Woo hoo! It’s day #41 of the COVID-19 shutdown, and we finally have some progress in Canadian Dentistry – the first re-opening for the province of Saskatchewan. The guidelines have been set and will now serve as a precedent for other provinces to prepare and adapt.

The plan for the ‘Return To Dentistry’ is outlined in a phased process. The plan includes what is required to manage COVID-19 and what is needed to protect the safety of the provider, patient and community.

The re-opening phased plan includes some key steps to prepare with team training, COVID-19 updates to the IPC manual, facility changes, operatory management and of course accessing the PPE (Personal Protective Equipment).

There is a new set of terms and acronyms associated with ‘the new normal’ that are important to know before reading these new detailed guidelines.

AGP (Aerosol Generated Procedures) – includes any treatment provided that uses air-water syringes, ultrasonics, slow and high-speed handpieces. This is pretty much 90% of all delivery in dentistry and hygiene!

ACE (Aerosol Controlled Environment) – meaning the operatory must be isolated from floor to ceiling with the point of entry closed off and secured during the procedure. As well, the aerosol operatory must have high-speed evacuation and suction and air management equipment.

APM (Aerosol Protective Measures) – involves the new behaviour and systems to lower the risk of aerosols and safety for the dental team and patient. These include:

  • Physical distancing in the reception room and common areas.
  • Team screening for COVID-19 and consent form.
  • Team training on new processes.
  • Patient COVID-19 risk screening using key questions.
  • Taking of one’s Temperature to confirm less than 38 degrees C.
  • Hydrogen Peroxide Rinse pre-procedural.

The biggest need and most common inquiry to the Transition Group regarding the COVID-19 Survival Guide for the past several weeks has been about PPE. The worry and panic are about the backorders and lack of supply for PPE available in Canada for a safe return to dentistry.

Phase 1 for PPE is divided into two categories.

  1. Non-Aerosol Procedures (such as hand scaling, exam, orthodontic checks, simple extractions and crown cementation).

*** The PPE required:

  • Level 2 or 3 masks
  • Eye protection or a face shield
  • Gloves
  • Regular IPC procedures for operatory and sterilization 

2. Aerosol Generated Procedures

*** The PPE required: 

  • NIOSH approved N95 or K95 must be fitted for DDS and CDA in the past 2 years
  • Cap for head
  • Gloves that cover coat or gown cuffs
  • Goggles or Face Shield 
  • Gown for barrier 

There are supply and demand challenges with obtaining N95 masks for dentistry similar to the shortage in medicine.

The most talked about component of PPE is the N95 mask with a ventilator that requires a certified fitting for all clinical team members in the practice. These masks are in a huge shortage and the cost is extremely high due to the demand and lack of authorized NIOSH factories in China. If the proposed export ban in China is activated, then no masks will be leaving China after the end of May 2020.

**The alternative to handle the shortage and lack of supply for AGP would be the KN95 with a Level 2 mask over top and a face shield.   

The reference to a KN95 mask is the European version of a N95 and much more readily available. The challenge is KN95 does not have any fitting certification yet in Canada and this will be important for the protection of aerosols.

Check out our COVID-19 Survival Guide, which we will be updating each day with more important information for your dental practice to Return to Dentistry!
Lisa Philp
Chief Visionary Officer
Transitions Group