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 compiled by the Practice Advisory team to assist you in getting up-to-date information in a timely manner.

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 March 10, 2022

Where can I access information about vaccination for myself and my dental office employees? 

Please refer to the following Ministry of Health documents: 

A list of LPHUs and their contact information is available here: (http://www.health.gov.on.ca/en/common/system/services/phu/locations.aspx).  

To determine the LPHU region for your dental office, you may refer to this tool: Public Health Unit Locator (gov.on.ca).

Are dentists allowed to provide non-emergent/non-urgent care through teledentistry during this pandemic?

Yes. 

  • Teledentistry enables the remote provision of non-emergent/non-urgent care to patients while ensuring ongoing physical distancing.
  • Dentists must exercise professional judgment to determine whether teledentistry is appropriate to manage the case or whether the patient should be seen in-person.

Please refer to the COVID-19: Guidance for the Use of Teledentistryfor information. 

Does the teledentistry platform I’m using (e.g. Zoom, FaceTime, Go-to-Meeting, Skype for Business, Microsoft Teams, etc.) comply with privacy requirements?

The College does not review, endorse nor approve of any specific technical platforms for teledentistry. To ensure that the platform you use complies with current privacy legislation, please contact the Information Privacy Commissioner: https://www.ipc.on.ca/about-us/contact-us/

You should protect the privacy and confidentiality of the patient’s personal health information, specifically by: 

  • using technology that has privacy and security settings in accordance with the Personal Health Information Protection Act, 2004. At minimum, technology must have controls to ensure only the intended patient has access to the appointment and where personal health information is stored and/or transmitted, strong encryption must be used. If unsure, dentists can confirm with the service provider that the technology meets Ontario privacy requirements.
  • conducting the teledentistry appointment in a private environment that will ensure patient information is not overheard or seen by other individuals; and
  • confirming with the patient that they are in a private setting and that the technology they are using is secure.

During this pandemic can we prescribe outside of the College’s recommendations for the management of dental pain for our patients? 

Dentists must continue to practice within the College's Guidelines with respect to prescribing narcotics and opioids.

The Guidelines provide guidance regarding the suggested maximum number of tablets for a single opioid prescription. However, it also states that in some situations, practitioners may consider exceeding the suggested maximum number of tablets. Practitioners are expected to exercise reasonable professional judgment in determining when this is justified, which should be documented.

Refer to COVID-19: Managing Infection Risks During In-Person Dental Care.

Please ensure that you keep a record of any patients that you speak with over the phone, so that you can provide documentation in the patient record once you return to the office.

Can I remotely provide a prescription to new patients (i.e. who are not existing patients of the practice) on an emergency basis over the phone or by video?

In order to prescribe medication for a new patient, technology with both audio-video capacity will be required to allow for an adequate assessment prior to prescribing medication. This means that you cannot provide a prescription to a new patient who does not have video conferencing capability.  

Please review the College Guidance on COVID-19 - Guidance for the Use of Teledentistry

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.

Where can I get more information about the fees and procedure codes used for teledentistry?

Please contact the Ontario Dental Association (ODA) by phone at 416-922-3900 or by email at info@oda.ca.

What are the COVID-19 screening questions we should ask our patients?

See the Ministry’s Patient Screening Guidance Document. 

At what temperature do we consider that a patient has a fever?

A fever is a temperature of 37.8°C or greater.

The College does not require dentists to take a patient’s temperature upon their arrival to the office. However, at the discretion of the dentist, temperature taking may be included in the office’s patient arrival protocol.

Click here for more information.

What is fallow time?

During an aerosol-generating procedure (AGP), high concentrations of droplets are created, which may contain infectious viral particles. Fallow time is the amount of time, measured in minutes, needed for these droplets to settle or be cleared from the operatory.

Fallow time begins when the patient and all clinical staff have exited the operatory and close the door. The operatory MUST remain vacant during the fallow period necessary to achieve 99% removal of airborne contaminants based on air changes per hour (ACH). At the end of the fallow period, the operatory is cleaned and disinfected, prior to treating the next patient.  

