At the time of the booking (online or over the phone), dental office visitors are screened for symptoms and the standard recommendations for self-isolation are followed if the client can be classified as high-risk.

• Recommendations from the CDC can be found here, which outline the global response to COVID-19.

Send notifications via email or text, prior to the clients appointment, of the measures that have been implemented to ensure their comfort during their appointment. This should also be available on your website or social media.

Dentists ensure that patients are triaged and appointments are scheduled by phone or via Teledentistry (no in-person or walk-ins).

Before arriving to the clinic, all individuals will complete a self screen by answering the questions mentioned here.

• The standard recommendations for self-isolation are followed if the patient can be classified as high-risk. For example, such measures are taken if a patient has returned from an international trip less than 14 days prior to their appointment or if they have been in recent contact with someone who has tested positive for COVID-19.

  • Recommendations from the CDC can be found here outlining the global response to COVID-19.

• It is important to note that self-reporting provides limited assurance, as some individuals can be asymptomatic.

Wellness screening at the dental office entrance

• Provide disposable masks to patients and visitors upon entry wherever possible and while patients are not receiving direct treatments. All visitors not receiving treatments are provided with masks.

• Conduct a contactless temperature check

• Provide sanitization wipes and hand sanitizer - this is located next to the door with clear signage, to ensure that all dental office visitors properly sanitize their hands.

• Screening questions to ask visitors:

  1. Are you feeling sick or experiencing any of the symptoms mentioned here. (Examples include a new cough, headache, weakness, fever, difficulty breathing, etc.)

  2. Have you travelled outside Canada in the past 14 days?

  3. Did you provide care or have close contact with a person with COVID-19 (probable or confirmed) while they were ill?

If possible and appropriate for the dental service required, online consultations are provided via video conferencing to assess the treatments.

• Online content will be created to demonstrate steps that patients can follow to improve dental hygiene at home.

• Live chats will be provided to help give expert advice, without patients having to come into the dental office itself.

• This is also a good opportunity to discuss any risks or concerns from the client, as well as put them at the ease of steps that have been taken to ensure their comfort when undergoing treatments.

Dentists require individuals accompanying a patient to wait outside unless it is absolutely required.

Dentists require patients (and guests)to perform hand hygiene with either 70-90% ABHR or soap and running water upon initial entry to the office.

Physical distancing measures:

• Create at least 6 feet of distance between each other and within shared areas.

  • Spaces are clearly labelled by visual markings for any areas where clients may be in line.

  • Managing the flow of client arrivals and providing a virtual waiting room are a few suggested solutions.

• Limit the number of occupants in an elevator at the same time (depending on where the 6 foot mark is in the elevator).

• Ensure that employees standing in the designated smoking area must also be at least 6 feet apart.

• Installing plexiglass barriers in front of the receptionist area is an efficient way to achieve proper physical distancing measures. Their material also allows them to be easily sanitized with disinfectant.

Dental workplace sanitation

• Enforce hand washing guidelines to be posted in all washrooms (See recommended hand washing protocols for further resources).

  • Provide a hand washing or sanitization facility near the entrance of the facility.

• Clear signage near the entrance, washrooms, waiting areas, break rooms and treatment areas regarding hand hygiene, donning and doffing of PPE (Personal Protective Equipment), use of break rooms and where and when food and beverages are consumed. More info on general guidelines here.

• Thoroughly sanitize all commonly used equipment between each appointment and use. This may include:

  • Dental Chairs

  • Sinks & lighting fixtures

  • Bottles and other frequently handled equipment

Employee and dentist zoned areas and breakout rooms:

• Provide fully-sterilized areas or zones designated for staff only intended for food, beverages and removing any personal protective equipment.

• Provide a hand washing or hand sanitization facility closest to the entrance of this break room.

• Prohibit access to clients and visitors.

• Clear instructions on how to remove and/or discard staff related PPE. See here for more general guidelines.

  • Provide garbage bins at all facility entrance, exits and staff break rooms to properly discard one time use PPE.

• Ensure there is limited sharing of utensils, as well as that any shared utensils are thoroughly cleaned between each use.

The point of entry into an office is limited to Dentists.

When returning from an extended break, Dentists shock their dental unit waterlines.

Magazines, toys, and any other non-essential items are removed from the office, reception area, and operations.

70-90% ABHR is available at all entry points to the office for visitors and at the reception area for use by the staff.

Inventory of PPE is taken and used to help inform the volume and scope of care that can be safely provided.

A designated space for staff and/or patients to self-isolate is provided for those experiencing symptoms of COVID-19.

Provide PPE to be readily available for all staff to cover nose, mouth and eyes.

• Ensure all staff know how to properly use their PPE.

Provide education, training and awareness to staff. See more details here.

• Hand hygiene

• Donning and doffing of PPE

• Use of break rooms

• Proper handling and cleaning of shared equipment and tools

Group employees in cohorts for all shifts.

• If one employee tests positive for COVID-19, the entire group may need to be tested (depending on your local Public Health Authority).

• Breaks are staggered throughout the day to encourage physical distancing.

