COVID-19 Frequently Asked Questions
1. Why is COVID-19 any different from other infectious diseases?
COVID-19 is caused by a novel (new) air-borne coronavirus, SARS-CoV-2, that current thinking suggests is transmitted by droplet and aerosol contamination and through close contact (less than 2 metres) with an infected person or through touching contaminated surfaces.
The overwhelming majority of pathogens in the dental practice are blood-borne viruses (BBVs) such as Hepatitis B, HIV, Hepatitis C and vCJD. There are extremely robust infection control procedures for dealing with BBVs but much less robust procedures for air-borne viruses and contact viruses. Additions to standard infection control procedures, including the use of PPE, are therefore considered necessary during the COVID-19 pandemic and possibly beyond.
2. What is the incubation period for COVID-19?
The incubation period for COVID-19 averages 5 days and can be up to 14 days, during which time patients are thought to be infectious even though they may be asymptomatic. It must therefore be assumed that many people may be asymptomatic and are either carrying or incubating the virus. This applies equally to clinicians, team members, patients, and members of the public. There may also be individuals who choose to conceal their symptoms to access treatment.
3. What are the symptoms of COVID-19?
COVID-19 is a respiratory illness and the symptoms include (but are not always limited to):
- Fever (a temperature over 37.8 degrees centigrade).
- A new persistent cough.
- Muscle pains.
- Shortness of breath and breathing difficulties.
- Severe pneumonia.
- Loss of taste and smell.
The two most prevalent symptoms of COVID-19 are a new, persistent dry cough and a temperature. It is now thought that loss of taste and smell are also significant, and, in some people, this is the only symptom they experience.
4. Which patients can and can’t be seen in general dental practices?
Only patients who are asymptomatic and whose household members are also all asymptomatic for COVID-19 can be seen.
Patients who are self-isolating because they have one or more of the published symptoms of COVID-19 and patients who are part of a household in which another member is self-isolating for the same reason cannot be treated in practice. No treatment can be provided in dental practice for these patients until the end of the self- isolation period.
If a patient can’t be seen at your practice you should know what the local arrangements are for seeing these patients e.g. an urgent dental care centre and you should make arrangements for them to be seen.
5. What risk assessments do we need to undertake?
You will need to undertake risk assessments for:
- Every patient you see at your practice during the pandemic.
- All clinicians and all team members.
- Your practice.
To understand how to undertake risk assessments, take our CPD courses in the New Patient Journey and Risk Assessments Demystified.
6. What is an Aerosol Generated Exposure (AGE)?
The Faculty of General Dental Practice (UK), the FGDP guidance issued in June created the descriptor ‘aerosol generated exposure’ or AGE. An AGE is then further qualified as being a low-risk AGE (breathing, speaking, coughing, and sneezing or activating the gag reflex, some dental treatments) and a high-risk AGE (dental treatment that creates an aerosol). A high-risk AGE equates to what we have come to describe as an Aerosol Generating Procedure or AGP. This is very helpful as it stratifies risk and allows a risk-based approach to the selection of appropriate PPE.
7. What are high-risk AGEs?
High-risk AGEs are dental procedures that include (but are not limited to) the use of:
- The air turbine.
- The three in one air/water syringe when use of air and water is combined.
- Slow speed handpieces used for caries removal or polishing.
- Surgical motors with irrigant/irrigation.
- Ultrasonic scalers and Piezo handpieces.
- Endosonic handpieces.
- Rotary endodontic handpieces.
- Sandblasting, air abrasion, air polishing
8. What is the difference between FFP2 and FFP3 masks?
FFP2 masks filter 94% of particles. They are the equivalent to N95 (USA) masks and meet the guidelines from the World Health Organisation (WHO) for protection against COVID-19.
FFP3 face masks have a marginal benefit over FFP2 masks and are the most effective at filtration. They provide filtration of 99% and have a maximum leakage of 2% to the inside.
FFP3 masks fit better and reduce the build-up of moisture, thereby lengthening the lifespan of the mask.
Version 1.1. of the FGDP guidelines states that in the absence of FFP3 masks, FFP2 can be worn whilst undertaking high-risk aerosol generated exposures.
A valved mask will only protect the wearer because the expired air can transmit infectious particles unfiltered into the air. The valve acts as a comfort device and allows air to escape from the mask, meaning it can be worn for longer periods.
A non-valved mask provides two-way protection and protects the wearer and the patient. Breathing with a non-valved mask is more difficult and dental team members who wear glasses may find it hard to wear because it causes the build-up of condensation and makes it harder to see clearly.
Current FGDP guidelines and guidelines from the Chief Dental Officers state that all FFP2 and FFP3 masks MUST be fit tested. Fit testing must be carried out by a competent person as described by the Health and Safety Executive (HSE).
9. How do I transport and clean my work uniform/scrubs?
All team members must be provided with adequate surgery-only uniform/scrubs and/or reception uniform for each working day.
Surgery-only uniform/scrubs must be worn under a disposable or re-usable gown and must be changed daily and laundered daily.
Clinical team members must not travel to and from work in uniform/scrubs.
Rooms or areas should be available for team members to change into and out of uniforms or scrubs.
Uniforms/scrubs should be transported home in a pillowcase.
The scrubs and the pillowcase must be laundered immediately on return home (or at the practice if the facility is available) and separately at 60c or at a higher temperature if the fabric allows.
They must be laundered separately to other items and the washing machine must be no more than half-full. They should then be tumble-dried and/or ironed.
10. What are the fallow time requirements?
The Standard Operating Procedures (SOPs) issued by the Office of the Chief Dental Officer for England state that 60 minutes fallow time must be allowed to elapse before environmental cleaning is carried out following a high-risk AGE/AGP. This is to allow the viral load to reduce following procedures that generate aerosols.
The Faculty of General Dental Practice guidance advises that the fallow time can commence when aerosol is no longer being generated e.g. if you are undertaking a crown preparation or other restorative procedure that initially generates large amounts of aerosol, you can start timing the fallow period from when the aerosol is no longer being generated, provided care is taken to avoid generating more aerosol by e.g. using the air/water syringe carefully so that more aerosol is not generated later in the procedure.
11.Can we open the drawers in our surgery during high and low risk AGEs?
Opening drawers is a tricky one! Actually we have been advised for many, many years that we should not open drawers during treatment due to the risks associated with any droplets in the air falling on clean materials in a drawer, so this isn’t technically a new ‘requirement’. However, realistically we all know that this isn’t always followed.
COVID-19 however poses a whole new risk level, especially while there is still much to learn about how it is spread and also while it is circulating in the community. For that reason, we should keep all drawers closed during treatment, whether this is for a high-risk AGE or a low-risk AGE. The differentiation between high and low risk levels of AGEs is very important because it acknowledges that there is no such thing as ‘no AGE’ because of speaking, breathing, coughing etc. That’s the reason theatres still cannot open and we have to wear masks in enclosed areas in public.
So, the answer is the ‘no opening drawers rule’ applies whatever you are doing.
Here you will find some resources that may help. You can sample them and/or download them.