COVID-19 Guidance FAQs
Updated May 22
In these uncertain and unprecedented times, OMSs must do all they can to balance patient care with safety. AAOMS strongly recommends adhering to the AAOMS guidance and interim protocols for the safety of the patient, staff and practitioner; however, these are merely recommendations. AAOMS does not possess the power to dictate provider practice, and the Association relies on all OMSs to utilize their best judgment in this stressful time.
AAOMS is not a regulatory body and, as such, cannot institute laws or regulations. Any guidance issued by AAOMS is merely a recommendation, and state law or rules supersede any guidance or direction given by AAOMS.
If the federal government, a state governor, department of health, dental board or other regulatory body issues an order affecting OMS practices, OMSs are expected to adhere to those guidelines.
AAOMS’s top priority remains the health of the public, patients, practitioners and staff. AAOMS continues to base its decisions on analyzation of scientific data, CDC, CMS and OSHA guidelines as well as the most current information available on COVID-19.
Most dental procedures that use mechanical instrumentation will produce airborne particles from the site where the instrument is used. Dental handpieces, ultrasonic scalers, air polishers and air abrasion units produce the most visible aerosols. (reference: JADA.ADA.org/article/S0002-8177(14)61227-7/pdf). Aerosol is created when high-powered devices need compressed air and water to work effectively. Most procedures performed by the dental team have the potential for creating contaminated aerosols and splatter. Aerosols are tiny particles or droplets that remain suspended in air. These aerosols represent an infection hazard due to their gross contamination with microorganisms and blood. A fourfold increase of airborne bacteria has been observed in areas where aerosol-producing equipment was used. Aerosols can float in air for a considerable time before being inhaled by dental staff and other patients. (reference: NCBI.NLM.NIH.gov/pmc/articles/PMC4437160)
Per the CDC's most recent COVID-19 recommendations: The practice of dentistry involves the use of rotary dental and surgical instruments (e.g., handpieces or ultrasonic scalers) and air-water syringes. These instruments create a visible spray that contains large particle droplets of water, saliva, blood, microorganisms, and other debris. This spatter travels only a short distance and settles out quickly, landing on the floor, nearby operatory surfaces, dental healthcare personnel (DHCP1), or the patient. The spray also might contain certain aerosols:
- N95 masks are recommended for all aerosol-generating procedures performed.
- The number of HCP present during the procedure should be limited to only those essential for patient care and procedure support. Visitors should not be present for the procedure.
- Aerosol-generating procedures should ideally take place in an airborne infection isolation room.
- Clean and disinfect procedure room surfaces promptly as described in the section on environmental infection control on the CDC website.
All non-aerosol procedures should be handled in a manner that is as minimally invasive as possible with available PPE. Interim infection prevention and control COVID-19 guidance can be accessed in the CDC’s Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings as well as the CDC’s Infection Prevention Practices in Dental Settings.
Procurement of N95 and proper PPE for members remains a top priority for AAOMS leadership and staff. Advocacy efforts are focused on working with federal and state legislators – as well as regulatory bodies – to designate oral and maxillofacial surgeons as first responders and require that OMSs receive appropriate PPE as soon as it becomes available. AAOMS also is working closely with distributors to assess other potential avenues for obtaining supplies.
In the interim, check with the state department of health or other agency coordinating COVID-19 response to determine if the state has established a centralized system or protocol to request PPE. In most cases, OMSs will be asked to fill out a form to request PPE and may be required to submit a burn log. Also consider checking with the local health department, hospitals, dental referrals, dental association or other local volunteer programs (depending on region). While PPE is scarce nationwide, there may be localized availability.
AAOMS recommends that treatment of any patients where the procedure requires the use of a handpiece generating aerosol spray be deferred unless the OMS has appropriate PPE, including an N95 mask and face shields. If appropriate and necessary PPE is not available, treatment should be delayed or alternative treatment modalities considered that do not generate aerosol spray or necessitate use of unavailable PPE. Alternative treatments, such as antibiotic therapy and all non-aerosol procedures, should be handled in a manner that is as minimally invasive as possible with available PPE.
The CDC also provides the following information in a statement:
For urgent clinical care of patients with known or suspected COVID-19, dental personnel and medical providers should work together to determine an appropriate facility for treatment and should follow the Interim Infection Prevention and Control Recommendations for Patients with Confirmed Coronavirus Disease 2019 (COVID-19) or Persons Under Investigation for COVID-19 in Healthcare Settings. The urgency and need for a procedure are decisions based on clinical judgement and should be made on a case-by-case basis.
- Dedicated medical equipment should be used when caring for patients with known or suspected COVID-19.
- All non-dedicated, non-disposable medical equipment used for patient care should be cleaned and disinfected according to manufacturer’s instructions and facility policies.
- Ensure that environmental cleaning and disinfection procedures are followed consistently and correctly.
- Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant to frequently touched surfaces or objects for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.
- Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.
- Management of laundry and medical waste also should be performed in accordance with routine procedures.
- Additional information about recommended practices for terminal cleaning of rooms and PPE to be worn by environmental services personnel is available in the Healthcare Infection Prevention and Control FAQs for COVID-19.
Generally, yes. Check with the state department of health or dental board for any state-mandated reporting requirements. Also be sure to check with a malpractice carrier for any recommendations.
No. It is not recommended that any COVID-19-positive patients be treated in a dental office setting unless airborne transmission precautions can be maintained. COVID-19-positive patients should be treated in a hospital isolation room with negative pressure. Unless urgent, treatment should be delayed until 14 days after resolution of symptoms, or if the patient has had two negative antigen tests. These recommendations are subject to change based on availability and reliability of SARS-CoV-2 testing. Refer to the CDC, FDA and state and local public health authorities for the most up-to-date recommendations.
There is no formal CDC recommendation regarding these patients, so caution and professional judgement will be key.
The real matter to address is if the patient has had exposure to COVID-19-positive patients. For example, if the patient is a nurse treating COVID-19-positive patients, he or she is likely using a maximum level of PPE. Providing care to a COVID-19-positive patient with appropriate PPE is not considered an exposure. If he or she lives with someone or is in close personal contact with someone who is found to be COVID-19-positive, then that is an exposure, and the patient should be presumed to be COVID-19-positive as well.
While there is little guidance, the recommendation is that patients who have been exposed complete COVID-19 testing or be quarantined for 14 days prior to being seen in an outpatient setting. If there is an emergent situation, the patient in this instance should be seen in a hospital setting following institutional protocols with airborne transmission precautions, and COVID-19 testing should be completed if possible. As with all patients, ask the patient to follow up within 14 days if symptoms of COVID-19 develop.
Please consult an employment practice attorney, malpractice insurer and HR advisor for advice in this area. Keep in mind, all employers are required to follow OSHA protocols per federal labor laws. As an employer, you are required to provide administrative, engineering and work practice controls, education and training as well as appropriate PPE. Though there is always a potential for employment practice accusation and litigation, compliance with appropriate and diligent hazard risk mitigation strategies should limit liability exposure risk.
Check the specifics of the state’s orders, but healthcare providers are typically classified as “essential providers” and exempt from the restriction if engaging in the essential service. If permitted to travel between states to engage in OMS practice, practitioners are advised to travel with their credentials to minimize hassles and avoid being asked to stay in quarantine or denied access to the state altogether. If you have questions on a specific situation, reach out to the state dental board, state OMS society or state dental association.