COVID-19 FAQ
The COVID-19 situation continues to evolve and we have received many messages from registrants and the public asking for clarification or additional guidance. Responses to the most common themes are provided in the FAQ below, and are updated on an ongoing basis.
The Minister of Health and the Provincial Health Officer continue to make regular joint statements, which are available here (audio recordings can be found on the BC Government’s SoundCloud Account). Orders, notices and guidance (including FAQ) related to COVID-19 are available on the Ministry of Health's website here.
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The World Health Organization has published a document titled Considerations for the provision of essential oral health services. The document speaks to ventilation in oral health care facilities as follows:
“Adequate ventilation in oral health care facilities reduces the risk of transmission in closed settings. According to the type of ventilation available (mechanical or natural), increase ventilation and airflow (door closed, adequate exhaust ventilation, negative pressure or mechanically ventilated equivalent air exchange capacity in room where possible - an average of 6-12 air exchanges per hour)
- Avoid the use of split air conditioning or other types of recirculation devices and consider installation of filtration systems. The following approaches can be considered: installation of exhaust fans; installation of whirlybirds (e.g. whirligigs, wind turbines) or installation of high-efficiency particulate air (HEPA) filters.
- Any modifications to oral health care facility ventilation need to be made carefully, taking into consideration the cost, design, maintenance and potential impact on the airflow in other parts of the facility."
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[accordion title="%20How%20should%20I%2C%20as%20a%20registrant%2C%20interpret%20the%20College%E2%80%99s%20guidance%20regarding%20patients%20considered%20higher%20risk%20for%20severe%20COVID-19%3F%20Should%20I%20defer%20elective%20care%20for%20these%20vulnerable%20patients%20during%20Phase%202%20and%203%3F"]The College has received questions asking how registrants should interpret the College’s guidance in the May 15 document, Transitioning Oral Healthcare to Phase 2 of the COVID-19 Response Plan which states, "Patients considered high risk for severe COVID-19 include those with pre-existing conditions such as serious respiratory disease, serious heart conditions, immunocompromised conditions, severe obesity, diabetes, chronic kidney disease or those undergoing dialysis, and liver disease; pregnant patients; and patients who are 70 years and over. These patients should be deferred whenever possible"?
Registrants are wondering: should I be deferring elective care for these higher risk patients during Phase 2 and beyond of the government’s response to the COVID-19 pandemic?
Patients seeking dental treatment who are more likely to suffer severe COVID-19 (should they become infected) must not be denied an in-person appointment without a telephone consultation with the dentist. Dentists must assess risk in consultation with the patient before a decision to defer or proceed with treatment is made. It is essential to determine the risks and benefits of providing care and to ensure the patient has the information necessary to provide full informed consent. The patient must give their consent for an in-person appointment but only after being informed of the steps being taken to protect them.
Higher risk factors for severe COVID alone should never be used or considered as an obstacle to care, especially during times of controlled community spread (low incidence and prevalence) as we find ourselves in now during phase 2 and 3.
In the case of individuals with well-controlled Type 1 diabetes who are without diabetes-related complications, Dr. Tom Elliott, Medical Director of BCDiabetes, has advised CDSBC that their condition should not preclude them from receiving dental care.
Age alone is not an indicator of an increased risk for severe symptoms; however, age is often associated with a higher probability of co-morbidities. Co-morbidities may increase the probability of severe COVID-19 in any age group but do not, increase the likelihood of contracting the disease.
Whenever possible patients should be deferred if they screen positive for presumed or confirmed COVID-19, or if they are higher risk for severe COVID-19 where risk cannot be mitigated. When inherent risks can be mitigated, care may proceed. [/accordion]
[accordion title="Should%20I%20be%20concerned%20about%20transmission%20of%20COVID-19%20from%20patients%20who%20may%20have%20the%20virus%20but%20are%20asymptomatic%3F"]Managing the risk of transmission of infection is a significant challenge in all healthcare settings including dentistry.
In dentistry, there is specific concern related to the potential for infection as a result of airborne transmission from people with pre-symptomatic or asymptomatic COVID-19 given the frequency with which aerosol generating procedures (AGPs) are performed and the duration of those AGPs. These AGPs are important to the delivery of dental services, and so it is critical to recognize that the risk of exposure to potentially infectious aerosols from a person with unrecognized COVID-19 is dependent on the extent of community transmission of COVID-19. As BC moves into phases 2 and3 of the government’s restart plan, there is evidence that community transmission has fallen to a significantly lower level based on number of new cases detected per day through current testing pathways. There is a lack of evidence that AGPs represent a significant risk in this context of controlled community transmission. There is not a clear evidence base for a general restriction on use of AGPs or for requiring routine use of airborne precautions (N95 masks) when AGPs are performed on people where there is no fever, no other symptoms suggestive of COVID-19 and no recent contact with a known case of COVID-19.
