ADA Recommendations for Dental Office Reopening

ADA Recommendations for Dental Office Reopening

Ready to reopen your practice, but worried about COVID-19?

The ADA has updated their Coronavirus FAQ as of April 16th. We have summarized their recommendations to make planning easier for your practice.

Dentists, dental assistants and dental hygienists have some of the highest risk occupations for COVID-19. It is simply not possible to practice dentistry without getting close to a patient's mouth, which is the main vector for disease transmission. Everyone is ready to get back to work, but doing so safely is of the utmost priority.

Updated ADA recommendations

Illness among staff and patients

Staff experiencing flu-like symptoms (fever with either cough or sore throat or muscle aches) should not report to work. Before seeking care at a clinic or hospital, anyone with symptoms should contact their health care provider by remote means first. The exception is for severe illness or difficulty breathing and shortness of breath- in this case, seek immediate medical attention.

Patients who are suspected or confirmed to have COVID-19 should be reported to your local and/or state health departments.

It is recommended to screen patients for international travel as well as signs of infection when you update their medical histories. Also include temperature readings as part of the routine pre-treatment assessment.

Waiting room

The CDC recommends social distancing wherever possible. To implement this in your practice, consider seeing patients by appointment only and asking patients to arrive on time rather than early. This will enable distancing in the waiting areas. The CDC has defined "distance" as approximately 6 feet (2m) from others; if this is not possible in your waiting area, staggering appointments or asking guests to wait in their car may be other options.

Remove entertainment material from the waiting room (magazines, toys, etc) so that these do not become a vector for transmission. Try to ensure that everything in the waiting area is easily disinfected.

PPE

The level of PPE that is required will depend on the procedures that are performed. The ADA notes that "under OSHA, PPE is considered “appropriate” only if it does not permit blood or other potentially infectious materials to pass through to or reach the employee's work clothes, street clothes, undergarments, skin, eyes, mouth, or other mucous membranes under normal conditions of use and for the duration of time which the protective equipment will be used."

Mask shortages are indeed a problem in some areas. It may be advisable to use different levels of masks for various purposes in order to preserve the most resistant masks for where they are necessary. The CDC guidelines for mask use have not changed, and the requirement is that masks are changed between patients (and during treatment if the mask becomes wet.)

The ADA recommends Level 1 masks  for patient evaluations, orthodontic visits, or operatory cleaning. These are procedures where low levels of fluids, aerosols, or spray are produced. Level 1 masks have the lowest levels of fluid resistance and filtration efficiency.

Level 2 masks provide a "moderate" barrier and are more appropriate for moderate levels of fluid, spray, or aerosols. These may be used for sealant placement, endodontics, or simple restorative or composite procedures.

Level 3 masks are best for procedures such as crown or bridge preparations, complex oral surgery, implant placement, or use of ultrasonic scalers. These procedures generate moderate or heavy amounts of blood, fluid spray, or aerosol exposure and so are best suited to the mask with the maximum level of fluid resistance.

N-95 respirators are different than surgical masks. They must be fit-tested for proper use. If your practice decides to use N-95 masks, OSHA has published requirements for medical evaluation and fit-testing.

During treatment

The ADA recommends having patients rinse with 1.5% hydrogen peroxide or commercially available rinses that contain 1.5% hydrogen peroxide just prior to beginning treatment. One commercially available product that exceeds this requirement is EverSmile PreOp. Hydrogen peroxide has been described by the CDC as active against a wide range of microorganisms, including bacteria, yeasts, fungi, viruses, and spores.

Use a rubber dam wherever possible to decrease possible exposure.

Use  high speed evacuation for all dental procedures producing an aerosol.

After treatment

After each patient, autoclave the handpiece used.

Clean and disinfect all patient areas including chairs, door handles, and bathrooms. The EPA has developed a list of registered surface disinfectant products for use against coronavirus. This virus type is one of the easiest to kill with the appropriate disinfection product. Routine cleaning procedures (using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant) are appropriate in healthcare settings, including where aerosol-generating procedures are performed.

To order PreOp or to get more information:

EverSmile PreOp currently comes in 16oz bottles for $19.99 each. This provides 100 patient doses.

We can be reached by email: info@eversmilewhite.com

Or by phone: (855) 595-2999

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