Dental Settings | CDC

Background

 

The following dental-specific recommendations should be used with CDC’s Interim Infection Prevention and Control Recommendations for patients with COVID-19. This information supplements, but does not replace, the general infection prevention and control (IPC) recommendations for COVID-19.

The practice of dentistry involves the use of rotary dental and surgical instruments (e.g., handpieces or ultrasonic scalers) and air-water syringes. These instruments create a visible spray that contains large particle droplets of water, saliva, blood, microorganisms, and other debris. This spatter travels only a short distance and settles out quickly, landing on the floor, nearby operatory surfaces, dental health care personnel (DHCP¹), or the patient. The spray also might contain certain aerosols.

Caring for patients requiring Transmission-Based Precautions is not possible in most dental settings as they are not designed for or equipped to provide this standard of care. For example, most dental settings do not have airborne infection isolation rooms or single-patient rooms, do not have a respiratory protection program, and do not routinely stock N95 respirators.

 

Recommendations

 

Postpone Elective Procedures, Surgeries, and Non-urgent Dental Visits

Services should be limited to urgent and emergency visits only during this period of the pandemic. These actions help staff and patients stay safe, preserve personal protective equipment and patient care supplies, and expand available health system capacity.

This recommendation aligns with the Centers for Medicare & Medicaid (CMS) Adult Elective Surgery and Procedures Recommendationspdf iconexternal icon, which states to limit all non-essential planned surgeries and procedures, including dental, until further notice.

 

Stay at Home if Sick 

Implement sick leave policies for DHCP that are flexible, non-punitive, and consistent with public health guidance (e.g., allowing employees to stay home if they have symptoms of respiratory infection). Ask staff to stay home if they are sick and send staff home if they develop symptoms while at work.

 

Contact Patients Prior to Clinically Urgent/Emergency² Dental Treatment

Call all patients before their scheduled appointments and screen for symptoms of respiratory illness over the phone (e.g., fever³, cough, shortness of breath). If the patient reports signs or symptoms of fever or respiratory illness, DHCP and medical providers should work together to determine the appropriate facility for emergency treatment.

 

People with COVID-19 who have completed home isolation clearance can receive emergency dental care. This is defined as:

• At least 3 days (72 hours) have passed since recovery (resolution of fever without the use of fever-reducing medications and improvement in respiratory symptoms, e.g., cough, shortness of breath), and at least 7 days have passed since symptoms first occurred.

OR

• For individuals with laboratory-confirmed COVID-19 who have not had any symptoms, at least 7 days have passed since the date of the first positive COVID-19 diagnostic test and have had no subsequent illness

 

Know Actions to Take if a Patient Has Suspected/Confirmed COVID-19

If a patient at your facility is suspected or confirmed to have COVID-19, take the following actions:

• Defer non-urgent procedures
  • Give the patient a mask to cover his or her mouth
  • Send the patient home if not acutely sick
  • Refer the patient to a medical facility if acutely sick (e.g., trouble breathing)
  • If treatment is urgently needed, refer to an appropriate facility
• Clean and disinfect the room and equipment according to the Guidelines for Infection Control in Dental Health-Care Settings—2003 pdf icon
  • Clean, disinfect, or discard the surface, supplies, or equipment located within 6 feet of symptomatic patients
  • Use products with EPA-approved emerging viral pathogens claims—refer to List Nexternal icon on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program from use against SARS-CoV-2

 

Additional Resources

 

¹DHCP refers to all paid and unpaid persons serving in dental healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including:

• body substances
• contaminated medical supplies, devices, and equipment
• contaminated environmental surfaces
• contaminated air

2The urgency of a procedure is a decision based on clinical judgement and should be made on a case-by-case basis

 ³Fever may be subjective or confirmed