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[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
The B.C. Ministry of Health and the Office of the Provincial Health Officer regularly release new information about COVID-19. Registrants of CDSBC should stay up to date on this information, along with the guidance for health professionals from the BC Centre for Disease Control. Orders, notices and guidance (including FAQ) related to COVID-19 are available on the Ministry of Health’s website here >>Clarification on recent updates from the Province is provided for registrants below.
November 12: Epidemiology and Modelling Update on COVID-19 Infections in Health Care Workers
At the November 12 briefing, Provincial Health Officer Dr. Bonnie Henry shared information about COVID-19 infections in health care workers and stated that more detailed data on this will be provided as it is collected.
The numbers provided today confirmed that a total of 83 dental professionals have contracted COVID-19 since the beginning of the pandemic, and that the majority of these cases have been traced back to the Pacific Dental Conference early on in the pandemic.
Epidemiological modelling shows that 1 in 10 individuals who had COVID-19 identified as health care workers (primarily nurses or care aids); however, most of those exposures leading to those infections are community/household exposures rather than workplace exposures. The proportion of health care worker cases has declined over time.
The slides from the presentation can be viewed on the BCCDC website here >>
Scope of Provincial Medical Mask Policy
The Provincial Health Officer, Dr. Bonnie Henry, has confirmed for CDSBC that a November 4 update to the provincial medical mask policy mandating medical masks for patients, staff and visitors in all healthcare facilities does not apply to our registrants / dental facilities (or other allied health practitioners in community settings). For guidance on all aspects of care, including mask usage, registrants should continue to look to the joint document for oral health care providers developed by the four oral health colleges Oral Health Care During Phases 2 and 3 of the COVID-19 Response. Dr. Henry has reinforced that patient screening is the key to keeping operations safe for staff and patients. This document outlines appropriate screening procedures and personal protective equipment required in dental facilities. Further to the requirements in the document, on October 26, Dr. Henry stated the expectation that people will wear masks in all indoor public spaces. At that time, she asked that businesses review their COVID-19 safety plans with this in mind. Read the joint statement here >>
PHO Restrictions on Lower Mainland and Fraser Valley (Effective November 7 through 23)Regional Measures for COVID-19 prevention were introduced by order of the Provincial Health Officer (PHO) on November 7. All individuals, places of work and businesses in the Lower Mainland and the Fraser Valley are instructed to significantly reduce their level of social interactions and travel. In the order, employers are instructed to redouble their efforts related to workplace safety as follows:
1. Employers must review their COVID-19 Safety Plans to ensure that they adequately protect workers from the transmission of COVID-19 in the workplace and are consistent with WorkSafeBC requirements.
2. An employer of a worker who is working in a workplace other than the worker’s private residence must ensure that the worker has done a daily health check for the symptoms of COVID-19
3. If an employer is not satisfied that a worker has done a daily health check the employer must not permit the worker to work at the workplace.
4. Employers should encourage workers to work from their private residence if feasible, unless there is a preference on the part of the employer or the worker for the worker to work at the workplace.
5. Employers must ensure that their COVID-19 Safety Plan includes measures to prevent workers from crowding together or congregating in higher risk spaces, including elevators, lobbies, stairwells, corridors, bathrooms, break rooms and kitchens.
The above excerpt is taken from section F of the "COVID-19 Prevention Regional Measures" order, which can be found here>> Unless extended by the PHO, the order expires on November 23, 2020 at 12:00 p.m.
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[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
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:
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.
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[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”)
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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 >> Recommended Resources for Health Professionals
The following agencies have provided specific information about COVID-19:
Please note that the material provided by these agencies is updated regularly as new information becomes available. Some guidance may not be updated to reflect Phase 2 requirements, and registrants should check the sites in the coming days.
A Careful Restart
As oral health professionals prepare to provide expanded dental care, it is critical to remember that May 19 is the beginning of a transition. This is intended to be a careful restart in keeping with the requirements of our “new normal.” CDSBC acknowledges and thanks all registrants for making practice accommodations to ensure patients receive safe and timely care during the COVID-19 pandemic.
