[accordion title="BC's%20Restart%20Plan%20and%20Oral%20Health%20Care%20(July%2015%2C%202021)"]

As COVID-19 continues to circulate in our communities we anticipate that COVID-specific guidance for oral health care providers in BC will remain in effect until the pandemic is resolved. It is encouraging that BC’s COVID-19 provincial state of emergency was lifted at the end of June, and that the province has moved into step 3 of its restart plan. In light of this, CDSBC’s Standards & Guidance Committee is currently considering updates to Oral Health Care During Phases 2 and 3 of the COVID-19 Response to ensure it contains the information that oral health care providers need to continue providing safe care as the province moves through its reopening. Registrants will be advised of any updates to the guidance. 

[/accordion] 

[accordion title="Step%203%20of%20BC's%20Restart%20Plan%20(begins%20July%201%2C%202021)"]With the provincial government's announcement that step 3 of BC's restart plan begins on July 1, the mask mandate order that came into effect last November (2020) will be lifted. The mask mandate was always supplementary to the joint guidance document for registrants, Oral Health Care During Phases 2 and 3 of the COVID-19 Response. When the mask mandate is lifted and step 3 begins on July 1, the joint guidance document will remain in effect and will provide the information that CDSBC registrants need to continue providing safe care during step 3 of the province's restart plan (including expectations for personal protective equipment and continued screening). WorkSafeBC has also published updated information in response to BC's restart plan. Registrants should stay up to date with evolving WorkSafeBC requirements https://www.worksafebc.com/en/covid-19/bcs-four-step-restart[/accordion] 

[accordion title="Provincial%20rollout%20of%20COVID-19%20vaccines%20(March%2017%2C%202021%2C%20Updated%20May%202021)"]

The rollout of the COVID-19 vaccine is being led by the provincial government and B.C.'s individual health authorities. The College is supporting the successful rollout of the provincial immunization plan by distributing information to registrants as it becomes available.

[/accordion] 

[accordion title="In-Person%20Course%20Work%20Extension%20for%20Sedation%2FGA%20Team%20Members%20(March%2031%2C%202021)"] Throughout the COVID-19 pandemic, some of our registrants who are clinical sedation and/or general anaesthesia team members have experienced difficulty registering for and/or attending required in-person courses. In recognition of this, we announced last April that courses with in-person components could be deferred. This deferral is extended again until May 1, 2021. [/accordion] 

[accordion title="Giving%20the%20vaccine%3A%20revised%20health%20order%20condenses%20coursework%20requirements%20(March%2026%2C%202021)"]

The public health order expanding the health professions able to administer a COVID 19 vaccine was updated by Provincial Health Officer Dr. Bonnie Henry on March 24. Key updates for CDSBC registrants: The 15-hour BCCDC Immunizer Competency course (C1) required by CDSBC registrants wishing to become vaccinators (dentists and dental therapists) has been replaced with a 3-hour BCCDC COVID-19 Immunization Competency Course for Non-Nursing Professionals and Occupations. The coursework requirement for dentists to become vaccinators is now one module (module C1). The coursework requirement for dental therapists to become vaccinators is two modules. In addition to module C1, dental therapists are required to take module B: in-person education and clinical lab training to perform intramuscular injections as per the BC Centre for Disease Control's – COVID-19 Immunization Skills Checklist The Quality Assurance Committee has determined that CDSBC registrants who complete the above training may submit it for CE credits.The updated public health order is here >> Note that this order was first issued on February 23 and was previously updated on March 14. It may continue to be updated by Dr. Henry as B.C.'s immunization plan unfolds. Review CDSBC's COVID-19 updates for registrants >>

COVID-19 Emergency Health Provider Registry Regulated health professionals who are interested in participating in B.C.'s mass immunization program may register their interest via the COVID-19 Emergency Health Provider Registry (EHPR) webform. It is our understanding from the Ministry of Health that opportunities are not limited to those administering the vaccine. Interested CDAs may also have the opportunity in the clinics to assist with tasks such as obtaining patient information, helping to educate patients about the vaccine, and obtaining informed consent for patients without complex medical conditions. More information about signing up is provided by the EHPR in their FAQ.

[/accordion] 

[accordion title="Opportunity%20for%20all%20CDSBC%20registrants%20to%20support%20B.C.%E2%80%99s%20immunization%20campaign%20(March%202%2C%202021)"]

To help meet the need for additional health professionals to support B.C.'s COVID-19 immunization strategy, the Provincial Health Officer (PHO) has temporarily expanded scopes of practice for certain health care professionals, including dentists and dental hygienists, to allow them to support the province's vaccination program rollout. Read more in our February 24 message to registrants here >> The Ministry of Health has indicated there may be other non-immunization (e.g. administrative) activities within the immunization campaign and/or other health service roles that may apply to all registered health professionals, including certified dental assistants and dental therapists.

B.C.'s immunization program Planning for wide-scale immunization is ongoing across the province. The PHO orders are a first step in expanding the pool of professionals able to participate in the mass immunization clinics, which are anticipated to launch in phase 3 of BC's immunization plan, beginning in April. Read more >>

How can I get involved? The COVID-19 Emergency Health Provider Registry (EHPR) is a provincial resource that connects health authorities with health professionals who have indicated their ability to deploy during the public health emergency. Certified dental assistants, dental therapists and dentists who are interested in participating in the mass immunization campaign can register their interest online through the COVID-19 EHPR by visiting https://forms.hlth.gov.bc.ca/registry-covid-19. As noted above, the Ministry has indicated that there may be opportunities to support the immunization campaign for all interested health professionals, regardless of whether they are named in the order. Providers are asked to fill out all fields in the online registration form as completely as possible to ensure health authorities can efficiently and appropriately contact you as needed. If you have questions about this process, please refer to these FAQs or email healthlinkbc@gov.bc.ca (include “COVID EHPR" in the subject line). Health authorities may also be posting specific positions or expressions of interest in the future. You are encouraged to monitor the website of your regional health authority for opportunities to express your interest directly.

