  These masks must be used in conjunction with faceshields, which were also delieved by DHHS and part of the NDA Office Opening Protocols.  Doug Carlson, the Chief Procurement Officer for the state of Nebraska was extremely helpful in making this delivery happening quickly.

3M-Mask-small
Masks per Dentist: We calculated our request estimating 1,300 dentists actively practicing + 3,250 dental team members (an average of 2.5 clinical staff per dentist) = 4,550 dental professionals. 4,550 people x 1 mask per day x 5 days per week = 22,750 masks. One week’s worth of masks, reused 4 times pursuant to the CDC Extended Use of Facemasks , equals one month supply. The NDA requested 45,500 masks, which would provide two months of kN95 masks for Nebraska dentists and their clinical staffs.

Each dentist will receive 40 3M 9002 kN90 masks - for themself and three clincal staff, along with faceshields.

The masks are currently being distributed to each NDA district. We will be sending out a seperate email to dentists in their NDA district, with the location of mask pickup, date and time. You must bring a printed version of your email notication to pick up your masks. If someone is picking up masks for multiple dentists in the same practice, they need to have the printed email notification for each dentist.



May 18, 2020
Not much to update other than members who are receiving PPE from their local health departments, some members not as much.  However, the one message that is clear - keep submitting requests for PPE, either through the DHHS form for submitting PPE requests or the local health department links below.

ADA - Understanding Mask Types - Surgical, N95, kN95

We are getting a lot of calls from organizations wanting to sell our members kN95 masks.  Here is the FDA approved list of kN95s.

On May 7, 2020 the FDA amended their April 3 Emergency Use Authorization (EAU) regarding kN95 respirators.

FDA - Certain Facepiece Respirators from China May Not Provide Adequate Respitory Protection - Letter to Health Care Providers.



May 14, 2020
The confusion of PPE distribution continues.  A little over a week ago, DHHS and DAS (Division of Administrative Services) asked if the NDA could distribute PPE directly to Nebraska dentists.  We said yes and were prepared to distribute the PPE to our Trustee District locations and have offices pick up from there.

THEN, last Thursday, DAS informed us that they were delivering PPE directly to the local health departments (LHD). 

What we are finding out now from our members . . . many, if not all, of the LHDs have their own form to fill out and their own priority for distribution . . . many times EXCLUDING dentists, even though dentists are #4 on the FEMA priority listing.

We have asked the dentists who are on their local health district (LHD) boards to reach out to whoever is the decision maker on distribution of PPE, make sure dentists are ON the list for distribution (not just for emergency only patients) and if they have a separate form dentists need to fill out.  One LHD told a member they would not receive any PPE because they were not treating COVID-19 patients.   The NDA Opening Protocols were drafted assuming everyone entering the office was asymptomatic.  We have also drafted CDC Extended Use of Facemasks that we were going to hand out with the distribution of N95 masks.  The ADA also has Extend the Use of N95 Masks

I’ll be posting the forms for each LHD as I receive them on this page.

Lancaster County - Requests and Distribution of PPE is managed by Lincoln-Lancaster County Health Department.  Please submit your requests using this link.  Many Lancaster County dental providers already have an account. 

North Central District Health Department - this form added 3 questions on the bottom of the DHHS form.

Elkhorn Logan Valley Public Health Department - Process Using the Online FormPreparation for PPE shortage

We also received a sample isolation gown from Britten Inc., who refocused their sewing operations to the manufacturing of Isolation Gowns for dental practices across the USA.   
Britten Washable Isolation-Gown-SpecSheet - Online Ordering 



May 13, 2020
The PPE that we were told was going to the health departments last week may be there, but for some reason some of the health departments don't believe dentistry qualifies even though FEMA currently lists dentistry #4 in priority.  We are in contact with the Governor's office to determine the disconnect.

Wellness Prevention Contacts_smallMonday evening, we received news of the loss of a Nebraska dentist graduate related to the stresses of COVID-19.  In addition to the resources listed here, the Board of Trustees asks you to reach out to members of your graduating class or local colleagues, touch base and make sure they are doing OK.  Although it may feel like it, no one is in this alone and we are here to help.  The Trustee in your district is always available to discuss what you are going through.


