Dental Healthcare Personnel (DHCP) FAQs
Are dentists allowed to resume deferred and preventive dental care?
The California Department of Public Health issued guidance to resume non-emergent care on May 7. On May 9, guidance was reflected in the Public Health Officer Order, in which hospitals and healthcare providers, including dentists:
- Shall take measures to preserve and prioritize resources; and
- May authorize and perform non-emergent or elective surgeries or procedures based on their determination of clinical need and supply capacity, and where consistent with State guidance.
Nothing in this Order shall prevent dentists or dental hygienists from conducting routine preventive care provided it conforms to any applicable State guidance.
Dental practitioners should evaluate the necessity of the dental care based on urgency of dental problems.
- Provide essential preventive care taking measures to minimize aerosol generation as transmission rates and supplies of PPE and tests dictate.
- Preventive services such as topical fluoride application, sealants, and scaling as well as minimally invasive restorative techniques may be considered.
Additional resources can be found at the California Dental Association’s website.
What is the risk of exposure to COVID-19 for DHCP?
The practice of dentistry involves the use of rotary dental and surgical instruments, such as handpieces or ultrasonic scalers and air-water syringes. These instruments create a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. Surgical masks protect mucous membranes of the mouth and nose from droplet spatter, but they do not provide complete protection against inhalation of infectious agents (Centers for Disease Control and Prevention).
DHCP are in the high-risk category for exposure to SARS-CoV-2 virus that causes COVID-19 when they are performing certain aerosol generating procedures. This risk requires a level of heightened awareness, training, preparation, and adherence to a combination of standard and transmission-based precautions as appropriate to ensure the safe provision of care (California Department of Public Health).
What are the infection control standards in dental settings?
At minimum, dental practitioners must follow the Centers for Disease Control and Prevention recommendations for:
- Engineering controls and work practices;
- Infection prevention and control measures including: source control (require facemasks at all times for everyone entering the dental setting); personal protective equipment (PPE) use (including training and demonstration of understanding of PPE use, respirator (N-95 or KN-95) or surgical mask, face shield, eye protection, gloves, and gowns); hand hygiene; screening and monitoring of DHCP; and patient management) (California Department of Public Health).
What personal protective equipment (PPE) practices should be implemented?
DHCP working in facilities located in areas with moderate to substantial community transmission are more likely to encounter asymptomatic or pre-symptomatic patients with SARS-CoV-2 infection.
- If infection is not suspected in a patient presenting for care (based on symptom and exposure history), DHCP should follow Standard Precautions (and Transmission-Based Precautions, if required based on the suspected diagnosis).
- Use universal eye protection, in addition to the surgical mask, to ensure the eyes, nose, and mouth are all protected from exposure to respiratory secretions during patient care encounters, including those where splashes and sprays are not anticipated. Protective eyewear (e.g., safety glasses, trauma glasses) with gaps between glasses and the face are unlikely to protect the eyes from splashes and sprays.
- Use a fit-tested
N95 respirator or a respirator that offers an equivalent or
higher level of protection such as other disposable
filtering facepiece respirators, powered air-purifying respirators
(PAPRs), or elastomeric respirators during aerosol generating
- Respirators with exhalation valves are not recommended for source control and should not be used during surgical procedures as unfiltered exhaled breath may compromise the sterile field. If only a respirator with an exhalation valve is available and source control is needed, the exhalation valve should be covered with a facemask that does not interfere with the respirator fit.
Employers should select appropriate PPE and provide it to DHCP in accordance with OSHA’s PPE standards (29 CFR 1910 Subpart I). Dental facilities must ensure that any reusable PPE is properly cleaned, decontaminated, and maintained after and between uses. Dental settings also should have policies and procedures describing a recommended sequence for safely donning and doffing PPE. For more information: Guidance for Dental Settings Section 1: Recommendations for Routine Care.