[/accordion] 

[accordion title="Dentists%20Among%20Health%20Professionals%20Included%20in%20Public%20Health%20Order%20as%20B.C.%20Prepares%20for%20Widespread%20Mass%20Vaccinations%20(February%2024%2C%202021)"]

Provincial Health Officer Dr. Bonnie Henry has issued a public health order expanding the number of health professions who are able to administer a COVID-19 vaccine. Dentists are among the health professionals listed in the order, which also includes dental hygienists, midwives, retired registered nurses, nursing/midwifery students, podiatrists, anesthesia assistants, medical lab technologists/assistants and pharmacy technicians.  

CDSBC will provide further information on this as it becomes available.  

This order is provided as part of a wider public health initiative that will be overseen by the health authorities. According to the February 23 joint statement from Dr. Henry and Minister Dix, the province is preparing for widespread mass vaccinations, beginning in April: “We are moving forward carefully and thoughtfully to ensure our systems and our health authorities have the tools and resources to take on the significant task ahead."  

The order sets out specific requirements, including that the immunization program will be approved by the medical health officer for that geographic area. It sets out both the mandatory training that is required, as well as specific limits for the different health professions. Further details are available in the order.  

The order, titled “Regulated and Unregulated Health Professionals SARS-CoV-2 Immunization Order – February 23, 2021," is issued under the Health Professions General Regulation. It does not include health professionals who can normally provide immunization services under their health profession regulations.  

Read the order here >>  

It is important to note that this order is provided in the context of a mass vaccination program. At this time, we do not have reason to believe vaccinations will take place within private dental offices.  

[/accordion] 

[accordion title="Message%20from%20the%20Registrar%3A%20COVID-19%20Update%20for%20Registrants%20(January%2028%2C%202021)"] Dear Registrants,

Today marks one year since the first case of COVID-19 in BC was announced. I recognize and acknowledge the sacrifices that each of you, as oral health professionals, has made over these past months in rising to the challenges of providing dental care.

In the early and uncertain days at the beginning of the pandemic, you kept your doors open where possible and allowed access to frontline oral health care for patients who needed you. And you have continued to provide the care necessary for the health of all British Columbians.

You have been asked to make unprecedented changes to the way you run and work in your practices. You have coped with the stress of adjusting your operations at a time where your business cannot function as usual. In the face of continued uncertainty, all of you have made financial and other sacrifices on behalf of patient safety.

Your individual actions on behalf of each of your patients have impacted and shaped the health and safety of the greater community. You have successfully and effectively implemented the public health measures and regulatory guidance required to reduce virus transmission.

However, as we await the day when all of the measures we are taking to reduce transmission begin to turn the tide of the pandemic, it is more important than ever to remain vigilant.

Continued patient and practitioner safety
The College’s role, as the regulator, is to ensure that the delivery of dental care is safe. It is reassuring to note there have been no reports of COVID-19 transmission at the dental treatment interface. The BC Centre for Disease Control is now publishing data about health care worker infections and it shows that case counts among oral health professionals remain low, with all cases contracted through community contact. This confirms the good work being done to prevent transmission in the dental office. You can stay up to date here >>

As we wait for the vaccine to be rolled out over the coming months, continued adherence to public health orders and directives, as well as the Infection Prevention and Control (IPAC) guidelines, and the joint guidance document Oral Health Care During Phases 2 and 3 of the COVID-19 Response are crucial. We know the recommended control measures are effective in reducing transmission: public health measures, environmental measures, administrative measures, personal measures, and personal protective equipment. It is important to remain compliant in all these areas to reduce the risk of COVID-19 transmission.

The two documents linked above lay out the responsibilities of oral health care providers to protect your patients, your staff and yourselves.

B.C.’s immunization plan
We recognize that many of you have important questions about when you will be eligible for a vaccination, or how you can help with the rollout of the COVID-19 vaccinations in B.C. Last week, the B.C. government shared the strategy for the province’s COVID-19 Immunization Plan. The answers to your concerns and inquiries will become clearer as the next few weeks go by.

Given the limited supply of approved vaccines, the government’s plan is focused on saving lives and maintaining capacity within the healthcare system, stopping the spread of COVID-19 by prioritizing those most vulnerable to severe illness and those charged with their immediate care and support.

The evidence indicates that age is the most significant factor impacting an individual's risk of severe illness and death. That risk is increased by the presence of certain severe chronic diseases and illnesses and living conditions. As such, priority to receive the vaccine will be based on age and contributing medical histories including those living in long term care facilities. The College supports this approach given the limited vaccine supply. Learn more >>

Expectations for professional and ethical conduct
Finally, now, more than ever, it is critically important for you as registrants to be compliant with the College’s expectations for professional and ethical behaviour. Only weeks after an independent investigation confirmed widespread racism in B.C.’s healthcare sector, there have been reports of racism related to COVID-19. Dr. Bonnie Henry and Minister Dix have spoken out against this, and the three political parties issued a joint statement this week:

“The disturbing examples related to COVID-19 cases in Indigenous communities and the recent report by Mary Ellen Turpel-Lafond into systemic racism in our health care system highlight the need for each of us to take an active role in stopping anti-Indigenous racism and racism in all its forms, everywhere. That is an act of reconciliation in which every one of us as individuals has a clear and critical role.” -- Murray Rankin, Minister of Indigenous Relations and Reconciliation, Rachna Singh, Parliamentary Secretary for Anti-Racism Initiatives, and Sonia Furstenau, BC Green Party leader

This is an important reminder that in the context of healthcare, all patients deserve care that is free of discrimination and racism.

In closing, I want to thank you for your continued commitment and vigilance on behalf of the patients you care for. In these unprecedented circumstances, now is the time for you, as trusted professionals, to lead by example. Thank you for all of these efforts you continue to make in providing the safest and best care possible for your patients.