The ADA has created a resource page for assistance during this time.





May 7, 2020
We received a call today from the Nebraska Department of Administrative Services (DAS) stating that PPE requested through the DHHS form that we put on the NDA website, was being loaded today for delivery to local health departments tomorrow. All kN95/N95 respirators being delivered have been approved by the CDC.

Going forward, DHHS would like dental offices to use this form for submitting PPE requests.

Yesterday, DAS contacted the NDA to assist in delivery of PPE and we were preparing for that effort until today's plan was announced to us. We did notice that a few offices had requested more N95 respirators that would likely be required for an office of that size, so we had prepared CDC Extended Use of N95 Facemasks



May 2, 2020
DHHS released the DHMs for each county that will take effect May 4th.  The DHMs for your county are listed on the DHHS website.   As they effect dental offices, there are no prohibitions for dental offices opening up on May 4th.

There remains confusion regarding whether the CDC and OSHA would prevent dental offices in Nebraska from opening May 4th should they choose to do  so.

The Covid-19 pandemic is an unprecedented event. As a result, the CDC is providing “guidance” for Covid-19, which is a “recommendation” and NOT a guideline.  The CDC guidelines for oral health safe care may be found here.   Please note that the CDC Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response states:  “DHCP should regularly consult their state dental boards or other regulating agencies for requirements specific to their jurisdictions.”    
 https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html

Nebraska controls what procedures are allowed to be provided, largely through our Board of Dentistry.  The Nebraska Board of Dentistry and State Dental Director have both approved the NDA Office Opening Protocols, which refer to the CDC for PPE and infection control recommendations but not what procedures can be provided.   The difference between “guidelines” and “guidance” was verified with CDC personnel, who stated, “Guidance is advice and guidelines are rules that should be followed. The ultimate authority lies with each individual state”. 

 
LikewiseOSHA issued guidance for dental offices operating in COVID-19.  

“Dentistry employers should remain alert of changing outbreak conditions, including as they relate to community spread of the virus and testing availability, and implement infection prevention measures accordingly. As states or regions satisfy the gating criteria to progress through the phases of the guidelines for Opening up America Again, employers will likely be able to adapt this guidance to better suit evolving risk levels and necessary control measures in their workplaces.

The NDA Board recommends that individual practitioners pay special attention to mask versus respirator requirements based on aerosole producing procedures.  These references may be found on the NDA’s COVID-19 page and Dental Office Opening Protocols.   

Each individual practitioner may determine the best time for them to return to practice which may be after the May 4th  date. 


May 2, 2020
Q: Does the CDC’s guidance supersede my state’s authority to open dental practices for non-emergency care?

A: The CDC does not have regulatory authority over the operation of dental practices. The guidance issued on April 27 is a non-binding recommendation. 

The CDC puts the onus on local and state authorities to make the final decision based on all the factors that should be considered. According to the CDC’s guidance, “Dental health care professionals should regularly consult their state dental boards or other regulating agencies for requirements specific to their jurisdictions.”

NDA Protocols CoverThe Governor has informed us that dental offices can reopen on May 4th.  The DHHS Office of Oral Health and NE Board of Dentistry support the NDA Dental Office Opening Protocols   Rear Admiral Timothy Ricks, Chief Dental Officer, U.S. Public Health Service praised the NDA Dental Office Opening Protocols and several states are using NDA protocols as a guide for writing up their own recommendations for reopening, along with the ADA Took Kit.  

PPE Summary

NDA Supply Source - Thermometers (gowns coming next week)

Face Shields - Hand Sanitizer - Innovation Campus UNL

DHHS has created a PPE Request Form.  Dentists who made earlier requests have started to receive N95 masks, distributed by their health department.  Only request a 4 week supply with CDC reuse guidelines.