For aerosol generating procedures, all patients (regardless of whether they have screened negative or positive for COVID-19) MUST be treated 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 and after such procedures. For such patients, the fallow period is 138 minutes (i.e., 2 hours and 18 minutes), unless the HVAC system has been assessed by a qualified HVAC professional and the number of air changes per hour (ACH) for the specific operatory is known to be greater than 2 ACH. If the number of ACH for a specific operatory is known, then the fallow time may be reduced using Table 2 of the guidance document

How should the operatory be managed after performing an AGP for a patient who screens COVID-19 negative?

The operatory must be managed with the same protocol used for patients that screen positive for COVID-19. 

At the end of the procedure, the patient and all clinical staff exit the operatory, which must remain vacant during the fallow period. The dentist must not remain in the operatory to write up the patient’s chart.

PPE is doffed in a manner that reduces the risk of transmission within the dental office.  Recommended Steps for Putting On and Taking Off Personal Protective Equipment

At the end of the fallow period, the operatory may be cleaned and disinfected, in preparation for the next patient. Unless otherwise calculated by a qualified HVAC professional, the fallow time is 138 minutes (i.e., 2 hours and 18 minutes), beginning from the time that the patient and all clinical staff have exited the operatory, which must remain vacant during the fallow period.

The fallow time may be reduced if an HVAC assessment has been conducted by a qualified HVAC professional and additional mitigating measures have been implemented. Refer to our guidance document for further details

How should the operatory be managed after performing an AGP for a patient who screens COVID-19 positive?

At the end of the procedure, the patient and all clinical staff exit the operatory, which must remain vacant during the fallow period. The dentist must not remain in the operatory to write up the patient’s chart.

PPE is doffed in a manner that reduces the risk of transmission within the dental office. Recommended Steps for Putting On and Taking Off Personal Protective Equipment

At the end of the fallow period, the operatory may be cleaned and disinfected, in preparation for the next patient. Unless otherwise calculated by a qualified HVAC professional, the fallow time is 138 minutes (i.e., 2 hours and 18 minutes), beginning from the time that the patient and all clinical staff have exited the operatory, which must remain vacant during the fallow period.

The fallow time may be reduced if an HVAC assessment has been conducted by a qualified HVAC professional and additional mitigating measures have been implemented. Refer to our guidance document for further details

Who can perform an HVAC assessment?

An HVAC professional, such as a licensed professional engineer or licensed HVAC technician who is experienced in HVAC design and operation in a health care facility,  can provide valid documentation to support their findings and recommendations. Dentists should exercise due diligence to ensure they are working with an appropriate company/individuals.

Is a fallow period required for non-aerosol generating procedures (NAGP)?

No, a fallow period is not required for non-aerosol generating procedures (NAGP). Following an NAGP, the operatory may be cleaned and disinfected immediately, as per standard procedures, in preparation for the next patient.

What do we tell a patient if they screen positive for COVID-19? 

A patient who screens positive for COVID-19 infection should self-isolate and contact their primary care provider or Telehealth Ontario at 1-866-797-0000 to determine next steps, or visit an assessment center to get tested.

Do I need to notify Public Health about patients who screen positive?

Although COVID-19 is a designated disease of public health significance and reportable under the Health Protection and Promotion Act, dentists are not required to report patients who screen positive to the local public health unit. Only probable and confirmed cases of COVID-19 must be reported. Please refer to this document for the definition of a probable case

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

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 23 in this Ministry of Health document: Management of Cases and Contacts of COVID-19 in Ontario.

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)

Please ensure you are using the online self-assessment tool when screening patients.

Patients that screen negative may be seen for dental treatment. 

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

What must I do if I 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 12 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.

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

Please refer to page 23 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 they test positive for COVID-19?

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

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

When can I return to work following a COVID-19 infection?

Please see the table on page 10 and 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.

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

When returning travellers enter Canada, officials at the point of entry will determine if they are exempt from quarantine.

