For BATAAN DENTAL CHAPTER Members

A BATAAN DENTAL CHAPTER BATCH HINIRANG PROJECT

 CHECKLIST
Stay healthy. Boost your immune system. Exercise.

Do not report to work if sick. Stay home.

Training accomplished for the all Dental Staff

 how to don and doff PPE  how to triage patients

 how to disinfect the  how to charge and
clinic receive payments

PREPARING YOUR CLINIC

You must designate areas for: Remove all magazines, toys and
reading materials and other objects
which are not easily disinfected.
Triage

Waiting area (not advisable) Schedule appointments wide apart.

Donning your PPE Put hand disinfection products

around the clinic.

Doffing your PPE

Put up signages on social
SEALED operatory distancing, hand hygiene…
 T  R I  A  G  E
 Symptomatic patients with
consistent with Covid 19
Stop! Reschedule
 Elective dental procedure the patient

 Asymptomatic patients NO tx! Reschedule

 Elective dental procedure the patient

 Symptomatic patients Request clearance from

consistent with covid19 the attending physician
 Emergency or urgent dental prior to any dental
procedure intervention

 Symptomatic patients May treat the

consistent with dental patient with
diagnosis (pulpitis, cellulitis)
appropriate
 Emergency or urgent dental
protocols and PPE
procedure

May treat the

 Asymptomatic patients
patient with
 Emergency or urgent
appropriate
dental procedure protocols and PPE

Triage
The process of sorting people based on
their need for immediate medical
treatment as compared to their chance
of benefiting from such care.
D

PHONE TRIAGE

Screen patients via telephone BEFORE their scheduled dental

visit
1. Explain to the parent that ALL elective procedures are postponed until
further notice

2. Ask if the patient or any family member have had any covid19
symptoms, if anyone was diagnosed and their recent travel history.
3. For the safety of the elderly or the medically compromised companions,
please advise them not to accompany the patients.

4. Inform the parent of the additional protocols you have in place in your clinic
and if they agree to it. You can ask permission to record the phone
conversation.
5. Only one parent/guardian will be allowed inside the operatory. Cooperative
patients who can be on their own may go unaccompanied. For special children
who need more than one accompanying person, please decide at your own
discretion
6. Everyone who enters the clinic should be wearing masks.

7. Inform them that they will be answering a screening health questionnaire and
will sign an informed consent form upon arrival.

8. Keep things and bags to a minimum.

9. Inform them of the possibility that they will wait outside

if there are too Many people inside your waiting area.
10. Our dental clinic should be your patient’s
first stop in their agenda for the day.
 UPON PATIENT’S ARRIVAL

TRIAGE AREA
Dental staff assigned
should be wearing
All patients and
appropriate PPE.
accompanying persons
should be wearing masks
upon entry.

Dental staff takes the

body temperature of
The parent/guardian
both patient and
answers health screening
parent/guardian.
form and signs informed
consent and waiver.
Dental staff will inform
patient if his treatment
Avoid too many people in will proceed or will be
the waiting room to rescheduled.
practice social distancing,
best to ask patients to
wait outside where they Patient and parent
can be reached by disinfect hands and
telephone. shoes before entering

WAITING AREA

Physical distancing shall be practiced in the waiting room area

at all times.
 LEVELS OF PPE PROTECTION
CHANGE TO YOUR SCRUB SUITS IN THE CLINIC

WHO: STAY IN THE RECEPTION AREA AND DON’T

LEVEL 1

Face Shield
ENTER THE TREATMENT AREA
Surgical Mask
• scrub suit/shirt worn upon entry to the clinic • surgical
Scrub suit
mask, • protective eyewear • closed shoes

WHO : CLEAN AND PREPARE INSTRUMENTS IN

Head cap
NON-CONTAMINATED AREAS
WHO : NOT DIRECTLY EXPOSED TO PATIENTS Face Shield
LEVEL 2

UNDERGOING TREATMENT
Surgical Mask
WHO : PROVIDE NON-AGP TO PATIENTS
• under garment/scrub shirt/suit • water repellent gown Water repellant
gown
• surgical mask • protective eyewear (not goggles) • head
cover • non-sterile examination gloves Disposable
gloves

WHO : DIRECTLY INVOLVED WITH TREATMENT Head cap

PROCEDURES AND WHEN AGP IS EXPECTED Goggles
Face Shield
• under garment/scrub shirt/suit • water repellent Respirator
LEVEL 3

surgical gown (preferably ankle length and neck length) •

properly test-fitted respirator masks (NIOSH N95 or Water repellant
FFP3) • protective eyewear or goggles • head cover • face gown
shield • shoe cover • sterile surgical undergloves taped to Disposable
wrist cuffs of gown and non-sterile examination gloves
overgloves
Shoe cover

