COVID Screening

Introduction

The College of Dental Surgeons of BC (CDSBC) is the regulatory body for certified dental assistants, dental therapists and dentists in British Columbia. The core function of the college is to protect the public by overseeing the conduct and competence of its registrants.

One of the ways CDSBC protects the public is by establishing standards and guidance for the profession. This has recently included the development of recommended guidance for oral health care providers during the COVID-19 pandemic.

Purpose

The purpose of this document is to help you, as a patient understand what to expect when going to your dental office during Phase 2 and 3 of the COVID-19 response plan in B.C.

Your dental experience will likely be different from what it was before the pandemic as your oral health care providers (which include not only CDSBC registrants but also dental hygienists, denturists, and dental technicians) follow CDSBC and other regulatory and public health guidance with the goal of preventing transmission of COVID-19.

Dentistry and COVID-19 in B.C.

There is no evidence of an increased risk of COVID-19 resulting from dental care. Despite this low risk, CDSBC, in collaboration with the other oral health colleges, has developed recommendations for oral health care providers to minimize risk during the pandemic.

Certified dental assistants, dental therapists, and dentists will continue to comply with the recommended guidelines during the pandemic, which follow guidelines and requirements provided by the Office of the Provincial Health Officer (OPHO), the BC Centre for Disease Control (BCCDC), the Provincial Infection Control Network (PICNet)
and WorkSafe BC (WSBC).

At the time of publication, the levels of COVID-19 in B.C. are low, so in most cases, dental offices will continue with standard infection prevention and control practices. The routine precautions outlined in CDSBC’s Infection Prevention and Control Guidelines were designed to prevent the transmission of potential pathogens, and have been shown to be effective over several decades. However, there will be new protocols to screen patients for COVID-19 and physical adaptations within the dental office, including enhanced hand hygiene, physical distancing, and office cleaning.

Note: Information in this document is based on current evidence and may change as continuing research becomes available.

Pandemic best practices

Measures to control the spread of COVID-19 include physical distancing of at least 2 metres and increased screening for signs, symptoms, and risk factors for COVID-19.

Your oral health care provider is expected to:

Adhere to guidance provided by the Provincial Health Officer (PHO).
Adhere to all BCCDC and PICNet guidance regarding infection prevention and control measures applicable to the practice environment, including personal protective equipment (PPE) use and environmental cleaning best practices.
Adhere to all BCCDC and WSBC guidance regarding occupational health and safety exposure controls to ensure a safe work environment for patients and staff.
Stop providing in-person care if they have any symptoms or signs of COVID-19.
Implement COVID-19 screening for staff and patients.
Wherever possible maintain physical distancing during appointments.
Have appropriate PPE for in-person care.

In the context of low levels of COVID-19 in B.C., an effective approach includes physical adaptations within the dental office, hand hygiene, PPE, and risk assessment with a focus on droplet and aerosol management and environmental cleaning.

COVID-19 guidance is subject to change as new information becomes available. If you have any questions or concerns about changes or protocols in your dental office, you should ask your dentist or other oral health care provider.

Patients are encouraged to make use of COVID-19 resources available at healthlinkbc.ca

What to expect

Before your appointment

You will receive a screening telephone call before an appointment is scheduled. You will be asked questions about the reason for your visit, your health, your medical history, social history, and recent travel outside of Canada. There will be questions specifically screening for risk factors and symptoms of COVID-19, including whether you have a
fever, difficulty breathing or swallowing, sore throat and are sneezing or coughing.

You will be screened into one of three groups, which will impact the management of your dental care:

Group 1: Possible COVID-19 patient

If you have symptoms, are confirmed COVID-19 positive, or are suspected COVID-positive (e.g. have traveled outside Canada within the last 14 days), your appointment will be deferred for 14 days unless you have a dental emergency.

In-person care

When determining whether possible COVID-19 patients should come in for treatment, the oral health care provider (OHCP) will consider the need for and appropriateness of in-person care in consultation with the patient.

The OHCP will consider:

the severity of your condition including but not limited to an infection,
swelling, trauma, fracture, uncontrolled bleeding, severe pain or a rapidly progressive condition;
the impact of your oral condition on your health-related quality of life
including the need for pain control;
the possible consequence of not receiving in-person dental care;
if your condition can be managed by telephone or by videoconference
without an in-person appointment or the need for an in-person appointment to manage your oral condition effectively.

If you need urgent treatment and are suspected or confirmed COVID-19 positive, in most cases, arrangements will be made to refer you to a hospital or specialist for treatment.