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[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.
In the coming days, CDSBC will communicate to our registrants on how care will continue through phase 2 of the restart. Our guidance and recommendations will, as always, be supported by evidence as it is available, and we will take our lead from the Provincial Health Officer and other public health experts as we develop expectations for our registrants in anticipation of the expansion of dental services.Dentists in particular have been expected to attend to the needs of their patients throughout the current pandemic, and so in that regard, this next phase can be understood as a continuation of care. Existing CDSBC standards and guidance (such as our Guidelines for Infection Prevention and Control) continue to apply to the provision of oral healthcare by our registrants, in tandem with any additional controls that have been implemented by government throughout the pandemic.There is detailed information about the new normal for employers and workplaces on the government webpage
B.C.’s Restart Plan.
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[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.
Dear Registrants,
Please review CDSBC’s new document: Expectations and Pathway for Patient Care during the COVID-19 Pandemic. This is intended as clarification of the March 29, 2020 communication to registrants titled Recommendations & Expectations for Clinical Care in the COVID-19 Pandemic.
Note that CDSBC’s
Guidelines for Infection Prevention and Control remain in effect, and that any recommendations contained in this document that move beyond the existing requirements of IPAC are specific to the COVID-19 pandemic.
This document is based on the latest available best practice and scientific evidence about this emerging disease and may change as new information becomes available. Edits will be noted in the schedule of changes on the last page of the document.
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[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.
Self-study maximum removed
In response, the maximum allowed for the self-study modality of learning for certified dental assistants, dental therapists, and dentists has been removed until December 31, 2020. This temporary removal of the self-study maximum will provide registrants the opportunity to grow their dental knowledge through online courses in order to meet their CE requirements while complying with the overarching physical distancing expectations from public health officials. During this time period, we strongly encourage our registrants who are using the self-study modality to take clinical courses.
Free online courses
In support of this, CDSBC is waiving the fee for all online courses available on our website until December 31, 2020. View our course offerings at:
www.cdsbc.org/courses
If you have questions about these changes, please contact Leslie Riva, Senior Manager: CDA Certification and Quality Assurance, at
lriva@cdsbc.org.
The changes described here have been approved by the Quality Assurance Committee. [/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.
In-office Assessments
All in-office assessments for deep sedation and general anaesthetic service facilities are being postponed. Rescheduling will begin July 2, 2020 at the earliest.
If your office is currently scheduled for in-office assessment between April 21 and June 30, 2020, we will contact you to reschedule.
Facilities with expiring Confirmation of Compliance between March 18 and July 1, 2020 will all be granted an extension until July 2, 2020. The College will contact individual facility owners for extensions as required; considerations for extension will be reviewed on a case-by-case basis.
Fees will be deferred until in-office assessments are scheduled.
Annual Self-assessments
All facilities with annual self-assessments due between March 18 and July 1, 2020 are being granted extensions to July 2, 2020.
If your self-assessment is complete, please send it by email using a
password-protected PDF to Ruby Ma, Sedation Program Coordinator, at
rma@cdsbc.org.
In-person Courses
In-person course work that does not align with the overarching social distancing expectations may be deferred until June 30, 2020. If you are unable to renew by June 30, please email
rma@cdsbc.org to request a further extension. Cases will be reviewed on an individual basis. Courses that may need to be deferred due to the in-person components include Basic Life Support, Advanced Cardiovascular Life Support, Pediatric Advanced Life Support and the Difficult Airway Course.
Registration of Qualifications
Registrants who wish to register for moderate sedation, deep sedation, or general anesthesia are asked to email their application package in the form of a
password-protected PDF to Ruby Ma, Sedation Program Coordinator, at
rma@cdsbc.org.
If you have questions about these changes, please contact the CDSBC Sedation Program Coordinator, Ruby Ma, at
rma@cdsbc.org.
