IDPH's Interim Guidance: Routine Oral and Dental Care
Bob Haney • May 15, 2020
In anticipation of the expansion of permitted oral and dental health care services, the Illinois Department of Public Health (“IDPH”) issued its Interim Guidance: Routine Oral and Dental Care
(the “Guidance”), a summary of which is provided below.
As they reopen, dental offices and their providers should be balancing a patient’s healthcare needs, the benefits of any particular procedure and the risk of exposure to that patient and staff. In addition to appropriate screening for COVID-19, dental professionals should always: (i) include optimized use of administrative controls, engineering controls, and use of PPE as described by CDC Infection Control for Dental Setting, ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission, and ADA’s Return to Work Interim Guidance Toolkit; and (ii) when performing aerosol-generating procedures on patients who have, or are suspected to have COIVD-19, use CDC’s Transmission Based Precautions, OSHA COVID-19 Control and Prevention guidance and airborne isolation rooms. Per the CDC, “when practicing in the absence of Airborne Precautions, the risk of SARS-CoV-2 transmission during aerosol generating dental procedures cannot be eliminated.”
Aerosolization of COVID-19
To minimize the risks of aerosolized COVID-19, dental offices should take the following steps:
- Reduce aerosolization through techniques such as high-volume evacuation, etc.
- Use portable operated HEPA filters of appropriate size, placement, and maintenance.
- Use a properly designed and maintained UV system that takes into account the design of fixtures, lamp type, lamp placement, airflow amount and mixing, etc.
Testing
Dental offices should consider incorporating COVID-19 testing as outlined in the Guidance into its provision of dental services and development of treatment plans while keeping in mind that tests can provide false-negative results, and an individual could begin shedding virus the next day after the negative test result.
Current Guidance
- Case Selection and Care Plan. If possible, patients with increased vulnerability to COVID-19 should defer elective oral and dental care. For patients with unknown COVID-19 statuses, procedures treating active diseases and that are minimally invasive should be prioritized, with hand instruments being used whenever possible. As aerosol generating equipment increases the risk of transmission, dental offices should consider the following in determining patient treatment plans:
- Risks vs. benefits of each procedure
- If possible, 24-48 hours prior to the appointment, administer a symptom screening from the CDC to the patient by telephone.
- This screen should be repeated upon the patient’s arrival at your office.
- Upon arrival, use a non-contact thermometer to check the patient’s temperature.
- Reschedule the appointment if the symptom screening is positive or if the temperature is over 100 degrees.
- While screening for COVID-19 through questionnaires and body temperature is helpful, it is not definitive as COVID-19 infection cannot be ruled out by a negative symptom screening and a normal temperature. Patients incubating the virus are usually infectious for 48-72 hours prior to exhibiting symptoms.
- Risk Mitigation. Transmission risk can be decreased through treatment selection and consideration of individual steps mitigating the creation and spread of aerosols and droplets (e.g., dry-field isolation, fourhanded dentistry). For a structured risk decreasing process, please refer to the ADA’s Interim Guidance for Minimizing Risk of COVID-19 Transmission, which addresses the risk of exposure and transmission before, during, and after planned oral and dental care.
- Protective Equipment. Dental offices should ensure that adequate PPE is available to provide patient care to best reduce the chances of spreading COVID-19 to its patients or staff. This must include appropriate PPE and treatment area safety procedures implemented with the specific type of procedures to be performed by the dental office in mind.
- Infection Control. In determining which services to offer and when, dental offices should, from the perspective of aerosol generation, consider a risk-sensitive approach with a limited set of services. Those procedures that involve the patient and staff to be close in contact but do not generate aerosol may be considered lower risk.
- For these lower-risk procedures, minimal PPE for protection of the airway includes American Society for Testing Materials Level 3 surgical mask and full-face shield.
- For moderate or high-risk procedures, either due to the generation of aerosol or close contact, minimal PPE for the protection of the airway includes a fit-tested N95, or higher-level respirator, with full face shield protection and a gown.
- For patients with COVID-19, an airborne infection isolation room should be used for aerosol-generating procedures.
- For patients whose COVID-19 status is unknown, dental offices should adhere to standards and practices at least as stringent as those recommended by the CDC, ADA and OSHA when performing aerosol-generating procedures.
- Aerosol Risk. For a list of oral and dental procedures by relative risk level, please refer to the Guidance. This list is not exhaustive for oral and dental treatments. While this list should be considered in determining treatment, dental offices should continue to take in as many other factors as possible in order to best determine the most appropriate plan of action for each patient.
As the as the dental services permitted and the guidelines for providing those services is continually changing and involving, it is important to be aware of what your practice may do and should do with regard to treating patients and putting proper safeguards in place. Our team is keeping up to date on these on-going developments and will be sure to advise you accordingly. Should you have any questions, do not hesitate to call or email us.
