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Dentists are urged to view the Centers for Disease Control and Prevention COVID-19 situation webpage for current insight. Standard precautions should be taken with all patients, at all times.

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Availability of Personal Protective Equipment

The CDC has not changed its guidance on single-use disposable facemasks, which are regulated by FDA to be single use and should be worn once and discarded.

Page 41 of the CDC Guidelines for Infection Control in Dental Health-Care Settings has the following guidance:

1. Wear a surgical mask and eye protection with solid side shields or a face shield to protect mucous membranes of the eyes, nose, and mouth during procedures likely to generate splashing or spattering of blood or other body fluids;
2. Change masks between patients, or during patient treatment if the mask becomes wet.

CDC urges Dental Health Care Personnel (DHCP) concerned about healthcare supply for PPE to monitor Healthcare Supply of Personal Protective Equipment for updated guidance, and to be familiar with the Interim Infection Prevention and Control Recommendations.

The CDC guidelines notes that, in cases when a patient presents with symptoms of a respiratory infection, DHCP may consider postponing non-emergency or elective dental procedures until a patient is no longer contagious with diseases that may be transmitted through airborne, droplet, or contact transmission (e.g., sneezing, coughing, and contact with skin).

If urgent dental treatment is necessary, DHCP and medical providers should work together to determine the appropriate precautions on a case-by-case basis to avoid the potential spread of diseases among patients, visitors, and staff. Because dental settings are not typically designed to carry out all of the Transmission-Based Precautions that are recommended for hospital and other ambulatory care settings, DHCP and medical providers will need to determine whether the facility is an appropriate setting for the necessary services for a potentially infectious patient.

Prevention of Suspected Respiratory Disease Transmission in the Dental Healthcare Setting

Patients with an acute respiratory illness may present for dental treatment at outpatient dental settings. The primary infection control goal is to prevent transmission of disease. CDC recommends a multi-step approach that begins before the patient arrives at the practice and includes guidance regarding their arrival and for the complete duration of the affected patient’s presence in the practice.

It may not be possible to know the cause of any patient’s illness so it is important to follow this guidance and standard precautions at all times.

Infection control issues during patient assessment:

• Patients with an acute respiratory illness should be identified at check-in and placed in a single-patient room with the door kept closed.
• Seek to prevent the transmission of respiratory infections in healthcare settings by adhering to respiratory hygiene/cough etiquette infection control measures at the first point of contact with any potentially infected person.
• Offer a disposable surgical mask to persons who are coughing; and provide tissues and no-touch receptacles for used tissue disposal.
• Ill persons should wear a surgical mask when outside the patient room.
• Dental healthcare personnel assessing a patient with influenza-like or other respiratory illness should wear disposable surgical facemask*, non-sterile gloves, gown, and eye protection (e.g., goggles) to prevent exposure. Since recommendations may change as additional information becomes available it’s a good idea to check the CDC website for COVID-19 updates.
• Patient and dental healthcare workers should perform hand hygiene (e.g., hand washing with non-antimicrobial soap and water, alcohol-based hand rub, or antiseptic handwash) after possible contact with respiratory secretions and contaminated objects/materials.
• Routine cleaning and disinfection strategies used during influenza seasons can be applied to the environmental management for COVID-19.

*Until additional specific information is available regarding the behavior of COVID-19, the guidance provided in the “Interim Guidance for the Use of Masks to Control Seasonal Influenza Virus Transmission” is recommended at this time. Also recommended is a review of Prevention Strategies for Seasonal Influenza in Healthcare Settings.

Summary

Respiratory hygiene/cough etiquette infection control measures along with contact precautions are currently recommended for preventing transmission of COVID-19 and all flu-like illnesses in a dental healthcare setting. CDC continues to monitor activity relating to COVID-19 and is coordinating efforts with health departments in Arizona, California, Illinois, Massachusetts, Washington, and Wisconsin and communicating with the World Health Organization. This is an evolving situation and CDC is updating its guidance and information as it becomes available.