Guidelines from Australian and American Dental Association (ADA)

Since the lockdown due to COVID 19 , most dental clinics have been closed or operating on emergency basis . However, no clear guideline or SOPs have been available for their guidance.

Based on the guidelines provided by American Dental Association and Australian Dental Association , we have developed some protocols that may help the private practitioners in minimizing  risk of transmission in their clinical practice.

Staff  Protocols

Proper PPE  should be available for staff

High risk staff should not be working (pregnant, pre-existing respiratory illnesses, older age group )

Anyone showing any symptoms of flu or allergies etc should not report to work and get tested according to the doctor’s instructions.

Reception Protocols

  • Remove magazines and toys from reception area to reduce contact transmission.
  • Hand sanitizers should be available for staff and patients. It is recommended that patients arrive wearing masks and keep them on till they reach the surgery.
  • It is recommended to minimize paper and money transactions and gloves should be worn by staff while handling cash.  Debit and credit cards are recommended for transactions.
  • Change the seats in reception area to a material that can be easily cleaned and disinfected
  • Reception desk should be disinfected frequently including the phone, keyboard, POS machines etc.
  • Frequent disinfection of door handles and water coolers should be done.

Appointment Scheduling Protocols

  • All patients who call should be triaged. Emergency procedures should be offered to get patients out of any immediate pain. All routine appointments need to be deferred until further notice
  • Only one person should accompany the patient if necessary.
  • Book extra time between patients to disinfect the surgeries properly.
  • Encourage the patients to adhere strictly to appointment times to avoid crowding the waiting area.
  • Encourage patients to wear masks before entering the clinic and use to gloves or hand sanitizers once in clinic.

Transmission Precautions

  • Patient placement (e.g. isolated surgery)
  • Adequate room ventilation should be maintained
  • PPE – Comprising of respiratory masks e.g. N-95 masks, protective eye wear (e.g. goggles / face shield), head cover and a protective gown.

Guidelines For  Dental Procedures

All restorative and endodontic treatments should be carried out under rubber dam with aPre-Tx rinse with 0.2% providence or 1.5% hydrogen peroxide .

Tripe syringe also produces aerosols and should be used sparingly.

High volume suction should be used for all procedures.

Root Canal Treatment

Recommended to do stage 1 only. Stage 2 and 3 should be delayed till the restrictions are in place.

Extractions

Basic extractions should be done of infected and mobile teeth. Any elective procedures should be avoided.

If an extraction turns surgical, then refer the patient to OMS or do emergency pulpectomy, and give the antibiotic script. The patient should be rebooked for surgical extraction later. Restorable sutures recommended reducing the need for follow up appointment.

Fillings

Fill under rubber dam, with minimal aerosol production. Use of slow speed are recommended along with GIC for restoration. Maximum use of hand instruments should be done.

Cracked Tooth Syndrome – Manage conservatively or as necessary. Ideally with a band placement till any definitive treatment can be carried out.

Broken teeth ( asymptomatic )

Trauma – as deemed necessary

Ortho – Triaged to determine need. Sandblasting and rebonding of brackets should be avoided due to aerosol generation.

  • Scaling  – should be avoided due to high aerosol production. Gum infections should be treated with hand instruments with a pre-Tx rinse. Polishing procedures should be avoided completely.
  • Impressions /prosthesis should be disinfected before sending and on receiving from the lab .

Post Procedure Cleanup

  • Standard disinfection protocols to be followed
  • Staff surgical mask and gloves to be changed for every patient.
  • Hand pieces and triple syringe tips to be sterilized after every patient
  • Dental unit to be disinfected along with overhead light and stools.
  • If aerosols were generated, then the room should be cleaned after 3 hrs to allow all suspended particles to settle (Acc to ADA recommendations)

Patients with suspected or confirmed COVID Infection

  • DO NOT treat even if patient in pain. Refer them to a hospital with antibiotic and pain killer prescription.

End Of Work Day

  • Staff should take off scrubs at clinic and go home in clean clothes.
  • Preferable to have separate work shoes that are left at work
  • Once home, remove shoes outside
  • Shower immediately and wash hair as well

It is critical that dental practitioners use their professional judgement and moral responsibility to protect the welfare of the entire population (including their team) by avoiding all care that is not urgent in nature. Reducing the volume and extent of dental practice will limit the spread of infection.

Dr. Mahwash Masood | Aussie Dental Clinic