Phase 3 and Dental Hygiene
On July 6, 2020 Governor Charlie Baker announced that Massachusetts is entering Phase 3—the Vigilant Phase—of the state’s four-phase reopening plan. Phase 3 offers no change for dental practices, which can continue to see patients for all procedures.
We understand this can be a confusing time. As practices move to expand care, it is important to work together and communicate openly with your supervising dentist to express your concerns and discuss the changes that will occur in your practice due to COVID-19 as you move forward in this phased reopening. Hygienists play a vital role on every dental team. Together, you can make sure your team is strong, compliant, and following all safety measures.
Join the MDS
Would you like to unlock access to all of the information and updates available exclusively to MDS members? If your dentist is an MDS member, you can sign up for complimentary membership today. If your dentist is not a member, you can join for a small yearly fee of $35. Go to massdental.org/join and make sure to choose "Allied Dental Health Professional (ADHP)" as your member type.
A dental hygienist licensed to practice in the Commonwealth must complete a minimum of 20 CEUs per renewal cycle. The two-year cycle runs from April 1 to March 31 of odd years (e.g., April 1, 2019, to March 31, 2021). The MDS provides members with complimentary CE opportunities online. Go to massdental.org/learning to view on-demand options and look out for our emails for upcoming webinars.
Frequently Asked Questions
The MDS has compiled the following questions and answers to offer general guidance to hygienists regarding the phased reopening of dental practices. We will continue to update this section as more information becomes available or as information changes.
What Are the Required Public Health Criteria and Safety Standards for the Dental Practice?
- All workers must have appropriate PPE to perform the service/procedure. If appropriate PPE is not available to protect the health care worker, the service/procedure should be canceled.
- Health care providers and staff must wear surgical face masks at all times.
- Facility or office must ensure social distancing for providers and staff to the maximum extent possible.
- Eye protection (goggles, visor, or mask with visor) must be provided and worn by all health care professionals while engaged in direct patient care for procedures with increased potential for droplet aerosolization.
- Providers must take steps to minimize the number of health care workers in the facility or office to those individuals necessary to complete the surgery/procedure.
- Providers must have a written protocol in place for screening all employees for symptoms of COVID-19 prior to entering the facility or office.
- Providers must adopt written policies that address worker safety and well-being.
What Are the Required Public Health Criteria for Safety Standards for Patient Safety?
- Providers must have a process for screening patients and companions for symptoms of COVID-19 prior to entering the practice.
- Providers must have policies and procedures for screening patients in advance of a service or procedure, including policies and procedures for testing patients for COVID-19 when medically appropriate, as well as for determining whether a procedure should go forward if a patient tests positive.
- Providers must develop policies permitting patient companions only in special circumstances or otherwise in adherence with Massachusetts Department of Public Health (DPH) and CDC guidance when necessary for the patient’s well-being. Special circumstances and populations may include pediatric patients and other special populations such as patients with disabilities or patients with intellectual or developmental disorders (e.g., autism, Down syndrome, etc.). These policies must be accessible to patients seeking care.
- Providers must require that all patients and companions wear mouth and nose coverings. However, the provider may consider waiving the requirement for mask and nose coverings for patients and/or companions in special circumstances.
What Are the Donning and Doffing Requirements for PPE?
The CDC recommends multiple sequences for the donning and doffing of PPE. Dental settings should have set policies and procedures describing a recommended sequence for safely donning and doffing PPE for all dental health care professionals in the practice.
What PPE Is Recommended for Aerosol-Generating Procedures?
Per the CDC’s Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response, during aerosol-generating procedures conducted on patients assumed to be non-contagious, DHCPs should consider the use of an N95 respirator or a respirator that offers a higher level of protection, such as other disposable filtering facepiece respirators, PAPRs, or elastomeric respirators, if available. Respirators should be used in the context of a respiratory protection program, which includes medical evaluations, training, and fit testing.
Is There an Alternative to N95 Respirators for Aerosol-Generating Procedures Conducted on Patients Assumed to Be Non-Contagious?
Yes, if a respirator is not available for an aerosol-generating procedure, use both a surgical mask and a full-face shield, according to the CDC’s Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response. Ensure that the mask is cleared by the U.S. Food and Drug Administration (FDA) as a surgical mask. Use the highest level of surgical mask available. If a surgical mask and a full-face shield are not available, do not perform any aerosol-generating procedures.
What Does the CDC Recommend for Patient Placement?
In its Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response, the CDC recommends:
- Ideally, dental treatment should be provided in individual patient rooms whenever possible.
- For dental facilities with open floor plans, to prevent the spread of pathogens there should be:
- At least six feet of space between patient chairs.
- Physical barriers between patient chairs. Easy-to-clean floor-to-ceiling barriers will enhance effectiveness of portable HEPA air filtration systems (check to make sure extending barriers to ceiling will not interfere with fire sprinkler systems).
- Operatories should be oriented parallel to the direction of airflow if possible.
- Where feasible, consider patient orientation carefully, placing the patient’s head near the return air vents, away from pedestrian corridors, and towards the rear wall when using vestibule-type office layouts.