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Q&A on state and federal DEA requirements for prescribing, dispensing and administering controlled substances and non-controlled substances, and on CURES, the state drug monitoring database.

Click here to download view the Prescribing and Dispensing Q&A pdf.

California health care workers must show proof of COVID-19 vaccination; unvaccinated workers must get tested regularly. The statewide policy will take effect Monday, August 9th, with full compliance required by August 23rd.
CDA is working with state officials to clarify the requirements for dental practices, including how COVID-19 testing will be conducted and who will pay for it.

Visit the CDA Newsroom to read the full article. You’ll also find FAQs, a vaccine confidence toolkit, and more to help you get ready for this upcoming policy.

In the past year, we have seen the results of our “workforce pandemic” cause some of our best and most dedicated dentist-employers to color outside the lines and hire less than adequate personnel to fill the most critical position in the dental office today – the clinical chairside assistant. More than ever before, we find ourselves collaborating with the SDDS team in helping member-dentists with their understanding of the scope of practice “rules” while grappling to understand how and why the qualified RDA has become nearly extinct. What is more telling than all else, is the surprise members experience when they see the effective date of the “new” laws of dental assisting.

On 1/1/2010, the unlicensed dental assistant and all categories of dental assisting became a matter of state law. Very unceremoniously, the dental assistant became a defined category with a defined scope of practice whose duties and functions were no longer at the discretion of the employer-dentist. One major outcome of AB2637 was the increased impact on an employer-dentist for allowing illegal functions, making it a misdemeanor or felony under the statutory provisions for aiding and abetting the illegal practice of dentistry, punishable by a criminal conviction, up to $10K in fines and six months in jail; compound that with legal requirements for the licensee to report said conviction to the Board within 30 days whereby the licentiate is at risk for loss of licensure for the criminal conviction. This is no longer a simple citation and fine like “running the stop sign” = this is a serious outcome and at no time have we seen more aiding and abetting than in these desperate times with employers taking huge risks in allowing duties and functions to happen by personnel who they are labeling as “a trainee” equal to that of an enrolled student.

Training and formal education are legislated and regulated entirely differently. Whether you are “training” a new non-licensed employee or have just hired a graduate of a Board-approved RDA program who has not taken or failed their licensure examinations, they are defined in law today as an unlicensed dental assistant, with a limited, basic and elementary scope of practice which does not allow for the performance of a licensed function, regardless of supervision, without the valid license to do so. Further, to identify “training” as that of or equal to a student enrolled in a Board-approved RDA program is inaccurate. Only an enrolled student of an approved program and a contract of affiliation in place from that institution or provider allows them to perform the functions without licensure. Once graduated, and until the examinations for licensure have been successfully completed, the graduate is no longer allowed to perform functions of the licensure category for which they completed their education, regardless of having a diploma or certificate of completion, until they possess the license and that is a matter of State law.

CDA members are asking how the state’s reopening will apply to dental practices.

Here, CDA Practice Support answers members’ top questions about physical distancing, patient screening, the use of face coverings and other requirements that will continue in health care settings after June 15.

1. Must we continue to screen patients and take temperatures?

Yes. Patient screening and temperature taking are recommended in the CDC guidance for dental practice. Employers are required by Cal/OSHA to implement controls to limit the COVID-19 transmission, and patient screening is considered a control.

2. Do vaccinated patients have to wear masks while in the practice?

Yes. CDC recommendations for fully vaccinated individuals clearly state that the recommendations do not apply to health care facilities. As a best practice, refresh patient communications and signage.

3. Do vaccinated staff have to wear masks while at work?

Yes. CDC guidance for vaccinated healthcare personnel state that PPE recommendations are unchanged. The Cal/OSHA emergency temporary standard continue to require mask use by all employees.

4. Are respirators still required to be used in the practice?

Yes, for aerosol generating procedures according to CDC guidance for dental practices and the Cal/OSHA emergency temporary standard.

5. Is physical distancing still required?

Yes, as required by Cal/OSHA.

6. Are barriers still required?

Yes, as required by Cal/OSHA.

