RCDSO- COVID-19 Frequently Asked Questions- Updated- April 1st 2020

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Our Practice Advisory Service receives many emails and phone calls daily from dentists and the public about COVID-19. Below is a list of FAQs compiled by the Practice Advisory team to assist you in getting up-to-date information in a timely manner.

Do I have to close my office? 

The College does not have the authority to order all dental offices closed. Only the Ministry can do this. The furthest that we can go is to strongly recommend all non-essential and elective dental services are suspended immediately. In the meantime, both the College and the ODA are making efforts with the Ministry on this issue.

You are required to limit your services to emergency treatment only, provided you can do so safely. Refer to this article in Dispatch for our latest guidance. Since clinical advice is rapidly evolving, we ask that you check this page frequently.

You are expected to put your patients’ interests and the safety of the community first. Ontario has declared a state of emergency, and the Canadian government is strongly urging all Canadians to practice social distancing.

What is the definition of an essential-dental treatment or a dental emergency? 

In dentistry, a “true emergency situation” includes oral-facial trauma, significant infection, prolonged bleeding or pain which cannot be managed by over-the-counter medications. 

Read our guidance on true emergency situations.

If you believe you have a unique clinical situation, please reach out by email to the College to seek specific guidance.

What are considered emergencies / true emergencies? 

Please refer to our latest guidance with respect to emergencies.  

How should dentists manage emergencies during this pandemic? 

Refer to this article in Dispatch for our latest guidance. Check this frequently as clinical advice is rapidly evolving. 

Avoid referring to a hospital dental department at this time.

If your dental practice is unable to meet required safety precautions or has closed, you can still help. Ontario has also launched a website to act as a central point for businesses and organizations who can supply emergency products and innovative solutions to support the province’s response to COVID-19.

During this pandemic can we prescribe outside of the College’s recommendations for the management of dental pain for our patients? 

Dentists must continue to practice within the College’s Guidelines with respect to writing of narcotics and opioids.

The Guidelines provide guidance regarding the suggested maximum number of tablets for a single opioid prescription. However, it also states that in some situations, practitioners may consider exceeding the suggested maximum number of tablets. Practitioners are expected to exercise reasonable professional judgment in determining when this is justified, which should be documented.

If you feel that the patient requires more than the Guidelines recommend, please screen the patient and evaluate their emergency over the telephone and determine if it is a true emergency.  You can then determine if pharmacotherapy (including the prescription of opioid) is indicated and how to proceed. If it is determined that treatment is required, with or without generating any aerosols, proceed with the appropriate PPEs.   

Please refer to our latest guidance with respect to emergencies. 

Please ensure that you keep a record of any patients that you speak with over the phone so that you can provide documentation in the patient record once you return to the office.

Can I remotely provide a prescription to new patients (i.e. who are not existing patients of the practice) on an emergency basis over the phone or by video?

Technology can allow dentists to gather necessary information needed to proceed with treatment. For instance, should dentists need to prescribe medication for a new patient, technology with both audio-video capacity will be required to allow for an adequate assessment prior to prescribing medication.  

This means that you cannot provide a prescription to a new patient who does not have video conferencing capability.  

At this time, the Office of the Information Privacy Commissioner of Canada has reminded individuals and organizations that Canada’s privacy laws remain in effect during the current COVID-19 situation. This applies to the use of information technology.

Keep appropriate records of the consultation, in compliance with College’s Dental Recordkeeping Guidelines and note specifically whether the care was provided by telephone or through teledentistry.

Please review the College Guidance on COVID-19 – Emergency screening of dental patients using teledentistry.

Can I use teledentistry for remote screening of emergency patients?

See our guidance on teledentistry here

What procedure(s) codes can I bill when/if I provide a consultation through teledentistry?

Please contact the Ontario Dental Association for questions/clarification regarding procedure codes under their Suggested Fee Guide.

