In response to the COVID-19 pandemic in the United States, in March, 2020, CDC recommended that dental settings should prioritize urgent and emergency visits* and delay elective visits and procedures to protect staff and preserve personal protective equipment and patient care supplies, as well as expand available hospital capacity. However, as the pandemic continues to evolve, and healthcare settings are responding to unique situations in their communities, CDC recognizes that dental settings may also need to deliver non-emergency dental care. Dental settings should balance the need to provide necessary services while minimizing risk to patients and dental healthcare personnel (DHCP)†. CDC has developed a framework for healthcare personnel and healthcare systems for delivery of non-emergent care during the COVID-19 pandemic. DHCP should regularly consult their state dental boards and state or local health departments for current local information for requirements specific to their jurisdictions, including recognizing the degree of community transmission and impact, and their region-specific recommendations.
Transmission: SARS-CoV-2, the virus that causes COVID-19, is thought to be spread primarily through respiratory droplets when an infected person coughs, sneezes, or talks. Airborne transmission from person-to-person over long distances is unlikely. However, COVID-19 is a new disease, and we are still learning about how it spreads and the severity of illness it causes. The virus has been shown to persist in aerosols for hours, and on some surfaces for days under laboratory conditions. COVID-19 may be spread by people who are not showing symptoms.
Risk: The practice of dentistry involves the use of rotary dental and surgical instruments, such as handpieces or ultrasonic scalers and air-water syringes. These instruments create a visible spray that can contain particle droplets of water, saliva, blood, microorganisms, and other debris. Surgical masks protect mucous membranes of the mouth and nose from droplet spatter, but they do not provide complete protection against inhalation of airborne infectious agents. There are currently no data available to assess the risk of SARS-CoV-2 transmission during dental practice. To date in the United States, clusters of healthcare personnel who have tested positive for COVID-19 have been identified in hospital settings and long-term care facilities, but no clusters have yet been reported in dental settings or among DHCP.1,2
*The urgency of a procedure is a decision based on clinical judgement and should be made on a case-by-case basis.
†Dental healthcare personnel (DHCP) refers to all paid and unpaid persons serving in dental healthcare settings who have the potential for direct or indirect exposure to patients or infectious materials, including:
- body substances
- contaminated medical supplies, devices, and equipment
- contaminated environmental surfaces
- contaminated air
Recommendations
DHCP should apply the guidance found in the Framework for Healthcare Systems Providing Non-COVID-19 Clinical Care During the COVID-19 Pandemic to determine how and when to resume non-emergency dental care. DHCP should stay informed and regularly consult with the state or local health department for region-specific information and recommendations. Monitor trends in local case counts and deaths, especially for populations at higher risk for severe illness.
Regardless of the degree of community spread, continue to practice universal source control and actively screen for fever and symptoms of COVID-19 for all people who enter the dental facility. If patients do not exhibit symptoms consistent with COVID-19, provide dental treatment only after you have assessed the patient and considered both the risk to the patient of deferring care and the risk to DHCP of healthcare-associated disease transmission. Ensure that you have the appropriate amount of personal protective equipment (PPE) and supplies to support your patient volume. If PPE and supplies are limited, prioritize dental care for the highest need, most vulnerable patients first.
If your community is experiencing no transmission or minimal community transmission*, dental care can be provided to patients without suspected or confirmed COVID-19 using strict adherence to Standard Precautions. However, given that patients may be able to spread the virus while pre-symptomatic or asymptomatic, it is recommended that DHCP practice according to the below considerations whenever feasible. Because transmission patterns can change, DHCP should stay updated about local transmission trends.
If your community is experiencing minimal to moderate† or substantial transmission‡, dental care can be provided to patients without suspected or confirmed COVID-19 using the below considerations to protect both DHCP and patients and prevent the spread of COVID-19 in dental facilities.
Considerations for additional precautions or strategies for treating patients with suspected or confirmed COVID-19 are also included below.
*No to minimal community transmission is defined as evidence of isolated cases or limited community transmission, case investigations underway; no evidence of exposure in large communal setting.
†Minimal to moderate community transmission is defined as sustained transmission with high likelihood or confirmed exposure within communal settings and potential for rapid increase in cases.
‡Substantial community transmission is defined as large scale community transmission, including communal settings (e.g., schools, workplaces).