The next phase of our COVID-19 Survival Guide is interpreting the return to dentistry requirements of the AGP (Aerosol Generating Procedures) in the treatment room/operatory.

There are many things to consider when getting the treatment rooms ready for Aerosol Generating Procedures and how to prepare for aerosol reduction and contamination.

The guidelines state that the treatment rooms allocated for Aerosol Generated Procedures must:

  1. Be cleared of all clutter, non-essential products and pictures and artwork.
  2. Have ALL CLOTH furniture and window coverings/curtains removed.
  3. Be closed from floor to ceiling to keep aerosols in the room and seal with plastic.
  4. Have an entry door or zippered door that can be closed during the procedure.
  5. Have signage at the entrance that shows it is an AGP room with the time of the last procedure.
  6. Have garbage cans with a lid for contaminated PPE doffing and removal before leaving the operatory.
  7. Have keyboard covers or a flat keyboard that is waterproof and can be wiped down.
  8. Have plastic barriers placed on all surfaces, such as counter and handles.
  9. Follow the IPAC disinfection process of wiping down all the surfaces.
  10. Have high volume suction and all instruments in wrapped trays until use.
  11. Have a hand washing station with an approved alcohol-based sanitizer.
  12. Include a rubber dam for restorative and endodontic procedures.

The most controversial or misunderstood guideline is the (ACH) where the air changes and settles at different times for Aerosol rooms. The recommendation states that when a room was used for an Aerosol procedure, it must sit for 120 minutes before disinfecting, giving it the time for reduction in aerosols. There are HEPA air filtration units available for the operatory that will reduce the time that an Aerosol room must be left closed. However, there is no way to know if this equipment will reduce the time that the Colleges require before using the room again.

The following are references received for our COVID-19 Survival Guide to give another perspective for evidence-based science about the time aerosols remain in the room. These resources provided below are here to help you make your own decision:

1. Article posted in Nature

2. Another study that shows that by using a High Volume Suction/Evacuator (HVE), use of HVE reduced 96%+ of all bacterial exposures:

Study on Dental Aerobiology

3. When considering the airborne nature of COVID-19:

Article in Emerging Infectious Diseases

Research Letter

Laboratory Research

4. When considering PPE, please read:

Research Letter from The Lancet

Research Publication 

Research Article

Research Article

The challenge we see with Aerosols is that a lot of dental clinics have semi-enclosed bays or completely open bays and will not have the capacity to meet these requirements of redesign and construction.

The other significant impact is that using solely hand instruments is taking us back to what feels like the ‘dark ages’ of dentistry and a simple air water syringe is considered an aerosol procedure.

These guidelines (if permanent) for Phase 1 will prevent access and affordability of dental care for patients due to massive cost of PPE, additional equipment and redesign, and the need to maintain payroll/staff with reduced patient visits.

Sign the petition in the link provided here if you want to have a voice in the evidence-based protocols regarding the 120 minute wait time for Aerosol generated treatment rooms.

Lisa Philp
Chief Visionary Officer
Transitions Group