IDPH's Interim Guidance: Routine Oral and Dental Care

In anticipation of the expansion of permitted oral and dental health care services, the Illinois Department of Public Health (“IDPH”) issued its Interim Guidance: Routine Oral and Dental Care (the “Guidance”), a summary of which is provided below.

 As they reopen, dental offices and their providers should be balancing a patient’s healthcare needs, the benefits of any particular procedure and the risk of exposure to that patient and staff. In addition to appropriate screening for COVID-19, dental professionals should always: (i) include optimized use of administrative controls, engineering controls, and use of PPE as described by CDC Infection Control for Dental Setting, ADA Interim Guidance for Minimizing Risk of COVID-19 Transmission, and ADA’s Return to Work Interim Guidance Toolkit; and (ii) when performing aerosol-generating procedures on patients who have, or are suspected to have COIVD-19, use CDC’s Transmission Based Precautions, OSHA COVID-19 Control and Prevention guidance and airborne isolation rooms. Per the CDC, “when practicing in the absence of Airborne Precautions, the risk of SARS-CoV-2 transmission during aerosol generating dental procedures cannot be eliminated.”

To minimize the risks of aerosolized COVID-19, dental offices should take the following steps: 

• Reduce aerosolization through techniques such as high-volume evacuation, etc.
• Use portable operated HEPA filters of appropriate size, placement, and maintenance. 
• Use a properly designed and maintained UV system that takes into account the design of fixtures, lamp type, lamp placement, airflow amount and mixing, etc. 

Dental offices should consider incorporating COVID-19 testing as outlined in the Guidance into its provision of dental services and development of treatment plans while keeping in mind that tests can provide false-negative results, and an individual could begin shedding virus the next day after the negative test result. 

1. Case Selection and Care Plan. If possible, patients with increased vulnerability to COVID-19 should defer elective oral and dental care. For patients with unknown COVID-19 statuses, procedures treating active diseases and that are minimally invasive should be prioritized, with hand instruments being used whenever possible. As aerosol generating equipment increases the risk of transmission, dental offices should consider the following in determining patient treatment plans: 
1. Risks vs. benefits of each procedure
2. If possible, 24-48 hours prior to the appointment, administer a symptom screening from the CDC to the patient by telephone.
3. This screen should be repeated upon the patient’s arrival at your office.
4. Upon arrival, use a non-contact thermometer to check the patient’s temperature.
5. Reschedule the appointment if the symptom screening is positive or if the temperature is over 100 degrees.
6. While screening for COVID-19 through questionnaires and body temperature is helpful, it is not definitive as COVID-19 infection cannot be ruled out by a negative symptom screening and a normal temperature. Patients incubating the virus are usually infectious for 48-72 hours prior to exhibiting symptoms.
2. Risk Mitigation. Transmission risk can be decreased through treatment selection and consideration of individual steps mitigating the creation and spread of aerosols and droplets (e.g., dry-field isolation, fourhanded dentistry). For a structured risk decreasing process, please refer to the ADA’s Interim Guidance for Minimizing Risk of COVID-19 Transmission, which addresses the risk of exposure and transmission before, during, and after planned oral and dental care. 
3. Protective Equipment. Dental offices should ensure that adequate PPE is available to provide patient care to best reduce the chances of spreading COVID-19 to its patients or staff. This must include appropriate PPE and treatment area safety procedures implemented with the specific type of procedures to be performed by the dental office in mind. 
4. Infection Control. In determining which services to offer and when, dental offices should, from the perspective of aerosol generation, consider a risk-sensitive approach with a limited set of services. Those procedures that involve the patient and staff to be close in contact but do not generate aerosol may be considered lower risk. 
1. For these lower-risk procedures, minimal PPE for protection of the airway includes American Society for Testing Materials Level 3 surgical mask and full-face shield. 
2. For moderate or high-risk procedures, either due to the generation of aerosol or close contact, minimal PPE for the protection of the airway includes a fit-tested N95, or higher-level respirator, with full face shield protection and a gown.
1. For patients with COVID-19, an airborne infection isolation room should be used for aerosol-generating procedures. 
2. For patients whose COVID-19 status is unknown, dental offices should adhere to standards and practices at least as stringent as those recommended by the CDC, ADA and OSHA when performing aerosol-generating procedures.
5. Aerosol Risk. For a list of oral and dental procedures by relative risk level, please refer to the Guidance. This list is not exhaustive for oral and dental treatments. While this list should be considered in determining treatment, dental offices should continue to take in as many other factors as possible in order to best determine the most appropriate plan of action for each patient.
   

As the as the dental services permitted and the guidelines for providing those services is continually changing and involving, it is important to be aware of what your practice may do and should do with regard to treating patients and putting proper safeguards in place. Our team is keeping up to date on these on-going developments and will be sure to advise you accordingly. Should you have any questions, do not hesitate to call or email us.