Stay safe. Be well,

Dr. Chris Hacker, Registrar/CEO

Resources

CDSBC’s updates and resources are available at www.cdsbc.org/about-cdsbc/news/covid-19. The key documents are:

• Oral Health Care During Phases 2 and 3 of the COVID-19 Response
• CDSBC’s Infection Prevention and Control Guidelines

Registrants seeking further guidance around protocols for dental offices (including the use of masks) are encouraged to refer to:

• Government of BC: COVID-19 Immunization Plan
• Orders of the Provincial Health Officer
• BC Centre for Disease Control
• Information tailored to health professionals in BC is available from the BC Centre for Disease Control at www.bccdc.ca/health-professionals/clinical-resources/novel-coronavirus-(covid-19).
• Public Health Agency of Canada
• World Health Organization

[/accordion] 

[accordion title="Update%20for%20Registrants%20Re%3A%20Provincial%20COVID-19%20Modelling%2C%20Mask%20Use%2C%20and%20Regional%20Restrictions%20(November%202020)"] Update: On November 24, an order mandating masks in all public indoor spaces came into effect. This applies to all common areas, such as waiting rooms of dental clinics. Read the order (and applicable exemptions) here: https://www.bclaws.gov.bc.ca/civix/document/id/mo/mo/m0425_2020
[/accordion] 

[accordion title="Oral%20Health%20Care%20During%20Phases%202%20and%203%20of%20the%20COVID-19%20Response%20(August%2018%2C%202020)"]

Dear Registrants, As B.C. continues in phase 3 of the government’s COVID-19 response, the interim guidance document for oral health care providers has been updated to ensure patients continue to receive safe and timely care. The updated document replaces the May 15 document titled Transitioning Oral Healthcare to Phase 2 of the COVID-19 Response Plan. Read the updated document at the link below: Oral Health Care During Phases 2 and 3 of the COVID-19 Response (August 18, 2020) >> A comparison document showing markup of changes between May 15 and August 18 guidance documents is available here. Key updates in this version include: Revised patient and staff screening protocols Increased detail related to screening for suspected or confirmed COVID-19 positive patients and patients vulnerable for severe expression of COVID-19 Updated personal protective equipment (PPE) for patients and providers (including a table outlining PPE by procedure and COVID-19 status of patient) Precautions for patients with suspected or confirmed COVID-19 A public-friendly version of the interim guidance document for oral health care providers has been created to help patients understand what to expect when seeking dental care. Guidance for Patients: What to expect when visiting a dental office during Phase 2 and 3 of BC’s response to the COVID-19 pandemic >>   Recommended Resources for Health Professionals Expert advice on the clinical aspects of COVID-19 comes from federal and provincial health and other governmental authorities. Our role as the regulator is to provide clear signposting to the current guidance provided by those higher authorities. The following agencies have provided specific information about COVID-19: BC Centre for Disease Control Provincial Infection Control Network (PICNet) Ministry of Health and the Office of the Public Health Officer WorkSafeBC BC’s Restart Plan The material provided by these agencies is updated regularly as new information becomes available, and registrants can expect CDSBC’s guidance to evolve as the material provided by these agencies is updated.

[/accordion] 

[accordion title="Expansion%20of%20Dental%20Care%20in%20Phase%202%20(May%2015%2C%202020)"]

Following guidance sent by CDSBC to registrants today about COVID-19, the BC Centre for Disease Control published a new document called “Infection Prevention and Control Guidance for Community-Based Allied Health Care Providers in Clinic Settings.” This document contains BCCDC’s authoritative guidance with respect to the use of N95 masks: these are only required for aerosol generating medical procedures with patients with suspected or confirmed COVID-19. The guidance document we distributed today (below) has been updated to reflect this change (please see section 7.b.ii: “Exposure prevention” and “9. Schedule of changes”)

As Premier Horgan has announced, next week is the start of the transition to phase 2 of the government’s COVID-19 response. This includes the expansion of community-based healthcare services, such as dentistry, under enhanced protocols.

Thank you for your patience as we awaited further direction from the Provincial Health Officer. That direction has arrived, and we are pleased to share it with you here, so that you can begin to plan how to safely resume in-person services. We are also providing specific guidance and protocols for oral health professionals to prevent the transmission of COVID-19 during emergent, essential and non-essential care of patients.

COVID-19: Important Update from the Provincial Health Officer (May 15, 2020)

In this letter to healthcare professionals, Provincial Health Officer Dr. Bonnie Henry discusses the easing of restrictions on health care services beginning the week of May 19. She highlights the accountability of health professionals to ensure the health and safety of patients and clients, colleagues, and support staff in every healthcare setting.

Read Dr. Henry’s letter here >>

Transitioning Oral Healthcare to Phase 2 of the COVID-19 Response Plan (May 15, 2020)

This interim guidance document consolidates CDSBC’s existing standards, guidance, and interim recommendations on COVID-19 with recommendations and direction from other authoritative agencies. It has been endorsed by all four oral health regulators and applies to certified dental assistants, dental hygienists, dental technicians, dental therapists, denturists and dentists.

The College expects registrants to read this guidance and follow the expectations within it as you resume the provision of dental care. It is a comprehensive document that covers topics such as ongoing pandemic best practices, personal protective equipment, and infection prevention and control principles and strategies. It replaces CDSBC’s previous guidance and expectations published prior to May 15, 2020, i.e. for phase 1 of the pandemic.

Read Transitioning Oral Healthcare to Phase 2 of the COVID-19 Response Plan here >> [/accordion] 

[accordion title="Phase%202%20of%20B.C.'s%20Restart%20Plan%20Begins%20May%2019%20(May%208%2C%202020)"] On Wednesday, Premier Horgan announced that British Columbia will be moving into Phase 2 of its restart plan on May 19, 2020.

This next phase of B.C.’s COVID-19 response anticipates more access to dental and other healthcare services under enhanced protocols. This means patients should be able to look forward to increased access to in-person elective care in a safe environment.

The guidance and recommendations provided to registrants so far during the COVID-19 pandemic remains available at www.cdsbc.org/about-cdsbc/news/covid-19/covid-19-for-registrants. [/accordion] 

[accordion title="Expectations%20and%20Pathway%20for%20Patient%20Care%20during%20the%20COVID-19%20Pandemic%20(April%2030%2C%202020)"] Note that this document has been temporarily unpublished in light of the May 15 COVID-19 update for registrants. It will be reposted once it has been udpated to align with that information. [/accordion] 

[accordion title="Self-study%20CE%20maximum%20temporarily%20removed%20in%20response%20to%20COVID-19%20(April%2022%2C%202020)"] CDSBC is seeking ways to reduce barriers to our registrants and support the need for physical distancing in order to prevent the transmission of COVID-19. The following announcement applies to all registrants.

