How a 230-location DSO is planning to test all patients for COVID-19 and assist with follow-up care
Imagine for a moment you're a dental patient, and you're scheduled for a routine hygiene appointment in one week. You've heard that going to the dentist might be unsafe, and you're unsure whether you should chance a visit. But as you're weighing your options, you receive a phone call. It's your dental practice, and they've asked you to come by 2–3 days before your appointment, when you'll be tested for COVID-19. There will be a diagnostic test using a nasal swab, and antibodies will be identified through a blood draw. You're told the test will take 15 minutes, and your results will be available in 1–2 days. You're surprised that your dentist is doing this, yet suddenly you feel safer. You're glad your dentist is prepared and taking your health seriously. You decide to keep your appointment.
This seemingly idealistic scenario is exactly what patients at Refresh Dental are experiencing today. The New Castle, Pennsylvania, based practice became the first in the state to administer COVID-19 diagnostic and antibody tests last week. Refresh Dental patients who test negative or have antibodies are seen as scheduled, while patients who test positive are rescheduled and directed to a partner organization, Integrated Health 21, for follow-up care. But how is this possible?
Refresh Dental is affiliated with North American Dental Group (NADG), a dental services organization (DSO) founded in 2008 and based in Pittsburgh. When COVID-19 became imminent in March, NAGD recognized the magnitude of the crisis and began mobilizing its resources to respond. Today, the DSO has plans to implement COVID-19 testing for all of its 230 affiliated practices across 15 states by September.
We had a chance to interview Andrew Matta, DMD, chief medical officer and cofounder of NADG. Here's what he told us about NADG's efforts to organize a comprehensive COVID-19 safety plan for clinicians, staff members, and patients.
Interview with Dr. Andrew Matta, chief medical officer, North American Dental Group
ZK: Dental practices across the country have varied widely in their COVID-19 responses. NADG's introduction of a COVID-19 diagnostic and antibody test protocol for every patient in its 230 affiliated practices shows a sophisticated degree of planning. It also shows a high degree of concern for patient and provider safety. Can you take us back to the very beginning of the pandemic as your team began to evaluate the data coming in? When did you know that COVID-19 would be a health crisis, and what were the early steps you took to secure testing, lab partners, and other resources?
Dr. Matta: When the pandemic first reached the United States, NADG quickly recognized that the public health challenge would be significant. Working with NADG’s supported professional organization, the Professional Dental Alliance (PDA) and its Dental Advisory Board (DAB), we immediately began developing updated clinical guidance for our supported practices. The innovative “Essential-Treatment Only” model and advanced infection control procedures were quickly implemented across all NADG-supported practices.
NADG also published tools, resources and guidelines at covid19dentalresources.com, as well as conducted briefings for other DSO and dental industry leaders in the United States and across the globe to share our perspective on how to operate responsibly in this unprecedented environment.
Additionally, we reviewed ways we could help relieve the pressure on overstressed hospital emergency rooms. We reached out to hospital administrators to offer our services for emergency dental care. It was during this time, with many dental practices shuttered and staff sitting idle, that we realized we could also play a role in expanding testing. The pilot test for this program was conducted by a NADG-supported physician oral surgeon in Scarsdale, New York, who sourced tests from a large national lab.
As NADG-supported offices began to reopen, we knew we needed to take even more precautions to protect the health and safety of our dentists, hygienists, and patients. Because so many carriers of the virus lack symptoms, we knew testing patients before treatment was the best option to minimize risk of infection.
We decided to partner with Integrated Health 21 because we didn’t just want to administer tests. We wanted to ensure our patients had access to physicians and quality care if they testrd positive. Lab Corp is a long-time partner of Integrated Health 21. Because they are a level 3 lab and have been working with federal and state authorities, health officials, and other key constituencies to make testing available across the country, we knew they were the right partner.