April 30, 2020

Aerosols and Splatter
We have received a lot of questions about aerosols.  Our thanks to Dr. Gary Lehn for providing the ADA JADA article Aerosols and Splatter in Dentistry   Although there is nothing specific on COVID-19, thekey takeaway is that viral particles have always been known to be present in dental aerosols.  The question has always been if the viral load in these aerosols is ever high enough to cause infection.  There is not any research to support transmission of a virus via dental aerosols that are produced on an asymptomatic patient.  Methods of reducing of the majority of dental aerosols is both inexpensive and simple to implement in all dental practices.    Dr. Lehn provided the articles below to reduce aerosols in dental offices:

More about bloodbourne pathogens in aerosols: https://www.cdc.gov/oralhealth/infectioncontrol/faqs/bloodborne-exposures.html

Evaluation of the spatter-reduction effectiveness of two dry-field isolation techniques

90% number - Jacks ME. A laboratory comparison of evacuation devices on aerosol reduction. J Dent Hyg 2002;76(3):202-6.

93% reduction with ultrasonic scaler - Harrel SK, Barnes JB, Rivera-Hidalgo F. Reduction of aerosols produced by ultrasonic scalers. J Periodontol 1996;67(1):28-32. 34. Jacks ME. A laboratory comparison

Micik RE, Miller RL, Mazzarella MA, Ryge G. Studies on dental aerobiology, I: bacterial aerosols generated during dental procedures. J Dent Res 1969;48(1):49-56.

Bentley CD, Burkhart NW, Crawford JJ. Evaluating spatter and aerosol contamination during dental procedures. JADA 1994;125: 579-84.

Klyn SL, Cummings DE, Richardson BW, Davis RD. Reduction of bacteria-containing spray produced during ultrasonic scaling. Gen Dent 2001;49(6):648-52.

 



April 29, 2020
PPE available through NDA Supply Source and Ultralight Optics.

UNL Hand SanitizerThe University of Nebraska–Lincoln is currently producing hand sanitizer at Nebraska Innovation Campus for healthcare facilities and essential businesses across the state. Local Lincoln pick-up is available via online request. More information available at http://handsanitizer.unl.edu.



OSHA Video - How To Perform A User Seal Check With An N95 Respirator
OSHA N95 Seal Check









Thank you to our friends at UNMC HEROS for sharing N-95 Donning and Doffing and N-95 Limited Re Use  HEROS also has a COVID-19 page with helpful media.



April 28, 2020
Dr. Charles Craft, DHHS State Dental Director and Dr. Ken Tusha, Immediate Past President of the NDA, speaking at the Governor's Press Conference about the NDA Office Opening Protocols.



April 27, 2020
We just spoke to Matt Miltenberger, the Governor's Chief of Staff.

On May 3, 2020, the State of Nebraska will be issuing 19 Directed Health Measures, one for each health department. All prior DHMs will be revoked or expired. As they relate to dentistry, effective May 4th, all DHMs will say the same thing, i.e., there will be no prohibition as to the type of services a dental office can perform.

Once we receive the published DHM, we will post it on this page.

The ADA released the Return to Work Toolkit

The CDC updated their patient screening questions, so we have updated our Patient COVID-19 Triage Consent Form with the new questions.

Best practices require N95/kN95 mask fitting
- contact either the NE Safety Council or CHI Health Company Care - you can not just submit their assessment --You need an account.  CHI Health Company Care - 402-475-6656;  or the Nebraska Safety Council at 402-483-2511 to get prices and decide which group to go with.

The Safety Council will accept the Assessment from CHI Health Company Care but each group has to have an account with them before they will process their paperwork.  

Donning and Doffing a Procedure Mask 1
Performing a Seal Check When Donning an N98 Mask

 


April 22, 2020

Office Opening

To aid dentists who may be reopening their practices when County Directed Health Mandates are lifted, the NDA along with significant information provided by the ADA has developed interim guidance for minimizing risk of COVID-19 transmission in order to practice during this pandemic and minimize the risk of virus transmission. Additional guidance documents from the NDA and ADA will likely be issued.

The longer dental practices remain closed to preventive care and treatment for early forms of dental disease, the more likely that patients’ untreated disease will progress, increasing the complexity and cost for treatment down the road.