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Bogus ADA Claims Regarding Dental Practice Websites Are Rampant. Your Lawyer Can Help You Tell the Difference Between a Real Problem and a Real Shakedown. Over 25 years have passed since the Americans with Disabilities Act (ADA) quite literally reshaped the landscape for people with disabilities. From building entrances to parking lots to restrooms to elevators, from hiring and employment opportunities to restaurants, stores, and websites, disabled Americans have far greater access to the same facilities, services, and opportunities as everyone else. Harassment at Best, Extortion at Worst For all the good it has accomplished, however, the ADA has also been abused by opportunistic individuals and attorneys who have used the law in bad faith to shake down small businesses, including dental practices, for alleged violations that have not actually caused any harm or infringed upon any rights afforded by the act. 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The business/practice may then receive more demand letters, often from the same firm, on behalf of other plaintiffs who make the same claim, and the extortion continues. Don’t Act Impulsively – Do This Instead All this is not to say that dental practice owners should consider all such claims and demands to be frivolous or ignore their ADA obligations relating to their website. To be sure, a meritorious ADA lawsuit can indeed expose a practice to significant financial and reputational damage. Before reflexively giving in to an ADA demand letter and settling a supposed claim, practice owners should take the following steps: · Don't Panic, But Don't Ignore It. As noted, a demand letter with legalese and ominous language doesn’t mean that you’ve done anything wrong or actually violated the law. While your immediate reaction may include fear, confusion, or anger, don’t act impulsively. 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We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
Why TODAY Is The Time To Prepare Your Practice – and Yourself - For an Uncertain Tomorrow
Bogus ADA Claims Regarding Dental Practice Websites Are Rampant. Your Lawyer Can Help You Tell the Difference Between a Real Problem and a Real Shakedown. Over 25 years have passed since the Americans with Disabilities Act (ADA) quite literally reshaped the landscape for people with disabilities. From building entrances to parking lots to restrooms to elevators, from hiring and employment opportunities to restaurants, stores, and websites, disabled Americans have far greater access to the same facilities, services, and opportunities as everyone else. Harassment at Best, Extortion at Worst For all the good it has accomplished, however, the ADA has also been abused by opportunistic individuals and attorneys who have used the law in bad faith to shake down small businesses, including dental practices, for alleged violations that have not actually caused any harm or infringed upon any rights afforded by the act. These self-appointed ADA compliance "testers" have filed thousands of nuisance ADA suits that have cost American businesses millions of dollars. According to one analysis, ADA lawsuits have increased by 320% since 2013, with over 4,000 suits filed in 2024 alone. Many plaintiff's law firms file hundreds of cookie-cutter ADA lawsuits each year. One person can visit multiple businesses or websites in a single day solely to identify even the slightest accessibility transgressions in order to generate claims. While these suits can focus on any number of alleged ADA shortcomings, those relating to website accessibility (discussed in detail in this earlier post ) filed by a handful of law firms and serial plaintiffs have earned the scorn of small businesses and practices across the country. That's because these "testers" and the lawyers who represent them specifically target small businesses, as they typically have limited means to defend themselves, may not be able to discern between legitimate and bogus claims, and often see a quick payoff as the path of least resistance. Here’s how the shakedown typically goes down: A plaintiff or their attorney sends the practice a demand letter in which they claim that the practice’s website is inaccessible to people with disabilities (e.g., missing image alt text, inaccessible forms, incompatible with screen readers). They cite a violation of Title III of the ADA. They make a demand for a cash settlement, often ranging from $2,500 to $25,000, alongside a request for accessibility fixes. The business/practice cuts a check in exchange for a release of any ADA claims by that plaintiff related to the website. The business/practice may then receive more demand letters, often from the same firm, on behalf of other plaintiffs who make the same claim, and the extortion continues. Don’t Act Impulsively – Do This Instead All this is not to say that dental practice owners should consider all such claims and demands to be frivolous or ignore their ADA obligations relating to their website. To be sure, a meritorious ADA lawsuit can indeed expose a practice to significant financial and reputational damage. Before reflexively giving in to an ADA demand letter and settling a supposed claim, practice owners should take the following steps: · Don't Panic, But Don't Ignore It. As noted, a demand letter with legalese and ominous language doesn’t mean that you’ve done anything wrong or actually violated the law. While your immediate reaction may include fear, confusion, or anger, don’t act impulsively. By the same token, don’t assume it is a bogus threat; crumble up the letter and throw it in the recycling. Deadlines in these letters are real, and failing to respond appropriately to a viable claim could lead to litigation. · Contact Your Attorney Immediately. This is not a DIY situation. Before responding to the letter or contacting the sender, consult with an attorney experienced in ADA compliance and website accessibility issues. Your lawyer can evaluate the demand letter or complaint, the validity of the claim, and the law firm behind it before formulating an appropriate response. Testers send many cookie-cutter letters that may contain boilerplate allegations of deficiencies that do not actually exist. · Evaluate Your Actual Compliance. Work with your attorney and website accessibility experts to have your website assessed against the Web Content Accessibility Guidelines (WCAG) , which courts often reference in ADA website cases. Understanding your site's actual accessibility helps inform whether settlement, remediation, or another approach makes sense and whether you need to take additional steps to avoid future claims. Keep in mind that this isn't just about legal compliance—it's good business. An accessible website serves all patients better and demonstrates your commitment to inclusivity. If you have questions about your business's ADA obligations and how to protect it from accessibility complaints, please call Grogan, Hesse & Uditsky at (630) 833-5533 or contact us online to arrange for your free initial consultation. At Grogan Hesse & Uditsky, P.C., we focus a substantial part of our practice on providing exceptional legal services for dentists and dental practices, as well as orthodontists, periodontists, endodontists, pediatric dentists, and oral surgeons. We bring unique insights and deep commitment to protecting the interests of dental professionals and their practices and welcome the opportunity to work with you. Jordan Uditsky, an accomplished businessman and seasoned attorney, combines his experience as a legal counselor and successful entrepreneur to advise dentists and other business owners in the Chicago area. Jordan grew up in a dental family, with his father, grandfather, and sister each owning their own dental practices. This blend of legal, business, and personal experience provides Jordan with unique insight into his clients’ needs, concerns, and goals.
