Information for Dental Providers

Oral healthcare is recognized as an essential component of overall health, so it is critical that infection prevention and control practices are in place to protect the health and safety of patients and dental healthcare personnel (DHCP) during the COVID-19 pandemic. We continue to learn about the transmission and severity of COVID-19 and the implications for dental practice. DHCP have a very high potential for exposure to SARS-CoV-2 when they are performing certain aerosol-generating procedures on known or suspected COVID-19 patients, so should not provide care to these patients.

Dental settings should balance the need to provide necessary services while minimizing risk to patients and DHCP. The Centers for Disease Control and Prevention (CDC) has developed a framework for healthcare personnel and healthcare systems for delivery of non-emergent care during the COVID-19 pandemic. DHCP should use their clinical judgment in determining those procedures that can be performed safely and effectively at this time. RIDOH recommends continued review of Guidance for Dental Settings from CDC and defers to this guidance in areas of question.

The following summarizes what DHCP need to do to assure safe care.  Individual dental practices will need to review this guidance and customize it for their clinical setting. This guidance represents suggested minimum standards, and some practices will choose to exceed these standards.

  • Depending on the conditions in any given community, the Governor may issue or update Executive Orders.
  • All DHCP should review the business sector guidance outlined on the Reopening RI website.
  • RIDOH has created a searchable COVID-19 provider web page that has many useful resources for addressing the pandemic. Surveillance information and education is intended to promote recommended practices.
  • Practices shall develop a written COVID-19 Control Plan outlining how their workplace will prevent the spread of COVID-19, including social distancing for patients and DHCP.
  • Place signs and posters at facility entrances and in strategic places, such as restrooms, registration desk, waiting rooms, exam rooms, providing instruction on washing hands, wearing face coverings, and cough etiquette.
  • To reduce asymptomatic and pre-symptomatic transmission, everyone entering dental offices must wear face coverings whether or not they have COVID-19 symptoms.
  • Consider the use of telehealth as a first step to evaluate a patient’s condition and make recommendations.
  • Prioritize use of non-surgical caries prevention and management strategies based on clinical judgement.
  • If aerosol-generating procedures are necessary, employ aerosol-management tools that may include the use of four-handed dentistry techniques, high-evacuation suction, dental dams, or other appropriate equipment to reduce or capture spatter and aerosols.

Questions are welcome and answered via email at [email protected].

  • Dental offices shall require the use of face masks by all patients before they enter the dental office, while waiting to be seen, and upon completion of treatment. This will minimize emissions of infectious particles by patients who may be infected but are asymptomatic. Dental offices should consider having a supply of face masks or cloth face coverings to provide to patients who arrive without their own.
  • Dentists must ensure they have adequate PPE for staff. DHCP should:
    • Wear eye protection and a face mask to ensure their eyes, nose, and mouth are all protected from exposure to respiratory secretions during patient care encounters, including those where splashes and sprays are not expected. Protective eyewear like safety glasses and trauma glasses with gaps between glasses and the face likely do not protect eyes from all splashes and sprays.
    • Use an N-95 respirator or a respirator that offers an equivalent or higher level of protection during aerosol-generating procedures.
  • It is strongly recommended that dental practices maintain, at minimum, a two-week supply of PPE, including face shields, goggles, surgical masks, gowns, N-95 respirators or respirators that offers an equivalent or higher level of protection, and other infection-control equipment.
  • To protect the health and safety of staff and patients, it is important that DHCP understand the difference in healthcare provider mask types and recommended use based on anticipated risk. Use respiratory protection as part of a comprehensive respiratory protection program that meets the requirements of OSHA's Respiratory Protection standard (29 CFR 1910.134) and includes medical exams, fit testing, and training. While fit testing is recommended, until that can be provided, users should perform a seal check at each use.
  • When removing potentially contaminated PPE such as an N-95 respirator, do not touch the outside of the respirator without wearing gloves. Follow safe practices for putting on and taking off PPE.
  • View a video on wearing and removing personal protective equipment in a COVID-19 environment.
  • Until the supply of PPE is more predictable and readily available, all DHCP should conserve PPE. Information is available from RIDOH, the American Dental Association (ADA), and RIDA.
  • CDC has developed strategies for optimizing the supply of PPE, including specifically for:

Screening DHCP

  • All DHCP must be screened for symptoms of COVID-19 before entering the building.
  • DHCP with suspected or confirmed COVID-19 and those with potential COVID-19 exposure should not enter the dental office. Those with signs or symptoms should call their healthcare provider to arrange for COVID-19 testing.
  • DHCP who develop COVID-19 symptoms during their work shift should go home immediately and be asked to isolate pending testing confirmation. All areas where the staff member worked and spent time should be cleaned and disinfected immediately. If feasible, close off the work area for 24 hours, open windows to increase ventilation as much as possible, and use an EPA-approved disinfectant.
  • Follow CDC guidance on work restrictions for DHCP exposed to COVID-19.

