The oral health community is feeling the urgency to get routine dental care back up and running, in large part because communities need the revitalized business and consistency in the public’s oral health. But this requires new strategies to reduce the chance of a COVID-19 resurgence.  

The new COVID-19 Oral Health Recovery and Transformation (COHRT) learning community, established by the DentaQuest Partnership for Oral Health Advancement and Community Care Cooperative (C3), is aiming to share those strategies in the coming months. The organizations are collaborating to help federally qualified health centers (FQHCs) respond to the rapidly changing dental landscape. More specifically, the COHRT initiative will develop and test strategies to adapt care pathways and deliver safe, effective and financially sustainable oral health care. The initiative will also broadly share key learnings and best practices with FQHCs and other safety net organizations across the country.  

During the past couple of months, many dental and government agencies put forth phased COVID-19 reentry plans to guide professional standards. Understanding the environmental and financial factors that will impact implementation and sustainability have been central to these plans, in particular the unique characteristics that make dental settings high risk. These factors include unpredictable utilization, a shifting regulatory environment, different consumer habits and increased cost and liability.   

To address those concerns, the COHRT initiative is proposing COVID-19 era investment and care changes in three domains, which can be applied in any order to support financial viability and care improvement. These domains align with federal Centers for Disease Control and Prevention (CDC) and American Dental Association guidance focusing on patient-provider contact.  

Domain 1: Advancing telehealth 

Domain 1 focuses on telehealth strategies — identification, development and adoption. Given current infection control and regulatory restrictions, telehealth technology can enable providers to have real-time, virtual patient visits.  

Teledentistry was gaining traction pre-pandemic, though with low real-world adoption. Since COVID-19 required dental practices to close their doors to non-emergency in-person visits, interest in teledentistry as an effective care delivery option has spiked. But widespread adoption requires us to quickly define new codes and rethink the flow of care for a variety of visit types. 

C3 received $200,000 from the DentaQuest Partnership to help FQHCs add teledentistry to their telehealth offerings as part of COHRT. COHRT will subsequently disseminate key learnings and best practices beyond Massachusetts to help FQHCs throughout the country transform the way dental care is delivered for everyone. 

Domain 2:  Limiting exposure 

This second domain involves an approach to care that leverages non-aerosol procedures for oral health management and maintenance. Primarily used pre-COVID-19 for patients who fear drills and anesthesia, these treatments protect providers and patients from airborne contagions like the coronavirus. They include sealants and silver diamine fluoride (SDF), which do not require aerosol-producing tools for application. Atraumatic restorative techniques also can prevent caries disease often after a single treatment and can be particularly helpful for underserved populations that may struggle to get to the dentist in the first place. 

Along with this shift to leverage these procedures, care coordination and development of new business models for specialty referrals will be key to success. 

Domain 3: Preventing infection 

Domain 3 involves adopting the latest infection control standards to operate all dental practices. Right now, the latest standards are still directly tied to the coronavirus response, addressing facility and equipment considerations, sterilization and disinfection and considerations for using test-based strategies to inform patient care. This also includes recommendations in new CDC documents for treating patients with suspected or confirmed coronavirus disease.  

Separately, the DentaQuest Partnership, using CDC guidelines, is developing companion guides in partnership with the nonprofit Organization for Safety Asepsis and Prevention (OSAP), dentistry's global resource for infection control and safety information and education. COHRT will use these guides to ensure this nonlinear approach to reopening dental care aligns with what will become official CDC guidance. Other activities include evaluating and adopting innovation that facilitates compliance with these guidelines and best protects providers and the public. 

For more about each of these domains and the learning community, please visit https://www.dentaquestpartnership.org/care-improvement/cohrt-dental-transformation.