03/24/2020

Updated COVID-19 recommendations for OMS

From AAOMS President Victor L. Nannini, DDS, FACS
Member Alert: Difficult times; difficult decisions. Always advocating for OMSs

Indeed, these are very difficult times for our nation and our members. What unites us is our desire to slow the spread of COVID-19.

With the number of patients testing positive growing by the hour, AAOMS believes it is imperative that oral and maxillofacial surgeons continue to treat emergent patients in your office-based practice to minimize the exposure risk to the public and to help ease the burden on our already overtaxed emergency rooms. With patient safety and resource conservation in mind, we also support the CMS request to limit non-essential medical, surgical and dental procedures and recommend all non-emergent treatment as defined by the ADA should cease immediately (until further notice).

We recognize the importance and impact of these two recommendations on every AAOMS member. Our top priority must be the health of the public, your patients, you and your staff.

We share the membership's concerns as scientific evidence (Meng et al, 2020; WHO, 2020; Kohn et al, 2003) has clearly shown procedures that require the use of a handpiece generate aerosol spray. What is most concerning is that without the proper personal protective equipment – including N95 masks and face shields – we are at high risk for the transfer of these aerosols, thereby increasing the potential transmission of the virus. In fact, the CDC COVID-19 recommendations suggest taking precautions when performing aerosol-generating procedures, including that all healthcare personnel in the room should wear an N95 or higher level respirator.

Because of the extreme risk for spreading COVID-19, we recommend that treatment of any patients where the procedure requires the use of a handpiece generating aerosol spray be deferred unless you have appropriate PPE, including an N95 mask and face shields. The use of regular protective masks in today's environment when aerosols of bodily fluids are possible will not be adequate to protect your patients, your staff or yourself.

OMSs have always practiced at the highest level when it comes to safety, and we should continue to do so.

For the safety of all involved and to help prevent the spread of this virus, AAOMS also is recommending:

• If you do not have the appropriate and necessary PPE at hand, treatment should be delayed.
• If a patient is COVID-19 positive, treatment should be delayed.
• All patients prior to OR procedures for oral and maxillofacial surgery should be tested for COVID-19.
• Emergent treatments, such as antibiotic therapy and all non-aerosol procedures, should be handled in a manner that is as minimally invasive as possible with available PPE.

To help protect our patients, our members and their staff, AAOMS is focusing its advocacy efforts on asking federal and state legislators as well as regulatory bodies to designate oral and maxillofacial surgeons as first responders and require that we receive appropriate PPE as soon as it becomes available.

In this stressful time when healthcare conditions are changing quickly, please know that we are analyzing scientific data, advocating on your behalf and trying to provide you with the best information possible. Please continue to visit AAOMS.org/news/COVID-19-updates or OMSNIC's COVID-19 FAQ webpage for the latest information and resources.