Updates have been made to the CDC’s Guidance on Dental Settings – Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response. Revisions were made on Tuesday, April 7, 2020 and were posted yesterday.
Here are the main updates:
- Description of risk to dental health care personnel (DHCP) – The Occupational Safety and Health Administration’s Guidance on Preparing Workplaces for COVID-19pdf iconexternal icon places DHCP in the very high exposure risk category, as their jobs are those with high potential for exposure to known or suspected sources of the virus that causes COVID-19 during specific procedures.
- When practicing in the absence of Airborne Precautions, the risk of SARS-CoV-2 transmission during aerosol generating dental procedures cannot be eliminated. Caring for patients requiring Airborne Precautions is not possible in most dental settings as they are not designed for or equipped to provide this standard of care. For example, most dental settings do not have airborne infection isolation rooms or single-patient rooms, do not have a respiratory protection program, and do not routinely stock N95 respirators.
- Recommendations for contacting patients prior to and after emergency dental care – Telephone triage all patients in need of emergency dental care. Assess the patient’s dental condition and determine whether the patient needs to be seen in the dental clinic. Use teleconferencing or teledentistry options as alternatives to in office care. If dental treatment can be delayed, provide patients with detailed home care instructions and any appropriate pharmaceuticals. DHCP should institute a policy to contact all patients who received emergency dental care in the dental setting 48 hours after receiving emergency care. DHCP should ask patients if they are exhibiting any signs or symptoms of COVID-19. If a patient reports signs or symptoms of COVID-19, refer the patient to their medical provider for assessment and follow CDC’s Healthcare Personnel with Potential Exposure Guidance.
- Recommendations for providing emergency dental care to non-COVID-19 patients including engineering controls, work practices and infection control considerations – If a patient must be seen in the dental clinic for emergency care, systematically assess the patient at the time of check-in. The patient should be asked about the presence of symptoms of a respiratory infection and history of travel to areas experiencing transmission of COVID-19 or contact with possible patients with COVID-19. If the patient is afebrile (temperature < 100.4˚F) and otherwise without symptoms consistent with COVID-19, then emergency dental care may be provided using appropriate engineering controls, work practices, and infection control practices.
Engineering Controls and Work Practices
Avoid aerosol generating procedures whenever possible. Avoid the use of dental
hand pieces and the air-water syringe. Use of ultrasonic scalers is not
recommended during this time. Prioritize minimally invasive/atraumatic
restorative techniques (hand instruments only). If aerosol generating procedures
are necessary for emergency care, use four-handed dentistry, high evacuation suction
and dental dams to minimize droplet spatter and aerosols.
- Requirement of surgical mask and full-face shield: If the minimally acceptable combination of a surgical mask and a full-face shield is not available, do not perform any emergency dental care. Refer the patient to a clinician who has the appropriate PPE.