Clinical Practice Guideline for an Infection Control/Exposure Control Program in the Oral Healthcare Setting
Course Number: 342
Course Contents
Medical Conditions and Work Restrictions
Oral health care facilities shall have written policies to protect patients and OHCPs with latex allergies, to protect OHCPs who are susceptible to opportunistic infections, and to protect patients from OHCPs with transmissible infections.
OHCPs and patients may become susceptible to latex-related adverse reactions, OHCPs may also develop acute or chronic conditions, which may predispose them to opportunistic infections, or OHCPs may acquire potentially transmissible infections. Such individuals should discuss the problem with their medical provider to determine if the condition might affect their ability to safely perform their duties.
Execution/ Compliance
Minimize latex allergy-related health problems among OHCPs and patients.
Reduce exposure to latex-containing materials by substituting non-latex products when appropriate and using appropriate work practice controls.
Train and educate OHCPs to recognize signs and symptoms of latex-related adverse effects, i.e.,
Allergic contact dermatitis
Urticaria
Angioedema
Allergic rhinitis
Anaphylaxis
Monitor signs and symptoms of latex sensitivity among OHCPs and patients.
Refer OHCP and patients with signs and symptoms suggestive of latex allergy to a medical provider to confirm diagnosis.
Minimize the exposure of OHCPs with acute or chronic diseases to patients who have been diagnosed with a transmissible infectious disease.
Consult with medical provider
Determine if condition(s) might affect ability to safely perform duties.
Minimize the exposure of patients to OHCPs who have been exposed to or have been diagnosed with an infectious disease (Tables 1, 2, 3, and 4).
Restriction criteria
Mode of transmission.
Period of infectivity.
Level of circulating viral burden.
Level of risk for the transmission of a pathogen in association with a procedure.
Procedure-related risk for bloodborne pathogen transmission.
Oral healthcare-associated procedures according to the level of risk for bloodborne pathogen transmission
Category I: Procedures with minimal risk of bloodborne pathogen transmission - History-taking
- Extraoral physical examination
- Intraoral examination
- Including the use of a tongue depressor, mirror, explorer, or a periodontal probe
- Routine preventive dental procedures - not requiring the administration of local anesthesia
- Application of sealants or topical fluoride
- Prophylaxis – not to include subgingival scaling with a hand instrument
- Orthodontic procedures
- Prosthetic procedures
- Fabrication of complete dentures
- Hands-off supervision of surgical procedures
Category II: Procedures for which bloodborne pathogen transmission is theoretically possible but unlikely - Dental procedures requiring the administration of local anesthesia
- Operative, endodontic, and prosthetic procedures and periodontal scaling and root planing
- Use of ultrasonic instruments greatly reduce or eliminate the risk of percutaneous injury to the provider
- If significant physical force with hand instruments is anticipated to be necessary, scaling and root planing and other Category II procedures could reasonably be classified as Category III
- Minor surgical procedures
- Simple tooth extraction not requiring excessive force
- Soft tissue flap procedures
- Minor soft tissue biopsy
- Incision and drainage of an abscess
- Operative, endodontic, and prosthetic procedures and periodontal scaling and root planing
- Insertion of, maintenance of, and drug administration into arterial and central venous lines
Category III: Procedures for which there is a definite risk of bloodborne pathogen transmission or that have been classified as “exposure prone” - General oral surgery
- Surgical extractions
- Removal of an erupted or unerupted tooth requiring elevation of a mucoperiosteal flap, removal of bone, or sectioning of tooth and suturing
- Apicoectomy and root amputation
- Periodontal curettage, gingivectomy, and mucogingival and osseous surgery
- Alveoplasty and alveoectomy
- Endosseous implant surgery
- Surgical extractions
- Open extensive head and neck surgery involving bone
- Trauma surgery, including open head injuries, facial fracture reductions, and extensive soft issue trauma
- Any open surgical procedure with a duration of more than 3 hours, probably necessitating glove change
Criteria for recommended clinical privileges:
No evidence of having transmitted infection to patients.
Obtained advice from an Expert Review Panel about continued practice.
Follow-up twice a year to demonstrate the maintenance of an acceptable viral burden.
Follow-up by medical professional with expertise in the management of infections with bloodborne pathogens.
Consulted with an expert about and strictly adhere to optimal infection control procedures.
Agreed to and signed a contract or letter from the Expert Review Panel that characterizes responsibilities.
Table 1. Work Restrictions: HAV, HBV, HCV, and HIV Infections.