If they are not required to quarantine

Starting April 25, 2022: 

  • There are fewer federal requirements for fully vaccinated individuals. 
    • Individuals are still required to report any positive results from a government-required test if they were selected to complete one.
    • While masks are no longer required to be worn for 14 days after arrival, masking is still mandatory for all health care settings, including dental offices.

Screening must still be performed for all patients prior to dental appointments, regardless of immunization status, using the Ministry's Patient Screening Guidance Document.

Screening must still be performed for all staff, regardless of immunization status using the Screening Tool for Workers.

For more information:

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

Are dental offices considered highest risk settings for the purposes of PCR Testing and Case and Contact Management?

    No.

    For further information please see this Ministry of Health document for a definition of highest risk settings: 

    Management of Cases and Contacts of COVID-19 in Ontario.

    Are patients, staff and visitors required to wear masks at a dental office?

    Updated June 14, 2022

    Although provincial masking requirements expired on June 11, 2022, the College is advising dentists to continue to follow the RCDSO existing COVID-19 guidance COVID-19: Managing infection risks during in-person dental care (rcdso.org)  which includes patient and staff masking.

    Please continue to follow this masking guidance until the College provides further direction.

    What should I do if a patient requests an exemption from wearing a mask?

    The College has created specific guidance on this issue: Mask-wearing exemptions. The pandemic has created a new legal landscape that has not yet fully formed, and this information represents the College’s best efforts to help dentists understand their obligations at this time. Dentists should consult with a lawyer for more information on this evolving area of the law.

    What is an accommodation under the Ontario Human Rights Code?

    Under the Ontario Human Rights Code dentists have a duty to provide health care services free from discrimination and a duty to accommodate. Dentists can obtain more information about these duties from the Human Rights Commission, who have a range of resourcesThere is not a defined list of what constitutes ‘reasonable accommodations’.  Determining what is a reasonable accommodation requires a careful case-by-case analysis.  Dentists will need to speak with patients about their needs, and work with the patient to determine what alternatives exist that can address those needs. Some examples of potential reasonable accommodations related to masks could include the following:
    • having the patient wear a different type of face covering such as a face shield or other covering/barrier
    • having the patient wear a mask for portions of the visit (e.g., as they move through the waiting areas) and/or
    • scheduling the patient at the end of the day to limit exposure to other patients
    • waiving the requirement for the patient to wear a mask
    If dentists have questions about how to comply with their legal obligations under the Human Rights Code, they should seek advice from legal counsel. 

    Should I include anything in the patient’s medical record about this?

    Yes. The College recommends that dentists document relevant information in the patient’s medical record.  If the patient has indicated that they have a medical reason for not wearing a mask, this information should be recorded.  Additionally, the dentist should record what accommodation they reached with the patient.  Dentists must note that they cannot require patients to provide proof that they are exempt from the requirement to wear masks.    

    When is an N95 respirator required?

    Effective March 9, 2022

    N95s respirators are now required in the following instances:

    1. any patient interactions involving confirmed, suspected or probable COVID-19 cases (for all staff)
    2. when performing an Aerosol generating procedure (AGP) for all patients regardless of screening

    N95s are not required when interacting with patients that screen negative or when performing non-aerosol generating procedures (NAGPs) on patients that screen negative

    Is the College’s guidance more cautious than Directive #1?

    Effective March 9, 2022

    Yes. The Directive refers to the use of N95/equivalent respirators with "suspected, probable and confirmed cases of Covid-19". For clarity and from an abundance of caution, the RCDSO is calling for N95/equivalent respirators to be used for any patient interactions involving confirmed, suspected or probable COVID-19 cases AND for ALL aerosol generating procedures (regardless of screening). We will closely monitor and update as necessary based on the evidence observed in the coming weeks.

    Do N95 respirators require fit testing?

    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 Directive #5 Q&A . 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 N95 respirators be used past their expiry date?

    Health Canada has issued a document on “Optimizing the use of masks and respirators during the COVID-19 outbreak”.

