COVID-19 Frequently Asked Questions

Our Practice Advisory Service receives many emails and phone calls daily from dentists and the public about COVID-19. Below is a list of FAQs with up-to-date information, compiled by the Practice Advisory team.

A list of FAQs for dentists who are considering performing Antigen POCT in their practice is available here.

A list of FAQs on vaccination status for COVID-19 and how dental offices should handle this topic is available here.

Updated August 3, 2022

Is a fallow period required following non-aerosol (NAGP) or aerosol generating procedures (AGP)?

No, a fallow period is not required following non-aerosol or aerosol generating procedures (NAGP), regardless of patient screening results. Empirical evidence has not been identified that supports the protective value of fallow time for COVID-19. Following these procedures, the operatory may be cleaned and disinfected as per the College's IPAC Standard in preparation for the next patient.

Do AGPs need to be performed in enclosed operatories?

No. Enclosed operatories are no longer required EXCEPT when treating a patient who is suspect or confirmed COVID-19 positive.  Patients that are suspected or confirmed COVID-19 positive must be treated in an enclosed operatory for aerosol-generating procedures (AGPs).

An enclosed operatory is one that is capable of containing the aerosol, which means floor-to-ceiling walls and a door or other barrier that can be closed.

Temporary walls and doors are permitted, provided they create an area to contain aerosols and are constructed of materials that can withstand repeated cleaning and disinfection.

Am I required to keep any enclosed rooms?

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 some existing enclosed operatories or by ensuring that temporary barriers can be reconstructed quickly if required.

What should I consider to improve office ventilation?

Dentists may wish to consider ventilation system upgrades or improvements, such as HEPA filtration units, in order to increase the delivery of clean air and dilute potential contaminants. Dentists should consult HVAC professionals who have experience with health care settings when considering changes to HVAC systems and equipment.

Resource: Use of Portable Air Cleaners and Transmission of COVID-19 (publichealthontario.ca)

Do I still need to continue to screen patients? 

Yes, all patients must be screened prior to entering the dental office using the Ministry’s COVID-19 self-assessment tool.  The ODA has a printable version of the screening tool available here.

The screening result needs to be documented in the patient record.

Is staff screening still required? 

No. The MOH no longer requires staff to be screened using the MOH worker screening tool. Dentists must continue to follow the College’s current IPAC Standard which requires staff to self-monitor for symptoms of severe respiratory illness such as COVID-19.

How do we manage patients that screen positive for COVID-19?

Patients who screen positive should only be seen in person for care that is urgent or emergent. Non-urgent or non-emergent care should be deferred.

When in-person care cannot be avoided, dentists must adhere to the following additional requirements:

  • the patient’s appointment must be scheduled at the end of the day (if possible) to decrease the risk to other patients,
  • the patient must don a mask prior to entering the office
  • the patient must be placed immediately into an enclosed operatory alone with the door closed.
  • dentists must avoid AGPs except as needed for emergency or urgent care that cannot be delayed.
  • where AGPs cannot be avoided, they must be performed in an operatory that is capable of containing aerosols.
  • dentists must use the lowest aerosol-generating options available.
  • dentists are advised to use a rubber dam with high-volume suction to minimize aerosols whenever possible

As always, when a care plan involves other oral health care professionals, the College encourages dentists to collaborate to ensure high quality care is provided in a seamless manner.  This will involve dentists exercising professional judgement regarding what information needs to be shared with other members of the healthcare team, such as patient consent details, or the results of the patient’s point of care risk assessment, (including patients’ COVID-19 status), while respecting and adhering to dentists’ privacy and confidentiality obligations.

May I treat an asymptomatic patient that has had close contact with a suspected COVID-19 case? 

Please refer to page 27 in this Ministry of Health document: Management of Cases and Contacts of COVID-19 in Ontario

For further information please contact your local public health unit directly.

What must I or my staff do after having a close contact with a suspected or confirmed case of COVID-19? 

A close contact is defined as a person who has had a high-risk exposure to a confirmed or probable case during their period of communicability. This includes household, community and healthcare exposures as outlined in: Ministry guidance on cases and contacts of COVID-19.  There are many factors that determine the risk of exposure as outlined in this document: Risk Assessment Approach for COVID-19 Contact Tracing (publichealthontario.ca)

Due to the number of cases in the community, individuals with symptoms indicative of COVID-19 can be presumed to be infected with COVID-19.

Please see page 27 in this Ministry of Health document: Management of Cases and Contacts of COVID-19 in Ontario.

What must I or my staff do if we have COVID-19 symptoms? 