Key elements in managing the risk are active surveillance for fever or respiratory symptoms before attendance and on arrival at the healthcare setting and the application of Standard Precautions (Routine Practices) when caring for all people in all settings at all times. In effect, key elements of contact and droplet precautions (use of gloves and a surgical mask) are routinely applied in dental practice. [/accordion]
[accordion title="What%20type%20of%20procedures%20are%20we%20allowed%20to%20do%20during%20phase%202%20and%203%3F"]In phase 2 and beyond of the BC government’s restart plan, oral health care providers are free to return to their full scope of practice as long as risk assessment informs their decision-making around the provision of care. [/accordion]
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COVID-19 FAQ for Dental Patients
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[accordion title="I%20received%20an%20additional%20COVID-19%20charge%20on%20my%20dental%20bill.%20Is%20this%20approved%20by%20the%20College%3F"]CDSBC does not recommend or set specific fees for dental treatment.
That said, CDSBC expects dental offices to communicate all estimated fees to patients before providing treatment. The discussion of cost prior to treatment is, and always has been, an important part of obtaining informed consent from a patient, along with a thorough discussion of any risks, benefits, and options.
Individual dentists in BC and across Canada set their own fees based on their assessment of the costs of delivering care (which may include the cost of personal protective equipment). Fees may vary between offices, so it would be appropriate for anyone with a concern about fees to discuss the matter directly with the dentist. [/accordion]
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On March 23, 2020, Provincial Health Officer Dr. Bonnie Henry issued an update addressed to all regulated health professionals in BC. Health professionals were asked to limit delivery of in-person services in community settings and this message remains current, despite the recent discussion of lifting some of these measures at a future date. To be clear, the message from the Provincial Health Office continues to be that “all non-essential and elective services involving direct physical contact with patients and clients should be reduced to minimal levels, subject to allowable exceptions, until further notice.” Regulated health professionals are encouraged to provide services via telephone/video where possible. Timelines of when non-urgent in-person care can resume remain unknown and this direction will be provided by the Provincial Health Officer at the appropriate time. In the meantime, stay the course, limit in-person services to patients who require urgent care that cannot be delivered via telephone/video, and continue to consult the CDSBC website for up-to-date information. We are all looking forward to being able to receive healthcare services again. But as Dr. Henry and Minister Dix said on April 22: “We have been clear from the outset, we are taking a whole-province approach and we need every individual, every business and every community to do that same. We cannot afford to have any weakness in our firewall that will result in a surge in new cases. To ease restrictions, we need a continued decline in both the number of new cases and the number of outbreaks. Until we clear that important hurdle, we can’t begin to make changes.” The College has struck an expert COVID-19 Response working group to develop practice guidance for registrants should restrictions on physical distancing be lessened over the next few months. [/accordion]
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We did not require dental offices to close, but many effectively did because the requirement for physical distancing of at least two metres applies to dental professionals. CDSBC has echoed the expectations from the Public Health Officer, and has strongly recommended that dental offices reduce all elective and non-essential care to minimal levels. For in-person dental care, we expect that any dental care that doesn’t need immediate attention would be deferred with proper follow up. If the patient’s needs can be managed over the phone or via video technology, we encourage dentists to do so. For example, the dentist may determine that a prescription for antibiotics or pain medication is appropriate. Dentists are being asked to provide essential and emergency dental care to patients. This is to avoid negative outcomes for patients and to reduce the burden on the hospital system. That said, CDSBC does not expect any dental professional to provide treatment in person unless it is safe to do so for both patients and the dental team. This requires a risk assessment and adherence to existing infection prevention and control protocols, which set out the minimum requirements for personal protective equipment (PPE). The dentist may use enhanced PPE if, in their professional judgment, it is appropriate to do so. This information is a summary only. Full details can be found under “Recommendations & Expectations for Clinical Care in the COVID-19 Pandemic.”[/accordion]
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You can use one or both of the two new public resources from the provincial government:- A new COVID-19 self-assessment tool available at https://covid19.thrive.health/
- Dedicated 1 888 COVID19 phone service for information about COVID-19
This includes the latest information on travel recommendations and social distancing, as well as access to support and resources from the provincial and federal governments. British Columbians can reach service representatives seven days a week, from 7:30 a.m. to 8 p.m., by calling 1 888 COVID19. Information is available in more than 110 languages.
