CDC Guidance for Dental Settings
from CDC
Key Points
- Dental settings have unique characteristics that warrant specific infection control considerations.
- Prioritize the most critical dental services and provide care in a way that minimizes harm to patients from delaying care and harm to personnel from potential exposure to COVID-19.
- Proactively communicate to both personnel and patients the need for them to stay at home if sick.
- Know the steps to take if a patient with COVID-19 symptoms enters your facility.
COVID-19 Guidance for Dental Practitioners
from OSHA
OSHA is committed to protecting the health and safety of America’s workers and workplaces during these unprecedented times. The agency will be issuing a series of industry-specific alerts designed to help keep workers safe.
If you are a dental practitioner, the following tips can help reduce the risk of exposure to
the coronavirus:
If you are a dental practitioner, the following tips can help reduce the risk of exposure to
the coronavirus:
- Encourage workers to stay home if sick.
- Maximize use of telemedicine for non-emergency consultations, and prioritize urgent and emergency procedures.
- Install physical barriers or partitions between patient treatment areas.
- Provide adequate ventilation and airflow in patient treatment areas so that air moves away from staff work areas.
- Frequently clean and disinfect surfaces and equipment with hospital-grade Environmental Protection Agency-approved cleaning chemicals from List N that have label claims against the coronavirus.
- Minimize the number of staff present when aerosol-generating procedures are performed, and ensure staff who are present are appropriately protected.
- Provide appropriate personal protective equipment, such as eye goggles, face shields, and N95 respirators, as necessary to protect dental practitioners and support personnel.
- Encourage workers to report any safety and health concerns.
For more information, visit www.osha.gov/coronavirus or call 1-800-321-OSHA (6742). Visit this link for more detailed guidance for dental industry workers.
To download the document click the link below:
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What Constitutes a Dental Emergency?
from ADA
The ADA recognizes that state governments and state dental associations may be best positioned to recommend to the dentists in their regions the amount of time to keep their offices closed to all but emergency care. This is fluid situation and those closest to the issue may best understand the local challenges being faced.
The ADA recognizes that state governments and state dental associations may be best positioned to recommend to the dentists in their regions the amount of time to keep their offices closed to all but emergency care. This is fluid situation and those closest to the issue may best understand the local challenges being faced.
The ADA recognizes that state governments and state dental associations may be best positioned to recommend to the dentists in their regions the amount of time to keep their offices closed to all but emergency care. This is fluid situation and those closest to the issue may best understand the local challenges being faced.
DENTAL EMERGENCY PROCEDURES
This guidance may change as the COVID-19 pandemic progresses. Dentists should use their professional judgment in determining a patient’s need for urgent or emergency care.
Dental emergencies are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding, alleviate severe pain or infection, and include:
Dental emergencies are potentially life threatening and require immediate treatment to stop ongoing tissue bleeding, alleviate severe pain or infection, and include:
- Uncontrolled bleeding
- Cellulitis or a diffuse soft tissue bacterial infection with intra-oral or extra-oral swelling that potentially compromise the patient’s airway
- Trauma involving facial bones, potentially compromising the patient’s airway
Urgent dental care focuses on the management of conditions that require immediate attention to relieve severe pain and/or risk of infection and to alleviate the burden on hospital emergency departments. These should be treated as minimally invasively as possible.
