The Canadian Dental Hygienists Association (CDHA) has developed the following interim guidance for
dental hygienists considering a return to work during the COVID-19 pandemic. CDHA’s best
practice recommendations are based, first and foremost, on ensuring safety for dental
hygienists, their clients, team members, families, and communities. Because the scientific
evidence guiding COVID-19 decision making continues to evolve, CDHA’s recommendations are
subject to change as we learn more.
In preparing to return to work, dental hygienists should consult with their provincial regulatory
body for new infection control recommendations in light of the COVID-19 pandemic. Dental
hygienists work in close proximity to clients in the operatory. The potential for airborne virus
spread when performing aerosol-generating procedures, such as ultrasonic scaling and air
polishing, or when using slow-speed handpieces or air/water syringes is high and increases the
risk of infection (Cochrane, May 2020).
CDHA will continue to provide updates as new research and information become available.
Questions for your employer can be found in the CDHA Return to Work Handbook For Dental Hygienists.
Download it today!
Prior to Reopening Your Office
Meet with your employer and colleagues to determine a “return to work” strategy for
the team. Consult
your provincial regulatory body for updated infection control protocols and
standards. Adhere to
regulatory requirements and practice standards as outlined by your provincial
regulatory body.
Considerations for discussion may include the following:
- Appointment management (staggering of appointments, length of appointments,
etc.)
- Client, staff, and visitor screening/risk assessment protocols
- Communication with clients regarding reopening protocols
- Dental unit waterline (DUWL) maintenance requirements
- Inventory of personal protective equipment (PPE)
- Physical distancing protocols for staff and clients
- Staff and client COVID-19 testing protocols
- Soft reopening with reduced staff
- Updated infection control policies
- Waiting room protocols
Share CDHA’s COVID-19 self-care tip sheet to encourage proper home oral care
routines until regular
dental hygiene visits are possible.
Dental hygienists who test positive for COVID-19 or present with symptoms
should not return
to work
and should follow provincial public health recommendations for self-isolation.
If sufficient PPE or appropriate infection control equipment cannot be acquired prior
to reopening
the office, CDHA recommends postponement of dental hygiene
services.
Resources and Recommended Reading
Work Environment
CDHA believes that every dental hygienist is entitled to work in a healthy and
respectful
environment. Contracts, policies, and procedures should be in place to guide
productivity,
improve job satisfaction, and protect the physical health and psychological
well-being of every
team member. To maintain a healthy and respectful workplace during the COVID-19
pandemic,
CDHA
recommends increasing and staggering client appointment times to permit
appropriate disinfection
and operatory preparation.
Conversations to Build Collaborative Workplaces
CDHA has developed a video series titled Conversations
to Build Collaborative
Workplaces. The AARCH
conversation framework outlined in the videos will guide dental hygienists who
are seeking to
bridge a divide with a member on their dental team, both in the short term when
the COVID-19
pandemic subsides and in the future. Please watch the Introductory Video:
Developing Your
Mindset, What is a Care Call,
and Scenario of
a Care Call for more detailed information. Use the Tips for Conversations to Build Collaborative
Workplaces and the Guide to Making Care Calls resource sheets to
provide further
guidance.
Psychological Health and Safety in the Workplace
The National Standard of Canada for Psychological Health and
Safety in the
Workplace (the Standard)
is a set of voluntary guidelines, tools, and resources intended to support
organizations in
promoting mental health and preventing psychological harm at work. This free online
toolkit will
help your team implement the Standard.
Unsafe Working Conditions
Employees have the right to refuse unsafe work conditions. If you return to work
and feel that
your health and safety are at risk, it is important to know your rights and
responsibilities.
Understand the steps you can take to remediate unsafe work conditions or
exercise your right to
refuse unsafe work. Employment law varies by province. Refer to CDHA’s Right to Refuse Unsafe
Work Conditions document.
If you are experiencing unsafe working conditions, CDHA recommends further
discussions with
your
employer. If a healthy and respectful workplace cannot be
established, CDHA
recommends
that you
report your concerns to the relevant body.
Provincial Regulatory Body Infection Control Guidelines
Consult with your provincial regulatory body regarding updated infection control
protocols and
standards. Contact information for provincial dental hygiene regulators can be
found in CDHA’s
Regulatory Chart.
