A Pan-Canadian narrative review on the protocols for reopening dental services during the COVID-19 pandemic

Abstract

The current coronavirus disease 2019 (COVID-19) pandemic is impacting the way in which dental services are provided. The aim of this narrative review was twofold: to summarize key areas from the Canadian protocols available for the reopening and restructuring of dental services across the country and to critically review these protocols based on existing evidence. A narrative review of the existing Canadian protocols, written in English and French, was undertaken between April 15 and July 13, 2020. The protocols were obtained by searching through regulatory bodies and websites from professional organizations, and from personal contacts through academic institutions and policy leaders. The data extraction form focused only on protocols related to dentistry, and the information was compiled by a hired assistant. Content was categorized via group discussions with the research team on eight areas: office management and procedures, patient and staff screening, treatment procedures, office layout, risk reduction, personal protective equipment, supporting information, and length and readability. Thirteen protocols were identified and offered substantial variation in the level of details provided. All but two protocols specified proper donning/doffing of personal protective equipment, while all protocols recommended daily monitoring of COVID-19 related signs and symptoms in staff and patients. They varied in terms of recommended mask types, eye and face shield protection, and head coverings. While all protocols aimed at restructuring emergency dental services, their recommendations were often not based on the published evidence. This narrative review summarized key areas from 13 provincial and territorial protocols in Canada to help oral health care providers plan the reopening of their services. The information conveyed across all documents was clear, but variance highlights the need for a coordinated effort to develop an evidence-based document for dental practitioners.

Uncertainties around COVID-19 from the perspectives of oral health care workers during the first wave of SARS-CoV-2 infections in British Columbia, Canada

“…This study explored the various ways in which the first wave of infections caused by the novel coronavirus outbreak led to feelings of uncertainty experienced by 45 oral health care providers and administrators in British Columbia, Canada, during the Spring of 2020. As the interviews took place during the first wave of infections, the findings have to be understood under that context-even if a second and third wave were assumed to happen, a vaccine was to be developed, and a protocol for care during a pandemic was presented [25] participants were not asked about these now pressing developments [26]. The uncertainties shared by the participants were dependent upon what was (un)known about the disease, what could be done to safely provide oral health care, to what extent the pandemic would impact participants' lives, what the future of oral health care would look like, and how similar/dissimilar the outbreaks of HIV and SARS-CoV-2 were by the Spring of 2020.…”

“…Their concerns around PPE are legitimized by the fact that oral health care professionals are at a higher risk for contracting SARS--CoV-2 than other professionals [38]. However, participants also realized that there are still many uncertainties and unknowns related to COVID-19, from the efficacy of the current infection control protocols [25,39] to striking a balance between self-care and patient care in their daily practice [7]. Although it is unthinkable that in this day and age an oral health professional would provide care without wearing disposable gloves, eye protection, and masks at the bare minimum, participants did mention the bare-handed dental care provided before the human immunodeficiency virus (HIV) pandemic.…”

Systematic Literature Review on Coronavirus Infectious Disease-19 and Dental Masks

“…The use of PPE is recommended when performing both aerosol-generating and -non-generating procedures in all dental practices. The use of PPE, such as N95, FFP2, or FFP3 masks, gloves, gowns, and protective glasses is the most important aspect of all dental procedures 16) . In addition to the use of PPE, hand hygiene and disinfection of all surfaces in the clinic are also recommended as infection control measures in dentistry 17) .…”

“…When treating patients suspected to have COVID-19, dentists should wear full PPE consisting of an N95 mask, gown, gloves, and protective glasses 22) . If treating a patient positive for COVID-19, an N95 (or higher) mask was recommended for all dental procedures 16) . The FFP2, FFP3, and N95 masks provide dental practitioners with greater protection from viral respiratory infections than dental masks 10) ; in fact, FFP2 masks were found to be 100 times more effective than dental masks 23) .…”

Characteristics and Detection Rate of SARS-CoV-2 in Alternative Sites and Specimens Pertaining to Dental Practice: An Evidence Summary

“…A narrative review of Canadian protocols to reduce disease transmission in the dental office included eight different areas involving administrative, physical and procedural controls. The absence of testing was noted as a potential limitation of practice [ 10 ].…”