We recognize that registrants may struggle to meet their continuing education (CE) requirements as a result of cancellations to in-person professional development activities during this unprecedented time. [/accordion] 

[accordion title="Ministry%20of%20Health%20Proposes%20Amendments%20to%20Health%20Professions%20General%20Regulation%20(April%2021%2C%202020)"] On April 21, the Ministry of Health announced that it is proposing amendments to the Health Professions General Regulation. Note that the notice period outlined below is 24 hours, ending at 11:59 pm on April 22, 2020.

Health regulatory colleges in British Columbia regulate using the Health Professions Act, the Health Professions General Regulation, specific professional regulations, and their own bylaws. To learn more about the specific regulations and bylaws for CDSBC, visit: www.cdsbc.org/about-cdsbc/regulations-bylaws.

Scopes of practice

The proposed amendments would give the Provincial Health Officer, during a declared public health emergency (e.g. COVID-19), the power to give certain health professionals or classes of health professionals authority to work outside of their regular scopes of practice. These services would be subject to limitations and conditions imposed by the Provincial Health Officer and situations where the health professional(s) could provide the services safely.

These regulations on their own do not authorize professionals to work outside their regulatory scope of practice, rather this would have to be authorized through an order by the Provincial Health Officer.

Complaints and investigations timelines

Additionally, the Ministry is proposing minor amendments to the Health Professions General Regulation to allow for a temporary suspension of complaints and investigations timelines during the COVID-19 public health emergency. To be clear Colleges' obligation to investigate and regulate their registrants is not suspended – they continue to have obligations to the public. Their investigations can continue during the state of emergency, this change in regulation is just an acknowledgment that there may be delays beyond the College or registrant's control – and that steps need to be taken to ensure that investigations don't get needlessly suspended and the public put at risk.

View the proposed amendments

The proposed amendments are posted here >>

The notice period that is required by the Health Professions Act before the proposed regulation amendments can be brought into force will begin on April 21, 2020, and due to the priority of implementing the changes in response to COVID-19, it is anticipated that the notice period for the changes will be shortened to 24-hours.

How to provide comment

The Ministry requests that any comments on these proposed regulation amendments be submitted by 11:59 pm on April 22, 2020. Please submit comments by e-mail to the Professional Regulation and Oversight Branch of the Ministry of Health at: PROREGADMIN@gov.bc.ca[/accordion] 

[accordion title="%20Changes%20to%20Sedation%2FGA%20requirements%20in%20response%20to%20COVID-19%20(April%2021%2C%202020)"] CDSBC is seeking ways to reduce barriers to our registrants and support the need for physical distancing in order to prevent the transmission of COVID-19. The following announcement applies to sedation providers and to deep sedation and general anaesthetic service facilities.

We recognize that some regulatory processes and requirements for sedation and general anaesthesia may be difficult, or even impossible, to accomplish at this time. The following changes are intended to provide additional flexibility. We request that all documents be submitted electronically in order to avoid unnecessary delay. [/accordion] 

[accordion title="Prescribing%20drugs%20under%20the%20Controlled%20Prescription%20Program%20during%20the%20COVID-19%20pandemic%20(April%202%2C%202020)"] Physical distancing, self-isolation, and quarantine are preventing some patient-clinician interaction. This may have an impact on patients requiring prescriptions for drugs under the Controlled Prescription Program (CPP). [/accordion] 

[accordion title="Recommendations%20%26%20Expectations%20for%20Clinical%20Care%20in%20the%20COVID-19%20Pandemic%20(March%2029%2C%202020)"] Dear members of the dental team,

Every health professional is being asked to play an important front-line role to contain the spread of the COVID-19 virus and provide essential health services. On March 26, the provincial government announced additional measures being taken under the Emergency Program Act, and included dentists on the list of essential direct-to-public health services during the COVID-19 pandemic. The Provincial Health Officer and Minister Dix have also said that the health of workers in the healthcare system is paramount, and you will see this reflected in their calls to the public to keep healthcare workers safe and in the detailed guidance on the BCCDC website.

Everyone at CDSBC knows this is a difficult position at a stressful time for all oral health practitioners, especially as you are being asked to make unprecedented changes to the way you run your practice.

Over the last weeks, the COVID-19 response has been evolving and changing. We understand gathering information and applying it in the context of oral health care has been extremely challenging. As such, we have been liaising with the Ministry of Health, the Office of the Provincial Health Officer, professional associations and other regulators to help determine the level of information we provide.

Expert advice on the clinical aspects of COVID-19 should and will continue to come from federal and provincial health and other governmental authorities, including the BC Centre for Disease Control. We, as the regulator, cannot create that advice; our role will be -- and must be – limited to providing clear signposting to all the current guidance provided by those higher authorities.

CDSBC does not expect any dental professional to provide treatment unless, in your professional opinion, it is safe to do so for both patients and the dental team. For our part, we will expect dental professionals to be aware of current guidance and to make decisions informed by it but we won’t be looking to second guess your clinical judgments made on that basis.

We understand the stresses you feel at a time where your businesses cannot function as usual, with the need for dental practices to be operating in a very different way. The recommendations and expectations that follow are intended to assist you in your decision-making.

We are all functioning differently, all of us are adjusting the way we work and live in this unfamiliar situation. It is a new experience for everyone. As Dr. Henry said yesterday, "we must be united in this, and 100% committed until we flatten this curve."

Recommendations & Expectations for Clinical Care in the COVID-19 Pandemic
March 29, 2020 (note: these replace the March 16, 2020 recommendations that were sent to registrants and posted on our website.)

Context

Novel coronavirus (COVID-19) is a new and emerging infectious disease threat. There is still much uncertainty around its clinical presentation, but the spectrum of disease may range from mild to moderate illness to pneumonia or severe acute respiratory infection.

Symptoms may include:

• fever
• tiredness (fatigue)
• dry cough
• more infrequently, patients may have aches and pains, nasal congestion, runny nose, sore throat, diarrhea or may show no symptoms at all

Modes of transmission of COVID-19 are:

• droplet spread
• interpersonal contact (e.g. direct or indirect contact with human fluids)
• contact with contaminated surfaces (COVID-19 can persist on certain surfaces from a few hours up to several days depending on the surface and ambient conditions)

Infectivity of symptomatic and COVID-19 positive patients:

• the science around durations and intensity of infectivity is still evolving
• the milder the symptoms, the less infectious the patient appears to be
• patients are most infectious at day 4 of symptoms and should remain in isolation for 10 days after the resolution of symptoms
• it appears patients who have been positive for the disease will develop immunity for at least a few months post-infection

Below are CDSBC's expectations regarding the provision of dental care during the COVID-19 pandemic:

1. CDSBC continues to strongly recommend all elective and non-essential dental services involving direct physical contact be reduced to minimal levels.
   
