Recommendations for the re-opening of dental services

A rapid review of recommendations for re-opening dental services following the closure or reduction of dental services across the world as a result of the COVID-19 pandemic has now been published.

The reivew is not a guidance document but summarises recommendations from the various sources identified within five themes relevant to the re-opening of dental services: practice preparation, personal protective equipment, management of the clinical area, cleaning and disinfection and dental procedures.

The review group comprised researchers and clinicians from a range of UK institutions including the Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, the Universities of Aberdeen, Dundee and Manchester, and Cochrane Oral Health.

Key messages:

• This review reports on national recommendations for the re-structuring and reopening of dental services from 11 countries
• There is a highly variable level of detail given across international sources
• Most sources recommend patient triage by telephone; some recommend temperature screening at reception 
• Most sources recommend avoiding aerosol generating procedures (AGPs), if possible 
• Filtering facepiece class 2 (FFP2, equivalent to N95) masks are recommended by the majority of international sources for both COVID-19 and non-COVID-19 confirmed cases undergoing AGPs.
• A minority of sources recommend use of a filtering facepiece class 3 (FFP3, equivalent to N99) mask for AGPs 
• Sources include recommendations on how to reduce the risk of transmission (e.g. use of pre-operative mouthwashes; high volume suction; rubber dam; and Personal Protective Equipment [PPE])
• In the majority of sources, there is no referenced, underpinning evidence and some areas are unlikely to ever have strong (or any) research evidence
• All sources emphasise the need to focus on activities that minimise risk (to staff/patients/public) but still support high quality clinical care
• There is a need to consider the inter-relationship between the appropriate use of PPE (including donning and doffing), AGPs and interventions to reduce aerosol generation
• Clarity is required on effective cleaning and disinfection processes, including the impact on patient scheduling and practice workflow.

The full review is available on the Cochrane Oral Health website

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