Status as of June 3, 5:00 p.m.
Pennsylvania Department of Health
The Pennsylvania Department of Health issued a revised guidance for dental health care personnel in Pennsylvania. The guidance allows dental health care providers the ability to provide non-emergency healthcare, including routine cleanings. It is effective statewide, and is not subject to the red/yellow/green standard, although it does provide separate standards for areas with no, minimal, moderate, or substantial transmission.
The guidance instructs providers to apply the CDC Framework to determine the conditions under which non-emergency and routine care can resume.
- For areas with no transmission or minimal community transmission, routine care practices can resume using standard precautions. The DOH guidance recommends utilizing the CDC Interim Guidance for Dental Settings when feasible, taking into consideration the possibility of transmission of the virus by presymptomatic or asymptomatic patients.
- For areas with minimal to moderate or substantial transmission, dental care can be provided using the CDC Interim Guidance for Dental Settings. According to the CDC framework, areas with minimal to moderate transmission can provide routine care, but should prioritize at-risk populations and those whose care, if continually deferred, would more likely result in patient harm. Areas with substantial transmission should consider deferring treatment until community transmission decreases.
All providers should utilize universal source control and actively screen for fever or COVID-19 symptoms regardless of community transmission levels. Practices should ensure that they have appropriate levels of PPE for all practitioners, and in the event that PPE is limited, prioritize care for most vulnerable patients first.
The Occupational Safety and Health Administration (OSHA) has released its guidance for dentistry workers and employers. The report directs employers to assess the hazards to which their workers may be exposed; evaluate the risk of exposure; and select, implement, and ensure workers use controls to prevent exposure. The guidance also defines exposure risk levels, and recommends engineering controls, administrative controls, safe work practices, and PPE requirements. In the event that proper PPE is not available, OSHA has provided a flexibility policy.
The Center for Disease Control (CDC) has issued revised a new guidance for dental settings. The guidance makes recommendations for resuming non-emergency dental care; provides new information regarding facility and equipment considerations, sterilization and disinfection, and considerations for the use of test-based strategies to inform patient care; and expands recommendations for provision of dental care to patients with and without COVID-19.
Due to the length of the CDC recommendations, providers are encouraged to review the guidelines in their entirety. A brief summary is below.
- Contact all patients prior to dental treatment to screen for COVID-19 symptoms, and ask patients to use a face covering upon arrival.
- Provide instructions and supplies addressing hand hygiene and cough etiquette. Install physical barriers at reception areas to limit close contact between triage personnel and potentially infectious patients. Place chairs in the waiting room at least six feet apart. Remove toys, magazines, and other frequently touched objects that cannot be regularly cleaned or disinfected. Minimize the number of persons waiting in the waiting room and overlapping dental appointments.
- Review the manufacturer’s instructions for use for office closure, period of non-use, and reopening for all equipment and devices.
Administrative Controls and Work Practices
- Limit clinical care to one patient at a time whenever possible. Avoid aerosol-generating procedures whenever possible. If aerosol-generating procedures are necessary for dental care, use four-handed dentistry, high evacuation suction and dental dams to minimize droplet spatter and aerosols. and limit personnel to only those essential for patient care and procedure support.
- Perform hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE.
Universal Source Control
- Wear a facemask at all times while in the dental setting. Personnel who do not require PPE can wear a cloth face covering. Those providing direct care can switch to a cloth face covering when PPE is not required.
- Select and provide PPE in accordance with OSHA regulations 29 CFR 1910 Subpart I. Provide training on its proper use.
- For procedures potentially involving spatter, wear a surgical mask, eye protection (goggles, protective eyewear with solid side shields, or a full-face shield), and a gown or protective clothing.
- During aerosol-generating procedures, consider the use of an N95 respirator or a respirator that offers a higher level of protection such as other disposable filtering facepiece respirators, PAPRs, or elastomeric respirators, if available. Respirators should be used in the context of a respiratory protection program, which includes medical evaluations, training, and fit testing.
- If a respirator is not available for an aerosol-generating procedure, use both a surgical mask and a full-face shield. Ensure that the mask is cleared by the US Food and Drug Administration (FDA) as a surgical mask. Use the highest level of surgical mask available. If a surgical mask and a full-face shield are not available, do not perform any aerosol-generating procedures.
- Necessary procedures on symptomatic patients should involve the use of a N95 or higher, should minimize personnel necessary, and should be scheduled at the end of the day.
Environmental Infection Control
- Personnel should ensure that environmental cleaning and disinfection procedures are followed consistently and correctly after each patient. However, it is not necessary to attempt to sterilize a dental operatory between patients.
Monitor and Manage Dental Health Care Personnel
- Implement sick leave policies for DHCP that are flexible, non-punitive, and consistent with public health guidance. Screen all DHCP at the beginning of their shift for fever and symptoms consistent with COVID-19.
PAGD staff is available at all times. All future PAGD live educational events have been cancelled or postponed. Refunds will be provided for everyone that has paid to attend.
PAGD will continue to host webinars that are free to members. Please continue to check this page for updates.