CDHA recommends that new provincial infection control protocols and standards
be reflected in
office manuals.
Personal Protective Equipment (PPE)
As essential primary oral health care providers, dental hygienists are at very high
risk of exposure
to COVID-19 and must take all steps necessary to protect themselves. Mitigate
the risk by
following your provincial infection control protocols and standards.
Watch How to Don PPE Here.
Watch How to Doff PPE
Here.
Mask Selection Guidance
Consult your regulatory body for mask requirements in your province or
territory. Respirators and
surgical mask procedures differ from one another. Ensure you are using each for
its intended use,
fit,
wear time, testing, and approval.
Surgical masks*
- Level 1 masks have the least fluid resistance, bacterial
filtration
efficiency,
particulate filtration efficiency, and breathing resistance.
- Level 2 masks provide a moderate barrier for fluid
resistance, bacterial and
particulate filtration efficiencies and breathing resistance.
- Level 3 masks provide the maximum level of fluid resistance
recognized.
**The layering of lower level masks for added protection is
not recommended
by public health experts.
N95 Respirators
Respirators cannot provide certified respiratory protection unless they are
designed, tested,
and government certified as a respirator. N95 respirators achieve a very close
facial fit which
supports effective filtration of airborne particles. Specifications for various
COVID-19
products, including N95 respirators, can be found on the Government of Canada website. Best
practice is to wear a custom fit tested N95 respirator following training on
fit, seal, use, and
disposal prior to first use. Disinfection of N95 respirators is not recommended.
Considerations for Use:
- Dental hygienists with respiratory issues may find using a N95 respirator
uncomfortable.
- Prolonged N95 respirator use may cause difficulty breathing. Consider
changing
your respirator
if this occurs.
Fit Testing of N95s
Fit testing is required by a certified individual every two years and is
performed on a specific
make
and model. A daily seal check must also be performed when donning your personal
protective
equipment.
Note: if the make and model of your N95 changes or if you gain or lose more
than 5 pounds, a new
fit
test is required.
Other Personal Protective Equipment
Gowns, exam gloves, hair bonnets, shoe coverings, and face shields should be
selected and worn based
on
provincial recommendations for aerosol-generating and non-aerosol generating
procedures during the
delivery of dental hygiene services. Appropriately placed barriers should also
be used and changed
between clients (e.g., keyboard computer covering, hose barriers, head rest
covers)
Disinfection
Ensure that disinfection protocols include the use of Environmental Protection
Agency
(EPA)-registered
disinfectants. A list of disinfectants approved for use against SARS-CoV-2 is
available on the EPA
website. Follow the manufacturer’s instructions for all cleaning and
disinfection products
and ensure
that product use aligns with Workplace Hazardous Materials Information System
(WHMIS) requirements.
Other Considerations
Preprocedural mouth rinse:
- Mouth rinses containing 1% hydrogen peroxide or 0.2% povidone have been
shown to
have a potential effect on COVID-19 (Clinical Review, April 2020).
- Chlorhexidine mouth rinse has not been shown to be effective in reducing the
intraoral viral load associated with COVID-19.
Client contact:
- If handshakes are a common greeting in your office, defer from handshaking
and
other physical contact with clients.
If appropriate PPE or infection control equipment cannot be acquired, CDHA
recommends
postponement of
dental hygiene services.
Resources and Recommended Reading
Mask Guidance
Donning and Doffing PPE
General PPE
COVID-19 Transmission
Client Care Considerations
Training and Education
Effective infection prevention and control programs have a training and education
component. Ensure
that your office manuals include these vital components.
CDHA recommends training and education for all team members on new infection
control policies
related to COVID-19.
Client Care and Professional Considerations
Client preparation and screening protocols will support the safe and effective
delivery of dental
hygiene services when returning to work. Keeping in mind that the services
deemed safe to
provide during the COVID-19 pandemic may or may not include aerosol-generating
procedures, refer
to your regulatory protocols and standards for risk-mitigating recommendations
in your area.
Client Preparation and Screening Protocols
Client preappointment preparation is integral to office health and safety. In
addition, dental
hygienists should use professional judgement to determine fitness to work on a
daily basis.
Video, telephone, email or text screening protocols prior to the client’s appointment
will mitigate
in-office risk. Most evidence-based sources recommend client triage by
telephone. The following
questions may guide the development of in-office screening protocols:
- Have you previously contracted COVID-19?
