Implementation Plan for Management and Treatment of Non-Emergent and Elective Dental Care
Plan for Prioritization of Procedures
Patient conditions that will be treated in phase 1 of elective care, will include any diseases, disorders and/or conditions of the oral cavity, maxillofacial area and/or the adjacent and associate structures that left untreated for the next 3 to 6 months would result in further deterioration of the patient’s health. (Examples may include caries control, management of periodontal disease, management of endodontic needs including fabrication of crowns on endodntically treated teeth as indicated. Management of edentulous space’s in the edentulous and partially edentulous patient as indicated to prevent worsening of malocclusion or bone atrophy. Management of malocclusion for new and existing patients. Management of diseased, fractured or impacted teeth. Treatment of temporal mandibular disorders. Management of Pathology. Management of trauma.)
Nicollet Station Dental will employ clinical judgment and assess patient oral and overall health and risk to the patient if the procedure is delayed any further.
Treatment will be based on clinical judgments and evaluating
- Patients Medical History
- Risk factors
- Geographic incidence of CODI-19 in our location
- Previously cancelled and postponed cases due to the COVID pandemic
- Availability of PPE including N95 or KN95 masks, gowns, face shields and hair coverings
- Prioritization of patients with more urgent needs
- Professional judgment to employ the lowest aerosol-generating armamentarium, when delivering any type of restorative or hygiene care.
- Example: use hand scaling rather than ultrasonic scaling when appropriate. If ultrasonic scaling is required, it should be used in conjunction with high volume evacuation and considering use of an assistant.
- For elderly patients with one or more diseases known to be associated with higher COVID mortality and/or immunocompromised patients, it is recommended to use teledentistry consultation to assess the urgency of their dental condition prior to considering any treatment for them.
Infection Control-Engineering Controls, Administrative controls
This plan includes PPE, Infection control, and Engineering Control Guidance provided by the Minnesota Board of Dentistry, CDC, and OSHA.
PPE utilization per Minnesota Board of Dentistry, CDC, and OSHA
- Gloves (nitrile)
- Cloth gowns to be laundered after each use.
- If there are shortages of gowns, they should be prioritized for:
- Aerosol-generating procedures
- Clinical procedures where splashes and sprays are anticipated.
- Disposable gowns to be discarded after each patient
- Eye protection (goggles or face shield) – disinfect between patients
- N95 or KN95 (note: Temporary discretion regarding fit test enforcement requirement means that providers can wear the mask that fits best.)For aerosol producing procedures.
- Given shortage of N95 masks, wearing an N95 and covering it with an ASTM Level 3 mask to prevent droplets and or splatter on your N95 mask. With this technique, the N95 mask may be reused.
- Proper donning and doffing will be practiced. (CDC Donning and Doffing)
Administrative Control Plan
- Placement of Plexiglas or other clear barrier between the front office/check out desk.
- Pens used by patients and visitors should be disinfected after each use. We use a container for disinfected/clean pens and a container for used/dirty pens.
- Credit cards should be disinfected before their use by office staff.
- Hand washing protocols are established and posted.
- Ready access of hand sanitizer as patients enter.
- Patients and visitors should arrive wearing masks, if they arrive without masks the dental office will provide them.
- Waiting room chairs will be placed 6 feet apart to maintain social distancing.
- All office toys, reading materials, or other communal objects, have been removed.
- On a regular schedule, all touchable surfaces will be sanitized with an approved surface cleaner.
- If visible dirty, surfaces will be cleaned using a detergent or soap and water prior to disinfection.
- To disinfect, products are used that meet EPA’s criteria for use against SARS-CoV and are appropriate for the surface.
Nicollet Station Dental Employees and Risk
List all employees and risk based on procedures that they are performing (same as you would with OSHA Blood borne Pathogen Standard)
| Well patients | Patients with suspected or confirmed COVID-19 | ||
| Dental procedures not involving aerosol-generating procedures | Dental procedures that may or are known to generate aerosols | Dental procedures not involving aerosol-generating procedures | Dental procedures that may or are known to generate aerosols |
| Work clothing, such as scrubs, lab coat, and/or smock, or a gownGlovesEye protection (e.g., goggles, face shield)Face mask (e.g., surgical mask) | GlovesGownEye protection (e.g., goggles, face shield)NIOSH-certified, disposable N95 filtering face piece respirator or better* | GlovesGownEye protection (e.g., goggles, face shield)NIOSH-certified, disposable N95 filtering face piece respirator or better* | GlovesGownEye protection (e.g., goggles, face shield)NIOSH-certified, disposable N95 filtering face piece respirator or better* |
Nicollet Station Dental will only treat suspected or confirmed COVID patients in the event of a life-threatening dental emergency and only if N95 is available. Treatment with teledentistry and medications may be necessary in the event it is not a life-threatening dental emergency.