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[accordion title="Why%20hasn%E2%80%99t%20CDSBC%20shut%20down%20all%20dental%20offices%3F"]CDSBC does not have the legal authority to require dental offices to close. Our role is to alert our registrants that they must be in compliance with direction from the Provincial Health Officer and other government and public health directives.
We are strongly recommending that elective and non-essential dental care be suspended during this time.
Finally, dental team members are part of the front line of healthcare. Shutting down patient care is not a helpful measure, as oral healthcare providers are in a good position to provide advice, screen, and care for those who need care.[/accordion]
[accordion title="I%20have%20a%20dental%20emergency%2C%20but%20my%20dentist%E2%80%99s%20office%20is%20closed.%20Is%20my%20dentist%20obligated%20to%20treat%20me%3F"]Dentists are required to manage their patients when, in their professional judgment, there is a dental emergency. This may or may not involve active treatment being provided by the dentist.
All dental offices should have an emergency number for patients to reach a dentist. It is possible that your situation can be managed with over-the-phone instructions and/or a prescription.[/accordion]
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Archived Topic: FAQ for attendees of the 2020 Pacific Dental Conference
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[accordion title="I%20attended%20the%20Pacific%20Dental%20Conference%20and%20am%20now%20in%20self-isolation.%20Does%20this%20mean%20my%20family%2Fthe%20people%20I%20live%20with%20also%20need%20to%20self-isolate%3F%20What%20about%20my%20colleagues%20at%20work%20who%20did%20not%20attend%20the%20conference%3F"]We have been advised by the Office of the Provincial Health Officer that the requirement for self-isolation applies only to the people who attended the conference.
Family members of conference attendee do not have to self-isolate. Co-workers of conference attendees also do not have to self-isolate. The isolation period applies only to the primary contact, who is the conference attendee.[/accordion]
[accordion title="I%20wasn%E2%80%99t%20at%20the%20Pacific%20Dental%20Conference%20the%20entire%20time.%20What%20if%20I%20was%20only%20there%20on%20the%205th%20of%20March%3F%20Do%20I%20still%20need%20to%20self-isolate%3F"]Yes. Anyone who attended the 2020 Pacific Dental Conference – regardless of dates – is expected to follow the direction of the Provincial Health Officer to self-isolate until March 22, 2020. [/accordion]
[accordion title="I%20continued%20to%20work%20the%20week%20following%20the%20PDC%2C%20do%20my%20family%2C%20friends%2C%20coworkers%20and%20patients%20who%20didn't%20attend%20the%20PDC%20have%20to%20self-isolate%3F"]No. Advice from the Office of the Provincial Health Officer indicates that only those people who are one degree of separation from a potential source need to self-isolate. No one that you have been in contact with since attendance at the PDC needs to self-isolate.[/accordion]
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Self-isolation means staying home and not going to work or school, and monitoring for symptoms for a period of 14 days.The instructions from the Office of the Provincial Health Officer and the BC CDC are:- For the health of your family, friends and community, try to stay at home.
- Do not go to work or school.
- Do not go to public areas, including places of worship, stores, shopping malls and restaurants.
- Limit visitors to your home.
- Cancel or reschedule non-urgent appointments.
- Do not take buses, taxis or ride-sharing where you would be in contact with others.
- It is okay to have family/friends drop off food or you can use delivery/pick up services for errands such as grocery shopping.
There is additional guidance provided in this fact sheet.[/accordion]
[accordion title="Why%20did%20CDSBC%20allow%20the%20Pacific%20Dental%20Conference%20to%20go%20ahead%3F"]CDSBC was one of many exhibitors and presenters at the conference but we did not organize or sponsor it, and have no authority to have prevented it.
We understand that the conference organizers worked from the best information that they had at that time. We and they are working together to ensure that patients are protected going forward, beginning with the self-isolation of all conference attendees until March 22. [/accordion]
[accordion title="My%20dentist%20attended%20the%20PDC.%20Can%20they%20still%20treat%20me%20or%20my%20family%3F"]No. Anyone who attended the Pacific Dental Conference must self-isolate until March 22, 2020. They may not provide treatment during that time, and only from March 22 if they have not shown any symptoms of COVID-19. [/accordion]
[accordion title="I%20received%20care%20in%20a%20dental%20office%20after%20the%20Pacific%20Dental%20Conference%20but%20before%20attendees%20were%20directed%20to%20self-isolate.%20Should%20I%20be%20worried%3F"]The Office of the Provincial Health Officer has advised that only conference attendees require self-isolation. In addition, all dental offices are required to be in compliance with CDSBC’s infection prevention and control guidance. This includes the use of gloves, masks and eyewear to keep the practitioner and the patient safe. [/accordion]
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