How to Set Up a COVID-19 Compliant and Safe Workplace for Your Staff and Patients Before Offering Nonessential Dental Care

​To prevent the further spread of COVID-19, CDC, ADA and OSHA issued recommended standards of care to protect both staff and patients. Take advantage of this slow time and get your dental practice ready for opening back up for nonessential business. Consider these guidelines when preparing your office for a soft opening to ensure the health and safety of your workplace. Every dental office is of course unique and, as such, each compliance solution will need to be tailored accordingly.

Change Appointment Confirmation Style

Explain new safety policies over phone appointment confirmation calls. During the call, ask if patients have any symptoms or a fever.

Stagger Patients

Do not stack dental appointments but rather ramp them up slowly. For example, only use chairs 1-3-5.

​Modified Patient Check-In

Close the reception room with process check-in over the phone. Patients wait outside (most typically in their vehicles) to be called-in for their appointments once the previous patient is gone and sanitation is complete, with operatory disinfected.

Reception Area

In your reception area, Cover your Cough must be posted and hand sanitizer, tissue and trash can with lid and foot pedal must be in place.

Front Desk Barriers

As noted, the reception area should be closed, with face-to-face receptionist interaction limited. 

Removal of Non-essential Items

Non-clinical items must be stored (e.g. dental display models, flyers, brochures, nightguard samples implant displays, etc.)

Dental Supply Deliveries

All supply deliveries from package carriers or dental suppliers must be accepted outside and sanitized once in practice. disinfected operatory is ready.

Sanitization Technician / Environmental Dental Assistant

A new dental position is created with this individual responsible for sanitizing all areas of concern. A roaming dental assistant is most qualified for this new job.

Surface Disinfectants

Infection control is nothing new to dentistry. An EPA grade disinfectant should be used. Check your labels to assure it kills the human corona virus or visit here for EPA's list. 

Air Purification & HEPA Filters

Medical-grade air purifiers in managing the dangers of indoor dental office air.  Dental workers breathe 11,000 L of indoor air a day; take the time to protect yourself, your staff, and your patients with clean, pure, and reenergized air.

Staff Screening

​Employees must be screened for temperature and symptoms before starting shift. They should be wearing a face mask when enter the practice.

​Patient and Visitor Screening

​Patients and anybody else entering your practice should be wearing their own cloth face mask upon arrival to the facility. Their temperature must be taken and properly screened for symptoms before entering.

Patient Greeting

​When patients enter the office, they should have their masks on, be greeted by the disinfection-control dental assistant or hygienist and taken back to the clinical room. Before treatment begins, they should be asked to wash their hands or use an alcohol-based hand sanitizer. 

Pre-Treatment Rinse

​During the COVID-19 outbreak, a pre-rinse is recommended for 30 seconds prior to treatment to add another layer of protection for your staff and patient. 

​Staff PPE

​Treating your operatories as operating rooms is recommended. Staff should have received job-specific training on PPE and demonstration on the proper use (e.g., putting on and removing without self-contamination). Establish a common COVID-19 clean area where PPE and gowns are placed and removed. Note cloth face coverings should NOT be worn in place of a respirator or facemask. Staff should remove their respirator or facemask and put on their cloth face covering when leaving at the end of their shift.

​Recommended PPE

• Eyes - safety glasses
• Face-Respiratory - N95 when appropriate otherwise 3-level mask with face shield
• Head – scrub cap
• Body – disposable gown
• Feet – disposable feet cover
• Face – dental face-shields should be used for ALL dental treatments, including hygiene and routine examinations
• Respiratory – NIOSH certified, disposable N95 filtering facepiece respirator or better during procedures that may or known to generate aerosols when, otherwise a level 3 mask (and always under a face shield).

Note: Face-shields are reusable if disinfected. Wiping down with medical grade disinfectant effectively cleans the shield.

Explain Use of PPE to Patients

​Explaining to patients how Personal Protective Equipment (PPE) is being used to protect them is perhaps the most important step you can take to ensure them of their safety.

​Contain Aerosol Spray

Dentist should use a rubber dam to contain spray during treatment whenever possible. Dental hygienists should utilize a dental assistant to assist when using a high suction for hygiene procedures that create aerosols.

Hygiene Recommendation

​As noted, when a hygienist treats patients, a disposable gown should be used. When a hygiene check/exam needs to be completed by the doctor, the hygienist should remove the gown and leave in room. The gown should NOT be worn in common areas. It can however be reused when working on the same patient. Doctors should switch gowns when moving between operatories.

Staff Hand Hygiene

Staff should perform hand hygiene before and after all patient contact, contact with potentially infectious material, and before putting on and after removing PPE, including gloves. Hand hygiene after removing PPE is particularly important to remove any pathogens that might have been transferred to bare hands during the removal process. Staff should perform hand hygiene by using a hand rub with 60-95% alcohol or washing hands with soap and water for at least 20 seconds. 

Rubber Dam and Benefits

​Dental dams should be used whenever possible during dental treatment. Dental dams provide a higher level of protection by reducing aerosol spray and will protect staff from potential ATD’s.

High Volume Evacuation (HVE)

​Using an HVE is a recommendation at this point that will most likely become a requirement in the new COVID-19 era. Add a roaming dental assistant to assist the hygienist during use of HVE treatments. Staggering appointments and adding time to appointments allows time for a dental assistant to roam.

​Payment for Services

​If possible, payment should be done over the phone or electronically (email). Otherwise, all exchanges of payment should be sanitized with disinfectant spray.

​Scheduling New Appointments

​If possible, re-appointments should be done in the operatory, not in open common areas. If interaction must take place then physical barriers, like tables or chairs, should be placed to ensure 6-feet of separation. Patients should also be wearing their masks. Patients should also be instructed that if they must touch or adjust their cloth face covering, they should perform hand hygiene immediately before and after.

Additional Resources

• https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
• https://www.cdc.gov/sars/guidance/infection/healthcare.html 
• http://www.osha.gov/publication/osha/covid19.html
• https://www.cdc.gov/oralhealth/infectioncontrol/index.html​ 
​• http://ada.gov/return-to-work.html
​​• http://epa.gov/pesticide-registration/list-n-disinfectants-use-againstsars-cov-2.html
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