Healthy Communities

COVID-19 Guidance for Dentists

Revised March 29, 2021

Per the Governor’s Executive Order on February 26, 2021, all Directives were changed to Guidelines. The continued public mask mandate concludes March 31, 2021. The following guidelines for dentistry are still the recommended protocols as the vaccination plan continues to expand and reach more of the population. Now is not the time to relax the measures that have effectively protected the dental community and patient base during this pandemic.

Screening Guidelines

  • To address asymptomatic and pre-symptomatic transmission, implement source control (require facemasks or cloth face coverings) for everyone entering the dental setting (dental health care providers, DHCP, and patients), regardless of whether they have COVID-19 symptoms.
  • Actively screen everyone (DHCP and patients) on the entrance to the facility for fever (≥100.0°F) and symptoms of COVID-19 immediately upon entering the facility.
  • It is recommended that patients/DHCP who meet the following criteria should delay treatment (or remain at work) until such symptoms abate:
    • Has a fever of 100.0°F+ or higher;
    • Have symptoms associated with COVID-19 (fever, cough, shortness of breath, difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, the new loss of taste or smell);
    • Had contact with a person known to be infected with COVID-19 within the previous 14 days;
    • Awaiting a pending COVID-19 test result OR had a positive test for COVID-19 in the last 10 days.

Management of Patients

Patients with an acute respiratory illness may present for dental treatment at outpatient dental settings. It may not be possible to know the cause of any patient’s illness, so it is important to follow this guidance and recommended standard precautions.

  • Seek to prevent the transmission of respiratory infections in healthcare settings by adhering to respiratory hygiene/cough etiquette. Advised to place proper signage within the facility as reminders.
  • Screen patients in a phone interview prior to the appointment.  Identify patients with an acute respiratory illness and defer treatment unless it is an emergency case. Ask such an emergency patient to remain in their automobile until summoned directly to the treatment area with a preferred time toward the latter part of the day’s schedule.
  • Reception rooms should:
    • Consider allowing only the patient and caregiver (when the patient is a minor or elderly that requires assistance) into the office/reception area. If possible, place seating arrangements to allow proper social distance between patients;
    • Provide alcohol-based hand sanitizer with at least 60% alcohol, tissues, and no-touch receptacles for waste disposal;
    • Recommend that magazines, journals, TV remotes, toys, or any other object typically handed by patients remain put away.

Treatment Considerations of Patients

While maintaining adherence to the proper screening and disinfectant protocols that have been established, the DHCP may utilize their own professional judgment regarding patient flow and treatments that are performed. Because of the frequent production of aerosols during dental treatments, the ADH recommends continue universal precautions with the following additional recommendations to minimize the possibility of disease transmission:

  • Utilization of N95 masks, or comparable type, is the recommended standard for the treatment team (dentist, dental hygienist, dental assistant) which provides the lowest risk of infection to the DHCP during the COVID-19 pandemic. Recommend clerical staff personal to wear surgical masks or cloth face masks.
  • Recommend patient and dental healthcare workers perform hand hygiene (e.g., handwashing with antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after possible contact with respiratory secretions and contaminated objects/materials.
  • Recommend routine cleaning and disinfection strategies used during influenza season be applied to the environmental management for COVID-19 (see links below).
  • Recommend preprocedural rinses with the antimicrobial products (chlorhexidine gluconate, cetylpyridinium chloride, or 0.2% povidone-iodine) to reduce levels of oral microorganisms in aerosols.
  • If the treatment requires the use of dental instruments which produces aerosols:
    • In addition to the typical eye protection and gloves, recommend clinical team members utilize face shields (or goggles) and a long sleeve jacket or disposable gown.
      • Cloth gowns can be laundered and reused indefinitely,
      • Disposable gowns may be reused unless visibly soiled or the integrity of the gown is compromised.
    • Using a dental dam is considered the best isolation of the treatment area.
      • Place HVE (high-volume evacuation) as close to the surgical site as possible to capture the generated aerosols,
      • Ultrasonic or piezo instrumentation may be utilized but highly recommend the usage of a four-handed approach to better capture generated aerosols. Other HVE devises such as Dry Shied, Isolite, SafetySuction, Zirc Mr. Thirsty, etc. are deemed suitable.
  • Implement procedures to minimize exposures after procedures:
    • Ask patients to wash their hands for 20 seconds and to wear their mask when they leave the treatment area,
    • When possible, provide all necessary information to patients in the procedure room to avoid congregation at the front desk/waiting area on their way to exit the clinic,
    • Complete paperwork electronically before or after the appointment if possible,
    • Allot extra appointment time for proper disinfecting protocols while also following the recommended time (product label) for the disinfectants to remain on surfaces to be effective.

Procedure Room Disinfection

  • Personnel to wear recommended PPE to wipe down all surfaces.
  • Clean and disinfect procedures to room surfaces (including faucet handles and all other handles in the room).
  • Follow the contact times as appropriate for the disinfectant product used, assuring the surface being disinfected stays wet for the duration of the recommended time (refer to product label).
  • Gloves to be doffed upon leaving the treatment room, immediately followed by performing hand hygiene procedures; face shields should be disinfected prior to next patient care.
  • Signage to indicate the room is clean and ready for next patient

Information on disinfectants for use against SARS-CoV-2, the virus that causes COVID-19:

Procedure for Disinfection of PPE:

Considerations for COVID-19 Positive Results in Patients or Staff Member

The ADH does not advise nor require that a patient demonstrate a negative COVID-19 test result to receive dental treatment. However, recommend any patient or staff member that reports signs or symptoms related to COVID-19 to be sent to the nearest facility for testing.

  • Delay treatment for 10 business days for any patient that test positive unless reporting pain and requires immediate attention and all precautions are taken as outlined previously in this guideline,
  • Any staff member that tests positive for COVID-19 is to not return to the dental facility until 10 days have passed from the time of the test confirmation.

Resources:

 
 

Public Health Accrediation Board
Arkansas Department of Health
© 2017 Arkansas Department of Health. All Rights Reserved. www.healthy.arkansas.gov
4815 W. Markham, Little Rock, AR 72205-3867
1-800-462-0599