- Have you been exposed to anyone with COVID-19? If so, when?
- Do you have any signs or symptoms of COVID-19 infection? (e.g., dry cough,
tiredness,
shortness of breath, fever)
Consider the following elements of preappointment client
preparation:
- Clients may be fearful of returning to the dental office. Consider how you
will
communicate with them prior to their scheduled appointment.
- A care call could include a welcoming message and a brief outline of new
office
protocols, reassuring them of their health and safety during their
appointment.
- Notify clients that, if they present with symptoms, their appointment will
be
cancelled. Consider revising current cancellation fee policies.
- Remind clients that they should come alone to their appointment if possible,
limit
their time spent in the waiting room, and leave unnecessary personal
belongings at home.
Consider the following elements of in-office client preparation:
- Post signs explaining new waiting room protocols.
- Require the use of alcohol-based hand sanitizer when entering and leaving
the dental
office.
- Ensure masks and tissues are available for client use. To manage potentially
asymptomatic carriers, ask clients to wear a mask in the waiting room.
- Have a non-touch garbage bin readily available for disposal of used masks
and tissues.
- Do not encourage client sharing of pens. Encourage clients to bring their
own or allow
them keep office pens for personal use.
- Some international evidence-based sources recommend temperature screening at
reception.
Consider sharing CDHA’s COVID-19 care call tip sheet to encourage communication with your
clients and
help them prepare for future appointments.
Financial Management, Well-Being, and Service Delivery
Considerations
Considerations
when resuming practice should include an understanding of how to
reduce or mitigate your
liability risks while also adhering to broader requirements.
Documentation
Refer to your provincial regulatory body’s recordkeeping guidelines.
Hand Scaling Considerations
CDHA recognizes that, when dental hygiene services
resume, aerosol-generating procedures will be delayed. Most evidence-based
sources recommend
avoiding aerosol-generating procedures if possible (Cochrane, May 2020).
Self-assess proper
ergonomics and hand instrumentation skills when returning to work to reduce the
risk of
repetitive stress injury (RSI) and increased operator fatigue.
Ergonomics
Posture, repetition, and force exertion are common risk factors for
neuromusculoskeletal (NMSK)
injuries
in the dental hygiene profession. CDHA, in conjunction with the Canadian
Memorial Chiropractic
College,
produced a three-part
webinar series on common NMSK injuries among dental hygienists. The
series reviews
work-related and personal risk factors for injury, and recommends ergonomic
modifications,
exercises,
and other solutions to minimize risk.
The three webinars are as follows:
- Webinar
I: What is neuromusculoskeletal disorder? Am I at risk?
- Webinar
II: How can I protect myself from NMSKs?
- Webinar
III: NMSK fitness care routine
Instrumentation Technique
Although CDHA recognizes that combined use of hand and powered instrumentation
may provide optimal
client care, updated provincial infection control protocols and standards may
require the temporary
use
of hand instrumentation only. In the absence of powered instrumentation, CDHA
recommends a review of
hand instrumentation technique including proper grasp, fulcrum, insertion,
activation, and
adaptation.
Instrument Sharpening
In order to provide optimal client care and reduce operator fatigue, hand
instruments should be
sharpened regularly. This article details how dull instruments can lead to
hand injury and
demonstrates
proper sharpening techniques.
Repetitive Stress Injuries
Occupation-related repetitive stress injuries (RSIs) can have significant
impacts on dental
hygienists. This article describes RSIs and preventive strategies to
mitigate risk of injury.
Physical Health
Consider incorporating chairside warm up and stretching exercises into your
daily routine. Another
way
to promote good physical and mental health is to engage in activities like yoga.
CDHA recommends implementing risk-mitigating screening protocols for the
office team,
visitors, and
clients. Delivery of dental hygiene services should be deferred
in the absence of
appropriate
staff and client screening protocols.
CDHA believes that dental hygienists are entitled to work in an environment
that supports and
promotes both the physical and psychological well-being of each member
of the team.
Additional information about the evolving situation may be found on your province’s
or territory’s
government website. The manufacturers of the equipment used in your practice may
also have
helpful product advice.
CDHA will continue to provide updates as they are available and will revise these
recommendations
accordingly.