Key principles

  1. This guideline provides additional advice and guidance to dental services during the COVID-19 pandemic.
  2. Dental services should keep up to date with new evidence and public health advice in managing their response to the COVID-19 pandemic.
  3. Dental services should implement measures to minimise and manage aerosols during Aerosol Generating Procedures (AGPs).
  4. Dental services should consult the Response and Escalation Framework and the Risk Monitoring Dashboard

Definitions

Aerosol Generating Procedures (AGPs) in dentistry include any procedure that uses any of the following devices: high speed hand pieces, surgical hand pieces, ultrasonic and sonic devices, air polishing devices, and lasers. Triplex where air and water are used together or used with air on a wet surface is onsidered aerosol generating.

Screening for COVID-19

All patients are to be screened upon arrival at the clinic. The latest screening questions can be found at COVID-19 screening at NSW healthcare facilities and usually consist of the following:

  1. Ask if they have any of the following symptoms Fever, cough, shortness of breath, chills, body aches, sore or scratchy throat, headache, runny nose, muscle pain, vomiting, nausea, diarrhoea, or loss of smell or taste.
  2. Comply with current entrance screening.
  3. Ask if they have been in contact with a COVID-19 case in the last 14 days or been asked to self-isolate by a health official.
  4. Ask if they have been to any of the locations or travelled on nominated public transport routes, during the time and date indicated, in the "Close contact" or "Casual contact tables at Latest COVID-19 case locations and alerts in NSW.
  5. Ask if they have been to any other places of high concern as defined by public health authorities.
  6. It is critical that all staff are screened according to current NSW Health advice or the Public Health Order before work.

Deferring dental treatment

All dental practitioners should exercise clinical judgment with consideration of current local epidemiology, NSW Health advice, protocols, risk level, as well as the nature of the dental procedure being performed. This will assist in determining whether to delay or defer treatment. Consideration should be given to the seriousness of the presenting condition, and to the patient's COVID-19 status (i.e. low risk, confirmed, or suspect).

Recommended risk management approach

  1. As the evidence-base is evolving, decisions regarding risk assessment remain the responsibility of the treating dental practitioner.
  2. In your risk assessment, you must consider:
    • The NSW Public Health Risk level and alert phase (green, amber or red)
    • localised areas with an increased level of community transmission and any associated LGA advice
  3. The risk assessment will influence the appropriate PPE, the clinic setting, and control measures to be used.
  4. COVID-19 confirmed or suspect cases should only be treated in a single room with a closed door. If an AGP is unavoidable, a negative pressure room or neutral pressure room with the door closed is to be used in addition to aerosol management (which may include high speed evacuation and other environmental controls.)
  5. Aerosol management must be considered when performing AGPs for patients at risk of having COVID-19, especially in areas with an elevated risk of community transmission.

Dental services - COVID-19 quick reference guide

Hand hygieneDisposable glovesFluid Resistant gownSurgical maskP2/N95 maskEye protection safety glassesFace shield or Mask with visorTreatment room requirements
COVID-19 low risk
without AGP
Yes Yes
Risk
assessment
(*likelihood
of spray
contamination)
Yes

or *Risk assessment

Yes

or *Risk assessment

Standard precautions apply at all times.

COVID-19 low risk
with AGP
Yes Yes
Yes
Yes
or *Risk assessment Yes

or *Risk assessment


Appropriate control measures
should be in place that consider the NSW Public
Health Risk level**
COVID-19 high risk or when at Red alert level **
with or without AGP
Yes Yes Yes
No Yes

Yes

or face shield or Mask with visor

Yes
or eye protection safety glasses

Implement aerosol management. Use isolated areas, single rooms with door closed where available, negative air flow and ventilation. High risk AGPs consider negative pressure rooms or equivalent.

COVID-19 high risk (confirmed or suspect)
with or without
 AGP
Yes Yes Yes No Yes Yes
or face shield or Mask with visor
Yes
or eye protection safety glasses

Implement aerosol management. Use isolated areas, single rooms with door closed where available, negative air flow and ventilation. High risk AGPs consider negative pressure rooms or equivalent.

Aerosol Generating Procedures (AGPs) in dentistry are defined as procedures that use any of the following devices: high speed hand pieces, surgical hand pieces, ultrasonic and sonic devices, air polishing devices, and lasers. Triplex - where air is used together with water, or air is used on a wet surface - is considered aerosol generating.

*Risk assessment for AGPs should consider the length of procedure and anticipated exposure to large volumes of blood/body fluids and respiratory droplets and prevalence of community transmission.

**Public Health Risk and alert phases are based on direction from Public Health response branch (PHRB) and the NSW Health Clinical Excellence Commission (CEC) further information can be found the on the Critical Intelligence Unit website and on the CEC Website

Document information

Developed by

Centre for Oral Health Strategy.

Consultation

Endorsed by

Dr Kerry Chant, Deputy Secretary, Chief Health Officer, NSW Ministry of Health.

For use by

To help guide dental services on PPE requirements during COVID-19 and post.


Current as at: Friday 17 September 2021
Contact page owner: Health Protection NSW