If it is determined appropriate to provide urgent treatment in your regular dental office, an appointment will be scheduled. Be aware, you may be offered only limited appointment times.

Group 2: Vulnerable patient

If you have screened COVID-19 negative and screening identifies you at greater risk for severe disease should you become infected, the administrative staff will schedule a virtual or telephone consultation for you with the dentist before the inperson appointment is scheduled.
Risk factors include patients who have other serious health conditions, such as severe heart or respiratory diseases, patients being treated for cancer (in particular lung cancer), immunocompromised, suspected or confirmed pregnancy, and other pre-existing health conditions.
In consultation with you, your dentist will take your risk factors into consideration before scheduling an appointment. This may include deferring unnecessary treatment or scheduling appointments at the beginning of the day to limit contact with other patients and staff.

Group 3: Healthy patient

When the telephone pre-screening determines that you are well and can be safely treated in person, an appointment can be scheduled for in-person assessment and/or treatment.

Your oral health care provider may be able to resolve your dental concern without an in-person appointment.

Scheduling an appointment

Appointments may be less frequent and staggered to limit the number of patients and staff in the office at any one time. When an in-person appointment is scheduled, you will be asked to come to your dental appointment alone. If you require someone to attend the appointment with you, they will also need to be screened prior to the appointment.

On arrival at the dental office

You may be asked to wait outside the dental office until called for your appointment. If you are traveling by public transportation, you should wear a mask.

Waiting room environment

When you enter the dental office, alcohol-based hand sanitizer will be available for you to use and you may notice the following changes to your dentist’s waiting room and reception areas:

fewer people present
chairs placed 2 metres apart
coffee tables, magazines, toys and ornaments have been removed
the door to the dental office is left open
a physical barrier between you and office staff
markings on the floor indicating 2-metre separation
signage explaining respiratory hygiene (steps for protecting others when you cough, sneeze or blow your nose), hand hygiene (best practices for handwashing), and office policies and protocols to maintain physical distancing

Checking in

If the administrative staff are not separated by a physical barrier and it is not possible for them to be 2 metres away from patients, they will be wearing a mask. If you do not come in wearing a mask, you may be given one.

The screening questions you answered on the phone will be repeated in-person and your temperature may be taken. If the screening identifies concerns, your appointment may be deferred or you will be immediately taken into an operatory.

During your appointment

If no concerns are identified during screening, you will be taken into an operatory for assessment and/or treatment.

Personal protective equipment

If you have not screened positive for COVID-19, the same routine personal protective equipment (PPE) is sufficient to protect you and your oral health care providers. This means your dentist, oral health care providers and staff may wear the same PPE (including gloves, mask, and eye protection) as they did prior to the pandemic.

Depending on your COVID-19 status, the treatment you require, and the procedure being provided, you may notice that your oral health care providers are wearing unfamiliar PPE such as different looking masks, face shields or other protective clothing.

Some oral health care providers may choose to wear a face shield or additional protective clothing regardless of a patient’s COVID-19 status; however, it is not a requirement for patients who have not screened positive for COVID-19. Additional levels of PPE are only strongly recommended for procedures that produce water spray for patients who are suspected or confirmed COVID-19 positive and require urgent
treatment.

Other safety measures

Depending on the procedure, your oral health care providers may also take the following precautions in the operatory to minimize the risk of contamination:

Use a rubber dam and/or high-volume suction, whenever possible
Remove unnecessary equipment
Keep countertops clear
Allow sufficient time between appointments for thorough cleaning

Payment and exit from the dental office

Touchless payment

When your appointment is over, you will likely be asked to pay your bill by a touchless payment method. You may be offered a means of touchless payment chairside.

In some dental offices where the physical layout makes it possible, you may be asked to exit from a different route than the one by which you entered in order to maintain physical distancing between patients and staff.

COVID-19 related fees

CDSBC does not recommend or set specific fees for any dental treatment. Individual dentists in B.C. and across Canada set their own fees based on their assessment of the costs of delivering care which may include the cost of PPE.

Fees do vary between offices; however, the expectation is that patients are fully aware of all costs prior to any treatment being provided. A patient’s informed consent is based on a thorough discussion of risks, benefits, all treatment options, and costs of treatment. Informed consent must be obtained before a decision to proceed is made.

Cleaning and disinfection of the dental offices

Careful precautions will be taken to clean the office and the operatories before and after your appointment and at the end of the day using detergent and hospital-grade cleaning products.