FAQ for Registrants

For individuals entering Nova Scotia from another part of Canada, there are no longer border restrictions as of Monday, February 14, 2022.  Therefore, these people can be treated normally, assuming they have passed other COVID-19 screening criteria.

Individuals who have travelled outside Canada within the past 14 days may have isolation and testing requirements, the details for which can be found here. Individuals required to isolate should receive dental care only if they have a true dental emergency, and then using airborne precautions.

Dental emergencies are potentially life-threatening conditions that require immediate treatment. These conditions include:

• Odontogenic infection associated with intra-oral and/or extra-oral swelling that has not responded to antibiotics over the course of two to three days, as prescribed by a client’s dentist or physician;
• Pain that cannot be controlled with a course of antibiotics/analgesics, as prescribed by a client’s dentist or physician;
• Orofacial trauma; or
• Prolonged post-operative bleeding.

If a DHCP/office staff member has visited a listed exposure location, follow the advice of public health. Ensure that you advise them that you are a health care worker.

If required to schedule a test, complete an online COVID self assessment (https://covid-self-assessment.novascotia.ca/en) or contact 811 to arrange a COVID test.

Review the list of locations identified by Public Health Alerts. If you are unsure, please contact Public Health directly to confirm the risk level of a location.

The list of locations identified by Public Health Alerts can be found at the following link  Potiential Covid-19 Exposures

The oral health regulators take direction from the CMOH when situations such as this arise.

If the patient screens positive for any of the COVID-19 risk factors, treatment should be deferred unless it is a true dental emergency. If it is not a true dental emergency, the patient should be managed pharmacologically by teledentistry until such time as their COVID-19 status is known. Patients who screen positive for symptoms and/or risk factors and are assessed and found to have a true dental emergency, should be referred to a facility that has the infrastructure to provide dental care using airborne precautions (i.e. operatories with floor to ceiling walls and doors, appropriate negative pressure ventilation, and PPE).

Hierarchy controls state the importance of pre-screening and screening. Therefore, all offices must continue to ensure patients pass the screening questions for COVID-19 symptoms and COVID-19 risk factors.
The importance of screening cannot be over-emphasized, and this provides a good example of why it is important to perform pre-screening (telephone screening) prior to the office visit, as well as a re-screening on the day of the appointment. Screening helps to identify patients who are possibly infected with COVID-19 before they enter a clinic, receive care and possibly transmit the virus in the process.

Airborne precautions are used to prevent the transmission of pathogens by aerosols. If it is deemed necessary to use airborne precautions, based on the screening criteria outlined in the PDBNS COVID-19 Reopening Plan for Dental Clinics Phase 3 Comprehensive Care document, the measures described below must be implemented. If this is not possible, a referral should be made to a clinic with the ability to provide care using these measures.

1. Fit tested N95 respirator or the equivalent (as approved by Health Canada)
2. Eye/Face protection:

It is at the discretion of the DHCP as to what type of eye protection they choose to wear. The important concept – regardless of whether goggles, a face shield, or a combination of both are used – is that the PPE must protect the eyes of the DHCP from splatter, droplets, and aerosols that may be generated during the provision of dental care.

3. Gown/lab coat
4. Gloves
5. Settling times based on air changes/hour (ACH):

 *adopted from

 https://www.cdc.gov/infectioncontrol/guidelines/environmental/appendix/air.html

If your office does not have floor to ceiling walls with doors, you should book the patient at the end of the day when there are no other patients in the facility. If you are unsure what the air changes/hour are in your facility, assume it is 2 and allow for 207 minutes of settling time after performing an aerosol generating procedure. The treatment room should be disinfected once the settling time has ended.

The COVID-19 Self-Screening Tool for staff needs to be kept for 28 days, after which it can be destroyed. However, the pre-screening and screening documents for patients cannot be destroyed as it is a part of the patient’s record. Please refer to the PDBNS Recordkeeping Guidelines regarding the retention period for patent records.

The Answer is yes.  

As indicated in the Provincial Dental Board of Nova Scotia’s document titled “COVID – 19 Reopening Plan for Dental Clinics Phase 3 – Comprehensive Care” and as approved by the Chief Medical Officer of Nova Scotia, patients must wear a non-medical mask to their appointment or be provided with a mask (non-medical or surgical) when they arrive.  Nova Scotia Public Health states, “You should wear a non-medical mask… if you’re going out to access medical care or other essential health services.”