   
2. Management of time sensitive treatment and essential and emergent concerns by registrants that helps avert or avoid negative patient outcomes will continue and be as minimally invasive as possible. The oral health care provider can determine the best place and manner in which the care can be delivered safely and appropriately. Management may include referral to an appropriate facility.
   
   
3. Protocols for management of time sensitive treatment and essential and emergent concerns should follow current expert peer-reviewed guidelines and recommendations.
   
   
4. Where possible, telephone and other forms of virtual technology are encouraged and should be used for triaging patient concerns. All dental offices should have an appropriate voicemail, email out-of-office, and email and telephone that are monitored daily.
   
   
5. All patients will be assessed and screened for symptoms of COVID-19 prior to any treatment considerations. If the patient has suspected or confirmed COVID-19 disease, and if the appropriate treatment requires direct physical contact, appropriate personal protective equipment (PPE) and infection prevention and control practices must be used.
   
   
6. Health professionals are in the best position to determine what is essential for their patient's well-being and these choices should be guided by principles of proportionality, harm reduction, fairness and reciprocity.
   
   
7. If the determined care requires physical contact, all registrants will perform a thorough pre-treatment risk assessment that includes risk to the patient, to the oral heath care provider and to the greater community before any treatment is undertaken. If risks are identified that cannot be immediately or sufficiently mitigated, the determined care must be postponed or referred to an appropriate provider.
   
   
8. If the determined care requires physical contact, the facility and staff will be compliant with expert authoritative opinion and existing CDSBC standards and guidance. Part A, Section 7 of CDSBC's Infection Prevention and Control Guidelines requires additional precautions in cases where patients are known or suspected of having an infection that can be transmitted by respiratory droplets. Additional precautions include enhanced appropriate personal protective equipment (PPE) for staff and patient, required patient hand hygiene and isolation, and capacity for social distancing.
   
   Recommendations for appropriate PPE can be found through BCCDC, Health Canada, authoritative health agencies and governmental bodies and expert opinion.
   
   Capacity to provide appropriate PPE for all oral healthcare providers must be assessed before treatment can be initiated. If appropriate PPE cannot be provided, the care must be postponed or referred to an appropriate provider.
   
   
9. Following remote or virtual triage, when considering management options, registrants will receive full informed consent from the patient before moving forward with definitive treatment decisions including transfer to another facility.
   
   
10. Advice, comments and care provided by registrants will be in keeping with current evidence provided by the scientific community. Registrants will not prescribe or recommend unproven treatments or medications for COVID-19.
    
    
11. Registrants will stay up to date with federal and provincial laws and with expectations of federal and provincial public health agencies to keep patients, staff and themselves safe. Registrants will comply with orders, recommendations, expectations and updates from the Office of the Provincial Health Officer.

References and Resources:

• BC Government List of Essential Services (March 26, 2020)
  https://www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/covid-19-provincial-support/essential-services-covid-19
  
• CDSBC Guidelines for Infection Prevention and Control: www.cdsbc.org/CDSBCPublicLibrary/Infection-Prevention-and-Control-Guidelines.pdf
• Defining Emergent, Essential (Urgent), and Non-essential (Elective) Care in Dentistry, CDSBC www.cdsbc.org/about-cdsbc/news/covid-19/defining-care
• BC Centre for Disease Control: COVID-19 Information for Health Professionals
  www.bccdc.ca/health-professionals/clinical-resources/covid-19-care
• BCCDC Clinical Reference Group Recommendations: Unproven Therapies for COVID-19 www.bccdc.ca/Health-Professionals-Site/Documents/Recommendation_Unproven_Therapies_COVID-19.pdf
• COVID-19: Important Update from the Provincial Health Officer (March 23, 2020) www.cdsbc.org/Documents/covid-19/PHO-Letter-Non-Essential-Services-Health-Mar-23-20.pdf
• COVID-19 Emergency screening of dental patients using teledentistry, Royal College of Dental Surgeons of Ontario (March 26, 2020) www.rcdso.org/en-ca/rcdso-members/2019-novel-coronavirus/covid-19---emergency-screening-of-dental-patients-using-teledentistry
  
• COVID-19: Temporary Authorizations for Controlled Drugs and Substances, College of Pharmacists of BC www.bcpharmacists.org/news/bc%E2%80%99s-covid-19-response-%E2%80%93-temporary-authorizations-controlled-drugs-and-substances

[/accordion] 

[accordion title="Provincial%20Health%20Officer%20Dr.%20Bonnie%20Henry%20issues%20expectations%20for%20regulated%20health%20professionals%20during%20COVID-19%20pandemic%20(March%2024%2C%202020)"] Provincial Health Officer Dr. Bonnie Henry has issued an important update for regulated health professionals in BC, including certified dental assistants, dental therapists, and dentists.

The update, issued March 23, 2020, provides Dr. Henry’s expectations for health professionals regulated under the Health Professions Act when providing patient and client care in community settings. It is intended to assist you in your decision-making to ensure professionals are all delivering the best and safest care to patients throughout this evolving crisis.

Read the update from Dr. Bonnie Henry (PDF).

Dr. Henry’s update is consistent with the guidance we have distributed to registrants and is available on the COVID-19 page of our website.[/accordion] 

[accordion title="One%20goal%3A%20to%20save%20lives%20(March%2022%2C%202020)"] Dear members of the dental team,

This morning we awoke to yet another new reality, to more change in an ever changing landscape. From reports overnight, it is apparent the novel coronavirus has landed hard in the dental community. Oral health care providers are testing positive for COVID-19 in increasing numbers throughout the province, some having been hospitalized with life-threatening and life-changing disease.

It is clear that we are entering a critical phase in the fight against COVID-19. Over the next 10 days, everything we do must have one goal, to save lives. Everything we do, or don't do, must shut down transmission.

