The California Department of Health has updated its guidelines for treating patients with dental emergencies, including patients with known or suspected COVID-19, in alignment with recommendations from the Centers for Disease Control or Prevention, the ADA, and the American Dental Hygienists’ Association.
Already, the Department of Health advises dental practices to postpone routine procedures, surgeries, and non-urgent visits and treat only those patients with dental emergencies. Patients who are treated should be screened for COVID-risk, including fever, respiratory symptoms, or potential exposure and triaged appropriately.
When patients with known or suspected COVID-19 require treatment, dental health care personnel (DHCP) and medical providers should work together to determine an appropriate facility for treatment. Patients with active COVID-19 infection should not be seen in dental settings, per CDC guidance, and treatment should be carried out in accordance with the Aerosol Transmissible Diseases (ATD) Standard.
DHCP should use recommended personal protective equipment (PPE) including a gown, gloves, eye protection such as a face shield or goggles, and respiratory protection including a powered air-purifying respirator (PAPR) or N95 respirator.
Any aerosol-generating procedures should follow best practices and be performed in an airborne infection isolation room. Those present in the room must wear a PAPR with a high-efficiency particulate air (HEPA) filter during the procedure. If a PAPR isn’t available, the dentist should wear an N95 respirator.
Dental procedures that are less likely to produce aerosols should be performed in an airborne isolation room unless it isn’t feasible to do so. In that case, the can be performed in a private room with the door closed.
DHCP should perform procedures in a manner that minimizes aerosol production such as the use of high-volume evacuation. Also, those in the room should wear a respirator at least as effective as an N95 filtering facepiece respirator. If surgical N95 respirators aren’t available, an industrial N95 with a face shield would be an alternative.
If additional follow-up care or procedures are required after the emergent care for patients with suspected or confirmed COVID-19, dental providers should wait until after symptoms have resolved (72 hours since the last fever without anti-fever medications and improved cough or other respiratory symptoms) and at least seven days have elapsed since symptom onset. Following the ATD Standard respiratory protection requirements described above would be prudent under these circumstances.
The Department of Health offers additional guidance for treating patients with urgent dental problems who aren’t symptomatic for COVID-19 and without known exposure to the virus as well as further resources.