The decision to reopen a dental office or remain closed, absent an
overriding Directed Health Mandate, is a decision to be made by each individual dental practice.  The following Dental Office Opening Protocols were developed to assist dentists in making that decision, as well as to encourage a concerted effort in making the PPE Screenshotreopening of dental offices the safest environment possible for patients, staff and dentist.  The NDA presents the following guidelines not as mandates, but as recommendations to aid dental teams in the reopening of their offices.

The safety of patients, dentists and dental team members has been and always will be the NDA and ADA’s utmost concern.

NDASupplySource now has limited amounts of PPE in stock.


 

Breaking News!  The Governor just informed the NDA that the DHMs will be lifted on May 4, 2020 to allow elective procedures.

DHHS has created a PPE Request Form.  Dentists who made earlier requests have started to receive N95 masks, distributed by their health department.

The NDA Board of Trustees will be approving the Office Opening Protocol Task Force Protocols on Wednesday April 22nd, which will incorporate the recently released ADA COVID19 Understanding Masks and ADA Interim Mask and Face Shield Guidelines.





April 16, 2020
Yesterday, the NDA Office Opening Protocol Task Force met via Zoom with the Chair of the ADA Task Force, Dr. Kirk Norbo. The ADA Task Force will be releasing their office opening guidelines as early as this Friday or perhaps Monday.

The NDA Task Force is currently simplifying the ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission that was issued on April 1st. This revised document will be used in conjunction with the soon to be released ADA Guidelines.

During the Task Force Zoom meeting, the Governor's office called about reopening the state. While no firm date has been established, dentistry is on their radar. An announcement may be made at an upcoming Governor's daily press conference.

The NDA Board of Trustees is hoping to approve and release the work of the NDA Task Force early to middle of next week. Please remember that local health departments have the authority to issue their own Directed Health Measure to address conditions occuring in their counties.

Due to the scarcity of N95 masks, the guidelines will recommend the next best option for protecting dental personnel working in an aerosol environment - the use of faceshields.

Innovation Campus Faceshield_smallThe NDA has been alerted to faceshields produced by Innovation Campus in Lincoln, NE. David Martin, Director at Innovation Studio, informed us "Dentists can submit needs to Innovation Studio. Please stress that we are trying to fill a need during the current shortage. These shields are meant to be cleaned and reused. The fewer they can get by with, the better. We’d rather have people pick them up, rather than ship. If someone is in desperate need and wants to send us a FedEx or UPS number, we could potentially put some in a box and send them."

Another Nebraska source for faceshields is at Brenmar in Lavista, NE.
Brenmar Company Face Shield


April 14

 

The NDA Board of Trustees meet via Zoom yesterday afternoon, creating an Office Opening Protocol Task Force.

Normal dentistry will not be happening soon. However, the Directed Health Measures applicable to the entire state of Nebraska will be ending, possibly as early as April 30th for Douglas, Cass and Sarpy counties if they are not extended.

The Office Opening Protocol Task Force will be taking information from the ADA, CDC and other reliable sources to create recommended guidelines for Nebraska dental offices to open for service, while keeping dentists, their staff and patients safe. We hope to have something to share with you in the next 7-10 days.

* * *
There remains confusion over the dates of the Directed Health Measures, "but the Governor said . . . May 11th."  The image below is from the linked DHM below.  It still says April 30th for Cass, Douglas, Sarpy Counties.  
DHM_April 10th
































 The ADA COVID-19 page is continually updated with information and recorded webinars, including Small Business Administration Loans: Understanding the Options for Dentist Owners

 


April 9, 2020
Paycheck-Protection-Program-Frequenty-Asked-Questions (003) (Issued April 8th)

******
CDC has just released new interim infection prevention and control guidance for dental settings for the COVID-19 response, and it can be found at:  https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html.

Key concepts have been updated, and the revisions include:

  • Description of risk to dental health care personnel (DHCP)when providing emergency care during the COVID-19 pandemic.
  • Recommendations for contacting patients prior to emergency dental care.
  • Recommendations for providing emergency dental care to non-COVID-19 patients including engineering controls, work practices and infection control considerations.
  • Potential exposure guidance.
  • Contingency and crisis planning.


The April 10th Directed Health Measure now encompases the entire state of Nebraska.