WHO : IN CONTINUOUS OR FREQUENT EXPOSURE Head cap

TO HIGHLY CONTAGIOUS OR AIRBORNE Goggles
LEVEL 4

TRANSMISSIBLE PATHOGENS Face Shield

Respirator
• undergarment/scrub suit, single-piece, waterproof,
head-to-toe (or ankle length) fitted suit with adjustable Water repellant
fit hood • sterile undergloves taped to wrist cuffs • sealed gown
and fitted goggles • face shield, fitted respirator mask Disposable
and overgloves gloves

Shoe cover
 DONNING OF PPE

Hand washing with Hand disinfection

soap and water with 70% alcohol

1. booties

3. if double gloving

2. gown

4. head cap

Donning the
PPE should be
3. face mask
done in a
separate clean
area.

6. gloves

5. face shield / goggles

 DOFFING OF PPE

• Utmost care should be done 1. Hand disinfection

in doffing PPE to prevent with 70% alcohol
cross contamination.
• Assign an inspector to make
sure you are doing it right.
2. gown

5. Hand disinfection
with alcohol 3. Hand disinfection
with alcohol

• Doffing the PPE should

be done immediately
4. booties after the treatment,
before exiting the
treatment area.
• Have bins ready for PPE
to be disinfected/
6. gloves washed and for single
use PPE to be thrown
7. Hand disinfection away
with alcohol

13. Hand washing

with soap and
water
8. face shield/goggles

12. mask

Exit the room.

Doffing of face
mask to be
done outside 10. inner gloves
the treatment 11. Hand disinfection
9. head cap if used with alcohol
area
 CASE SELECTION

EMERGENCY CARE MANAGEMENT

• Trauma (permanent tooth
avulsion/pulp exposure)
• Cellulitis that restricts swallowing
or extends to the eye
• Uncontrolled bleeding
-Extraction of infected teeth
-Splinting of avulsed permanent teeth
-May refer the patient to a hospital for
admission if the infection is causing airway
compromise and/or severe trismus

For emergency and urgent care, you may treat this patient in the dental office with
appropriate protocols and PPE. If appropriate PPE is unavailable, please refer to
another dental office for management.

MANAGEMENT URGENT CARE

• Extraction of infected teeth • Severe, uncontrolled pain
• Arrest caries techniques • Spreading, recurrent or continuing
• Glass ionomer restorations without using infection
a handpiece • Severe dental trauma
• SSC using Hall technique • Certain medically compromised
• Extra-oral radiograph patients
•

MANAGEMENT
• Recommend analgesics to manage pain
NON-URGENT CARE • May prescribe antibiotics if you are concerned about
swelling and/or systemic infection
• Mild or moderate pain • Advise patient to avoid hot and cold food.
• Minor dental trauma • Reinforce oral hygiene practices
• Routine care• • Remind the parents to increase the immunity of the
children by eating healthy and drinking vitamins.
• Advise the parents to update you of the child’s status.
 DENTAL PROCEDURE

PERFORM WITH CAUTION MUST AVOID

NAGP AGP

Be careful of saliva and droplet Be careful of aerosol transmission.

transmission. The use of The use of rubber dam and HEPA
preprocedural mouth rinse * filters to minimize aerosols are highly
is highly recommended. recommended.

Oral exam Radiographs **

Ultrasonic Use of high and low

scalers* speed dental drills

Extractions Atraumatic
and tissue Restorative
excision Treatment
Use of air /
Any procedure that water syringe Air prophylaxis
will induce crying

* 0.2% povidone-iodine or 1% hydrogen

peroxide * The highest aerosol producing
** Periapical radiographs can cause
gagging. Extra-oral imaging is
procedure
encouraged.
 DURING TREATMENT &
IN-BETWEEN PATIENTS
A PRE-PROCEDURAL MOUTH RINSE of 0.2% povidone-iodine should be swabbed
in the oral cavity of the patient prior any procedure.

HAND DISINFECTION AEROSOL CONTROL PRACTICES *

• Rubber dam isolation**

• 70% alcohol or alcohol based sanitizers
• Hand washing with soap and water
Please wash hands before and after each
patient; before donning PPE; within
doffing PPE and every chance you get.
• Intra-oral high volume evacuator
• Extra-oral vacuum unit (optional)***
* Aerosol should be minimized at all times.
** Highly recommended
***No scientific study showing efficacy in
catching aerosols.

