Healthy Communities

COVID-19 Guidance for Dentists

Effective June 15; Revised June 22, 2020 to reflect CDC revisions June 17, 2020 **Treatment Consideration of Patients below.

On May 11, Arkansas dental facilities and dental health care providers (DHCP) resumed clinical services while adhering to the Directive on Resuming Elective Dental Services. Since dental work often creates aerosols, it carries an added risk of spreading COVID-19, especially to the DHCP, who may then spread it to others. The Arkansas Department of Health Directive and associated Guidelines follows the peer-reviewed recommendations of the CDC and other professional organizations in a conscientious effort to keep patients, DHCP and the community safe. Considering the August 4, 2020 updates from the CDC’s Guidance for Dental Setting, the ADH’s “Guidelines for Resuming Non-Urgent/Non-Emergent Elective Services” have been updated to reflect the current knowledge for safely practicing dentistry during the pandemic.

Summary of Recent Changes to reflect August 4, 2020 CDC Updates

  • Updated definition of fever to either measured temperatures of ≥100.0°F (reduced from 100.4°F).
  • Protective eyewear (safety glasses) with gaps between glasses and the face likely do not protect eyes from all splashes and sprays.  Current recommendations call for the addition of facemask (or goggles) to ensure the eyes, nose and mouth are protected from exposure due to respiratory secretions during patient encounters.
  • Request that patients contact the dental office if they develop signs or symptoms or are diagnosed with COCID-19 within two days following the dental appointment. This precaution may prove beneficial in the event contract tracing needs to be implemented.
Screening Guidelines
  • To address asymptomatic and pre-symptomatic transmission, implement source control (require facemasks or cloth face coverings) for everyone entering the dental setting (DHCP and patients), regardless of whether they have COVID-19 symptoms.
    • Ask patients to provide their own face covering;
    • Provide disposable mask for non-masked patients.
  •  Actively screen everyone (DHCP and patients) on the spot for fever (≥100.0°F) and symptoms of COVID-19 immediately upon entering the facility.
  • Patients/DHCP who meet the following criteria SHOULD NOT BE TREATED (or remain at work) at this time:
    • Has a fever of 100.0°F+ or greater;
    • Have symptoms associated with COVID-19 (fever, cough, shortness of breath, difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, 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. 
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 always important to follow this guidance and 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.
  • All patients should be screened in a phone interview prior to the appointment.  Patients with an acute respiratory illness should be identified during a phone screening interview and defer treatment unless it is an emergency case. This emergency patient should be asked to remain in their automobile until summoned directly to the treatment area with a preferred time toward latter part of schedule.
  • Reception rooms should:
    • Follow screening guidelines for all patients as indicated above;
    • Only allow the patient and caregiver, if patient is a minor or elderly that requires assistance, into the office/reception area. If possible, place seating arrangement to allow six feet distance between patients;
    • Provide tissues and no-touch receptacles for used tissue disposal;
  • Remove all magazines, journals, TV remotes, toys or any other objects that may typically be handled by patients.
Treatment Considerations of Patients 
 
While maintaining an adherence to the proper screening and disinfectant protocols that have been established, the DHCP may utilize their own professional judgement regarding patient flow and treatments that are performed. Examples of dental procedures according to relative risk for aerosol generation is found at the conclusion of this document. Universal precautions are to be strictly followed in order to minimize the possibility of disease transmission. Because of the frequent production of aerosols during dental treatments, the ADH recommends the following:
  • Dental team members that are 65 years of age and older may provide dental treatment provided said member passes the daily screening process.
  • The ADA has provided guidelines for mask types for consideration for dental healthcare providers for utilization during patient treatment. 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. Clerical staff should always wear surgical masks or cloth face mask. For additional guidance, refer to the ADA's Return to Work Interim Guidance Toolkit.
  • Patient and dental healthcare workers should perform hand hygiene (e.g., hand washing with antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after possible contact with respiratory secretions and contaminated objects/materials.
  • Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management for COVID-19 (see links below).
  • Patients should use a preprocedural mouth rinse of 1% hydrogen peroxide or 0.2% provodine to reduce the oral microflora.
  • If treatment requires the use of dental instruments which produces aerosols:
    • In addition to the typical eye protection and gloves, the treatment team members are to utilize face shields (or goggles) and a long sleeve jacket or disposable gown.
      • Cloth gowns can be laundered and reused indefinitely;
      • Due to the shortage of such PPE, disposable gowns may be worn the entire day 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. may be 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 longer appointment times for proper disinfecting protocols while also following the recommended time (product label) for the disinfectants to remain on surfaces in order to be effective.
Procedure Room Disinfection
  • Personnel must wear recommended PPE to wipe down all surfaces.
  • Clean and disinfect procedure room surfaces (including faucet handles and all other handles in 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 should 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 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 in order to receive dental treatment. However, any patient or staff member that reports signs or symptoms related to COVID-19 should be sent to the nearest facility for testing; it is advisable to identify as a healthcare worker to expedite test results.

  • A patient that test positive should not receive dental treatment for 14 days; exception for patients reporting pain that requires immediate attention and all precautions are taken as outlined previously in this guideline;
  • Decisions regarding the return to work for healthcare personnel (HCP) should be made based on the context of circumstances and the severity of the illness.
    • HCP with mild to moderate illness who are not severely immunocompromised:
      • At least 10 days have passed since symptoms first appeared and
      • At least 24 hours have passed since last fever without the use of fever-reducing medications and
      • Symptoms (e.g., cough, shortness of breath) have improved
      • HCP who are not severely immunocompromised and were asymptomatic throughout their infection may return to work when at least 10 days have passed since the date of their first positive viral diagnostic test.
  • HCP with severe to critical illness or who are severely immunocompromised1:
    • At least 20 days have passed since symptoms first appeared
    • At least 24 hours have passed since last fever without the use of fever-reducing medications and
    • Symptoms (e.g., cough, shortness of breath) have improved

Note:  HCP who are severely immunocompromised but who were asymptomatic throughout their infection may return to work when at least 20 days have passed since the date of their first positive viral diagnostic test.

 

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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