Patients wearing a non-medical mask will need to take it off prior to starting their treatment and asked to put the mask back on when treatment is completed.

It is recommended that all DHCPs and staff wear a mask (non-medical or surgical) at all times when physical distancing cannot be followed.  This includes staff areas and lunchrooms.  Masks may be removed when eating.

The Public Health Agency of Canada (PHAC), recommends that masks should not be placed on children under the age of two.

According Nova Scotia’s rules for masks in public places, children under the age of two are not required to wear masks.

Children aged two to four are exempt from wearing masks if their caregiver cannot get them to wear a mask.

For information regarding the exemptions for wearing a mask, please go to: https://novascotia.ca/coronavirus/masks/#Exemptions

It is up to the DHCP’s discretion regarding the evidence that a patient should provide about the medical reason for not wearing a mask. DHCP’s should use their clinical judgement in such circumstances which may include contacting a patient’s physician to understand the reason why a mask cannot be worn.

For additional information regarding public mask use, please go to:

https://novascotia.ca/coronavirus/masks/

Exemptions to wearing a mask may include – anyone with a valid medical reason for not wearing a mask, anyone who is reasonably accommodated under the Human Rights Act of Nova Scotia, and anyone who is unable to remove the mask without assistance.

You are not required to wear a mask if you are alone.

Physical distancing should be practiced whenever possible.  A mask (non-medical or surgical) must be worn when physical distancing is not possible.

The importance of screening cannot be over-emphasized.  Screening helps to identify patients who are possibly infected with COVID-19 before they enter a clinic, receive care and possibly transmit the virus in the process.  Pre-screening (telephone screening) should be done prior to the day of the appointment (when feasible), in addition to in-person screening on the day of the appointment.  Screening must include COVID-19 symptoms and COVID-19 risk factors.

Every dental office must have a back to work site plan as directed by the Chief Medical Officer of Health and Occupational Health and Safety.  This plan is to be office specific using the Guidelines developed in the COVID -19 Reopening Plan for Dental Clinics document that can be found on the PDBNS website.

Yes, dental practice site visits are currently underway. The dental offices chosen in the audit process are required to provide their clinic’s site-specific re-opening plan to the Board office. The Registrar and Deputy Registrar review the Site-specific COVID 19 Re-opening Plan for these offices prior to the visit and at the time of the visit the Registrar and Deputy Registrar review its implementation.

There are a number of different factors to consider. These include spacing, physical barriers, air exchange in the clinic and mitigation strategies to reduce aerosols. There should be physical barriers of adequate height and length between operatories and 2 metres spacing between operatories.

If you practice in an open concept office with no physical barriers separating chairs and you are performing an AGP, treat one patient only in the space. This does not apply when performing  a non-AGP procedure and physical distancing measures are met.

The air exchange in the clinic should be optimized to reduce the aerosols generated with AGPs. In addition, the use of dental dam (whenever possible) and the effective use of HVE and four-handed dentistry will significantly reduce aerosols.

The physical barriers between chairs must be solid so that they can be cleaned and disinfected. In addition to Plexiglas barriers, supplemental barriers, may be used to direct staff/ patent flow.

Case reports from Ontario, Quebec, and China have shown that where the routine wearing of masks was not part of protocols, staff-to-staff infections were common based on contact tracing and follow-up. Therefore, social areas within an office (lunchrooms, shared offices and washrooms) pose a higher risk for transmission of SARS-CoV-2.

It will be challenging to practice physical distancing in your office. Work with your team to develop a process for patient flow into and through the practice to encourage physical distancing and minimize interaction with other staff or patients.

Develop protocols to include:

• Wearing masks where physical distancing is not possible.
• Limiting the total number of people at the workplace and where they are assigned to work.
• Staggered start times, breaks, and lunches.
• Alter the workplace layout of the floor by moving furniture or using visual cues such as tape on the floor to enhance physical distancing.
• Arrange lunchrooms and break rooms to follow physical distancing practices. Consider erecting partitions on lunchroom tables.
• Meals should minimize use of appliances. Any appliances used with high touch surfaces such as microwaves or refrigerators should be disinfected after use.