OPERATORY SURFACE
SUCTION MACHINES
DISINFECTION *
• 70% or >70% alcohol
• Use of high volume evacuators *
• 0.1% sodium hypochlorite bleach**
• 3% hydrogen peroxide *** • Suction tips discarded/sterilized
• Quaternary ammonium • Saliva ejectors are discouraged
• Detergent/soap
* For all clinical contact surfaces * Suction tips should be discarded or
including all exposed surfaces after sterilized after each patient use.
every patient. Hoses should be flushed with a
** Recommended for non-porous surfaces volume of water and sodium
but may damage colored fabrics
hypochlorite (do not leave in line
*** 0.5% Hydrogen peroxide : suitable
for more than 15 minutes).
for non-porous and porous surfaces
•

USE OF HANDPIECES PAPOOSE BOARD

• Should be minimized
• Disinfect the board with a surface
• Use anti-retraction handpieces
disinfectant.
• Should be heat-sterilized; surface
• Change the wrap after every patient.
disinfection is NOT enough
 MIDDAY AND AT THE
END OF THE DAY
Washable PPE gowns and used scrub suits should be packed in a
plastic bag before going home. These should be washed
separately from the rest of the household laundry.

Put all the used disposables and

Change from your scrub suit used patient-care items, in a
to your street clothes yellow trash bag with a biohazard
before heading home. logo and dispose of properly.

Clean the floor midday and at the end

of each day with detergent and water
Clean, pack and sterilize all or a low level disinfectant (e.g. 0.1%
instruments. Do not NaClO or 3% hydrogen peroxide).
disinfect if you can sterilize.

UVC radiation and HEPA filters may be used as an adjunct

for further disinfection of the operatory and its exposed
surfaces. Pls follow manufacturer’s instructions.
 FREQUENTLY ASKED
QUESTIONS

What mask is best to use during treatment?

Surgical masks are adequate for non-aerosol generating procedures (NAGP)
while a respirator (N95) is indicated for aerosol generating procedure (AGP) because
of its snug fit and higher filtration capacity. To improve fit of surgical masks, taping
the sides to the facial skin with micropore tape may be done to improve its seal. Both
are meant to be changed per patient. In case of an N95 shortage, a surgical mask may
be worn on top of the N95 to preserve the N95’s integrity. Change the surgical mask
every patient. There are also certain methods of extending the life of N95s. Or a
surgical mask may be used with an air purifier in the operatory.

Do we use a “bunny suit” or isolation gown during treatment procedures?

“Bunny suits” are recommended for persons with continuous exposure to SARS-
CoV-2 positive cases. It is impractical for dental office use because doffing is difficult
and complicated which can increase the chance for self- and cross-contamination. CDC
recommends isolation gowns, preferably ankle length during non-aerosol generating
procedures

Do we use double gloves?

For NAGP procedures, CDC recommends the use of single glove technique. It is
the clinician´s prerogative to wear double gloves for his/her personal preference,
especially when gloves easily tear.

Do extra-oral aerosol vacuums, HEPA filters and UVC sterilization work to clean the
air?
There is no concrete evidence that extra-oral aerosol vacuums work as well as
we like them to be, as they are fairly new. However, some studies say it helps reduce
aerosols in the air. Portable HEPA filtration units have the ability to filter well,
however the room filtration efficacy is dependent on room size, room air movement
(aircons and fans) and unit maintenance. UVC sterilizers are an established means
of disinfection but no evidence is available yet for its efficacy against the SARS CoV-2
virus. It is potentially hazardous to humans, therefore manufacturer’s instructions
should be followed.
 FREQUENTLY ASKED
QUESTIONS

Is an airconditioner a factor of SARS-CoV-2 transmission?

Control air flow. Make sure air flow in the operatory and waiting area moves
away from you and your staff. It is recommended to frequently renew indoor air either
by opening the windows or using mechanical ventilation, to allow an air exchange
between patients.

How many accompanying persons are allowed inside the clinic?

We limit the people in the clinic as much as possible to prevent cross-infection.
In pediatric patients, only one parent or guardian may be allowed inside. However,
special children may need more than one companion inside the dental clinic. While
this is unavoidable, the dentist should be aware of the risks and consequences of
allowing more people inside the clinic.

Is there a need for patients to be in PPE?

There is no evidence that patients in PPE will prevent SARS-CoV-2
transmission in the dental clinic. Please consider the scarcity of PPE, as these should
be worn by our frontliners. However, we ask that all persons who come in the dental
clinic should wear masks, wash their hands with alcohol and their shoes disinfected
before entry. But due to our close proximity to the patient especially during a
procedure requiring head lock, it may be prudent for the patient to wear a head cap.