Directed Health Measures Nebraska Counties















Summary through April 6th:
Until May 11, 2020
- Hooker, Arthur, McPherson, Logan, Thomas, Lincoln,  Dakota, Cedar, Dixon, Wayne, Thurston, Boone, Nance, Platte, Colfax, Otoe, Johnson, Nemaha, Pawnee, Richardson, Fillmore, Saline, Thayer, Jefferson, Gage, Blaine, Loup, Garfield, Wheeler, Custer, Valley, Greeley, Sherman, Howard, Keith, Perkins, Chase, Hayes, Frontier, Dundy, Hitchcock, Red Willow, and Furnas counties effective immediately and continuing until May 11, 2020 
Until May 15, 2020 - Boone, Colfax, Nance, Platte counties. (local DHM take priority over State DHM)
Until May 11, 2020 - 
Antelope, Boyd, Brown, Cherry, Holt, Keya Paha, Knox, Pierce, Rock, Hooker, Arthur, McPherson, Logan, Thomas and Lincoln counties.
Until May 11, 2020 - Adams, Clay, Webster, Nuckolls, Buffalo, Dawson, Gosper, Phelps, Kearney, Harlan and Franklin counties. 
Until May 11, 2020 -  Sioux, Scotts Bluff, Banner, Kimball, Dawes, Box Butte, Morrill, Cheyenne, Sheridan, Garden, Deuel, and Grant counties.
Until May 6th -  Lancaster, Dodge, Saunders, Washington, Hall, Hamilton, York, Seward, Butler, Polk, Merrick, Madison, Stantson, Cuming and Burt counties.
Until April 30th - Cass, Douglas & Sarpy counties.  


April 3, 2020

East-Central District Health Department issued a DHM for Boone, Colfax, Nance, Platte counties, extending to May 15, 2020.  Poorly written, the DHM excludes medical providers in paragraph 3, but later prohibits elective surgeries and procedures in paragraph 9.

Can I See My Patient TodayWe have created a Can I See My Patient Today? infographic to help offices operate during Directed Health Measures and the current NDA recommendation, to use in conjunction wth the ADA Guidance for Screening Patients COVID19, COVID-19 Pandemic-Patient Disclosures, COVID-19 Pandemic Emergency Dental Treatment and COVID-19 Protocol



April 2, 2020
DHHS issued another DHM, adding  Antelope, Boyd, Brown, Cherry, Holt, Keya Paha, Knox, Pierce, Rock, Hooker, Arthur, McPherson, Logan, Thomas and Lincoln counties effectively immediately and continuing until May 11, 2020.
Directed Health Measures Nebraska Counties















Summary through April 3rd:
Until May 15, 2020 - Boone, Colfax, Nance, Platte counties.
Until May 11, 2020 -
Antelope, Boyd, Brown, Cherry, Holt, Keya Paha, Knox, Pierce, Rock, Hooker, Arthur, McPherson, Logan, Thomas and Lincoln counties.
Until May 11, 2020 - Adams, Clay, Webster, Nuckolls, Buffalo, Dawson, Gosper, Phelps, Kearney, Harlan and Franklin counties. 
Until May 11, 2020 -  Sioux, Scotts Bluff, Banner, Kimball, Dawes, Box Butte, Morrill, Cheyenne, Sheridan, Garden, Deuel, and Grant counties.
Until May 6th -  Lancaster, Dodge, Saunders, Washington, Hall, Hamilton, York, Seward, Butler, Polk, Merrick, Madison, Stantson, Cuming and Burt counties.
Until April 30th - Cass, Douglas & Sarpy counties.  


DHHS issued another DHM, adding Adams, Clay, Webster, Nuckolls, Buffalo, Dawson, Gosper, Phelps, Kearney, Harlan and Franklin counties effectively immediately and continuing until May 11, 2020.

Summary through April 1st:
Until May 11, 2020 - Adams, Clay, Webster, Nuckolls, Buffalo, Dawson, Gosper, Phelps, Kearney, Harlan and Franklin counties. 
Until May 11, 2020 -  Sioux, Scotts Bluff, Banner, Kimball, Dawes, Box Butte, Morrill, Cheyenne, Sheridan, Garden, Deuel, and Grant counties.
Until May 6th -  Lancaster, Dodge, Saunders, Washington, Hall, Hamilton, York, Seward, Butler, Polk, Merrick, Madison, Stantson, Cuming and Burt counties.
Until April 30th - Cass, Douglas & Sarpy counties.  