Other urgent dental care:
- Severe dental pain from pulpal inflammation
- Pericoronitis or third-molar pain
- Surgical post-operative osteitis, dry socket dressing changes
- Abscess, or localized bacterial infection resulting in localized
- pain and swelling
- Tooth fracture resulting in pain or causing soft tissue trauma
- Dental trauma with avulsion/luxation
- Dental treatment required prior to critical medical procedures
- Final crown/bridge cementation if the temporary restoration is lost, broken or causing gingival irritation
- Biopsy of abnormal tissue
Other urgent dental care:
- Extensive dental caries or defective restorations causing pain
- Manage with interim restorative techniques when possible (silver diamine fluoride, glass ionomers)
- Suture removal
- Denture adjustment on radiation/oncology patients
- Denture adjustments or repairs when function impeded
- Replacing temporary filling on endo access openings in patients experiencing pain
- Snipping or adjustment of an orthodontic wire or appliances piercing or ulcerating the oral mucosa
DENTAL NON EMERGENCY PROCEDURES
Routine or non-urgent dental procedures includes but are not limited to:
- Initial or periodic oral examinations and recall visits, including routine radiographs
- Routine dental cleaning and preventive therapies
- Orthodontic procedures other than those to address acute issues (e.g. pain, infection, trauma) or other issues critically necessary to prevent harm to
- the patient
- Extraction of asymptomatic teeth
- Restorative dentistry including treatment of asymptomatic carious lesions
- Aesthetic dental procedures
To download the document click the link below:
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Summary of ADA Guidance During the COVID-19 Crisis
from ADA
Key Points
- Dental settings have unique characteristics that warrant specific infection control considerations.
- Prioritize the most critical dental services and provide care in a way that minimizes harm to patients from delaying care and harm to personnel from potential exposure to COVID-19.
- Proactively communicate to both personnel and patients the need for them to stay at home if sick.
- Know the steps to take if a patient with COVID-19 symptoms enters your facility.
The COVID-19 pandemic, caused by coronavirus (SARS-CoV-2 virus), has caused major disruption in the lives of dental teams in the USA. ADA and many state dental associations have urged dental offices to treat only emergency patients; some states or local governments have mandated this. The ADA continues to urge dental offices to follow closure recommendations. Safety of the dental team and patients or people accompanying patients is essential while treating emergency patients and following this crisis.
COVID-19 is different from the flu, the common cold and SARS-1 and may require different precautions than dental teams have been employing since the early 1980s.
The emerging science is indicating that:
COVID-19 is different from the flu, the common cold and SARS-1 and may require different precautions than dental teams have been employing since the early 1980s.
The emerging science is indicating that:
- COVID-19 is “stickier” than previously seen viruses – infection is easier
- COVID-19 causes serious symptoms in persons over 60, and those with underlying medical conditions
- COVID-19 may be spread through the airborne route, meaning that tiny droplets remaining in the air could cause disease in others even after the ill person is no longer near
- COVID-19 may be spread through aerosols produced by high and low speed handpieces, ultrasonic scalers, air/water syringes, or an infected patient coughing, and even when taking intra-oral radiographs
- Individuals infected with COVID-19 may be shedding virus and communicating the disease even before they show symptoms, including transmission through saliva
- Children may be asymptomatic and infectious
- COVID-19 survives on environmental surfaces for various periods of time, including metal and plastic surfaces, as found in the dental office.
This has serious implications for the dental team, in terms of personal protective equipment (PPE), treatment room disinfection and treatment of patients. It is important that dentists and dental teams thoroughly understand the risks of treating patients, the need to continue treating patients with emergency oral health issues so they do not present to hospital emergency room departments, and the realities of what PPE is available to dental personnel.
During the active COVID-19 crisis and beyond, risk must be minimized during dental treatment:
During the active COVID-19 crisis and beyond, risk must be minimized during dental treatment:
- Screen for dental emergencies using teledentistry or other remote modalities, minimizing the risk of transmission
- Fully utilize available PPE, understanding that surgical masks, which do not seal around the nose and mouth, are not adequate to completely protect against aerosol-borne disease transmission
- Take extra-oral radiographs whenever possible; intraoral techniques may induce coughing
- Reduce aerosol production as much as possible through use of hand instrumentation and employment of dental dam and high speed suction.
- N95 masks, with a positive seal around the nose and mouth, in combination with a full face shield, should be worn when treating patients in close proximity to their respiratory system, similar to the protocol for medical teams performing intubations. If N95 masks are not available, surgical FDA approved masks must be worn for each patient and not reused, in conjunction with proper utilization of goggles, gowns and gloves.
To download the document click the link below:
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