The College has no involvement with determining procedure codes or establishing fee guides. As it is neither our mandate, nor our fee guide, we cannot provide advice on this.

If we do not have N-95 respirators, what do we do if we are treating emergencies? 

Refer to this article in Dispatch for our latest guidance. Check this frequently as clinical advice is rapidly evolving. 

I have run out of surgical masks and N-95s, what do I do? 

Refer to this article in Dispatch for our latest guidance. Check this frequently as clinical advice is rapidly evolving. 

Do N-95 masks require fitting?

N-95 masks require proper fitting in order to provide optimal protection for the dentist and the patient. If you don’t have the right size, protection could be compromised.

Where can I get information or training on fitting N95 masks?

Manufacturer’s instructions must be followed. We suggest that you and your team contact the suppliers/manufacturers for more information on proper fitting and usage. 

The occupational health department of your local hospital may be able assist. Also, some colleagues (dentists/specialists) in your community may have the training, resources and staff to conduct proper N95 mask testing. You can reach out to them.

We’ve included below names of some companies who will provide fit testing. Note: the College does not endorse any company but is providing this information as a resource for dentists who may need this type of assistance.  The following is not an exhaustive list.

For your information: 

Levitt Safety

3M offers a fit test kit for sale

Mask fit test training from Safety First Training

Mask fit testing from GTA Home Health Care

See this YouTube video on the mask fitting process

http://www.synergy-employment.com/services/n95-mask-fit-testing

There is a shortage of N-95 masks, can we use KN-95 or other “equivalent” masks instead?

Health Canada, the regulator for medical devices in Canada, accepts the NIOSH certification as an appropriate quality standard for N95 masks used by health care providers. Equivalent alternate standards are also acceptable.

For more details click here

The Ontario Ministry of Health has indicated that, based on comparison, it is reasonable to consider China KN95, AS/NZ P2, Korea 1st Class, and Japan DS FFRs as “equivalent” to US NIOSH N95 and European FFP2 respirators, for filtering bioaerosols such as viruses.

Prior to selecting a respirator mask, dentists should review their local respiratory protection regulations/requirements or check with their local public health authorities for selection guidance.

Can N95 masks be used past their expiry date? 

Health Canada has issued a document on “Optimizing the use of masks and respirators during the COVID-19 outbreak”.

According to this document, there is no specific timeframe beyond the expiry dates for N95 respirators at which they would no longer be considered suitable for use. In times of increased demand and decreased supply, consideration can be made to use these expired N95 respirators. An expired mask can still be effective at protecting health care provider if:

  • the straps are intact
  • there are no visible signs of damage
  • they can be fit-tested

Health care providers should inspect the mask and perform an appropriate seal check.

The Ministry has issued a Guidance document on “Information on the Use of N95 Filtering Facepiece respirators beyond the manufacturer-designated shelf life”.  

Are N-95 masks required for all treatment?

If a patient presents with an emergency that CANNOT be managed without generating an aerosol (i.e. high-speed handpiece or air-water syringe MUST be used), then care MUST be provided using enhanced precautions (i.e. fit-tested N-95 mask, gloves, eye protection, face shield and protective gown).

  • If possible, use a rubber dam to decrease possible exposure to infectious agents.
  • If possible, use high-speed evacuation to minimize aerosols.

If a patient presents with an emergency that CAN be managed without generating an aerosol (i.e. high-speed handpiece and air-water syringe will NOT be used), care can be provided using routine practices and contact/droplet precautions (i.e. procedure/surgical mask, gloves and eye protection).

Refer to this article in Dispatch for our latest guidance.

What questions should we ask our patients over the phone in order to identify their symptoms if we need to see them for an emergency? 

Follow a similar line of questioning you would use for an emergency if a patient were present. Ask about symptoms, severity of issue, medications, review the patient’s medical history, allergies, case history, trauma, sleeplessness, etc.  