How long should a treatment procedure be?

The treatment procedure should be as short as possible to minimize droplet and

aerosols transmission, for the safety of all in the operatory. For this reason, only
emergency and urgent care procedures are recommended to be done.

Courtesy of the Philippine Pediatric Dental Society Incorporated

a specialty affiliate of the Philippine Dental Association
SUMMARY OF PERSONAL PROTECTIVE EQUIPMENT

RECEPTION / CLEAN AREA/ OPERATORY / OPERATORY

TRIAGE NON AGP NON AGP / AGP

Single Glove x   
non-sterile
Double Glove x x x optional
non-sterile
Half face piece respirator x x x 
Properly-fitted n95 x x x 
Surgical mask    optional
Cloth mask x x x x
Eyewear-protective    Yes but
polycarbonate unsealed always with
face shield
Eyewear- fitted / sealed x  optional  optional Yes but
goggles always with
face shield
Face shields    
Single use head cap optional Preferred Preferred Preferred
Coveralls (fluid repellent) x Not Not optional
recommended recommended
Isolation gown, long sleeved x   
and ankle length (reusable)
Disposables Preferred Preferred Preferred Preferred
Reusable fluid repellent / acceptable acceptable acceptable acceptable
resistant
apron x x x optional
Shoes: rubber, soled; no    
laces
booties x x x 

Where to remove PPE:

1. Never remove mask inside the operatory
2. Remove gloves, goggles / face shield and gown at doorway before leaving the
operatory
3. 3. Remove mask / respirator outside room after the door has been closed. Ensure
that hand disinfectant are available at the point needed
 INFECTION AND CONTAMINATION PREVENTION: THE RECOMMENDED USE
OF PPE, PERSONAL DISINFECTION, OPERATORY DISINFECTION, SURFACE
DISINFECTION, AND AEROSOL CONTROL PRACTICES AS EVIDENCED IN
SCIENTIFIC LITERATURE.

Reusable Isolation Gowns must be made of moisture repellent material and

PPE
withstand washing without deteriorating. Materials that may be water repellent
are Taffeta, Taffeta with Silver Back Lining (SBL), Coated Taffeta, Spun
Polypropylene Fabric
Polycarbonate Wrap around Lenses: Recommended for use with a full face-
shield when doing AGP since these are not sealed on the sides
Protective
Sealed goggles: Recommended for use with or without a face-shield since these
eyewear
are sealed around the periphery. However, there is the possibility of moisture
retention or fogging on the inner lens of the goggles with time.
Surgical Masks: must be of adequate thickness and impermeable to light to
moderate droplets or aerosols. These may be worn for non-AGP procedures
or AGP procedures of short duration as long as this is used with a full face
Procedure
shield
masks
Respirator Masks: Must be fitted properly with no peripheral leaks. These are
worn together with other face protective equipment when
moderate to long AGP are expected. Respirator masks may be disinfected
and reused provided they are not soiled or directly aerosolized.
Double Gloving: Recommended when long procedures are expected and/or
Procedure
when procedures are done where there is danger of glove damage
gloves
Single Gloving: Recommended for short procedures and where there is no risk
of glove damage
This equipment are only recommendations and each dentist must inquire
regarding the manufacturer recommendations specific to their office set up and
Operatory
size.
decontamination
UVC Units: UV decontamination is potentially hazardous to humans and must
equipment
be done strictly following manufacturer’s instruction
HEPA Filtration Units: Room filtration efficacy is affected by room size, room air
movement (caused by air conditioners, electric fans) and
unit maintenance
0.1% Bleach: Recommended for non-porous surfaces but may damage colored
Operatory
fabrics
surface
3% Hydrogen Peroxide: Suitable for non-porous and porous surfaces
decontamination