COVID-19 Employee Screening
Every clinic day Nicollet Station Dental must conduct an active health screening of all staff members to assess for signs and symptoms of COVID-19. This will include assessment for fever and symptoms associated with COVID infection as recommended by in CDC: Interim Infection Prevention and Control Recommendations for Patients with Suspected or Confirmed Coronavirus Disease 2019 (COVID-19) in Healthcare Settings. These daily screenings must be maintained in a logbook. Staff will not work while sick, even if presenting with mild signs or symptoms. If during the workday they develop signs or symptoms of illness they should leave the office.
Training for N95/KN95 Use
Nicollet Station Dental will ensure training and have fit testing performed when it becomes available. In the meantime, Nicollet Station Dental will have all staff watch training provided in videos from 3M related to N95 use.
Nicollet Station Dental will use N95 or KN95 masks for aerosol generating procedures and employ MDG and CDC PPE preservation methods whenever possible. Non-aerosol generating procedures can utilize a face shield and surgical mask
Patient Considerations
Nicollet Station Dental will require patients and visitors to wear cloth coverings or facemasks and will provide to patients when needed if they do not present with one. It is recommended to remind patients of the mask policy when phoning to confirm patient appointments.
Each patient must be informed that even with mitigation equipment and techniques there is risk of COVID transmission while receiving care in a dental setting and the procedure may be cancelled on short notice if the patient tests positive for or experiences symptoms of COVID-19.
Patients will be provided a consent form and will be required to read and sign it.
Patients rinse with a solution of 1-1.5% hydrogen peroxide for 1 minute prior to exams and procedures (or other appropriate rinses. Please evaluate your product for effectiveness against COVID)
Social distancing and other infection prevention measures by Nicollet Station Dental:
- Make sure chairs are spaced in reception areas to allow social distancing (6 feet apart) and wipe down with disinfectant in between patients.
- Check in and check out areas are separated.
- Operatories are not open air design layouts.
- Masks will be worn at all times in clinic
Nicollet Station Dental Plan for Infection Control Prevention references the Board of Dentistry Guidelines.
Clinical staff that are licensed are required by the Board of Dentistry to have a course in infection control every biennial cycle. This is also a requirement for non-licensed clinical dental assistants.
Nicollet Station Dental will provide resources for infection control education for all staff, clinical and non-clinical.
Assessment of Clinical Operatories
List operatories and if they are not uniform: list mitigation strategies for operations and what they will be used for (Example – ortho, fixed or removable prost, aerosol generating procedures, dental hygiene (using hand scalers only or use of ultrasonic only where High Volume Evacuation is available and the hygienist has an assistant or another risk mitigation strategy to reduce aerosol production)
| Op #4 | Botox & fillers | |
| Op#5,7,10,11 | Hygiene | Using hand scalers or use of ultrasonic with high volume evacuation with assistant or LEAF attachment |
| Op#6,8,9,12 | Dr. Op’s | All procedures including aerosol generating procedures |
Community Considerations
Nicollet Station Dental will continue to collaborate with peers and supply chain representatives to ensure adequate supply, including PPE, is present in order to provide care for non-emergent and elective procedures and surgeries.
Reduction of Care
In the event of another surge in COVID-19 cases. Nicollet Station Dental would follow Board of Dentistry recommendations and follow Government orders that might revert to treatment of urgent Dental care only. This would allow PPE preservation from the dental community providing elective care. Patients with urgent needs would be treaties as previously and patients with elective needs will be postponed in the event of another Peacetime Emergency in the future. Patients will be screened for urgent needs and prioritized based on need for treatment.
Screening and Testing for Patients and Visitors
See Further Instructions when Developing your screening and testing plan
- Nicollet Station Dental will conduct screening and temperature check for couriers, delivery persons, and other visitors who enter the facility. Ill or febrile visitors are not allowed to enter the facility.
- All patients will undergo active screening for fever or symptoms of COVID-19, including measurement of body temperature.
- Patients, and any accompanying visitors, will be advised to come to the facility wearing a cloth face covering or facemask, or are provided one by the facility if needed.
- In the future, Nicollet Station Dental may use RT-PCR testing of patients prior to elective procedures to help inform infection prevention and control practices to protect staff and patient safety, with the understanding that a negative RT-PCR test represents a single point in time and patients may be infected in the interim prior to the procedure.
- If developing a protocol for the RT-PCR or other diagnostic test prior to elective procedures, Nicollet Station Dental would consider testing within the shortest time window available (e.g. 24-72 hours) preceding the procedure, based on laboratory turnaround time.
- If no protocol for patient testing is implemented Nicollet Station Dental will consider all patients potentially COVID-19 positive and take appropriate precautions when conducting aerosol-generating procedures. This means use of N95 or KN95 masks, face shields, gowns and high volume evacuation.
- Nicollet Station Dental will consider the availability, accuracy and current evidence regarding tests when developing their testing protocols
Due to current lack of availability to dental clinic systems at this time, Nicollet Station Dental will continue to follow all other universal precautions when treating patients and use PPE to protect against exposure.