College update March 23
March 23, 2020
The College strongly recommends all non-essential and elective dental services are suspended immediately. Emergency treatment should continue.
What is a “true emergency situation”?
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.
How should emergency cases be managed?
Considering the current pandemic situation, the College is UPDATING its guidance regarding the management of emergencies.
PLEASE READ CAREFULLY.
All emergency cases should be triaged by telephone first by taking a verbal history of the patient’s condition and providing appropriate pharmacotherapy if indicated.
In those few cases where telephone management is insufficient, clinical assessment may be necessary provided the dental practice has appropriate safety precautions and PPE in place.
Scenario 1: 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)
- Many dental emergencies can be managed without generating an aerosol.
- Using routine practices and contact/droplet precautions (i.e. procedure/surgical mask, gloves and eye protection), obtain a history of the patient’s condition and conduct an emergency clinical dental examination. Determine the nature of the emergency and provide care WITHOUT GENERATING AN AEROSOL.
- Do NOT use high-speed handpiece. Instead, use hand instuments or low-speed handpiece instead.
- Do NOT use air-water syringe. Instead, use cotton roll or guaze.
Scenario 2: 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)
- If an aerosol will be generated, then care MUST be provided using enhanced precautions (i.e. fit-tested N95 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.
To protect dentists, dental staff and conserve PPE supplies, AEROSOL-GENERATING PROCEDURES SHOULD BE AVOIDED. Consider using pharmacotherapy instead.
If your dental practice does NOT have required safety precautions in place to manage emergency cases in person, you are still responsible to triage emergency care via telephone first and then by referral to a nearby dental or specialty practice that can provide such care.
- Contact emergency patients 7 to 10 days after providing clinical care.
- Confirm that the emergency has resolved AND patients are not showing any signs of COVID-19 infection.
- Emergency patients may test positive for the virus some days after their dental visit.
Avoid referring to a hospital dental department at this time.
IMPORTANT: If your dental practice has required safety precautions in place to manage emergency cases in person, including access to and ability to safely use fit-tested N95 masks, gloves, eye protection, face shield and protective gown, please immediately notify the College at firstname.lastname@example.org. The College is collecting this information to help improve patient access to emergency dental care.
If your dental practice is unable to meet required safety precautions or has closed, you can still help. Consider donating supplies of PPEs and other IPAC resources directly to a colleague on the list of dental practices that are seeing emergency patients.
Alternatively, consider donating these supplies to a local hospital, public health unit, or community health centre.
During this pandemic, all PPEs are valuable and make a difference. Your generosity can go a long way.