Fallow Periods Recommended Only for Highest-Risk Procedures

Dentistry Today

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The Faculty of General Dental Practice UK (FGDP(UK)) and College of General Dentistry (CGDent) say they welcome the Scottish Dental Clinical Effectiveness Programme (SDCEP) review of the mitigation of aerosol-generating procedures (AGPs) and that they will be issuing updated COVID-19 guidance shortly in view of its recommendations.

The SDCEP document represents the consensus of a working group comprising dental professionals from across primary care, secondary care, academia, and public health, in addition to expert opinion from subject specialists in particle physics, aerobiology, and clinical virology.

The report was compiled following a review of the currently available evidence on the generation and mitigation of aerosols in dental practice and the association risk of coronavirus transmission, the FGDP(UK) said.

Among the key positions, and in contrast to those adopted to date in official protocols, the report divides dental procedures into three categories of aerosol generation potential according to the instruments used, with fallow periods recommended only for the highest-risk procedures. The report also suggests the determination of fallow time using a multifactorial approach with a benchmark of 15 to 30 minutes.

The SDCEP noted that its document does not have the status of guidance. Its aim was to identify and appraise the evidence related to several predetermined questions about AGPs in dentistry and to use a process of considered judgment of this evidence and other relevant factors to reach agreed positions that may be used to inform policy and clinical guidance.

The FGDP(UK) and CGDent said that their guidance, published in June, also set out a more nuanced approach to considering the generation of aerosols in dental practice. And while allowing for potential adjustment of fallow time, the FGDP-CGDent guidance accepted a 60-minute period following procedures carrying a higher risk of exposure to potentially infective aerosols.

“SDCEP’s review of dental AGPs has been extremely thorough and followed a rigorous and methodical approach. Its publication is potentially a very significant moment in the recovery of dental practices in the midst of the coronavirus pandemic, and I commend the SDCEP Team for the hard work and dedication they have shown in producing this report,” said Ian Mills, dean of FGDP(UK), trustee of CGDent, and member of the SDCEP review group.

“We welcome in particular the more refined stratification of the transmission risk inherent in types of dental procedure; the allowance for fallow time to be calculated from the cessation of the procedure; and the sophisticated approach to calculating fallow time, which considers both procedural and environmental mitigation factors such as high-volume suction, the use of rubber dame, and provision of adequate air ventilation,” said Mills.

“These approaches align exceptionally well with our own guidance, and we feel it is important that current standard operation procedures are reviewed in light of SDCEP’s recommendations,” said Mills.

“Adoption of these measures will enable the increased delivery of patient care to tackle the backlog of unmet need and avoid further deterioration in dental access and oral health inequality. A reduction in fallow time will also support the viability of practices, while the maintenance of universal precautions will continue to keep both patients and members of the dental team safe,” said Mills.

“We aim to update our guidance as soon as possible and are currently working with partners to develop an online fallow time calculation tool to support its implementation,” Mills said.

SDCEP’s “Mitigation of Aerosol Generating Procedures in Dentistry—A Rapid Review” is available online. The current FGDP-CGDent guidance, “Implications of COVID-19 for the Safe Management of General Dental Practice—A Practical Guide,” also is available online from the FGDP(UK) and CGDent.

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