Further information may also be obtained from the Ministry of Health’s website regarding questions about travel and other circumstances that may lead to self-isolation and the inability to treat an emergency: https://www.ontario.ca/page/2019-novel-coronavirus   

In addition to the above, please check the College website for regular updates with specific reference to clinical dental practice.  

We already adhere to standard precautions. Can dentists do anything else to prevent transmission in our offices while we treat emergencies? 

  • Practice safe social distancing. Do not keep many people in your waiting room.
  • Screen patients
  • Make sure PPE you are using is appropriate for the procedure performed
  • Use high speed evacuation for all dental procedures
  • Clean and disinfect public areas frequently, including door handles, chairs and bathrooms.

What do we tell a patient if they screen positive for COVID-19? 

The patient must self-isolate immediately. You are responsible for reporting this to Public Health as a reportable disease. You can contact Public Health directly.

How do I manage a staff member’s illness and return to work? 

If you or a member of your staff is ill please refer to this memo from the Ministry of Health for guidance.

Where do I go if I am experiencing symptoms of COVID-19? 

Contact your doctor if you’re experiencing symptoms of the COVID-19 novel coronavirus. Telehealth Ontario is also a key hub for advising the public or HCP re: online assessment and options for live assessment (if deemed necessary). Telehealth No. 1 866-797-0000. Stay in self-isolation until you receive instructions otherwise from one of the above sources. 

Click here for the Ministry self-assessment link. 

My practice is unable to meet the required safety precautions in place to manage emergency cases in person, including access to and ability to safely use fit-tested N-95 masks, gloves, eye protection, face shield and protective gown, or I am closed.  Is there any way I can help? 

Ontario has launched a website to act as a central point for businesses and organizations who can supply emergency products and innovative solutions to support the province’s response to COVID-19.

During this pandemic, all PPEs are valuable and make a difference. Your generosity can go a long way.

Is the College providing a support fund or any financial relief for dentists experiencing loss of income and business during the pandemic? 

The College does not provide employment advice or related financial advice. We suggest you seek legal advice from an employment lawyer.

You can obtain additional information by logging into your ODA member’s account

You may wish to review the financial assistance packages announced by both the Ontario and Canadian Governments, as well as seek professional advice on your obligations. 

Also review, the Federal COVID-19 Economic Response Plan: Support for Canadians and Businesses to check if you or your staff are eligible: https://www.canada.ca/en/department-finance/economic-response-plan.html  

Will the College continue to recommend that dental offices treat emergencies only? 

Since our advice to dentists released March 15, the Government of Ontario has declared a State of Emergency. The government has also clarified that only “health care professionals providing emergency care including dentists” are considered to be in the category of ‘essential services’.

As a result, the College will not revisit its strong recommendation that all non-essential and elective dental services should be suspended until the State of Emergency has been lifted by the Government of Ontario.

Keep your office open if you can ensure emergency dental care can safely be provided to patients both in the short and long term. 

The College continues to closely monitor the situation. We constantly consult with the Ministry of Health and Public Health.

As the situation continues to evolve very rapidly, visit the College’s website and follow us on Twitter on a regular basis for updates.

Many dentists apparently are not heeding the College’s recommendation and are continuing with non-emergency treatment in their office. What will the College do about this?  

The College sought legal advice and confirmed that we do not have the legal authority to close dental offices. Our approach and advice is similar to most health care regulators under Ontario’s Regulated Health Professions Act (RHPA), and by regulators in many other provinces; we are limited to “strongly recommending” that all dental offices close.

Ontario’s Chief Medical Officer of Health and Canadian health authorities have asked that dentists only remain open to ONLY provide emergency services and ONLY when you have the PPE and facilities to do that safely.

Dentists are expected to consider the best interests of their patients and communities at all times. Ontario has declared a state of emergency, and the Canadian government is strongly urging all Canadians to practice social distancing.

We continue to raise these issues with the relevant authorities. In the meantime, dentists should be aware that if their clinic remains open other than for emergency care, Public Health could be notified to take strong action.

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