Released May 7, updated guidance for resuming deferred and preventive dental care.
View CDPH Guidance
Updated May 19, interim infection prevention and control guidance for dental settings during the COVID-19 response.
View CDC Guidance
On April 27, as part of the governor’s framework for modifying his shelter-in-place order, he announced plans to permit hospitals to begin to provide some additional essential surgical care, such as tumor removal and heart value replacement. That guidance stated that the California Department of Public Health would be updating its April 7 dental guidance separately. On May 7, CDPH released updated interim guidance for dental care.
This movement to begin to open up the economy and allow more business activity is influenced by California’s success in managing the pandemic early on, which has resulted in low community transmission rates and surge preparation in our health care system. These are excellent signs and bode well for California’s continued successful pandemic response. Additionally, for health care in general and dentistry in particular, plentiful access to PPE and expanded testing are also essential to moving forward with more care.
The CDPH guidance states that, “It is important to continue to monitor COVID-19, including case counts and hospitalizations and their impact on the health care delivery system” and encourages dental offices to track trends in their communities via a new state data portal at update.covid19.ca.gov/. The guidance also notes that, “Many local health departments are also publishing community-level data that may be helpful to your practice for assessing pandemic conditions in your community.”
As dentists assess their individual access to required resources and readiness to resume providing more dental care, it is important that they review the May 7th CDPH interim guidance. That guidance remains fundamentally the same, recommending protocols that reduce close contact between individuals and practices that reduce the opportunity for aerosol disease transmission during the dental visit.
The following FAQ is designed to answer some of your questions:
You must comply with Cal/OSHA’s requirements for the airborne transmissible disease (ATD) standard, which include:
As patients may still unknowingly carry and transmit SARS-Cov 2, the coronavirus that causes COVID-19, each patient seeking care at your dental office or clinic must be screened to limit the risk of virus transmission.
This screening is essential to determine the appropriate options for managing the patient’s dental care and the appropriate location for that care. Dentists are reminded that patients with active symptoms of an ATD should not receive treatment in a dental office, and if in-person consultation occurs, the patient must be wearing a mask prior to entering the dental office. Dentists should work with the patient’s medical provider to determine the appropriate setting for further care for persons with confirmed or suspected COVID-19.
CDA has a resource that provides guidance on screening patients for COVID-19.
It is best to begin the screening process at the time the appointment is requested. Ask the patient over the telephone or telehealth platform if they:
Have tested positive for COVID-19 and, if yes:
Furthermore, as California moves farther into the next stage of pandemic management and regions within California begin to loosen stay-at-home orders, people will also begin to move between communities, states and countries that have varying levels of COVID-19 activity. If your community has low transmission levels and businesses are operating, you may want to consider adding a screening question that asks whether the patient or members of the patient’s immediate household have traveled outside of the community within the last three weeks. Patients with potential exposure to the SARS-Cov 2 virus from areas with active transmission rates should postpone care for three weeks, or if emergency care is required, it should be provided under COVID-19 suspected status.
If a patient passes these screening questions and will be seen in the office but plans to bring a driver, remind the patient that the driver should remain outside the office. Obtain the driver’s phone number to notify them that the patient is ready to leave. If a parent, guardian or caretaker must accompany a patient to the appointment, provide a face mask if they are not wearing one and be certain they comply with social distancing rules in the waiting area.
When the patient presents:
Adequate PPE is a prerequisite to opening your dental office for nonemergency care. If you do not have adequate supplies to protect you and your staff, you must readjust your care schedule to this reality. You may want to reach out to your local dental society, colleagues and other health care professionals or facilities to learn if supplies are available. Emergency supplies can also be requested through your local Medical and Health Operational Area Coordinator (MHOAC). Please know that there may be a long waiting period.
MHOAC Contact List
Single-use masks, or disposable masks, should not be washed for the purpose of reusing with patients. The CDC provides guidance on extended use and reuse of N95 respirators. OSHA provides guidance on decontamination of respirators.
That is a decision that can only be made at the time of the event and certain factors would have to be considered and assessed. For example, an employee or a patient whose partner has a co-worker exhibiting symptoms is a low-risk situation compared to a situation where an employee or patient has a partner who has symptoms consistent with COVID-19. Individuals who have reported possible exposures to their medical care providers should follow the provider’s instructions. Consult with your local public health department if exposure risk is high, for example, when a patient was seen in the office and then reports within a couple weeks that they have tested positive for COVID-19. CDC has FAQs on suspected or confirmed cases of COVID-19 in the workplace.
Be sure to keep up with news on the virus and on guidelines or orders from your local public health department.
Interim CDC guidance for businesses and employers recommends that:
For in-depth interim guidance and resources on preparing your practice, patient care and practice management, visit https://www.cda.org/Home/Practice/Back-to-Practice
California licensed dentists can now order limited quantities of critical personal protective equipment that is in short supply through traditional, commercial distribution channels.
Learn if and how your practice can establish a respiratory protection program, a requirement for practices using N95 or equivalent masks.