No dental office employee can be required to work without the proper PPE as outlined in the Return to Work Guidelines for the Oral Health Professions of Nova Scotia.  If you feel you are not being provided with proper PPE as outlined in the Guidelines, we recommend that first and foremost, you should have a discussion with your employer. It is the responsibility of all clinics to follow the Guidelines.  If you feel you are being asked to work in an unsafe environment, you may contact Nova Scotia Occupational Health and Safety or the Provincial Dental Board to have your concerns addressed.

All regulated oral health professions have their own reopening guidelines and protocols.  They can all be found in the Return to Work Guidelines for the Oral Health Professions of Nova Scotia. These guidelines have been developed by the four oral health regulatory bodies in Nova Scotia: the Provincial Dental Board of Nova Scotia (PDBNS), the College of Dental Hygienists of Nova Scotia (CDHNS), the Denturist Licensing Board of Nova Scotia (DLBNS) and the Nova Scotia Dental Technicians Association.  CDHNS guidelines closely mirror those found in the COVID-19 Reopening Plan for Dental Clinics.

Impressions, prostheses, or appliances should be cleaned and disinfected as soon as possible after removal from the patient’s mouth, before drying of blood or other organic debris. The manufacturer’s instructions regarding the stability of specific materials during disinfection should be consulted. Wet impressions or appliances should be placed in an impervious bag prior to transportation to a commercial dental laboratory. As a precautionary measure, labs should treat all received items as contaminated. Increased caution should be used when handling items that have had direct patient contact. These items must be thoroughly disinfected or sterilized, as appropriate, before proceeding.  Labs must clean and disinfect the area for receiving incoming cases immediately after decontamination of each case.  Labs must clean and properly disinfect (whenever possible sterilize) items before sending them out, and must package and label to indicate “cleaned”.  Please see “Dental Laboratory Asepsis” p. 37 NSDA IPAC 2013.

Impressions, prostheses, or appliances should be cleaned and disinfected as soon as possible after removal from the patient’s mouth, before drying of blood or other organic debris. The manufacturer’s instructions regarding the stability of specific materials during disinfection should be consulted. Wet impressions or appliances should be placed in an impervious bag prior to transportation to a commercial dental laboratory.

Non-critical items pose the least risk of transmission of infection, as they have no contact with the patient. Non-critical items should be cleaned after use or, if contaminated, cleaned and then disinfected with an appropriate low-level disinfectant (e.g. chlorine-based products, 0.5% accelerated hydrogen peroxide, 3% hydrogen peroxide, 60 to 95% alcohols, iodophors, phenolics and quaternary ammonium compounds).  Cleaning and disinfection of some non-critical items may be difficult or could damage surfaces. It may be preferable to use disposable barriers to protect these surfaces.

There is no limit on the number of Dental Health Care Practitioners (DHCPs) in your office. If social distancing among staff cannot be maintained, then surgical masks must be worn at all times when social distancing is not possible. You should have the appropriate number of staff required to effectively operate your office and provide care in a safe environment.

It is recommended that dentists carefully manage patient and staff flow and contact.

This includes the following:

• Have patients notify your office once they have arrived and direct them when it is appropriate to enter the clinic.
• It is acceptable to use waiting rooms if social distancing measures are enforced.
• Conduct patient flow as to best maintain proper social distancing, and consider providing patients with a mask or have them bring a mask from home to be worn in the office.

As the patient is leaving:

• Try to have paperwork completed before the patient arrives at reception.
• Choose a touchless payment method, if possible.

Yes, you can use nitrous oxide and oxygen sedation when you return to work. The following precautions must be taken:

1. Use as low of flow as possible
2. Ensure the circuit and nasal hood is appropriately reprocessed according to manufacturers’ instructions
3. Consider the use of disposable items (nasal hoods) when possible
4. Disinfect the nitrous oxide and oxygen unit (including reservoir bag) appropriately between patients

Resource: https://ramedical.com/infection-control-guide-to-care-of-inhalation-sedation/

It is recommended that other individuals should not be present in the operatory during patient care. If an individual such as a parent or other caregiver is present, then they must wear a mask and be 2m away from the patient. If this distance is not possible, then the individual must don the same PPE as the dental care providers. It is important that caregivers are not exposed to the patient’s bacteria through spatter contamination.

One of the best ways for all age groups to prevent infection is to wash their hands regularly and avoid touching their face. A parent or caregiver should wash their infant’s hands prior to a baby wellness check.

Of note, hand sanitizer is not recommended for use on infants as their skin is still developing and changing and the risk of ingesting without proper supervision is high.