Practice Reopening Resources

Pre-Screening and Appointment Scheduling

• Initial telephone conversation
  Teledentistry:
  • Should be used to triage and manage patients
  • Incorporate when required to minimize unnecessary patient visits
• Communicate to patients the difference in the dental environment and patient care:
  • Changes to PPE requirements
  • Safety policies put in place
  • New mandatory protocol
• Review patient chart for treatment plan and radiographic prescription and schedule accordingly
• Document:
  • All answers to COVID19 screening questions
  • Patient’s chief complaint
• Book date/time of appointment
  • Appointments should be scheduled with social distancing in mind
  • Leave appropriate time between appointments to accommodate environmental cleaning
  • Consider donning and doffing times
  • Following an aerosol-generating procedure, cleaning and disinfection of the operatory must be delayed to allow settling of the aerosol (refer to current provincial guidance)
• Gather financial information for treatment (insurance, type of payment)
  • Limit patient to staff interactions in the clinic—taking payment over the phone if possible
  • Limit cash payments if possible—decontaminate cash when accepted

Preparing for Patient Arrival

• Plan for dental team members in the practice
  • Limit to only staff members required for care
  • Temperature to be taken morning of work-day (e.g. non-contact thermometer)
  • Team members to sign consent form or take oath indicating that they are not experiencing any Covid related symptoms
  • Remove facial hair if applicable for mask use
• Arrange for greeter at entrance
• Administrative staff to wear appropriate PPE
• Advise patient to remain outside the practice (e.g. in car) until notified
• Advise patient that only they may enter office for appointment
  • Spouses, friends, caregivers and parents need to wait outside. They can assist patient to the front door and hand off to greeter if required
• Select suitable operatory
  • Preferably with closed door and adequately ventilated
  • If AGDPs are performed, adjacent open concept operatories should not be used simultaneously
• Prepare the operatory for procedure
  • Take all steps required to avoid having to leave and return to the operatory during the procedure (consider radiographs)
  • Place barriers on any non-smooth and high-touch surfaces
• Post safety cleaning schedule and signage for i.e., (“AGDP in progress”, and “120 minutes until safe to decontaminate”)
• Donn full PPE in operatory where the procedure will be taking place (gloves, protective eyewear, face shield, gown, fitted N95 Mask, optional: hair and foot covers).
  • See donning and doffing resource 

Patient Arrival

• Contact patient when clear to enter office
• Observe all physical distancing measures
  • Maintain 2 metres (six feet) distance
  • NO SHAKING HANDS
• Where possible greeter should meet patient at entrance
• Upon entering the office, have the patient put on boot covers, don a mask, and perform hand hygiene with ABHR
• Greeter to take patients temperature (non-contact thermometer) and if cleared they can be escorted directly to the treatment area
• Minimize patient contact with surfaces, including door handles, counters etc.

Whenever an aerosol procedure is provided, dental care should be provided using enhanced precautions (i.e. N95 mask – or NIOSH approved respirator (fitted), gloves, eye protection, face shield and protective gown). If unable to procure N95s, use best PPE available. Always follow local regulatory guidelines.

• Review medical history
  • Patient should complete forms at home to minimize time in the office
  • If paper copy, place a barrier on pen and clip board, and after patient is done remove barrier, discard it and disinfect the pen and clipboard
• Review material information about procedure(s) and have patient verbally agree to informed consent forms
  • These should be provided to the patient and signed prior to arrival
  • If sedation will be provided, ensure adherence to standard of care
• Paper charts should not be brought into the operatory during an AGMP
• Take vitals including blood pressure, pulse and respirations per minute
• Have patient doff mask and rinse with 1% hydrogen peroxide for 30-60 seconds
• Use of extraoral imaging preferred over intraoral
• Open pouches/cassettes of sterile instrumentation for procedure
  • Ensure BI/CI pass and document in the patient’s chart
• Complete procedure maintaining appropriate PPE and aerosol reduction
  • Be sure not to touch your face, mask, glasses, etc. during the procedure
  • Ensure PPE in operatory is not exposed to aerosols in environment
  • Consider 4 handed dentistry for dental hygiene appointments
  • Avoid the use of ultrasonic instruments, high-speed handpieces, and air/water syringes whenever alternatives are available
  • Restorative treatment performed with rubber dam adding additional protection to the dental provider
  • Disposable and single-use instruments and devices should be used whenever possible to reduce the cross-infection risks
  • High Volume Suction should be functioning during all treatment when aerosols are being generated
  • Consider external aerosol evacuator
  • For handpieces, piezos/cavitrons, the amount of water should be reduced as much as possible while still having a coolant effect
  • Operatory doors, where they exist, should be closed during treatment
  • Once in the operatory do not step out until treatment is finished.
  • If absolutely necessary to do so, PPE should be doffed before stepping out
• Provide PPE disposal/collection areas
• Taking into consideration increased amounts of waste

• The patient should wait in the dental operatory until safe dismissal is possible
• Discuss financial arrangements and process appropriately
  • Ideally this can be done without the patient having to handle any equipment
  • Consider requesting the patient’s payment information over the phone, adhering to privacy regulations (PCIDSS)
• If patient was escorted to appointment, contact escort to let them know treatment is completed and to meet the patient at the exit door
• Once confirmation received, provide ABHR and allow patient to leave treatment area and exit practice directly
  
  Post-Procedural Cleaning and Disinfection:
• Following an AGDP, cleaning and disinfection must be delayed to allow aerosol settling
  • Refer to current provincial guidance regarding timing
• Remove barriers and soiled sundries and place in covered waste in the operatory
• Remove gross soil from all instruments using a wet gauze (not alcohol-based wipe)
• Clean and disinfect all surfaces including floor and allow the appropriate kill time dependant on the disinfectant you are using
• Doff PPE excluding N95 mask (gloves, gown, protective eyewear, face shield)
  • Doff PPE in a dedicated area within the operatory
• Donn appropriate PPE (gloves, protective eyewear)
• Transport instruments to reprocessing area in a covered container
  
  Reprocessing of Instruments
• Use N95 (if available) when creating aerosols in steri-area
  • Especially if treating patients with COVID19 risk symptoms
• Consider presoaking instruments in H2O2 solution prior to placing in ultrasonic
  
  Environmental Cleaning of Waiting area
• Increase frequency of standard environmental cleaning
  • Use log of cleaning for accountability
• After the patient is dismissed, proceed with environmental cleaning protocols
• Wipe down the front desk area including:
  • Pens
  • Doorknobs
  • Counters
  • Chairs
  • Computer keyboards etc.
• Disinfect all touch surfaces close to patient exit path

• Contact patients 48-72 hours after providing care
  • Follow-up regarding the treatment provided
  • Ask them if they are demonstrating any new symptoms of Covid-19
• Document all communication in patient record

• Do not leave office in scrubs or clinical attire
• Bring a change of clothing to change into and properly store garments (scrubs) in plastic bag so you can wash when you return home (unless using a laundry service)
• Use ABHR before leaving the practice