A comprehensive review of infection control guidelines relating to COVID-19 for dentists and dental hygienists

The results and/or conclusions contained in the research do not necessarily reflect the views of all CITF members.

A CITF-funded study, published in JADA, summarized the strategies for reopening oral healthcare practices as infection prevention and control guidelines (IPCG) evolved during the pandemic. The researchers found that updates between March 2020 and January 2022 differed across all provinces and territories in Canada, as well as between dentists and dental hygienists in the same jurisdictions, particularly in regard to face-covering recommendations. The research was led by Dr. Sreenath Madathil (McGill University) in collaboration with Dr. Paul Allison (McGill University), Dr. Mehak Khanna (McGill University) and Dr. Walter Siqueira (University of Saskatchewan).

The researchers collected guidelines emitted between March 2020 and January 2022 that mentioned personal protective equipment (PPE) or enhanced IPCGs specific to COVID-19 and recorded information across five broad categories:

• Metadata (e.g., province, phase of reopening, category of oral healthcare professional);
• Guidance for screening patients and staff members (e.g., temperature check, travel history, contact tracing);
• Office setup (e.g., barrier screens, reduced seating, airflow assessment);
• PPE recommendation (e.g., fit-tested respirators);
• Risk-mitigating strategies (e.g., procedural mouth rinse, rubber dam).

From the final 116 eligible documents reviewed, the researchers found that across the study period:

• There was general homogeneity in restricting non-essential oral healthcare services in March and April 2020;
• Most of the jurisdictions (7 out of 13) provided separate recommendations for dentists and dental hygienists;
• None of the jurisdictions issued IPCGs for dental hygienists during the emergency phase of the pandemic;
• Only a few jurisdictions updated their face-covering recommendations after the re-opening phase of the pandemic.

The study was retrospective and the researchers’ access to regulatory guidelines from the initial days of the pandemic for some provinces and territories (NU, NWT, YK, NB) was limited. The researchers also did not compare any outcomes such as adherence behaviour or infection rates among oral healthcare providers. However, the longitudinal nature of the study allowed for detailed reporting of similarities and differences in re-opening strategies and face-covering recommendations for dentists and dental hygienists, and among Canadian regulatory jurisdictions over time. Observations from this study should encourage policy makers to share experiences and lessons learned with a view to creating evidence-informed guidelines for future pandemics and outbreaks that would help avoid confusion, unnecessary restrictions in dental care, and financial strains from frequent changes.