Transmission has been aided by bias and denial on behalf of those patients and practitioners who continue to seek and provide non-essential care, aware or unaware they are symptomatic. Regardless of individual behaviour, however, it is apparent we have arrived at the beginning of the vertical growth portion of the transmissibility curve. As front line workers, we must begin to see ourselves as agents of both prevention and transmission, ensuring the former but mitigating and eliminating the latter.

Provincial and national bodies, from governments to health authorities, from associations to regulators, have been struggling to find balance between levels of prescriptive direction. From orders to recommendations, they all end up in the same place, leaving it to the discretion of the practitioner and the profession to determine the necessary essential or emergent care that is in the best interest of the patient, the attending health care workers and the extended community.

CDSBC and the BCDA have been working through the weekend to provide prescriptive guidance on triaging and managing emergent and essential care for your patients. We will also be providing more definition around appropriate personal protective equipment (PPE). As soon as we confirm alignment with the authoritative public health bodies, we will distribute that to you on an urgent basis.

All of us, when we decided to enter the profession, expressed a desire to help others as the reason to be considered for inclusion in dentistry. Upon graduation, we committed to honour the social contract, to always act in the best interest of our patients, and for the health and well-being of the community in which we live and work. Now is the time to exercise those passions and obligations. It's not too late to help flatten the curve, but it is our individual actions on behalf of each of our patients that will impact and shape the health of that greater community. This is where the responsibility lies. This is where behaviour must change.

Dr. Chris Hacker
Registrar and CEO, CDSBC[/accordion] 

[accordion title="Defining%20Emergent%2C%20Essential%20(Urgent)%2C%20and%20Non-Essential%20(Elective)%20Care%20in%20Dentistry%20(March%2019%2C%202020)"] Dental healthcare providers rely on their professional judgment and clinical expertise to make decisions in the best interests of their patients. As a regulator, CDSBC normally avoids providing prescriptive, clinical advice because we recognize that professionals have the training and the expertise to make decisions and provide care based on the unique needs of each individual patient.

However, under the lens and pressure of a pandemic, we recognize dental healthcare providers and patients will sometimes want and require more detailed guidance.

Much concern has been expressed about determining and defining the differences between emergent, essential (urgent) and non-essential (elective) care.

As professionals, we need to make decisions and provide care in ways that will decrease the burden on hospital departments, allowing them to focus on the critical support of patients affected directly by viral infection.

By limiting the types of care provided and respecting the need for social distancing and subsequent transmission, we can help flatten the curve of transmissibility and prevent overwhelming these facilities. As well, by triaging, managing and providing emergent and essential care, dentists can help solve patient concerns before they reach the level of hospitalized care.

CDSBC has not asked you to close your offices. But we are strongly recommending that provision of all non-essential (elective) care be suspended immediately. To help practitioners better interpret this recommendation, we provide the following definitions of emergent, essential (urgent) and non-essential care. Emergency dental care is defined as potentially life-threatening conditions requiring immediate management or treatment to stop ongoing tissue bleeding, alleviate severe pain or infection and include:

• Cellulitis as a result of an uncontrolled infection compromising the airway
• Severe uncontrolled hemorrhage (bleeding)
  
• Trauma to the orofacial complex especially to facial bones that potentially compromise the patient’s airway
• Uncontrolled severe pain
• Uncontrolled infection

 

ESSENTIAL (URGENT) CARE
 

Essential care is separate from emergency care and focuses on the management and treatment of conditions that require immediate attention to relieve pain and/or risk of infection. These should be treated as minimally invasively as possible. These conditions would include (but not limited to):

• Pericoronitis or third molar pain
• Post-operative osteitis (dry socket dressing changes)
  
• Abscess with localized pain and swelling
• Treatment required before critical medical procedures can be provided
• Dental trauma involving avulsion or luxation of a tooth
• Tooth fracture resulting in pain or causing soft tissue trauma

 

NON-ESSENTIAL (ELECTIVE) CARE
Non-essential care is routine or non-urgent procedures and would include (but not limited to): [/accordion] 

[accordion title="Letter%20to%20All%20Registrants%3A%20We're%20Here%20to%20Help%20(March%2019%2C%202020)"] To the CDSBC community,

You know how serious the situation is. It is impacting all of us – personally and professionally. I too am in self-isolation. I am writing you today with a promise, and a request.

Over the last day, the federal and provincial governments have announced measures to support our citizens in this crisis. Our political leaders are re-writing legislation, introducing new funding and benefits to protect families, jobs and businesses, and delaying payment deadlines.

My promise is that the College is also committed to bold action at this critical time. While we live constantly with the minutiae of regulatory requirements, more importantly, what we care deeply about is doing whatever is necessary to protect your health and well-being as healthcare providers, so that you can do the same for your families, your neighbours - and your patients.

Many messages sent to us have expressed anxiety or uncertainty – or worse. However, it is remarkable and inspiring to see how many of you have put up your hand to ask how you can help. Others have submitted ideas as to how we can stop the spread of the virus and provide the care our patients need.

Building on your suggestions, and Dr. Bonnie Henry’s remarks about the broader requirements to deliver healthcare, I intend to take up the challenge of working with partners within and outside dentistry to facilitate the public's access to essential and emergent dental care. We will need your help to coordinate the assignment of the necessary people and personal protective equipment - and to join forces to provide the required dental care to both patients you know and those you don't.

There are many questions still to be answered. But this is a situation like most of us have never seen. It is forcing us to go beyond our limits. We are united now in our shared obligation to each other and to our patients in a way that many of us never imagined.

Now the request: It is imperative we remain united and that we support the actions of the Public Health Officer, Dr. Bonnie Henry, and the Ministry of Health. If you have any concerns or requests, please direct them to either your professional association or to us as your regulator, not to the Office of the Public Health Officer. Dr. Henry and her team must be allowed to continue to focus on the critical work of monitoring and responding to this public health emergency. We as British Columbians are relying on her incredible leadership. As she said so eloquently yesterday, "Legal orders are measures of last resort. We all must do our civic duty to proactively protect our community." Dental offices must stay open where possible, allowing access to frontline oral health practitioners by patients who need them. The College also expects that your communications to patients and staff are consistent with what Dr. Henry and other health officials have stated.

We need to follow the call to action from Dr. Henry, Minister Dix, and Premier Horgan. It is our shared responsibility. It is also the only way we will win the battle with COVID-19. With your continued commitment, we will get through this together.