Sarpy County Health Department
called the NDA to inform us that they are now reporting dental offices that are still performing hygiene procedures in their offices, in violation of the DHM.  (*In the event of noncompliance with the terms of this Order, law enforcement and other Municipal and Local Public Health Department personnel will be required to aid the Department in enforcement of the Order, pursuant to 173 NAC 6 and NEB. REV. STAT.§ 71-502.)


March 31

Yesterday, DHHS issued another Directed Health Measures naming the following counties under the  Directed Health Measure: Sioux, Scotts Bluff, Banner, Kimball, Dawes, Box Butte, Morrill, Cheyenne, Sheridan, Garden, Deuel, and Grant counties effective immediately and continuing until May 11, 2020. 
For the counties not specifically listed in the DHM, the NDA  Board is recommending dental offices in Nebraska follow the Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response issued by the CDC until April 30th.  

March 30

The NDA Board of Trustees met during a noon Zoom call and reviewed DHHS's recent expanded COVID-19-State Directed Health Measure on March 29th, which now includes Cass, Douglas & Sarpy counties through April 30th and  Lancaster, Dodge, Saunders, Washington, Hall, Hamilton, York, Seward, Butler, Polk, Merrick, Madison, Stantson, Cuming and Burt, counties through May 6th. This DHM is a mandate, not a recommendation.  Failure to comply with this mandate will result in legal action for enforcement by civil and/or criminal remedies.  Dentistry as usual is off limits.

The key language appears on page 4 of the DHM which the NDA believes applies to dental offices:

2.         Elective surgeries and elective procedures are hereby prohibited. For the purposes of this Order, this means a surgery or procedure that is scheduled in advance because it does not involve a medical emergency. Surgeries or procedures that must be done to preserve the patient's life or physical health, but do not need to be performed immediately, are allowed by a case-by-case determination of the medical provider.

Because some dental office believe that the DHMs do not apply to them, we asked Dr. Craft, NE State Dental Director at DHHS to consult with Thomas J. Safranek, M.D., DHHS State Epidemiologist.  Dr. Safranek agrees that the DHMs apply to both dental and medical providers and are working to include this language in the next updated DHM.

For the remainder of NE counties not affected by the DHM listed above, the NDA Board is recommending dental offices in Nebraska follow the Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response issued by the CDC until April 30th.  In short, the Guidance states "Postpone elective procedures, surgeries, and non-urgent dental visits, and contact patients prior to emergency procedures. Stay at home if sick and know steps to take if a patient with COVID-19 symptoms enters your facility."

The Nebraska Board of Dentisty has previously issued a statement on what constitutes an emergent/urgent dental procedure.

CARES Act WebinarWatch the ADA Webinar What’s in the CARES Act and How It Can Immediately Impact My Dental Practice

The Academy of Dental CPAs and ADA provide a quick recap of the loans affected by the CARES act: Economic Injury Disaster Loan (EIDL) - Section 7(b) of SBA and Paycheck Protection Loan - Section 7(a) of SBA.

The Small Business Owners Guide to the CARES Act -  The programs and initiatives in the Coronavirus Aid, Relief, and Economic Security (CARES) Act that was just passed by Congress are intended to assist business owners with whatever needs they have right now. When implemented, there will be many new resources available for small businesses, as well as certain non-profits and other employers. This guide provides information about the major programs and initiatives that will soon be available from the Small Business Administration (SBA) to address these needs, as well as some additional tax provisions that are outside the scope of SBA.

Message from Mike Graham, Senior Vice President, ADA Government and Public Affairs

Like some of you perhaps, I have received some emails asking whether a dentist owner can apply for and receive funding from BOTH an Economic Injury Disaster Loan (EIDL) and Paycheck Protection (PPP) loan.

The simple answer is YES.

