Since first emerging in Ontario in November, the Omicron variant has spread rapidly.
Recent data and evidence estimate that Omicron is four to eight times more infectious than the Delta variant, and urgent action is needed to slow transmission and reduce the strain on an overburdened healthcare system.
Dentists must do their part to help slow the transmission of Omicron and preserve health system capacity by adhering to RCDSO’s COVID-19: Managing Infection Risks During In-Person Dental Care guidance document as well as the additional requirements outlined below, which are consistent with the direction of Ontario’s Chief Medical Officer of Health.
CMOH Directive #1: Dentists and Staff Must Continue to Don N95 Respirators (or their Equivalent) for All In-Person Patient Interactions and for the Provision of All Direct Clinical Care
RCDSO’s requirements issued on December 22, 2021, continue to be in effect. These requirements reflect the Chief Medical Officer of Health’s revised Directive #1.
- Dentists must don a fit-tested, seal-checked N95 respirator (or the equivalent, as approved by Health Canada) for all in-person patient interactions and for the provision of all direct clinical care.
- Dentists must ensure that all staff don a fit-tested, seal-checked N95 respirator (or the equivalent, as approved by Health Canada) for all in-person patient interactions except where there is a physical partition or barrier between office staff and patients.
- Dentists and staff who are not yet fit-tested for an N95 respirator must don a well-fitted surgical/procedure mask, a KN95 respirator, or a non-fit-tested N95 respirator (or the equivalent, as approved by Health Canada). Dentists must make reasonable efforts to ensure that all staff who are not yet fit-tested for an N95 respirator obtain fit testing at the earliest opportunity
Explanatory note: Directive #1 applies to the provision of care and all patient interactions with suspected, probable or confirmed cases of COVID-19. Given the rate of community transmission and the high total case counts, RCDSO has adopted a cautious approach. Requiring dentists and staff to use N95s for all patients and for both the provision of care and patient interactions is a conservative interpretation intended to keep everyone as protected as possible. It is consistent with direction and developments in other sectors, where the general public is being advised to wear N95s or the most protective mask possible when going out in public, and where teachers are being furnished with N95s in professional settings.
Dentists are permitted to extend the use or reuse an N95 respirator (or the equivalent) if they adhere to the guidance set out in Public Health Ontario’s Universal Mask Use in Health Care document.
CMOH Directive #2: Restrictions on Non-Emergent and Non-Urgent Surgeries and Procedures
The Chief Medical Officer of Health has issued a revised Directive #2 which requires that dentists must immediately cease:
- Non-emergent and non-urgent major surgical procedures (e.g., osteotomies, such as LeFort and bilateral sagittal split procedures, and use of rigid fixation) that carry a substantive risk of resulting in the use of emergency medical services or other hospital services.
- Other non-emergent and non-urgent dental procedures that carry a substantive risk of resulting in the use of emergency medical services or other hospital services.
- Non-emergent and non-urgent sedation and general anesthetic procedures requiring a sedation or anesthetic team (i.e., parenteral moderate sedation, deep sedation and general anesthesia) as described in the RCDSO’s Standard of Practice on the Use of Sedation and General Anesthesia in Dental Practice.
Surgeries and procedures may be provided if they are for the treatment of emergency or urgent care that cannot be delayed (see the College’s definitions for emergency/urgent and non-emergent/non-urgent).
Routine dental procedures and services performed by dentists and dental hygienists in community settings may continue. In addition, the use of nitrous oxide and oxygen sedation, oral minimal sedation and oral moderate sedation are permissible, as they do not require a sedation or anesthetic team.
The Ministry of Health has also developed a question and answer document for Directive #2.
In addition to complying with Directive #2, RCDSO encourages dentists to take any additional steps they can to support the broader objective of reducing the mobility of Ontarians. For non-emergent and non-urgent care, RCDSO recommends that dentists manage care remotely through Teledentistry where possible and to defer in person non-emergent and non-urgent care when possible.
Dentists are Temporarily Permitted to Administer COVID-19 Vaccines Under Supervision
On December 23, 2021, the Ontario Government introduced regulatory amendments that remove legislative restrictions on who can administer a COVID-19 vaccine. These efforts will help to increase capacity to support Ontario’s booster dose rollout.
For a temporary period, dentists are now permitted to administer COVID-19 vaccines at approved vaccination sites and under the supervision of a physician, registered nurse or nurse practitioner, or pharmacist. Education and training courses will be provided.
Dentists who are interested in participating in the COVID-19 booster rollout can register at the Health Workforce Matching Portal.
The College Will Continue to Monitor the Situation and Will Provide Additional Updates as Necessary
The College will closely monitor the environment and will advise dentists of any new direction from the Chief Medical Officer of Health.
Dentists who have questions that are not addressed here or RCDSO’s COVID-19: Managing Infection Risks During In-Person Dental Care guidance document are advised to review the College’s COVID-19 FAQ and/or contact the College’s Practice Advisory Service (PAS) at (416) 934-5614 or email email@example.com.