Take good care, stay strong, please help however you can.

Dr. Chris Hacker
Registrar and CEO, CDSBC[/accordion] 

[accordion title="CDSBC%20Statement%20on%20COVID-19%20(March%2017%2C%202020)"] To all of you in the CDSBC community,

This afternoon Provincial Health Officer Dr. Bonnie Henry announced that the COVID-19 crisis has been declared a public health emergency. You can stay up to date on news from the office of the Provincial Health Officer here. The Ministry of Health is publishing all of the COVID-19 statements here. Audio recordings of the press conferences are available at soundcloud.com/bcgov.

Dr. Henry and Minister Dix have demonstrated leadership and transparency by providing daily updates on the spread of COVID-19. Like you, we at CDSBC are doing our best to stay on top of the changing situation and what actions we as individuals need to take. But I hope that above all, we can take Dr. Henry’s words to heart: “This is our time to be kind, to be calm, and to be safe.”

New resources for COVID-19
Since yesterday, the province has announced two new resources related to COVID-19
1. New COVID-19 Assessment Tool: https://covid19.thrive.health/
2. Dedicated 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.

Requirement for immediate self-isolation for PDC attendees I want to thank the many people who have submitted comments and questions in response to our announcement yesterday. Please know that we are tracking your messages as they come in, and the staff team is doing our best to respond to the different topics and issues. We are balancing the need to communicate quickly with the need to provide information that is accurate, and this requires us to do our research.

Our first priority today was to answer your questions about Dr. Henry’s requirement for immediate self-isolation for anyone who attended the Pacific Dental Conference earlier this month. This conference is being treated as a cluster, and it is imperative that we follow this direction and remain in self-isolation until March 22. Many of our staff at CDSBC attended the conference, and they too are in self-isolation.

You can read our responses to the most commonly-asked questions about self-isolation for PDC attendees here: www.cdsbc.org/Pages/covid-19-faq.aspx

What we’re working on nextI appreciate that many of our registrants have questions about my announcement yesterday, including concerns about mandated closure. We will be providing more information shortly.

Finally, I refer you to Minister Dix’s words today. In recognizing the sacrifices that every one of us is making in this difficult time, Minister Dix noted: “These are our duties to our communities, to the ones we love…and the ones we don’t know.”

Dr. Chris Hacker, Registrar and CEO [/accordion] 

[accordion title="Urgent%20Message%20from%20Registrar%2FCEO%20about%20COVID-19%20(March%2016%2C%202020)"] Elective and non-essential dental services to be suspended immediately; Attendees of 2020 Pacific Dental Conference to self-isolate

To the certified dental assistants, dental therapists and dentists of the College of Dental Surgeons of BC (CDSBC):

In the words of our Prime Minister today, exceptional circumstances are calling for exceptional measures, and it is time to take every precaution to keep people safe.

In alignment with today's direction from the Office of the Provincial Health Officer, CDSBC is now able to offer the following recommendations and guidance in response to the COVID-19 pandemic. This guidance is in place until further notice and we will be in regular contact with you, knowing that this situation is rapidly changing.

CDSBC and CDHBC have worked collaboratively on this message to provide consistent instructions to all dental professionals.

Below are CDSBC's recommendations regarding the provision of dental care:
Anyone who attended the 2020 Pacific Dental Conference must immediately self-isolate. A joint statement from the BC Ministry of Health and Dr. Bonnie Henry asks that anyone who attended self-isolate until March 22, 2020.

March 29 Update: Note that the struck out text below (items 1 through 4) has been replaced with the updated recommendations and expectations shared on March 29.

1. CDSBC strongly recommends that all elective and non-essential dental services be suspended immediately.

2. Management of emergent concerns by registrants must continue. These would include patients requiring immediate treatment due to infection, acute pain and/or trauma. The oral health care provider can determine the best place and manner in which the care can be delivered safely and appropriately. Management may include referral to an appropriate facility.

3. All registrants must perform a thorough pre-treatment risk assessment that includes risk to the patient, to the oral heath care provider and to the greater community before any treatment is undertaken. If risks are identified that cannot be immediately or sufficiently mitigated, the determined care must be postponed or referred to an appropriate provider. Pre-screening of patients by phone is preferable. Offices should develop a pre-screening protocol for patients who present in person.

4. Care provided must be compliant with existing CDSBC Infection Prevention and Control (IPAC) standards and guidance or the treatment must cease. Capacity to provide appropriate personal protective equipment (PPE) for all oral healthcare providers must be assessed before treatment can be initiated.

CDSBC is also changing our business practices in response to this emerging situation. As a result:

5. All in-person meetings have been suspended until further notice, all speaking engagements and presentations by CDSBC staff are cancelled until further notice, all non-essential business travel for staff has been cancelled. All oral health care providers and CDSBC employees must follow current advice from the Office of the Provincial Health Officer.

6. We are reviewing the requirements for sedation certification and Quality Assurance (QA). Consideration is being given to extending current permits, extending deadlines for renewals and extending expiration dates of certificates including basic life support certification (BLS). Registrants can continue to earn and pursue continuing education (CE) credits but should not feel compelled to attend live or interactive sessions in order to fulfill requirements. Further clarification will be provided in the near future. It the responsibility of all of us as medical professionals to stay up to date with the requirements of public health agencies to keep ourselves, our staff and our patients safe.

We will be publishing all of our updates on the COVID-19 page of our website.

Dr. Chris Hacker, Registrar and CEO [/accordion] 

[accordion title="COVID-19%20notification%20for%20attendees%20of%20Pacific%20Dental%20Conference%202020"] Attendees of the 2020 Pacific Dental Conference, were directed to stop providing all dental care immediately, including emergencies, until March 22, 2020, per the March 16 announcement from the Provincial Health Officer, and CDSBC's message to all registrants that same day (see above). PDC attendees may only treat patients on or after March 22 if you have not developed any symptoms of COVID-19.

UPDATE: Anyone who attended the 2020 Pacific Dental Conference, has completed self-isolation and has not tested positive for COVID-19 infection or shown signs or symptoms of COVID-19 infection may return to practice as of March 22, 2020.

