Due to the nature of dental care requiring face-to-face interaction, the risk of COVID-19 cross-contamination is very high in the dental setting. For dental practices, strict and effective infection control protocols are urgently needed. In this article, through research and experience, we are going to create a detailed step-by-step guide for dental practices to minimize the risk of COVID-19 infection when giving dental care.
We will break the guideline into three parts: before, during, and after giving dental care.
Before giving dental care
Step 1: Identify your team members who belong to the high-risk group.
According to the CDC, people who are 65 years and older or those who have underlying medical conditions, such as chronic lung disease, asthma, heart conditions, or diabetes, might be at higher risk for severe illness from COVID-19. Your practice must identify such personnel within the doctors and staff before beginning dental treatment.
Step 2: Health assessment for all team members.
Next, practices need to monitor the health of all doctors and staff up until the dental procedure. Any member who shows symptoms related to COVID-19, such as fever, cough, dyspnoea, or muscle pain, should be identified and evaluated. If you don’t have available test kits or are unable to confirm whether or not a team member has been infected, it is better to remove such individuals from the dental procedure to prevent potential infection for the patients.
Step 3: Health assessment for patients.
Before scheduling an appointment, practices need to detect potential cases of coronavirus through initial patient screening via telephone. At the minimum, practices need to ask questions about the patients’ overall health condition, such as whether or not they have shown signs of respiratory illness symptoms. Please read our article for a more detailed guide on patient screening.
In case when a patient is only identified at check-in to have influenza symptoms, practices should place the patient in a single patient room with the door kept closed.
Step 4: Have adequate personal protective equipment (PPE).
At the minimum, dental professionals at your office need to be equipped with masks, gloves, eyewear, and gowns. It will be even better if they have face shields. In a situation when you don’t have enough PPE to carry out a procedure, we strongly recommend temporarily stopping scheduling appointments until all PPE are available.
Step 5: Adopt general housekeeping best practices.
More than ever, general housekeeping best practices are needed at your dental offices. Practices need to have staff disinfect common areas, including entry doors, reception chairs, and front desk counters throughout the day. Additionally, dental offices should provide hand sanitizer in all bathrooms and at the front desk for team members and patients to use.
Step 6: Prevent cross-contamination in the patient waiting room.
First of all, to minimize the risk of cross-contamination between patients, practices should aim to shorten their time present at your office. This means moving the whole scheduling and payment process online. Additionally, you should schedule appointments in a way that minimizes patient contact. For example, you can schedule appointments further apart with an added hour in between.
Secondly, we advise offices to remove touchable items that could lead to cross-contamination, such as magazines and toys. Furthermore, offices should offer disposable surgical masks to patients who are coughing, and provide tissues and no-touch receptacles for used tissue disposal.
Finally, practices need to adopt social distancing in the waiting room at all times. In a situation where more than one patient is present at the same time, offices need to have a staff member to direct the patients into seats with enough distance from each other.
During the dental procedure
Step 7: Apply standard infection prevention practices.
Standard precautions need to be implemented on all procedures, regardless of suspected or confirmed infection status of the patient. According to the CDC, these practices include at least the following:
- Hand hygiene.
- Use of personal protective equipment (e.g. masks, gloves, eyewear, gowns).
- Respiratory hygiene/cough etiquette.
- Sharps safety (engineering and work practice controls).
- Safe injection practices (i.e., aseptic technique for parenteral medications).
- Sterile instruments and devices.
- Clean and disinfected environmental surfaces.
Step 8: Have patients use pre-procedural mouth rinse of peroxide.
Many dental procedures, such as those including the use of high-speed turbines and running water, release a large number of particles of droplets and aerosols mixed with the patient’s saliva to the air. These particles can potentially travel across distances up to 20 feet. This allows viruses to enter another person’s respiratory system directly, suspend in the air, or contaminate surfaces in the dental office.
To minimize infection risk, we advise dentists to have patients use mouth rinse before procedures. The ADA and CDC are recommending peroxide to kill the viruses inside a patient’s saliva. Some products with peroxide are Colgate Peroxyl and Listerine Whitening Mouthrinse.
Step 9: Reduce aerosol production as much as possible.
During the dental procedures, dental professionals should use an extraoral suction system to remove droplets and aerosol particles generated. Most suction systems on the market nowadays are capable of filtering most viruses and germs, reducing the risk of COVID-19 infection.
After the dental procedure
Step 10: Clean and disinfect PPE and the environment.
After giving dental care, practices need to disinfect and clean the reusable PPE with soap and water. Next, practices have to disinfect environmental surfaces, instruments, and devices according to standard infection prevention practices.
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