Pathogen | Circulating Viral Burden | Clinical Privileges |
---|---|---|
HBV and HCV | <104 GE/mL | Category I, II, and III procedures* |
≥104 GE/mL | Category I and II procedures* | |
HIV | <5 x 102GE/mL | Category I, II, and III procedures* |
≥5 x 102GE/mL | Category I and II procedures* | |
* Clinical privileges predicated on the infected healthcare provider meeting the following requirements:
|
Infectious state | Restrictions | |||
---|---|---|---|---|
Post-exposure Susceptible OHCP | Exclude from duty from the 5th day after first exposure through the 21st day after last exposure OR for 4 days after rash appears. | |||
Acute infection | Exclude from duty for 5 days after rash appears. | |||
Post-exposure Susceptible OHCP | Exclude from duty from the 12th day after first exposure through the 26st day after last exposure OR for 9 days after onset of parotitis. | |||
Acute infection | Exclude from duty for 5 days after onset of parotitis. | |||
Post-exposure Susceptible OHCP | Exclude from duty from the 7th day after first exposure through the 21st day after last exposure. | |||
Acute infection | Exclude from duty for 5 days after rash appears. |
Infectious state | Restrictions | |
---|---|---|
Herpes simplex | Acute orofacial herpes | Evaluate the need to restrict from the care of patients at high-risk until lesions heal. |
Acute herpetic whitlow | Exclude from duty until lesions heal. | |
Acute genital herpes | No Restrictions | |
Varicella (chicken pox) | Post-exposure Susceptible OHCP | Exclude from duty from the 10th day after first exposure through the 21st day after last exposure. |
Acute infection | Exclude from duty until all lesions dry and crust. | |
Varicella zoster (shingles) | Post-exposure Susceptible OHCP | Exclude from patient care from the 5th day after first exposure through the 21st day after last exposure. |
Acute infection Healthy OHCP | Cover lesions and restrict from the care of patients at high-risk until all lesions dry and crust. | |
Acute infection Immunocompromised OHCP | Restrict from patient care until all lesions dry and crust. |
Infectious state | Restrictions | |
---|---|---|
Influenza and syncytial viruses | Acute infection with fever | Exclude from the care of patients at high-risk until acute symptoms resolve. |
Group A streptococci | Acute infection | Restrict from duty until 24 hours after treatment is initiated. |
Meningococcus | Acute infection | Exclude from duty Until 24 hours after start of effective therapy |
Mycobacterium tuberculosis | PPD Positive | No Restrictions |
Acute infection | Exclude from duty until proven non-infectious. | |
OHCP with potential exposure* |
| SARS-CoV-2 | OHCP with confirmed infection |
* Risk criteria for potential exposure: Prolonged close contact (>15 minutes) with a patient, visitor, or HCP with confirmed SARS-CoV-2 infection and
|
Healthcare Emergency Temporary Standard
On June 21, 2021, the Occupational Safety and Health Administration (OSHA) adopted a Healthcare Emergency Temporary Standard (Healthcare ETS) protecting workers from SARS-CoV-2 infection in settings where they provide healthcare or healthcare support services. As such, the Healthcare ETS attempts to maximally mitigate the airborne transmission risk associated with SARS-CoV-2 in the workplace. In addition, the Centers for Disease Control (CDC) has continued to update and refine its SARS-CoV-2 mitigation guidance (Interim Infection Prevention and Control Recommendations for Healthcare Personnel During the Coronavirus Disease 2019 (COVID-19) Pandemic). The Healthcare ETS was to be superseded by a permanent standard within 6 months. However, on December 27, 2021 OSHA announced that it had yet to complete the final rule and as a consequence withdrew the non-recordkeeping portions of the Healthcare ETS.
The most recent recommendations (August 2021 for OSHA and May 2024 for CDC) are indicated in this table and in the “work restrictions” table 3 above. As of the most recent update of this course in June 2025, some of the CDC documents have been archived and are no longer being updated. The OHCP should bear in mind that OSHA will vigorously enforce the general duty clause and its general standards, including the Personal Protective Equipment (PPE) and Respiratory Protection Standards, to help protect healthcare employees from the hazard of COVID-19 and other respiratory viruses.
OSHA COVID-19 Healthcare Emergency Temporary Standard (ETS) and CDC Guidance Pertaining to Dentistry20,21 |
Each facility should maintain a COVID-19 plan and have an assigned designated safety coordinator with authority to ensure compliance.
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Ensure existing HVAC systems are used in accordance with manufacturer’s instructions and design specifications for the systems and that air filters are rated Minimum Efficiency Reporting Value (MERV) 13 or higher, if the system allows it. |
Dental treatment should be provided in individual patient rooms whenever possible. For facilities with open floor plans, there should be:
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When performing aerosol generating procedures on patients who are not suspected or confirmed to have SARS-CoV-2 infection, ensure that OHCP correctly wear the recommended PPE (Standard Precautions) and use mitigation methods such as four-handed dentistry, high evacuation suction, and dental dams to minimize droplet spatter and aerosols. For additional protection, the OHCP may choose to wear a NIOSH-approved N95 or equivalent or higher-level respirator. |