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Interim Dental Infection Prevention and Control Guidance for the COVID‑19 Response – A New Paradigm
Considerations for Additional Precautions or Strategies for Treating Patients with Suspected or Confirmed COVID-19

Course Author(s): Michaell A. Huber, DDS

Considerations for Additional Precautions or Strategies for Treating Patients with Suspected or Confirmed COVID-19

Have a protocol in place to manage the patient presenting for dental care with suspected or confirmed COVID‑19 infection.2

  • If a patient arrives at your facility and is suspected or confirmed to have COVID-19, defer dental treatment and take the following actions:
    • If the patient is not wearing a cloth face covering, provide them a facemask to cover his or her nose and mouth.
    • If the patient is not acutely sick, advise them to return home and contact their primary care provider.
    • If the patient is acutely sick (e.g., difficulty breathing), refer to the ER or call 911 as needed; inform referral facility of possible COVID‑19 infection.
  • If emergency dental care is determined to be medically necessary for a patient who has, or is suspected of having, COVID‑19, OHCP should follow CDC’s “Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID‑19) in Healthcare Settings,” including the use of PPE.28
    • Dental treatment should be provided in an individual patient operatory with a closed door.
    • If possible, avoid aerosol-generating procedures (e.g., use of dental handpieces, air/water syringe, ultrasonic scalers).
    • If aerosol-generating procedures must be performed, take appropriate precautions.
      • OHCP in the room should wear an N95 or higher-level respirator, such as disposable filtering facepiece respirator, powered air-purifying respirator (PAPR), or elastomeric respirator, as well as eye protection (goggles or a full-face shield), gloves, and a gown.
      • Limit OHCP in the operatory to only those essential for patient care and procedure support. Visitors should not be present for the procedure.
      • Aerosol-generating procedures should ideally take place in an airborne infection isolation room (AIIR).
    • Consider scheduling the patient at the end of the day.
    • Do not schedule any other patients at that time.
  • People with COVID-19 who have ended home isolation can receive dental care following Standard Precautions (Table 3).29
Table 3. Decision Tree to Discontinue Home Isolation for Persons with Confirmed or Suspected COVID‑19.29

Symptom-based Strategy

Persons with confirmed or suspected COVID-19 who have symptoms and were directed to care for themselves at home may discontinue home isolation when:

  • At least 10 days have passed since symptoms first appeared, and
  • At least 1 day (24 hours) has passed since recovery defined as resolution of fever without the use of fever-reducing medications and improvement in symptoms, and
  • Other symptoms have improved.

Note: For persons who were asymptomatic throughout their infection may discontinue isolation 10 days since the date of their first positive viral diagnostic test.

Note: Persons with severe illness may be infectious beyond 10 days, warranting isolation for up to 20 days. Consider consultation with an infectious disease expert.

Persons Who have NOT had COVID-19 Symptoms but Tested Positive and are Under Isolation

Test-based Strategy

No longer recommended, but may be considered for persons who are severely immunocompromised, in consultation with an infectious disease expert.

Criteria: Negative results of an FDA Emergency Use Authorized COVID‑19 molecular assay for detection of SARS‑CoV‑2 RNA from at least two consecutive respiratory specimens collected ≥24 hours apart (total of two negative specimens)*
*All test results should be final before isolation is ended. Testing guidance is based upon limited information and is subject to change as more information becomes available.
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