The Los Angeles County Department of Public Health Oral Health Program (DPH OHP) has updated its COVID-19 dental care recommendations to reflect the most recent guidance from the Centers for Disease Control and Prevention (CDC), Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response. Dental Healthcare Personnel (DHCP) should continue to follow the California Department of Public Health (CDPH) Guidance for Resuming Deferred and Preventive Dental Care. The current recommendations include the following:
DHCP should balance the need to provide necessary services while minimizing risk to patients and staff. Before providing any care, it is important to ensure that appropriate personal protective equipment (PPE) and sanitation supplies are available to support patient volume, and that updated engineering controls, work practice protocols, and infection control measures are in place.
Dental Healthcare Personnel Frequently Asked Questions (FAQs)
Aerosol-generating procedures involve 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.
Symptomatic patients are considered recovered after the following conditions have been met:
Asymptomatic patients with lab confirmed COVID-19 are considered recovered after:
Immunocompromised patients with COVID-19, see CDC guidance on Duration of Isolation and Precautions for Adults with COVID-19.
For more information regarding recovery and discontinuation of isolation, see CDC, Discontinuation of Isolation for Persons with COVID -19 Not in Healthcare Settings.
A person is considered to be a close contact of a patient with presumed or confirmed COVID-19 if, within 2 days before the patient’s symptoms began and until the patient is no longer required to be isolated, they (a) were within 6 feet of the patient for a total of 15 minutes or more within a 24-hour period or (b) had unprotected contact with the patient’s body fluids and/or secretions (such as being coughed on/sneezed on, shared utensils or saliva, or provided care without wearing protective equipment). Close contacts typically include household members, intimate partners, co-workers, and caregivers.
Close contacts must self-quarantine for 14 days after the last time they were in contact with the case. They may return to regular activities after the 14 days have passed, if they have remained asymptomatic, and have had no further contact with the case. If they continue to live with, have contact with, and/or care for a person with COVID-19, then see additional details in the provider Isolation & Quarantine Guidance page.
Yes. DHCP whose job duties do not require PPE (e.g., clerical personnel) should wear facemasks (surgical masks or procedure masks) or cloth face coverings for source control at all times while in the dental setting, including in breakrooms or other spaces where they might encounter co-workers.
Universal source control is recommended to prevent asymptomatic transmission between staff, visitors, and patients. Continued community transmission has increased the number of individuals potentially exposed to and infectious with SARS-CoV-2. Symptom screening will not identify individuals who are infected but otherwise asymptomatic or pre-symptomatic. Additional interventions are needed to limit the unrecognized introduction of SARS-CoV-2 into dental practices including universal source control.
As part of source control efforts, dental healthcare professionals should wear a facemask or face covering at all times when they are in the dental setting. Masks or respirators are preferred, but non-medical face coverings can be used for non-patient care activities. Extended use and reuse of masks and respirators should be based on principles set forth in prior CDC PPE optimization guidance.
For more information, see the CDC Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response.
Professional judgment should be exercised with regard to the use of disposable foot covers or head covers. See ADA for more information on guidance in regard to clothing.
Cal-OSHA has not waived the N95 annual test during the COVID-19 pandemic. Initial respirator fit testing is required before an employee uses a respirator, or when an employee changes to a different model, make, or size of respirator. There are no changes to these requirements.
To reduce usage of respirators and prioritize fit testing equipment and supplies for fit testing of new models, Cal/OSHA will allow a 90-day delay for meeting annual fit testing requirements provided there are no changes an employee's physical condition that could affect respirator fit.
For more information on N95 fit testing click here.
The CDC developed a series of strategies or options to optimize supplies of PPE in healthcare settings during periods of limited supply, along with a burn rate calculator. Optimization strategies are provided for gloves, gowns, facemasks, eye protection, and respirators.
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 SARS-CoV-2 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).
DHCP should implement the use of universal eye protection and wear eye protection in addition to their 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 likely do not protect eyes from all splashes and sprays.
During aerosol generating procedures DHCP should use an 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.
Yes. As a contingency, reusable (i.e., washable) gowns that can be used are typically made of polyester or polyester-cotton fabrics. Gowns made of these fabrics can be safely laundered according to routine procedures and reused. Care should be taken to ensure that providers do not touch outer surfaces of the gown during care.
Any reusable gown that becomes visibly soiled during patient care should be removed and cleaned. Gowns should cover personal clothing and skin (e.g., forearms) likely to be soiled with blood, saliva, or other potentially infectious materials.
CDC recommends DHCP consider using a portable HEPA Air Filtration Unit as an adjunct engineering control in the treatment room while the patient is actively undergoing, and immediately following, an aerosol-generating procedure. OSHA also provides guidance on the Engineering Control of Dental Care Settings: If possible, use directional airflow, such as from fans, to ensure that air moves through staff work areas before patient treatment areas—not the reverse. A qualified industrial hygienist, ventilation engineer, or other professional can help ensure that ventilation removes, rather than creates, workplace hazards.
The CDC removed a recommendation to wait at least 15 minutes after completion of dental treatment and departure of a patient without suspected or confirmed COVID-19 to begin the room cleaning disinfection process. The ADA advises that it is still important to wait before disinfecting patient treatment rooms after aerosol-generating procedures. How much time is needed before disinfecting patient rooms is at the individual clinic's discretion but should be based on a number of variables such as room air flow rate, length of aerosol-generating procedures, volume of patients, use of HEPA air filtration devices, and the use of rubber dams and high speed evacuation.
All patients should be telephone screened for symptoms prior to the visit. If they report a fever or other symptoms of COVID-19 (cough, shortness of breath or difficulty breathing, chills, repeated shaking with chills, muscle pain, headache, sore throat, or new loss of taste or smell), they should contact their healthcare provider and should have their dental visit deferred.
If a patient arrives at your facility and has fever or other symptoms of COVID-19, give them a mask (if not already wearing one). If not acutely sick, send the patient home and have them contact their healthcare provider. Refer them to “Home Care Instructions” which includes information about how to get testing if they do not have a primary care provider. If the patient is acutely sick refer the patient immediately to a medical facility or call 9-1-1 if you notice emergency warning signs. For the latest information on testing, please visit the LAC DPH testing webpage for providers.
The LAC DPH COVID-19 Surveillance Dashboard includes an array of data and metrics, such as data on testing, hospitalizations, cases and deaths by city/community, an interactive map, etc. For information on the cities of Long Beach and Pasadena, see their COVID-19 dashboards: Long Beach Dashboard | Pasadena Dashboard.
Make sure all safety measures and updated protocols are in place and you have at least a two-week supply of PPE on hand. Communicate with your staff the office workflow and procedures to ensure social distancing of patients and staff. The ADA Return to Work, CDA Back to Practice, and CDC Releases Interim Reopening Guidance for Dental Settings have resources available on returning to work. In addition, refer to the DPH Monitoring Healthcare Personnel Guidance for information regarding the routine monitoring of staff, return to work recommendations, and management of high risk exposures.
On September 4, 2020, the DPH LAC issued the Resuming Deferred and Preventive Health Care in Los Angeles County recommendations and FAQs, which includes guidelines for dentists.
OSHA issued new guidelines for dentistry workers and employers. As states or regions satisfy the gating criteria to progress through the phases of the guidelines for Opening up America Again, employers will likely be able to adapt this guidance to better suit evolving risk levels and necessary control measures in their workplaces. Employers should assess the hazards to which their workers may be exposed; evaluate the risk of exposure; and select, implement, and ensure workers use controls to prevent exposure.