Testing DHCP

Screening Patients

  • Before their dental appointments, screen all patients by telephone for any symptoms of, or possible exposure to, COVID-19. If necessary, consult the patient’s medical provider for the patient’s COVID-19 status. For COVID-19-positive patients, coordinate with the patient’s medical provider for appropriate management.
  • All patients must be screened for symptoms of COVID-19 before entering the facility. Patients with suspected or confirmed COVID-19 and those with potential COVID-19 exposure should not enter the dental office.
  • The screening should include an assessment of:
    • Exposure to anyone diagnosed with COVID-19 in the past 14 days and
    • Symptoms of cough, shortness of breath or difficulty breathing, fever, chills, muscle or body aches, sore throat, headache, nausea or vomiting, runny nose or stuffy nose, fatigue, and/or recent loss of taste or smell
  • Dentists planning urgent or time-sensitive care for which an aerosol-generating procedure is necessary, but cannot be controlled through the use of rubber dams or other isolation measures, may order testing for patients.
  • Patients with active COVID-19 infection, either symptomatic or asymptomatic, should not receive dental treatment in a dental office. Dentists and medical providers should work together to identify an appropriate facility for treatment. Procedures on patients with COVID-19 should be carried out in accordance with CDC Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response.
  • When assessing whether to treat patients who are not severely immunocompromised with a history of suspected or confirmed COVID-19, use a symptom-based strategy when symptoms have resolved or a time-based strategy for asymptomatic patients.
    • Symptom-based strategy:
      • At least 24 hours have passed since last fever without the use of fever-reducing medications and
      • Symptoms have improved and
      • At least 10 days have passed since the date of their first positive diagnostic test
    • Time-based strategy for asymptomatic patients:
      • At least 10 days have passed since the first positive text

Addressing Positive Cases of COVID-19

  • Dental offices may learn that patients or staff who have been in the office later tested positive for COVID-19.
  • Dental offices should request that patients contact the dental clinic if they develop signs or symptoms or are diagnosed with COVID-19 within two days after the dental appointment.
    • Staff who have prolonged, close contact with someone who tested positive for COVID-19 should follow guidance for healthcare workers. Close contact for healthcare exposures is defined as:
        • Being within approximately six feet of a person with COVID-19 for longer than 15 minutes, such as caring for or visiting the patient or sitting within six feet of the patient in a healthcare waiting area or room, or
        • Performing an aerosol-producing procedure without appropriate PPE
  • Suspected cases of COVID-19 should be reported to RIDOH immediately. For questions and to report cases, call the RIDOH Center for Acute Infectious Disease Epidemiology at 401-654-6990 from 8:30 a.m. to 8:30 p.m. seven days a week or call 401-276-8046 outside of those hours.
    • Dental offices with concerns about exposure of other patients will talk with clinical consultants from RIDOH to determine recommended next steps.
  • Establish and implement patient scheduling and traffic flow protocols and infection control precautions to minimize exposure to, and the spread of, COVID-19. Limit the number of patients in the office or clinic to allow everyone to stay at least six feet apart from others. If physical distancing is not possible in the waiting room, consider having patients wait outside.
  • The CDC recommends optimizing engineering controls, such as ventilation and filtration, in dental offices. While RIDOH provides guidance on indoor air circulation, DHCP should recognize the complex nature of a dental office and consider staff placement and the use of partitions. Dental practices may engage a Certified Industrial Hygienist (CIH) or Professional Engineer (PE) who focuses on HVAC issues for help.
  • For infection control, dental practices, at a minimum, shall:
    • Clean and disinfect operatory surfaces promptly after completion of clinical care for each patient.
    • Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
    • Clean, by removing any visible dirt and grime, before using disinfectants. Disinfectants remove most germs and are most effective on clean surfaces or objects. Coronaviruses are relatively easy to kill with most disinfectants. The Environmental Protection Agency has published a list of disinfectants for use against the virus that causes COVID-19. When using cleaning and disinfecting products, always read and follow the manufacturer’s directions.
    • Manage laundry and medical waste in accordance with routine procedures.
  • Sterilization protocols do not vary for respiratory pathogens. DHCP should perform routine cleaning, disinfection, and sterilization, and follow the recommendations for Sterilization and Disinfection of Patient-Care Items in the Guidelines for Infection Control in Dental Health Care Settings - 2003.
  • DHCP should follow the manufacturer’s instructions for times and temperatures recommended for sterilization of specific dental devices.