Infection control standards were initially developed for dentistry in response to the HIV epidemic and included Standard and Transmission-based Precautions. Based upon emerging evidence regarding SARS-CoV-2 and previous investigations studying other coronaviruses, spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts.88 Close contact can occur while delivering patient care and is currently defined by the CDC as: 1) being within approximately 6 feet (2 meters) of a patient with COVID-19 for a prolonged period of time (≥30 minutes) or 2) having direct contact with infectious secretions from a patient with COVID-19. Infectious secretions may include sputum, saliva, serum, blood, and respiratory droplets.88 No reliable data currently exist to assess the risk of SARS-CoV-2 during routine dental practice or to determine whether the routine PPE and Standard Precautions used by DHCP is adequate to protect them.
CDC and ADA interim recommendations updated on April 7, 2020 for infection prevention and control include:88,89
- Postponement of elective and non-essential dental procedures until deemed safe by public health and governmental authorities.
- DHCP and patients should stay at home if experiencing COVID-19 symptoms and seek medical care as recommended based upon symptoms and healthcare provider assessment.
- Assess and triage patients using teledentistry prior to an in-person dental visit. Assess the emergent nature of the patient’s dental needs and any symptoms related to COVID-19. Patients with confirmed or suspected COVID-19 should be referred to contact the emergency department to determine the optimal patient care options, even for dental emergencies.
- If urgent and/or emergent dental treatment must be delivered for an asymptomatic patient, DHCP should then assess the likelihood of aerosol production during care.
- If the needed procedure is unlikely to produce aerosols, DHCP can use routine PPE and the procedure is considered low-risk.
- If aerosols are likely to be produced, the following PPE standards are recommended:
- N95 (KN95) or higher-level respirator masks
- Full face shield or goggles
- Disposable gown
- Head coverings
- If N95 or higher respirator masks are not available due to supply-chain or other issues, use of a surgical mask and full-face shield should be worn and patients should be referred for COVID-19 testing after the procedure.
- Practice how to properly don, use, and doff PPE in a manner to prevent self-contamination.
- Perform hand hygiene with alcohol-based hand rub before and after all patient contact, contact with potentially infectious material, and before putting on and upon removal of PPE, including gloves. Use soap and water if hands are visibly soiled.
- Clean and disinfect clinical surfaces with approved disinfection protocols and utilizing disinfectants from EPA-approved emerging viral pathogens claims (List N).90
- Screen all DHCP at the beginning of their shift for fever and respiratory symptoms. Document shortness of breath, new or change in cough, and sore throat. If they are ill, have them put on a facemask and leave the workplace.