On August 6, 2020, the California Division of Occupational Safety and Health (Cal/OSHA) updated Interim Guidance on COVID-19 for Health Care Facilities: Severe Respirator Supply Shortages. While supply chains for obtaining respirators are not fully restored, the supply of respirators for hospitals and other employers involved in patient care has improved to a point that prioritization of respirators for high hazard procedures and some other optimization strategies are not currently necessary. The Centers for Disease Control and Prevention has developed a series of strategies or options to optimize supplies of PPE in healthcare settings when there is limited supply, and a burn rate calculator that provides information for healthcare facilities to plan and optimize the use of PPE for response to the COVID-19 pandemic.
What are the COVID-19 screening and triaging protocols for persons
entering a dental healthcare facility?
- Post visual alerts (e.g., signs, posters) at the entrance and in strategic places (e.g., waiting areas, elevators, break rooms) to provide instructions (in appropriate languages) about hand hygiene and respiratory hygiene and cough etiquette. Instructions should include wearing a cloth face covering or facemask for source control, and how and when to perform hand hygiene.
- Provide supplies for respiratory hygiene and cough etiquette, including alcohol-based hand rub with at least 60% alcohol, tissues, and no-touch receptacles for disposal, at entrances, waiting rooms, and patient check-ins.
- Install physical barriers (e.g., glass or plastic windows) at reception areas to limit close contact between triage personnel and potentially infectious patients.
- Remove toys, magazines, and other frequently touched objects from waiting room that cannot be regularly cleaned and disinfected.
all persons entering the facility for fever and symptoms consistent with COVID-19 or exposure
to others with SARS-CoV-2 infection.
- Document absence of symptoms consistent with COVID-19.
- Actively take the temperature of all persons entering the facility. Fever is defined as either measured temperature ≥100.0°F or subjective fever.
- Ask all persons entering the facility if they have been advised to self-quarantine because of exposure to someone with SARS-CoV-2 infection.
- Properly manage anyone with symptoms of COVID-19 or who has been advised to self-quarantine.
The Public Health Officer’s Order requires that all San Diego County residents wear a face covering whenever they are outside their residence and within 6 feet of someone who is not from their household. Children under the age of 2 are not required to wear a mask. The order requires individuals to use a face covering inside all businesses, including healthcare facilities, and when they are within 6 feet of another person.
How should DHCP be monitored and managed?
DHCP should regularly monitor themselves for fever and symptoms consistent with COVID-19 and be reminded to stay home when they are ill. DHCP should receive no penalties for remaining at home when ill or under quarantine.
- Implement sick leave policies that are flexible, non-punitive, and consistent with public health guidance.
- For information on work restrictions for health care personnel with underlying health conditions who may provide care for COVID-19 patients, see CDC’s Healthcare Workers Clinical Questions about COVID-19: Questions and Answers on COVID-19 Risk.
If DHCP experience a potential work exposure to COVID-19, follow CDC’s Healthcare Personnel with Potential Exposure Guidance and the San Diego County Public Health Officer Order, Section 16c:
- Promptly notify the County Department of Public Health at 888-950-9905 that there is an employee diagnosed with COVID-19, and provide the name, date of birth, and contact information of the employee.
- Cooperate with the County Department of Public Health’s COVID-19 response team to identify and provide contact information for any persons exposed by the employee at the workplace.
- Provide notice of the exposure to any employees, and contractors (who regularly work at the workplace) who may have been exposed to COVID19, as stated in the State’s COVID-19 Employer Playbook for a Safe Reopening, available at https://files.covid19.ca.gov/pdf/employer-playbook-for-safe-reopening--en.pdf.
Should patients who are suspected or confirmed to have COVID-19 receive
No. Patients and staff with suspected or confirmed COVID-19 and those with known COVID-19 exposure should not enter the dental office. If a patient is suspected or confirmed to have COVID-19, or is a close contact of someone with COVID-19, defer non-emergent dental treatment. Surgical procedures that might pose higher risk for SARS-CoV-2 transmission if the patient has COVID-19 include those that generate potentially infectious aerosols or involve anatomic regions where viral loads might be higher, such as the nose and throat, oropharynx, and respiratory tract (see Surgical FAQ).
