On September 23, 2022 the CDC updated its guidance on universal masking protocols for healthcare workers stating that asymptomatic individuals (including patients and providers) no longer need empiric use of Transmission-Based Precautions, which includes masks. However, this guidance only applies to settings that are not in a ‘High Community Transmission’ level. This marks a shift to a Community Based Guidance strategy for healthcare settings, away from a testing or vaccine status strategy, which is no longer recommended. In areas/counties where transmission levels are High, source control e.g. masks are still recommended for patients and providers. In areas where transmissions levels are not high, source control, e.g. masks are optional in common areas, such as waiting rooms or staff rooms, that are separate from patient treatment areas.  However, any provider may choose to continue to implement source control for patients and/or staff. These recommendations are provided for general healthcare providers.

For Dental Settings specifically, the CDC’s updated guidance recommends the following with regard to Aerosol Generating Procedures (AGP):

Due to the presence of AGP in the dental setting, providers may choose to implement these recommendations as well:

• Patients with suspected or confirmed SARS-CoV-2 infection should postpone all non-urgent dental treatment until they meet criteria to discontinue Transmission-Based Precautions. Because dental patients cannot wear a mask, in general, those who have had close contact with someone with SARS-CoV-2 infection should also postpone all non-urgent dental treatment until they meet the healthcare criteria to end quarantine.
• Dental care for these patients should only be provided if medically necessary. Follow all recommendations for care and placement for patients with suspected or confirmed SARS-CoV-2 infection. Extra attention may be required to ensure HVAC ventilation to the dental treatment area does not reduce or deactivate during occupancy based on temperature demands.
• If a patient has a fever strongly associated with a dental diagnosis (e.g., pulpal and periapical dental pain and intraoral swelling are present) but no other symptoms consistent with COVID-19 are present, dental care can be provided following the practices recommended for routine health care during the pandemic.
• When performing aerosol-generating procedures on patients who are not suspected or confirmed to have SARS-CoV-2 infection, ensure that DHCP correctly wear the recommended PPE (including consideration of a NIOSH-approved particulate respirator with N95 filters or higher in counties with high levels of transmission) and use mitigation methods such as four-handed dentistry, high evacuation suction, and dental dams to minimize droplet spatter and aerosols.
• Commonly used dental equipment known to create aerosols and airborne contamination include ultrasonic scaler, high-speed dental handpiece, air/water syringe, air polishing, and air abrasion.
• Dental treatment should be provided in individual patient rooms whenever possible with the HVAC in constant ventilation mode.
• For dental facilities with open floor plans, strategies to prevent the spread of pathogens include:
• At least 6 feet of space between patient chairs.
• Adjunct use of portable HEPA air filtration systems to enhance air cleaning
• 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 that extending barriers to the ceiling will not interfere with fire sprinkler systems).
• Operatories oriented parallel to the direction of airflow when possible.
• Where feasible, consider patient orientation carefully, placing the patient’s head near the return air vents, away from pedestrian corridors, and toward the rear wall when using vestibule-type office layouts.
• Ensure to account for the time required to clean and disinfect operatories between patients when calculating your daily patient volume.

The CDC recommends frequently checking local transmission rates and monitoring any local ordinances. The GDA will continue to monitor for updates from the CDC, GA DPH, Georgia Board of Dentistry, and the ADA and report to the membership.

PLEASE NOTE THAT THIS ADVISORY IS BEING PROVIDED FOR INFORMATIONAL PURPOSES ONLY AND IS NOT INTENDED TO BE CONSTRUED AS A SUBSTITUTE FOR LEGAL ADVICE FROM A GEORGIA LICENSED ATTORNEY.

Please contact the GDA’s Director of Health Policy, Emma Paris, at emma@gadental.org  if you have additional questions about this GDA Member Advisory.