A media release from Vancouver Coastal Health notified attendees of the 2020 Pacific Dental Conference of a possible exposure to COVID-19. Read the March 12 statement here. Those with questions about this possible exposure should contact Vancouver Coastal Health or the British Columbia Dental Association directly.
[/accordion] 

[accordion title="Letter%20to%20Health%20Care%20Workers%20from%20Dr.%20Bonnie%20Henry%20(March%2014%2C%202020)"] The following letter from Dr. Bonnie Henry, Provincial Health Officer, was received Friday evening from Mr. David Byres, Associate Deputy Minister, Clinical Leadership, Ministry of Health. Following his request, this message is being distributed to certified dental assistants, dental therapists, and dentists in the province of British Columbia.

Letter to health care workers from Provincial Health Officer >> [/accordion] 

[accordion title="IPAC%20Reminder%20to%20CDSBC%20Registrants%20%2F%20Dental%20Office%20Protocols%20(March%204%2C%202020)"] As always, CDSBC registrants (dentists, dental therapists and certified dental assistants) should abide by CDSBC's Infection Prevention and Control Guidelines, which lays out the responsibilities of dental healthcare providers to protect the safety of their patients and themselves.

With respect to dental office protocols for containing the spread of COVID-19, a risk assessment must be done before each interaction with a patient in order to determine interventions that are required to prevent the transmission of infection.

Both patients and dental professionals seeking further guidance around protocols for dental offices (including the use of masks) are encouraged to refer to the above-mentioned agencies who are closely monitoring the spread of COVID-19 (BC CDC, PHAC, WHO).

Information tailored to health professionals in BC is available from the BC Centre for Disease Control at www.bccdc.ca/health-professionals/clinical-resources/novel-coronavirus-(covid-19). [/accordion] 

[accordion title="General%20COVID-19%20Information%20(posted%20March%204%3B%20updated%20March%2019%2C%202020)"] The BC Centre for Disease Control and the Public Health Agency of Canada, the World Health Organization, and other agencies are monitoring the spread of the novel coronavirus (COVID-19) and have published information for both healthcare practitioners and the public.

BC Centre for Disease Control has information for the public available in multiple languages here. This information is being updated regularly.

Symptoms of the virus are similar to other illnesses, including the flu and common cold (cough, sneezing, fever, sore throat and difficulty breathing).

Anyone in B.C. who is concerned that they may have been exposed to, or are experiencing symptoms of COVID-19, should contact their primary care provider, local public health office, or call 8-1-1.
[/accordion] 

[accordion title="Information%20and%20Hotlines"]

• BC Centre for Disease Control (BCCDC):Information line: 1-833-784-4397  

  • Information for public: www.bccdc.ca/health-info/diseases-conditions/coronavirus-(novel)
  • Information for health professionals: www.bccdc.ca/health-professionals/clinical-resources/novel-coronavirus-(covid-19)

• Public Health Agency of Canada information line:  

  • 1-833-784-4397

[/accordion] 

[accordion title="References"]

• BC Government List of Essential Services (March 26, 2020) https://www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/covid-19-provincial-support/essential-services-covid-19
• CDSBC Guidelines for Infection Prevention and Control: www.cdsbc.org/CDSBCPublicLibrary/Infection-Prevention-and-Control-Guidelines.pdf
• Defining Emergent, Essential (Urgent), and Non-essential (Elective) Care in Dentistry, CDSBC www.cdsbc.org/about-cdsbc/news/covid-19/defining-care
• BC Centre for Disease Control: COVID-19 Information for Health Professionals
  www.bccdc.ca/health-professionals/clinical-resources/covid-19-care
• BCCDC Clinical Reference Group Recommendations: Unproven Therapies for COVID-19 www.bccdc.ca/Health-Professionals-Site/Documents/Recommendation_Unproven_Therapies_COVID-19.pdf
• COVID-19: Important Update from the Provincial Health Officer (March 23, 2020) www.cdsbc.org/Documents/covid-19/PHO-Letter-Non-Essential-Services-Health-Mar-23-20.pdf
• COVID-19 Emergency screening of dental patients using teledentistry, Royal College of Dental Surgeons of Ontario (March 26, 2020) www.rcdso.org/en-ca/rcdso-members/2019-novel-coronavirus/covid-19---emergency-screening-of-dental-patients-using-teledentistry
• COVID-19: Temporary Authorizations for Controlled Drugs and Substances, College of Pharmacists of BC www.bcpharmacists.org/news/bc%E2%80%99s-covid-19-response-%E2%80%93-temporary-authorizations-controlled-drugs-and-substances

KEY BC WEBSITES FOR COVID-19 INFORMATION

• BCCDC (http://covid-19.bccdc.ca/)
• Office of the Provincial Health Officer
  (https://www2.gov.bc.ca/gov/content/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/current-health-topics/covid-19-novel-coronavirus)
• BC Government News (https://news.gov.bc.ca/#)

LINKS TO TOPIC-SPECIFIC COVID-19 INFORMATION

• Health Professions Review Board timeline communication (http://www.hprb.gov.bc.ca/CovidLetter.pdf)
• Ministry of Public Safety and Solicitor General's timelines order (https://news.gov.bc.ca/releases/2020AG0028-000578)
• Ministry of Public Safety and Solicitor General's essential services order (https://news.gov.bc.ca/releases/2020PSSG0020-000568) (https://www2.gov.bc.ca/gov/content/safety/emergency-preparedness-response-recovery/covid-19-provincial-support/essential-services-covid-19)
• Dr. Bonnie Henry’s March 23 guidance (https://www.cdsbc.org/Documents/covid-19/PHO-Letter-Non-Essential-Services-Health-Mar-23-20.pdf)
• Liability (https://news.gov.bc.ca/releases/2020AG0029-000616) (http://www.bclaws.ca/civix/document/id/oic/oic_cur/m094_2020)
• PPE Supply Hub (https://news.gov.bc.ca/releases/2020PSSG0023-000609)
• PPE Utilization Framework (https://www2.gov.bc.ca/assets/gov/health/about-bc-s-health-care-system/office-of-the-provincial-health-officer/covid-19/ppe_allocation_framework_march_25_2020.pdf)

KEY FEDERAL WEBSITES FOR COVID-19 INFORMATION

• Public Health Agency of Canada (https://www.canada.ca/en/public-health/services/diseases/2019-novel-coronavirus-infection.html)

[/accordion]