We anticipate working with Integrated Health 21 to administer approximately 100 tests per week at the Refresh Dental practice in New Castle, Pennsylvania. We are also in the process of scaling the testing out to 10 other NADG-supported practices and expect they will have the same or higher volumes, which would mean more than 1,000 tests will be administered per week once the programs are in place. The goal is to implement testing in all 230 supported practices across 15 states by September.
ZK: Dental practices have struggled to find reliable and reputable partners for securing resources during the pandemic. Many practices have been unable to secure adequate supplies of personal protective equipment (PPE), let alone diagnostic resources. With concerns about gray market products, inaccurate testing, and similar challenges, how did you approach the supply chain problem and manage to secure what you needed for an extensive network of providers?
Dr. Matta: We approached this challenge through creativity, collaboration, and controls. Our doctor partners played a key role in networking. At the same time, we formed new, long-term manufacturing partnerships to assure sustained availability of high-quality PPE from domestic sources.
NADG also worked closely with Midway Dental, a key partner, on sourcing PPE from overseas. Midway put a team on the ground in China to validate the quality of its private-label products, such as surgical masks, and source new products, such as KN95 respirators. NADG also quickly pivoted to direct sourcing of face shields, gowns, and other PPE products.
ZK: What has the initial response from providers and patients been? Did you feel you had to take extra steps to educate your network of patients and providers about the importance of testing, the role of dentistry in the pandemic, etc., given the fractured information landscape in our culture today?
Dr. Matta: The response has been overwhelmingly positive from both NADG supported dentists and dentists outside our network. Dentists are experts in infectious disease, so we didn’t need to educate our providers on the importance of following infectious control protocols and implementing testing. Education was mostly focused on new processes and procedures in the COVID environment.
Since practices have been reopening, the response from NADG-supported dentists and hygienists has been great. They continue to tell us that they feel safe in their practices. Many are anxiously waiting to begin administering COVID-19 tests in their own practices because it adds an extra level of protection.
ZK: Are there any other things you'd like to highlight about NADG's response to the pandemic, such as infection control, patient communication, etc.?
Dr. Matta: At NADG, we are committed to pioneering a new culture of dentistry. Our dentist-centric approach elevates the level of patient care our affiliated practices can deliver. I am very proud of our response to the COVID-19 pandemic. We created an innovative “Essential Treatment Only” model and advanced infection control procedures very early in the pandemic—a model and approach the entire dental industry is now using.
In addition, we spearheaded the crusade to expand the scope of services for dentists so that they could begin administering COVID-19 tests and help the nation expand testing capacity, a critical step in reopening the country.
Across the country, the NADG team put communities first during the COVID-19 crisis. From donating PPE to health-care systems to making the COVID-19 tools and resources available to dental practices across to the globe, the goal has always been to help in the fight against this public health pandemic.
Each NADG affiliate that is now open for emergency and/or routine dental care is taking added steps to ensure that patients, team members and dentists are protected. Extra precautions include the use of advanced personal protective equipment (PPE), enhanced infection control, comprehensive patient screening, including questionnaires and temperature checks, and an updated patient visit protocol that includes social distancing and a no-guest policy.
ZK: If you had to look to the future, how do you think dentistry will change because of what we are experiencing today?
Dr. Matta: This pandemic has really shined a spotlight on dentists and the important role we currently play in the delivery of health care, as well as the expanded role we could play in the future.
The dental setting is an ideal access point for COVID-19 testing and other diagnostic testing. Patients often visit their dentist more than their primary care doctor. And because dentists already have the expertise to administer diagnostic tests and routinely communicate with other health-care providers, it just makes sense.
In addition, there is ongoing evidence of the direct connection of oral and systemic health. The integration of dentists more closely into a patient’s overall health is a key evolution toward the wellness of patients.
Zachary Kulsrud is the group editorial director for Endeavor Business Media's dental group, publishers of Dental Economics, DentistryIQ, Perio-Implant Advisory, and RDH magazine.
Editor's note: Find DentistryIQ's complete coverage of the COVID-19 pandemic at our coronavirus topic center.