7. Can the Cavitron and other aerosol generating devices be used?

There are no rules or regulations restricting these devices if they are necessary to perform dental treatment. However, Cal/OSHA requires an employer to do a COVID-19 risk assessment and to mitigate those risks to the extent feasible. The employer should describe the mitigation elements in their COVID-19 prevention/addendum to the Injury and Illness Prevention Plan. These elements can include but are not limited to respirators, high-volume evacuation and portable air filtration units.

8. Does CDA still recommend patients rinse with hydrogen peroxide rinse prior to any dental procedure?

Neither CDC, CDA or the ADA recommend a pre-rinse as a COVID-19 prevention method. The CDC states, “Although SARS-CoV-2 was not studied, PPMRs (preprocedural mouth rinses) with an antimicrobial product . . . may reduce the level of oral microorganisms in aerosols and spatter generated during dental procedures.”

Dentists registered with the U.S. Drug Enforcement Administration should be aware that the DEA is no longer sending renewal notices by U.S. Postal Service as of last June. Instead, registrants will receive renewal notifications by email and should confirm that their email address on file is current.

The California Division of Occupational Safety and Health’s current regulations on COVID-19 related screening, testing and quarantining apply to dentists, dental team members and other health care workers in California who are fully vaccinated against the novel coronavirus, as well as to fully vaccinated patients who enter health care settings.

Dental offices, therefore, must continue to screen all patients and dental staff, including those who are fully vaccinated, for COVID-19 and follow other Cal/OSHA regulations on COVID-19 prevention, such as using proper personal protective equipment and requiring that patients wear masks and socially distance, until Cal/OSHA amends its COVID-19 regulations. These infection prevention procedures must be documented in a written plan, as required by Cal/OSHA.

Following an uptick in vaccine supply and administration, news outlets earlier this month widely reported the U.S. Centers for Disease Control and Prevention’s interim public health recommendations for fully vaccinated individuals. The CDC considers a person fully vaccinated if more than two weeks have passed since they received a single-dose vaccine, like the Janssen COVID-19 Vaccine by Johnson & Johnson, or the second in a two-dose vaccine series.

But the news created confusion both for health care workers and patients seeking care because those recommendations are intended only for non-health-care settings and allow fully vaccinated people to refrain from observing social distancing and wearing masks in some situations. They also allow fully vaccinated individuals to refrain from COVID-19 testing and quarantine following exposure to someone with confirmed or suspected COVID-19.
The CDC issued separate recommendations for fully vaccinated individuals in health care settings, and those recommendations more closely align with current Cal/OSHA regulations. Cal/OSHA expects to update its regulations to address exposure protocols for fully vaccinated employees later this year. Until then, dental practices should continue to:

– Screen all patients and staff for COVID-19 and record employees’ COVID-19 symptoms, exposure or positive test, regardless of whether the employee was exposed in the dental office (CDA has a tracking form)
– Ask fully vaccinated staff who have had close contact with someone who tested positive for or has symptoms of COVID-19 to quarantine
Ensure six feet of physical distancing
– Provide employees with proper personal protective equipment, including respirators for aerosol generating procedures
– Follow all other Cal/OSHA COVID-19 prevention regulations
Cal/OSHA will enforce annual fit requirements for tight-fitting respirators.

Medical evaluation and fit testing is a Cal/OSHA requirement for use of most respirators, including the N95. Employers are required to provide an initial fit test and an annual fit test. “Annual” means one year from the last fit test for the specific model being used.
Although OSHA temporarily suspended the annual fit test in April 2020 due to the public health crisis, Cal/OSHA announced it would continue enforcing the annual fit-test requirement. The agency will allow a 90-day delay for meeting annual fit-testing requirements provided there are no changes in an employee’s physical condition that could affect respirator fit. Such conditions include, but are not limited to, facial scarring, dental changes, cosmetic surgery or an obvious change in body weight.

Fit testing is a two-step process that is usually performed by two different entities: The medical evaluation occurs first and is followed by the actual fit test. A licensed health care professional must perform the medical evaluation using a questionnaire to gather specific required information.

Dental practices that do not receive consistent shipments of the types and sizes of respirators they ordered should document those events. Cal/OSHA only considers NIOSH-certified respirators, such as N95s, as appropriate protection when respiratory protection is required in the dental office.

The CDA Practice Support resource N95 Fit Testing Requirements explains how to locate a medical evaluator and fit tester and all the steps required as part of the fit test.