May 8, 2020
The Pennsylvania Department of Health (Department) is revising healthcare community guidance to reflect Governor Wolf’s strategic phased reopening plan, particularly related to performing non-urgent procedures. There is still no data available to assess the risk of COVID-19 transmission during dental procedures; however, there is a better understanding of which procedures have increased risk of transmission and how to utilize Personal Protective Equipment (PPE) to reduce the risk. Therefore, the Governor and the Secretary of Health have revised their business closure orders issued on March 19, 2020, as subsequently amended, to remove the prohibition on “elective,” i.e., non-urgent and non-emergent, dental procedures.
All providers licensed by the Pennsylvania State Board of Dentistry should adhere to the following operating protocols state-wide.
Each dental provider should apply their clinical judgment along with their knowledge of the incidences of COVID-19 cases in their area, the needs of their patients and staff, and the availability of necessary supplies to assess whether to re-engage in the provision of non-urgent and non-emergent dental care. For example, if a clinician determines that lack of treatment will result in irreversible damage to a patient, the clinician should pursue treatment with the appropriate level of PPE per Occupational Health and Safety Administration (OSHA) and CDC Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response guidance relative to PPE. Providers should routinely consult the CDC guidance when providing care, noting that recommendations and guidance could change frequently.
Providers may perform non-aerosolizing, non-urgent and non-emergent care only if proper PPE, per OSHA guidance, is available for all dental care practitioners, including dental hygienists. Procedures that create a visible spray that contain large particle droplets of water should not be performed because they are considered aerosol generating; however, as a last resort when clinically necessary, aerosol generating procedures are allowed, only if proper PPE, per OSHA guidance, is available for all dental care practitioners including dental hygienists, since not all patients who have COVID-19 are symptomatic, i.e., they could be asymptomatic or pre-symptomatic. The Department of Health and the Pennsylvania Emergency Management Agency are not currently prioritizing dental practices for PPE distribution, so proper PPE must be secured by the practice.
If infection control protocols outlined by the CDC and OSHA cannot be followed, the procedure should not be done.
All patients should be screened for symptoms of COVID-19, such as temperature over 100.4 degrees Fahrenheit, cough or other symptoms, before arriving at the practice, social distancing should be maintained while in the practice, and patients should wash or sanitize hands frequently and wear a mask when not undergoing treatment. Tele-dentistry should continue to be employed when possible as patients might be able to be treated virtually with antibiotics and pain medication. Please remember to continue to use proper opioid guidelines in the dental practice, per clinical judgment.
PATIENTS SUSPECTED OF CONFIRMED TO HAVE COVID-19
The Department is aware that many dental practices will not be able meet the stringent infection prevention and control requirements for treating patients suspected or confirmed to have COVID-19. If emergency dental care is medically necessary for a patient who has, or is suspected of having, COVID-19, airborne precautions (an isolation room with negative pressure relative to the surrounding area and use of an N95 filtering disposable respirator for persons entering the room) should be followed. In these cases, dental treatment should be provided in a hospital or other facility that can treat the patient using the appropriate precautions.
ADDITIONAL RESOURCES:
- Check the CDC and the Pennsylvania Department of Health websites regularly for updates.
- Visit the Pennsylvania Department of Labor and Industry website for valuable information regarding unemployment compensation for DHCP staff.
- In order to stay up-to-date with this and other public health issues, please sign up for the Pennsylvania Health Alert Network (PA-HAN) at https://han.pa.gov
Access the press release here: Guidance on COVID-19 for Dental Health Care Personnel in Pennsylvania