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Aerosols in the Dental Office: Best Practices for Patient and Practitioner Safety

Course Number: 619

Prevention of Airborne Disease Transmission Dental Office

Infection control standards were initially developed for dentistry in response to the HIV epidemic and included Standard and Transmission-based Precautions. Based upon emerging evidence regarding SARS-CoV-2 and previous investigations studying other coronaviruses, spread is thought to occur mostly from person-to-person via respiratory droplets among close contacts. Close contact can occur while delivering patient care and is currently defined by the CDC as: 1) being within approximately 6 feet (2 meters) of a patient with COVID-19 for a prolonged period of time (≥30 minutes) or 2) having direct contact with infectious secretions from a patient with COVID-19. Infectious secretions may include sputum, saliva, serum, blood, and respiratory droplets.103,104

Current recommendations from the CDC and regional/state dental boards include risk-based assessment of community infection rates and individual patient and practitioner risk assessments to reduce COVID-19 transmission in the dental office. The following current best-practices to address high-risk pandemic outbreaks:106

  • Patient Triage: Telephonic or entrance triage including symptom screening and/or body temperature check, and limited patient proximity in public areas/waiting areas, and informed consent discussion about the risk of contagion.

  • Infection control measures for Patients: These include proper hand hygiene and preprocedural mouthrinse.

  • Arrangement of the Clinical Environment: These include proper ventilation and evacuation and segregation of COVID-19 positive patients in need of emergent care.

  • Cleaning: Cleaning includes decontamination of contaminated surfaces with disinfectants that have been shown to be effective against SARS-CoV-2.107

  • Surveillance: Post-treatment surveillance to determine if COVID-19 symptoms or positivity develops in patients and practitioners.

  • Personal protective equipment for Practitioners: The use of disposable or sanitizable gowns, eye protection, and appropriate level masks for non-aerosol generating procedures and the addition of surgical caps and respirators for aerosol-generating procedures.

It should also be noted that the implementation and utilization of such protocols is currently being revised by OSHA and the CDC and dental healthcare workers are encouraged to regularly review all of the following:108

  • The level of ongoing community transmission of COVID-19 in their community.

  • The phase of reopening (if applicable) the community in which the dental practice is located has entered.

  • The risk to dental practitioners and support staff of being exposed to sources of SARS-CoV-2, including suspected and confirmed COVID-19 cases and people who are infected with SARS-CoV-2 but do not have signs and/or symptoms of COVID-19 (but who may be able to spread the virus to others without knowing it).

  • The availability and ability of the employer to implement controls to protect workers from exposure to sources of SARS-CoV-2.