Prepare an outbreak management plan including communication protocol in the event that your staff has tested positive for Covid-19. This will include but not be limited to the following:

• Training and certification for IPAC: https://www.publichealthontario.ca/en/education-and-events/online-learning/ipac-courses (Infection Prevention and Control (IPAC) – Online Learning)

• Communication to Public Health (notify accordingly if any of your staff has tested positive).

• Measures taken for increased cleaning.

• Tracing staff exposure by placing employees into cohorts to determine other potential exclusions.

Create policies to prevent employees from working if they have symptoms or have had symptoms in the last 48 hours (including temperature screening).

• Contactless methods of temperature screening are recommended where possible, with the use of digital thermometers for accuracy. These are available for all employees pre-shift.

• Any new symptoms, including but not limited to: fever, cough, shortness of breath, muscle aches, fatigue, sore throat, conjunctivitis (red eyes), loss of appetite, increased spit up, dizziness, headache, runny nose, chest pain, coughing up blood, diarrhea, nausea/vomiting, abdominal pain, stuffy nose, lost of taste or smell.

• In the case that any unusual or suspicious symptoms are present, employees will refrain from coming into work and follow local public health protocol regarding testing.

• Encourage remote working where possible to reduce in office traffic.

Follow hand washing guidelines posted in all washrooms.

Use PPE provided by employer to cover nose, mouth and eyes (eg. non-surgical masks, plus face shields or safety glasses).*

• If plexiglass face screens are used, these will be sanitized between each appointment.

Self-monitor for symptoms and do not report to work if the symptoms are present.

• If these symptoms are developed at the workplace, employees should inform their employer promptly to be temporarily relieved of their duties.

Enable contactless payment solutions to be the default method of payment to limit any physical contact with the employees and reception area.

Conduct post-treatment consultations over video conferencing and phone tools. These will be scheduled prior to or post-appointment using online booking systems.

Send satisfaction surveys around service and adherence to COVIDsafe measures to the client following the meeting to ensure standards were properly met.

For any contactless prescription pick-up, appointments are arranged ahead of time, where prescriptions will be dropped into a designated area for patients to pick-up in person — all while maintaining the recommended 6 foot distance.

• There is a designated area in the dentists office where clients can confirm their prescription pick-up once they arrive at the optometrist office.

• Clients can then confirm their ID and pick-up in person with the clinic in the most efficient way.

Patients are asked to disinfect with 70-90% ABHR before leaving the dental practice.

Patients are asked to inform the office staff if they are experiencing any symptopms of COVID-19 within 14 days fo their appointment.

Ensure there is enhanced cleaning of all office areas, treatment rooms and waiting areas — this includes high-touch surfaces, resident rooms and washrooms, which are cleaned at least twice a day.

Establish a separate washroom for staff and patients or visitors (recommended)

• Signs are printed to ensure that the toilet lid is closed before flushing the toilet, as COVID has been found in both urine and stool.

Use EPA approved disinfectants for the appropriate length of time (each disinfectant has its own guideline on contact length of time to kill the virus).

Patients who have screened or tested positive for COVID-19 are not treated in-person except as required for emergency or urgent care that cannot be delayed.

If unavoidable treatments that are considered to be emergency based or urgent care that cannot be delayed, dentists are not performing aerosol-generating procedures (AGPs) on patients.

• Dentists and staff ensure that patients do not remove their mask, except as required for treatment, and do not leave their mask in the office.

• Patients who have screened or tested positive for COVID-19 immediately be placed into an operatory alone with the door closed.

  • Where an operatory is unavailable, COVID-19 positive patients are instructed to wait outside (in their vehicle or parking lot).

  • Dentists require patients to rinse with 1%-1.5% hydrogen peroxide or 1% providone-iodine for 60 seconds prior to examination of oral cavity.

When possible, dentists to minimize the use of intra-oral radiographs when a patient has screened or tested positive for COVID-19.

Contents of all operatories are minimized in which AGPs may be performed on patients who have screened or tested positive for COVID-19 including unnecessary equipment, supplies, plants, and artwork.

During aerosol-generating procedures, patients who have screened or tested positive for COVID-19, are in an operatory that is capable of containing aerosol. This requires:

• Floor-to-ceiling walls

• Door that must remain closed during and after such procedures

Use of PPE during aerosol-generating procedures

Cleaning and disinfections of the operatory are only undertaken following the necessary fallow period.

• Ensure that operatories (including all clinical contact surfaces and equipment) are cleaned and disinfected prior to treating a new patient.

• Cleaning and disinfection are undertaken using appropriate hospital-grade low-level disinfectant (has a DIN from Health Canada).

The operatory is left empty (with the door closed) to permit clearance and/or settling of aerosols.

• The length of time that the operatory must be left empty is determined by the air changes per hour (ACH).

• The aim is to achieve 99.9% removal of airborne contaminants (see Table 2 in the guideline).

An HVAC system is consulted to calculate ACH.

• Copies of any documentation that support the HVAC assessment and any need for engineering controls are retained.

If the rate of air does not change for an office that is confired by an HVAC professional, a rate of 2 air changes per hour can be assumed and a minimum fallow time of 3 hours following an AGP can be adhered.