Due to the number of cases in the community, individuals with symptoms indicative of COVID-19 can be presumed to be infected with COVID-19.

Please see Table 1 on page 11 in this Ministry of Health document: Management of Cases and Contacts of COVID-19 in Ontario.

For further information please  contact your local public health unit directly.

What must I or my staff do if we test positive for COVID-19 and when can we return to work? 

Dentists and/or staff who test positive for COVID-19 must:

For further information please contact your local public health unit directly.

How should I manage patients and/or staff who have returned to Canada from international travel? 

The Government of Canada determines the rules for entering Canada, including individuals who are fully vaccinated.

Travelers are required to follow federal guidelines. For more information:

COVID-19: Travel, testing and borders - Travel.gc.ca

Are we allowed to use sedation?

First confirm sedation is required and that the treatment cannot be provided without it.

Technique

Oral sedation used alone can be a sedative technique that minimizes aerosols vs. other sedative techniques. However, patient acceptance and an effective dose is key to prevent coughing, crying etc. that could also create more aerosols with any conscious sedation technique. You must stay within your level of authorization for the sedation dose provided.

Nitrous Oxide Oxygen

If oral sedation alone is not sufficient and nitrous oxide oxygen is used, a viral filter may be placed between the tubing and the machine. However, all delivery systems are different and one technique does not fit or apply to all systems. Check with the manufacturer on what is necessary to guard against viral transmission. You are responsible for ensuring the system is sterilized for viruses in between patient use as suggested by the manufacturer of the delivery system that you have.

Monitoring and Emergency Equipment

Use disposable emergency equipment where possible. All equipment for patient monitoring must be cleaned and disinfected according to manufacturer’s instructions for use. In the unlikely event of cardiopulmonary resuscitation, a viral filter should be placed on the bag-valve-mask to protect the equipment from contamination if used. If oxygen delivery is required, it is advisable to use disposable nasal cannula/nasal hood or other oxygen delivery device. All tubing should be properly cleaned and disinfected as per the manufacturer’s instructions for use. Try to limit gas flows to the minimum required to prevent surplus gas from the patient contaminating the air. Similarly ensure the nasal hood fits snugly, to minimize gas leaks.

Are patients required to wear masks at a dental office?

As of June 11th, 2022, all mask mandates have been lifted for indoor settings with the exception of long-term care and retirement homes.

Although mask mandates have been lifted, the Chief Medical Officer of Health continues to recommend that patients and visitors continue to wear masks in all health care settings. Dentists can continue to implement masking policies that ask all patients, and visitors to wear a mask when in the office.

Patients who are suspected or confirmed COVID-19 positive, must wear a minimum ASTM Level 1 procedure mask prior to entering the office

Are visitors in treatment areas required to wear masks?

Dentists are advised to conduct a risk assessment for each visitor in the treatment area.  They will need to take into account:

  • the type of procedure (AGP vs. non-AGP)
  • the patient and visitor screening results
  • whether the visitor is a member of the patient’s household
  • whether the office setting allows appropriate distancing

If the risk assessment indicates that the visitor may be at an increased risk of infection then a non-fit-tested N95 respirator (or equivalent) is required.

Reference: Interim IPAC Recommendations for Use of Personal Protective Equipment for Care of Individuals with Suspect or Confirmed COVID 19 (publichealthontario.ca)

What if a patient refuses to wear a mask?

If you have a policy that asks patients to wear masks, patients should adhere to that policy. Some patients may request an exemption from the mask requirement.  In these cases, dentists are expected to offer appropriate accommodations to ensure care can be safely provided.

Dentists should not refuse to provide care to patients that refuse to wear masks.

Are dental staff still required to wear masks?

Yes. Currently, all health care workers, including dental staff, are required to follow routine practices which includes universal medical masking, at all times, while in the office except for the purpose of eating and drinking.

Please see the PPE table for task specific masking requirements.

Are N95s required in the reprocessing area? 

When you are reprocessing and aerosols are anticipated (e.g., if using ultrasonics or handpiece lubricating devices) and you can mitigate the aerosols by containing them within the unit, then you are not required to use an N95 respirator or equivalent.

If aerosols cannot be mitigated, then the staff person generating the aerosol must don an N95 respirator or equivalent.

If no aerosols are anticipated or if you are able to mitigate the aerosol, then an ASTM level 2–3 mask is required.

Do N95 respirators require fit testing? 

Yes. N95 respirators require a tight fit for protection against aerosols. Fit testing is required for each clinical staff member and for each brand or model of N95 respirator. In other words, the fit test is only applicable to the specific respirator model, unless the manufacturer indicates otherwise.

