COVID-19: Managing infection risks during in-person dental care

Dentists are expected to continue to follow RCDSO’s Standard of Practice on Infection Prevention and Control (IPAC) as well as the revised guidance specific to COVID-19 described below. This revised guidance anchors to key external resources, including those of Ontario’s public health authorities (see relevant links).

Updated August 3, 2022

Office precautions

Office setup

      1. RCDSO recommends that dentists continue to post signage in common areas outlining office policies for patients and visitors (e.g., office policies for patient and/or visitor masking and instructions for patients who are experiencing symptoms of COVID-19).
      2. RCDSO recommends that dentists maintain physical barriers at key contact points to reduce the spread of droplets (e.g., a plexiglass shield at reception).

Screening

Personal precautions

Risk assessment

A point of care risk assessment (PCRA) is the first step in routine practices and must be performed prior to all patient interactions. The PCRA will inform the interventions that are necessary to prevent the transmission of infection, including requirements for personal protective equipment (PPE).

      1. Masking is no longer mandatory for all patients and visitors except as may be indicated by the PCRA and where noted in RCDSO’s PPE Table.
        1. For more information about patient and visitor masking see RCDSO’s COVID-19 FAQ.
      1. Dentists and staff must continue to don masks and all other necessary PPE as set out in RCDSO’s PPE Table.

Patients with suspected or confirmed COVID-19

General requirements

      1. Patients with suspected or confirmed COVID-19 must not be treated in-person except as needed for emergency or urgent care that cannot be delayed.
        1. Patients should be advised to self-isolate and contact their primary care provider or Telehealth Ontario at 1-866-797-0000 to determine next steps.
      1. When in-person care cannot be avoided, dentists must adhere to the following additional requirements:
        1. the patient’s appointment must be scheduled at the end of the day (if possible) to decrease the risk to other patients,
        2. the patient must don a mask prior to entering the office (see RCDSO’s PPE Table), and
        3. the patient must be placed immediately into an operatory alone with the door closed.

Aerosol-generating procedures (AGPs)

The following guidance has been updated after a careful review of the available evidence, in consultation with external subject matter experts, and in partnership with Ontario’s other regulated oral health professions:

  • All requirements for fallow time have been rescinded
  • Enclosed operatories are required only for the treatment of patients with suspected or confirmed COVID-19

Given the continued risk of a new variant of concern as well as the potential for future pandemics, the College recommends that dentists maintain capacity for enclosed operatories even if they are not providing care to COVID-19 positive patients. This can be achieved by maintaining existing enclosed operatories or by ensuring that temporary barriers can be reconstructed (see RCDSO’s COVID-19 FAQ for more information)

      1. If a patient is suspected or confirmed COVID-19 positive, dentists must avoid AGPs except as needed for emergency or urgent care that cannot be delayed.
      2. When care cannot be delayed, dentists must use the lowest aerosol-generating options available.
      3. AGPs must be performed in an operatory that is capable of containing aerosol. This requires floor-to-ceiling walls and a door (or other barrier) that must remain closed during the procedure. Temporary walls and doors are permitted, provided they contain aerosols and are constructed of materials that can withstand repeated cleaning and disinfection.
      4. Dentists are advised to use a rubber dam with high-volume suction to minimize aerosols whenever possible.
      5. Dentists must ensure that operatories are cleaned and disinfected between each patient appointment.

Table 1: Requirements for the Use of Personal Protective Equipment (PPE)

The requirements set out in this table align with the applicable recommendations of the Ministry of Health and Public Health Ontario as set in in:


Dentists and Staff

Non-aerosol generating procedures (NAGPs) when the patient has screened negative for COVID-19

  • ASTM level 2 or 3 procedure/surgical mask
  • Gloves
  • Eye protection: goggles or face shield
  • Isolation gown (optional)

 

Non-aerosol generating procedures (NAGPs) for patients with suspected or confirmed COVID-19

 

Aerosol generating procedures (AGPs) when the patient has screened negative for COVID-19.

 



 

Aerosol generating procedures (AGPs) for patients with suspected or confirmed COVID-19.

 



 

Cleaning and disinfection of operatory or other treatment area

  • Minimum ASTM level 1 procedure mask
  • Gloves
  • Eye protection: goggles or face shield

 

Reprocessing of reusable instruments (reprocessing area)

Reception duties and screening

  • Minimum ASTM level 1 procedure mask
  • Physical barrier recommended

 

Administrative and other tasks (common and staff areas)

  • ASTM level 1 procedure mask

 

Patients and Visitors

Patients who are suspected or confirmed COVID-19 positive

  • Minimum ASTM Level 1 procedure mask prior to entering the office

Visitors present during an AGP (e.g., a parent, caregiver, or personal support worker)

  • PPE to be determined by a risk assessment for the visitor (to include the nature of the procedure, the degree of prior exposure of the accompanying visitor to the patient, and the ability to maintain appropriate distancing). For more information, see RCDSO’s COVID-19 FAQ.

 

Relevant links