Extra-Oral Vacuum (EOV) Units: There is no scientific study that shows the
Aerosol control
efficiency of EVO units in catching aerosols. Based on vacuum flow
practices
studies, air suction units create turbulence around the portal of the suction
and may spread more aerosol.
 Dental procedures necessitating the use of equipment and machines, driven
by air turbine, will create a spray of aerosolized saliva, inadvertently spreading
the virus to the dental staff in very close range and may stay suspended
contaminating the air within the operatory.
The size of the aerosol determines the rate of their spread in the environment
and the distance of distribution on surfaces.
A machine which can suction the aerosol may decrease microbial
Extra-Oral
contamination. However, these machines may be more sensitive to large
Vacuum
particulates like bacteria or the smaller sized virus to about 0.5-5um only. The
Machines
smallest size virus isolated for the SARS-CoV2 is 0.2um.
This may not still effectively eliminate the minute sized SARS CoV2 virus, but
it may still significantly reduce the microbial count within the operatory during an
aerosol generating procedure.
The direction and distance of the suction cone increases the ability of the
machine to absorb aerosols. It has been suggested that absorption
ability could be dependent on the power of the machine.
When combined with other measures, such as use of rubber dam, minimal
treatment time, the use of EOVM may decrease viral exposure during AGP, since
it adds another layer of protection for the dental team.
After the procedure, some clinicians recommend to leave the machine open
at a lower speed to decontaminate the operatory.
HOWEVER, this is NOT to replace a negative air pressure environment
recommended when managing COVID 19 positive patients. Nor should this
allow complacency in using the device for aerosol generating procedures.

Note: Before purchasing any device, please do your research and keep in mind that these
devices have not yet been proven to be effective in eliminating minute sized SARS CoV2 virus.

RECOMMENDED DISINFECTION AND STERILIZATION

PROTOCOLS FOR DENTAL CLINICS TREATING
PATIENTS
A. DURING
Treatment area/patient care area COVID-19 PANDEMIC
● All critical, heat resistant semi critical instruments and handpieces should be cleaned and
sterilized after each use or discarded.
● Heat sensitive semi-critical items can be processed with high-level disinfection
eg. 2% Gluteraldehyde.
● High touch/clinical surfaces that are difficult to clean must be covered using a physical
barrier for every patient or disinfected between patients.
(eg: 0.1% Sodium hypochlorite or 70% alcohol)
● Use moistened wipe/cloth to clean all surfaces with freshly prepared disinfectant
solution. (eg: 0.1% Sodium hypochlorite or 3% hydrogen peroxide). Always discard
remnant diluted solution
● Floor - Use Wet Moping- Multi Bucket Technique:
(i) Water followed by
(ii) Detergent followed by
(iii) Low Level Disinfectant like 3% hydrogen peroxide, 0.1% Sodium hypochlorite or EPA
approved agents
● Do not perform disinfectant fogging
B. Reception and patient waiting area
● Avoid sweeping with broom
● Use wet mop with warm water and detergent or hospital disinfectant
(eg. 0.1% Sodium hypochlorite).
● Frequently touched surfaces must be disinfected frequently.
● Mop heads and cleaning cloths must be decontaminated regularly by Laundering (heat
disinfection) with detergent and drying at 80 °C and changed frequent

Note: Disinfectants approved by the Environmental Protection Agency, Disinfectant List Coronavirus
Disease 2019 (COVID-19) 03/13/2020 are recommended for surface disinfection
procedures.

WASTE MANAGEMENT AND DISINFECTION

1. Infectious waste is classified as Biohazard and must be placed
in a yellow, clearly marked plastic bag with this symbol.

2. All infectious waste such as used gloves, single PPE must be placed here and covered
during the workday. At the end of the day, this bag must be deposited in a suitable location
outside of the clinic for waste disposal and away from the public and potential
scavengers. Please make sure you make arrangements at your place of work where this is and
find out how or when this waste can be disposed-off properly.
3. Infectious PPE intended for reuse such as gowns, goggles, protective eyewear, face shields
and respirator masks must likewise be placed in a separate bag for after-hours disinfection.
4. Reusable gowns may be disinfected by washing them separately from your personal clothing.
Disinfect the gowns by spraying or soaking them in a 0.1%-0.5% chlorine bleach solution for
5 minutes and wash with detergent and water the usual way.
5. Goggles, protective eyewear and face shields may be disinfected with 0.1%-0.5% chlorine
bleach solution, rinsed, wiped and dried.
6. Respirator masks may be reused only if they are not heavily or visibly soiled or were not
exposed heavily to aerosols or droplets (NAGP procedures or very short AGP procedures)
HOWEVER, the process of disinfecting involves subjecting these masks to dry heat (in an oven)
at 70ºC for 1 hour. The masks must be test fitted prior to use and may be re-disinfected and
reused a maximum of 3 times using this method.

Based on the following guidelines:

“Interim Guidelines on Infection Prevention during COVID 19 Pandemic”, PHILIPPINE DENTAL ASSOCIATION,
April 26, 2020
“PPDSI COVID INFOGRAPHICS”, PHILIPPINE PEDIATRIC DENTISTRY Society Inc., April 29, 2020

Prepared by:

DR. KAREN M. DE PANO DR. LEANNI-LI S. ANACLETO

BDC PRES 2020-2021 BDC SECRETARY 2020-2021