The changes described here have been approved by the Sedation and General Anaesthetic Services Committee. [/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).
The Ministry of Health, the College of Pharmacists of BC, and the regulatory colleges of all the prescribers of controlled drugs are working toward a solution. In these exceptional times, prescribers are asked to ensure their patients have
access to these medications as necessary. If it is not possible to meet with a patient face-to-face, prescribers should consider alternative means to getting duplicate prescriptions to pharmacies.
Health Canada has provided temporary exemptions to parts of the
Controlled Drugs and Substances Act (CDSA) and its Regulations to permit pharmacists to extend prescriptions, transfer prescriptions, and for pharmacists and pharmacy employees to deliver controlled medications, and to permit prescribers to issue verbal orders for controlled medications. Accordingly, the College of Pharmacists of BC has amended its bylaws relating to the
Pharmacy Operations and Drugs Scheduling Act
(PODSA) and the
Health Professions Act
(HPA).
During the pandemic, it is now acceptable for prescribers to fax prescriptions, or give verbal prescriptions for controlled drugs to pharmacists, and then deliver (by mail courier or other means) a hard copy of the original duplicate form. It is essential the pharmacists receive the original duplicate form as soon as reasonably possible.
Clinicians are expected to weigh carefully the risks and benefits to both patients and the public when prescribing by these means. The need for physical distancing and self-isolation and the risks of travel to medical appointments for clinicians and patients, have to be placed in context with the overarching need to access necessary medications.
To further enable access to these controlled prescriptions, pharmacists are able to provide emergency supplies of controlled drugs. Pharmacists are also able to deliver these medications when it is safe and in the best interest of the patient to do so, which includes practising physical distancing and screening for potential COVID-19 exposure. Information on corresponding College of Pharmacists of BC Bylaw changes can be found
here. [/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 PandemicMarch 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:
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fever
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tiredness (fatigue)
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dry cough
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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:
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droplet spread
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interpersonal contact (e.g. direct or indirect contact with human fluids)
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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:
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the science around durations and intensity of infectivity is still evolving
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the milder the symptoms, the less infectious the patient appears to be
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patients are most infectious at day 4 of symptoms and should remain in isolation for 10 days after the resolution of symptoms
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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:
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CDSBC continues to strongly recommend all elective and non-essential dental services involving direct physical contact be reduced to minimal levels.
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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.
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Protocols for management of time sensitive treatment and essential and emergent concerns should follow current expert peer-reviewed guidelines and recommendations.
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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.
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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.
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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.
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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.
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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.
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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.
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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.
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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:
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[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.
EMERGENT 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:
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Cellulitis as a result of an uncontrolled infection compromising the airway
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Severe uncontrolled hemorrhage (bleeding)
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Trauma to the orofacial complex especially to facial bones that potentially compromise the patient’s airway
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Uncontrolled severe pain
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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):
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Pericoronitis or third molar pain
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Post-operative osteitis (dry socket dressing changes)
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Abscess with localized pain and swelling
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Treatment required before critical medical procedures can be provided
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Dental trauma involving avulsion or luxation of a tooth
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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):
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Recall examinations including routine radiographs
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Routine debridement and preventive therapies
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Orthodontic procedures other than those to address acute issues (e.g. pain, infection, trauma)
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Restorative dentistry (including treatment of asymptomatic carious lesions)
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Aesthetic dental procedures.
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[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"]
[/accordion]
[accordion title="References"]
KEY BC WEBSITES FOR COVID-19 INFORMATION
LINKS TO TOPIC-SPECIFIC COVID-19 INFORMATION
KEY FEDERAL WEBSITES FOR COVID-19 INFORMATION
[/accordion]
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[accordions title-color="primary-dark" color="primary" title-text-size="20px"]
[accordion title="What%20are%20considerations%20for%20improving%20ventilation%20in%20dental%20facilities%3F"]
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."
[/accordion]
[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]
[/accordions]
