Covid-19 Emergency Action Plan

March 31, 2020

Important: This document is for dentists who treat dental emergencies in their offices. The application form on page 5 must be completed and submitted to the Provincial Dental Board for review and approval. Only approved clinics can treat patients.

The purpose of this document is to serve as a guide for dentists providing care to patients in designated Emergency Dental Clinics with dental emergencies during the COVID-19 pandemic. The information contained in this document are best practises based on the pertinent literature available at present.

Please visit the PDBNS website to keep informed about updates and new information.

Considerations when contacting/scheduling patients with dental emergencies (as defined by PDBNS COVID-19 dental emergency protocol)

• Appointments should be booked at appropriate intervals as to avoid overlap of appointment times. In other words, there should only be one patient in the treatment facility at any one time.
• Operatories should be used in a rotating fashion between procedures to allow as much time as possible for aerosols to settle before disinfecting between treatments.
• Depending on the clinic layout and the type of treatment provided, the disinfection/wait times between procedures will vary.
• Patients should be reminded by phone when booking to remove all jewellery from the neck up and any removable dental prostheses.
• Instruct patients to remain in their car or outside the office upon arrival and contact the treatment facility via telephone to check-in.
• Review screening questions pertaining to dental emergency and COVID-19 symptoms.
• Any non-essential escorts/familial members are not permitted within the facility.

Triage:

• Triage member will greet patient at the door.
• Triage team PPE (see Table 1):
• • Level 1 mask, eye protection, gown/lab coat, scrubs, gloves
• Triage:
• • Temperature, vitals, H2O2 rinse (timed 30 seconds), as required.
  • Provide necessary PPE to patients Level 1 mask, hand sanitizer.
  • Bring patient for diagnostic imaging as required.
  • Triage person to bring patient to assigned operatory.
• ** The patient should NOT be touching door handles** – staff should be opening all doors for patient +/- visitor.

PATIENT CARE:

Aerosol generating procedures (AGPs) are procedures that can generate aerosols that consist of small droplet nuclei in high concentration and present a risk for airborne transmission of pathogens that would not otherwise be spread by the airborne route (e.g. coronavirus, influenza).

Examples of AGPs in Dentistry would include the use of a rotary dental handpiece (especially a high-speed handpiece) and the use of three-way air-water syringe.

Non-aerosol generating procedures (non-AGPs) are procedures with lower likelihood of generating aerosols. Examples of non-AGPs would be procedures such as a patient exam, a simple extraction, incision and drainage, temporary filling (without use of handpiece or air water syringe), and taking a panoramic radiograph.

We strongly recommend not performing AGPs whenever possible. In the rare instance that a situation arises which requires an AGP, please refer to table 1 to ensure the use of appropriate PPEs. If you do not have the appropriate PPEs available do not perform the AGP. Refer the patient to Dal/VG/IWK or designated Emergency Dental Clinic for management of the dental emergency.

Based on the literature available, some additional measures should include:

• a pre-treatment oral rinse (e.g. 1% hydrogen peroxide x 30 seconds).
• high volume suction.
• Rubber dam whenever possible.
• extra-oral diagnostic imaging preferred (panoramic radiographs or CBCT) rather than intra oral imaging to minimize patient coughing.
• The 4-handed technique is beneficial for minimizing aerosols.

Should I wear an N95 mask when providing care to a patient?

N95 mask are ONLY required for aerosol generating procedures (AGPs). Staff performing AGPs must be fit-tested and educated in proper donning and doffing of PPE.