Where can I get information or training on fitting N95 respirators?

A list of companies that provide fit testing can be found on pages 5-7 of the MOH . In addition, the below list of companies also provide this service:

For additional information about fit testing 3M offers a fit test kit for sale.

Note: The College does not endorse any particular company, but provides this information to assist dentists. Some companies may have suspended in-person fit testing, while others are assessing each request individually.  Dentists must provide their own N95 masks for fit testing.

Please contact the manufacturer or refer to the Manufacturer’s Instructions for Use (MIFUs) if you have any technical questions.

Can I reuse or extend the use of N95 respirators? 

N95 respirators (and equivalents) are single use items, however, Public Health Ontario has indicated that extended use and re-use is permitted in select instances.  Extended use refers to the practice of wearing the same N95 respirator for more than one patient, without removing/touching the respirator between patient encounters, while re-use refers to the practice of using the same N95 respirator for multiple patient encounters and removing it between the patient encounters.

Click here for more information.

If you are having difficulty procuring N95 respirators, please contact the ODA at info@oda.ca.

The Government of Ontario, through a partnership with the Ontario Dental Association, is providing 3M Aura Health Care Particulate Respirator and Surgical Masks, 1870+, N95 to dental professionals free of charge.

Click here for more information.

Can we use KN95, P95, P100 or other “equivalent” masks instead?

Health Canada accepts the NIOSH certification as an appropriate quality standard for N95 respirators. Equivalent alternate standards are also acceptable.

These include respirators that are approved or certified under standards used in other countries that are similar to NIOSH-approved N95 respirators.

Health Canada maintains a list of NIOSH N95 alternatives.

Prior to selecting a respirator, dentists should review Health Canada’s respiratory guidance or check Public Health Ontario for selection guidance.

What type of dental procedures require dentists to wear gowns? 

Isolation gowns are required for ALL aerosol-generating procedures performed on ALL patients, regardless of whether they have tested or confirmed positive or negative for COVID-19.

Isolation gowns are also required for non-aerosol generating procedures performed on patients with suspect or confirmed COVID-19

Isolation gowns are optional for non-aerosol generating procedures performed on patients who have screened or tested negative for COVID-19.

Gowns must be changed after each patient use. For more information on gowns:

Health Canada Personal protective equipment against COVID-19: Medical gowns

Medical Isolation Gowns for COVID-19 in Health Care Settings

Can dentists and their staff use washable/reusable gowns instead of disposable gowns? 

Yes, both disposable and reusable/washable gowns are acceptable. As with any personal protective equipment (PPE), attention must be paid to the donning and doffing procedure in order to avoid contaminating the user.

For more information on donning and doffing of PPE, click here.

Reusable/washable gowns must be changed and laundered after each patient use.

Please note: reusable/washable gowns must be laundered either on-site or at a commercial laundry facility. Home laundering is not permitted.

Public Health Ontario (Best Practices for Environmental Cleaning for Prevention and Control of Infections in All Health Care Settings) and the Canadian Standards Association have listed the following requirements for the on-site laundering of reusable/washable gowns in dental offices:

  • There must be a dedicated space, physically separate from other areas of the laundering facility.
  • The space must contain a sorting area for soiled items that is kept under negative pressure.
  • If the dental office is unable to comply with these requirements, another option is to use a commercial laundry service.
  • Household laundering and laundromats do not meet these requirements.
  • While awaiting on-site laundering or pickup for transportation to a commercial laundry facility, reusable/washable gowns should be stored in laundry bins/containers lined with a barrier (such as a garbage bag) to avoid contamination.
  • For on-site laundering, use hot water and an appropriate detergent. If the items are heavily soiled, a disinfectant (e.g. chlorine bleach) may be added.

Scrubs worn as clinic attire may be laundered at home.

Can I use a fabric lab coat instead of a gown? 

The use of lab coats instead of gowns is discouraged and should only be used as a last resort because they do not provide the same degree of protection. Most lab coats have V-necks and/or do not have elastic bands at the wrists. Because of their design, they can expose the healthcare worker’s skin/clothing at the neck and wrist area.

The front buttons of lab coats can also pose risks of contamination during the donning and doffing procedures.

In the event of a disposable gowns shortage, reusable gowns would be the preferred alternatives.

References:

US Centers for Disease Control and Prevention – Strategies for Optimizing the Supply of Isolation Gowns

Public Health Ontario -  Recommended Steps for Putting On and Taking Off Personal Protective Equipment