    According to this document, there is no specific timeframe beyond the expiry dates for N95 respirators at which they would no longer be considered suitable for use. In times of increased demand and decreased supply, consideration can be made to use these expired N95 respirators. An expired mask can still be effective at protecting a health care provider if:

    • the straps are intact
    • there are no visible signs of damage
    • they can be fit-tested

    Health care providers should inspect the mask and perform an appropriate seal check.

    The Ministry has issued a Guidance document on “Information on the Use of N95 Filtering Facepiece respirators beyond the manufacturer-designated shelf life”.

    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 respirators with exhalation valves?

    Some commercially available respirators have exhaust valves, which are intended to make the respirator more comfortable for the person wearing it, but also allow infectious respiratory droplets to be released outside the respirator. Respirators with exhaust valves will not protect others from COVID-19. Health Canada and Public Health Ontario do not recommend the use of respirators with exhalation valves. If no other options are available and such respirators must be used, cover them with a facemask that does not interfere with the respirator fit.

    Reference:

    Optimizing PPE During COVID-19 Pandemic (Ontario Health)

    COVID-19 medical masks and respirators for health professionals

    Guidance for Dental Settings (CDC)

    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.

    Find out if the brand, model number/product line of your P95 or P100 respirators is listed under the Centers for Disease Control and Prevention (CDC) listing of NIOSH-approved P95 or P100 respirators.

    NIOSH-Approved P100 Particulate Filtering Facepiece Respirators

    NIOSH-Approved P95 Particulate Filtering Facepiece Respirators

    NIOSH-Approved Particulate Filtering Facepiece Respirators

    Some concerns have been recently identified with some KN95 respirators (specifically those with ear loop design) that pose a difficulty in achieving a proper fit, which is essential for use.

    Health Canada has asked manufacturers and importers to stop the sale of any products that do not meet the filtration criteria of 95% and re-label them as face masks.  KN95s that meet the filtration criteria and that can be fit tested may continue to be sold and used as 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.

    How do I know if the N95 respirator is a counterfeit?

    • Confirm that your product has been certified by NIOSH by entering the approval number, which can be found on the respirator, in the NIOSH database.
    • Review the product package and respirator to ensure it has the appropriate markings and details, as required by NIOSH. This includes the TC (Testing and Certification) approval number (a number set by NIOSH), the name of the manufacturer, the NIOSH name or logo, the model number, and filter efficiency (N95).
    • Look at product markings, such as the name of the manufacturer, to determine whether there are any obvious signs that the product is counterfeit (e.g., incorrect spelling).
    • Check for the presence of this symbol on the mask:

    • If your mask is fraudulent or unauthorized, stop using it as it may not protect you against COVID-19.
    • Report information on the potential false or misleading advertising or sale of unauthorized products to Health Canada.

    For more information: Fraudulent and unauthorized N95 respirators may not protect consumers against COVID-19

    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 screened positive or negative for COVID-19.

    Isolation gowns are also required for non-aerosol generating procedures performed on patients who have screened or tested positive for 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

    What type of clothes and PPE are non-clinical/front desk/administrative staff required to wear?

    Like clinical staff, staff who do not have clinical responsibilities must change their clothes and shoes upon reporting to work and when leaving to return home. Non-clinical staff may wear casual shoes and clothes for work or scrubs, as per the office policy. Clothing worn in the office must not be worn outside of the office and should be laundered after each shift.

    The College has advised dentists to continue to follow the requirements outlined in the COVID guidance document. The document indicates that:

    • Dentists and staff must wear an appropriate mask at all times except as needed for eating and drinking.

    If there is no barrier between staff and patients, then staff need to wear at a minimum a level 1 mask and maintain a distance of 2m (6 ft). 

    Staff must continue to wear N95s for any patient interactions involving confirmed, suspected or probable COVID-19 cases.

    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

    Must I have floor-to-ceiling walls and a door that can be closed in all my operatories?

    All AGPs must be performed in an operatory that is capable of containing the aerosol, which means floor-to-ceiling walls and a door or other barrier that can be closed. This requirement for AGPs applies to ALL patients (whether they have screened positive or negative for COVID-19).

    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.