1. Does evidence exist to support the transmission of SARS-CoV-2 during dental practice?
No. The CDC recently reported that “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 (“Dental Health Care Professionals”).”
2. Does evidence exist to support the inadequacy of Standard Precautions during dental practice?
No. The CDC has not maintained that DHCP are inadequately protected when providing dental treatment to asymptomatic patients using Standard Precautions because data to assess that risk also is not available.
3. Have dental offices in New Jersey been fully “reopened” to perform “business as usual”?
Not completely. According to an Administrative Order dated May 18, 2020 issued by the New Jersey Division of Consumer Affairs, dentists can perform medically necessary or therapeutic services in an office but should “postpone any elective surgery or procedure for asymptomatic patients if, in the health care professional’s judgment, a postponement will be unlikely to result in an adverse outcome.” In other words, any procedure can be performed if, in the treating dentist’s professional judgment, a postponement will likely result in an adverse outcome. Unless otherwise obvious, it is urged that the reason for the decision be documented in the patient record. As long as reasonable judgment is exercised in making a treatment decision, there is no cause to be concerned about State Board of Dentistry action.
4. Can routine patient examinations be performed?
Yes. To determine whether a condition exists which requires treatment, it is essential to conduct a patient examination.
5. Am I required to comply with CDC Recommended Infection Control Practices for Dentistry and applicable OSHA regulations?
Yes.
6. What do current CDC Recommended Infection Control Practices seek to achieve?
The Recommendations seek to balance the need to provide necessary services while minimizing risk to patients and health care personnel.
7. Do CDC recommended practices require N95 or KN95 masks for treating asymptomatic patients?
No. CDC guidance updated on May 19, 2020 provides: “If a respirator is not available for an aerosol-generating procedure, use both a surgical mask and a full-face shield. . . If a surgical mask and a full-face shield are not available, do not perform any aerosol-generating procedures.”
8. Does OSHA require either a respirator or a “fit test” as a pre-condition to treating an asymptomatic patient.
No. There are no specific OSHA standards for dentistry. OSHA provides standards for General Industry in which dentistry is included. It requires employers to conduct a hazard assessment which takes into consideration a number of factors. When aerosol-generating procedures on asymptomatic patients during the COVID-19 pandemic are performed, a guidance issued by OSHA recommends, but does not require, that NIOSH-certified disposable N95 filtering face plate respirators or better be used. The OSHA guidance was issued prior to the more recent guidance released on May 19, 2020 by the CDC. The ADA is working with experts in the hazard assessment arena to develop a tool to assess an airborne hazard and to help guide dentists through the hazard assessment process.