Registered dental hygienist Nancy Watson, who works at area dental clinics in central Aroostook County, tends to a patient at the St. Apollonia Dental Clinic in Presque Isle on Nov. 2 during the statewide day of free care organized by the Maine Dental Association. Credit: Anthony Brino | BDN

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A number of Maine dentists had been expecting to reopen their practices at the beginning of May when Gov. Janet Mills made her announcement about a four-phase reopening of the state’s economy. But after a week of confusing messages, they are now allowed to provide emergency treatment only.

As recently as Monday, the day before Gov. Janet Mills announced her administration’s four-phase reopening plan, the Maine Dental Association told members it “may be technically possible” to reopen for normal business once the governor’s stay-at-home order expired May 1.

“The message there was we’re back, we’re working again,” said Dr. Brad Rand, a Brewer dentist who is the Maine Dental Association’s president. “As more details have come out, it has been much more yellow light caution than green light go.”

[Our COVID-19 tracker contains the most recent information on Maine cases by county]

On Tuesday, Rand told association members in another message that he and Executive Director Angela Westhoff had met with Mills’ senior health policy advisers and asked them to allow dentists to resume routine operations starting May 1.

Then, on Wednesday, Economic and Community Development Commissioner Heather Johnson said in a press briefing that dentists were among those health care providers who could reopen during the first phase of the state’s economic restart to perform elective procedures.

“Dentists are part of the elective medical procedures that are part of phase one,” she said, without providing further detail.

Yet the department later posted guidelines to its website that deferred to the U.S. Centers for Disease Control and Prevention on dental practices. The CDC recommends that dental care be limited to emergencies only “during this period of the pandemic.”

[Mainers want haircuts and stylists want work, but salons aren’t all opening as restrictions lift]

Rand, who had planned to reopen in mid-May, sent an urgent message to members early Thursday warning them that only emergency care would be allowed during the reopening’s first phase.

“The result for Maine dentists has been disappointing,” Rand said. “At least for our industry, the details were not there in order to be able to make good, informed decisions for the dentists and dental practices.”

The conflicting messages about dentistry over the past week underscore the concerns among businesses as the state shifts from a broad economic shutdown to the first phase of the Mills administration’s reopening plan.

Dr. Jonathan Shenkin, a pediatric dentist in Augusta, had also been preparing to reopen his practice in mid-May. He spent thousands of dollars procuring personal protective equipment including N-95 masks, installing protective barriers in the office area and putting in an air filtration system, he said. Now, he’s uncertain when his practice will reopen.

“This is the time where we need to have leaders that are capable of putting plans together based on stakeholder involvement and being able to implement those plans,” Shenkin said. “And right now, you’re seeing disarray, disorganization and lack of leadership in putting [a plan] together, not just dentistry.

“If stage one is so disorganized and they’re going to spend all their time now trying to fix stage one, how are they going to get prepared for stage two that starts in June?” he said.

[Here are the answers to your questions on the reopening of Maine’s economy]

A Maine Department of Health and Human Services spokeswoman didn’t address confusion over dental practices in a response to questions from the BDN.

The Maine Board of Dental practice, which is the licensing authority for dentists and dental hygienists, acknowledged the confusing messages from various agencies in draft guidance published on its website Thursday.

In its own message published last week, on April 23, the board said that licensed dental professionals who treated patients for elective dental procedures during the coronavirus emergency risked engaging in unprofessional conduct.

“So long as CDC guidelines continue to recommend limiting dental treatment to ‘emergency visits only,’ as they currently do, the Board expects dental practitioners to continue to limit their practices to emergency and urgent care,” the board said in the draft guidance, which is the subject of an emergency meeting Thursday afternoon.

The licensing board’s statement on April 23 put hygienists whose employers had decided to resume routine procedures in the difficult place of violating licensing guidelines by going back to work or potentially losing employment, said Clarke, the hygienists’ association president.

Working within inches of patients’ mouths and performing procedures that cause saliva to spray put those in dental professions at especially high risk for contracting the coronavirus. The coronavirus has been shown to survive in aerosols for hours and on some surfaces for days, according to the U.S. CDC.

[Read the timeline for reopening Maine’s economy]

A dental hygienist in Hancock County said she’s scared of the potential exposure to the coronavirus from performing dental procedures. Unless patient safety and personal protective equipment guidelines are spelled out, she said, she does not feel comfortable resuming routine dental procedures.

“If I had the proper PPE and systems in place I would go back,” she said. “If I do not, I won’t be returning, whether that is unfortunately walking away from a job or getting fired. We swore an oath as health care professionals to first do no harm. And there’s no price that is worth more than that.”

Shenkin, the pediatric dentist in Augusta, said Maine should have followed guidelines issued by the federal Centers for Medicare and Medicaid Services, which advise states with low rates of COVID-19 to allow facilities to provide for nonemergency care, over U.S. CDC guidelines.

“There are parts of Maine that are well beyond ready to open up, including for comprehensive dental care,” he said. “There are people that spent a lot of money in preparation for reopening the next couple of days, and now they’re stuck with all these bills because of poor planning by the administration.”

Watch: Janet Mills outlines her plan to reopen Maine businesses

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