Unfortunately, there is considerable misinformation out there.  ADA staff has been working hard with our consultant experts, Capitol Hill staff from both the House and Senate Small Business Committees, as well as members of the Academy of Dentist CPAs – and they have confirmed our reading of the most recent versions of the final bill, bill summary and additional documents.  A dentist can receive funding from BOTH an EIDL loan and PPP loan.    The ADA issued March 28, 2020 - Small Business Owners Guide to the CARES Act
 
Therefore, we still recommend that dentists apply for the EIDL loan first – so that they can get the EIDL $10,000 grant and EIDL loan as quickly as possible. Then, if necessary, apply for the 7(a) loan, some or all of which is subject to loan forgiveness if used for eligible expenses. Bottom line is that you can roll the EIDL loan into the 7(a) loan if you like (you are not required to do so).
 
ADA staff is working with the Academy of Dentist CPAs to develop a Fact Sheet on EIDL loans and PPP loans as well as a "Decision Point Flow Chart" that may assist dentist owners in making decisions in the future.


March 25
Dear NDA Members,

The NDA Board of Trustees voted today to extend the NDA BOT COVID-19 Statement March 16 recommendation to April 6, 2020, aligning with the current ADA recommendation.

The NDA Board of Trustees realizes this is a fluid situation and will continue to aggressively monitor information from the ADA, CDC and the Nebraska Department of Health on a daily basis, until we are through this crisis. We are in uncharted waters. The uncertainty of this pandemic makes it impossible to predict at this time if or when the April 6th date will be extended. 

Thank You and Stay Safe!
NDA Board of Trustees

March 27

We have received forms used by dental offices performing procedures during the COVID-19. COVID-19 Pandemic - Patient Disclosures and COVID-19 Pandemic Emergency Dental Treatment along with CDC guidance for dental offices.

The ADA Webinars scheduled for March 27 will be available on ADA COVID-19 Resources for Dentists.

DHHS has issued two Health Directed Measures affecting Lancaster/Dodge/Sounder counties and Cass/Douglas/Sarpy counties.

http://dhhs.ne.gov/Documents/COVID-19-StateDirectedHealthMeasures-Lancaster-Dodge-Saunders-Counties.pdf

http://dhhs.ne.gov/Documents/COVID-19-StateDirectedHealthMeasures.pdf

USA_Map_State_Mandates_March 27The key language is:

2.         Elective surgeries and elective procedures are hereby prohibited. For the purposes of this Order, this means a surgery or procedure that is scheduled in advance because it does not involve a medical emergency. Surgeries or procedures that must be done to preserve the patient's life or physical health, but do not need to be performed immediately, are allowed by a case-by-case determination of the medical provider.

As of March 27, 2020, thirty states have issued statewide mandate for emergency procedures only.


On March 18th, the ADA issued What Constitutes a Dental Emergency? to assist dentists to determine which procedures should be allowed during these times.  Also, last week, the Nebraska Board of Dentistry considered the NDA and ADA recommendation, along with the ADA's What Constitutes a Dental Emergency and issued a Board of Dentistry Statement on March 20, 2020.  This Statement provides further guidance to Nebraska dentists on recommended allowable procedures to be performed in the office.  The March 20th bulletin from the CDC aligns with the NE BOD statement.

Finally, we know you have a lot of questions about what to do. We are trying to get answers for you so please be patient.  We are still drinking from the firehose here.  We are also asking for your help. If you could share any information you have please contact your NDA Leadership 

We believe the more we can share and learn from each other will help us get through this uncharted territory together. We will try to post all information we gather on this page.

We would like to remind you that it is our responsibility to take care of our patients of record who have dental emergencies. We do not want to overwhelm the emergency departments with dental emergencies that we should be seeing in our offices.

We understand you will have questions about what to do next following this announcement. For the most up-to-date information and support, continue checking this webpage.

The Association of State and Territorial Dental Directors (ASTDD) is a national non-profit organization representing the directors and staff of state public health agency programs for oral health.  The ASTDD suports the ADA recommendation. 

DHHS has created a PPE Request Form Dentists who made earlier requests have started to receive N95 masks, distributed by their health department.
"State":"NE"