People with COVID-19 who have ended home isolation, and close contacts of persons with COVID-19 who have ended quarantine, can receive dental care following Standard Precautions (Centers for Disease Control and Prevention).
Should patients who are close contacts to suspected or confirmed
COVID-19 receive dental care?
No. Patients and staff with suspected or confirmed COVID-19 and those with close contact with persons with COVID-19 should not enter the dental office. If a patient is suspected or confirmed to have COVID-19, defer non-emergent dental treatment. Patients with active COVID-19 infection should not receive dental treatment in a dental office. Dentists and medical providers should work together to determine an appropriate facility for treatment. Procedures on patients with COVID-19 should be carried out in accordance with Cal/OSHA’s Aerosol Transmissible Diseases (ATD) Standard.
What is the guidance for patients who are suspected or confirmed to have
COVID-19 but need dental care?
Patients with active COVID-19 infection should not receive dental treatment in a dental office. Dentists and medical providers should work together to determine an appropriate facility for treatment. Procedures on patients with COVID-19 should be carried out in accordance with Cal/OSHA’s Aerosol Transmissible Diseases (ATD) Standard (California Department of Public Health).
If emergency dental care is medically necessary for a patient who has, or is suspected of having, COVID-19, DHCP should follow CDC’s Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings.
- Provide dental treatment in an individual patient room with a closed door.
- Adhere to Standard Precautions and use a NIOSH-approved N95 or equivalent or higher-level respirator gown, gloves, and eye protection.
- Avoid aerosol generating procedures (e.g., use of dental handpieces, air/water syringe, ultrasonic scalers) if possible.
- If aerosol generating
procedures must be performed:
- Complete in an airborne infection isolation room.
- Wear an N95 or equivalent or higher-level respirator as well as eye protection, gloves, and a gown.
- Limit DHCP present during the procedure to only those essential for patient care and procedure support. Visitors should not be present for the procedure.
- Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control.
- Limit transport and movement of the patient outside of the
room to medically essential purposes.
- Patients should wear a facemask or cloth face covering to contain secretions during transport.
- Schedule patient at the end of the day (as possible). Do not schedule any other patients at that time.
What steps should be taken if a patient or DHCP is suspected or
confirmed to have COVID-19?
- Stay home and do not come into work.
- Notify their primary healthcare provider to determine whether medical evaluation is necessary.
- Employer should promptly report when a DHCP is diagnosed with COVID-19 to the County Public Health Services by calling 888-950-9905.
If DHCP experience a potential work exposure to COVID-19, follow CDC’s Interim U.S. Guidance for Risk Assessment and Work Restrictions for Healthcare Personnel with Potential Exposure to COVID-19. Information about when DHCP with suspected or confirmed COVID-19 may return to work is also available in the Interim Guidance on Criteria for Return to Work for Healthcare Personnel with Confirmed or Suspected COVID-19.
If patients or DHCP believe they have experienced an exposure to COVID-19 outside of the dental healthcare setting, including during domestic travel, they should follow CDC’s Public Health Guidance for Community-Related Exposure. Separate guidance is available for international travelers.
What resources are available if DHCP or patients need to be tested but
do not have a primary care provider?
It is recommended that DHCP or patients first contact their healthcare provider for a COVID-19 test.
If they are unable to get a test from their healthcare provider, the County of San Diego (County) has coordinated free diagnostic COVID-19 testing at many locations.
For children and youth, it is first recommended that they contact their healthcare provider or pediatrician.
- Most children, youth, and their caregivers can receive testing through the COVID-19 Collaborative for Children in partnership with Rady Children's Hospital. Contact your Rady pediatrician or e-mail firstname.lastname@example.org for more information.
- Children, youth and caregivers covered by Kaiser Permanente should consult with their pediatrician or physician provider directly, or through www.kp.org.
If child or youth are unable to get a test from their healthcare provider, children 6 months and older are able to be tested at any County-coordinated test site.
K-12 school personnel are encouraged to first contact their school or school district for testing site information.
- Who may be contacted to report a case of non-compliance in dental settings?
Last Updated: 11/02/2020