This section provides guidance for dentistry workers and employers. This guidance supplements the general interim guidance for workers and employers of workers at increased risk of occupational exposure to SARS-CoV-2.

Remain aware of changing outbreak conditions, including the spread of the virus and testing availability in your community, and update hazard assessments and implement infection prevention measures accordingly. As states or regions satisfy the gating criteria to progress through the phases of the Guidelines for Opening up America Again, you will be able to adapt this guidance, along with the general recommendations in OSHA’s Guidance on Returning to Work, to better suit evolving risk levels and necessary control measures in your workplaces.

For the most up-to-date information on OSHA’s guidance see Protecting Workers: Guidance on Mitigating and Preventing the Spread of COVID-19 in the Workplace.

In making decisions about when, where, and how to reopen dental practices and return to pre-pandemic operations, employers should consider:

• The level of ongoing community transmission of COVID-19 in that community.
• The phase of reopening the community in which the dental practice is located has entered.
• The risk to dental practitioners and support staff of being exposed to sources of SARS-CoV-2, including suspected and confirmed COVID-19 cases and people who are infected with SARS-CoV-2 but do not have signs and/or symptoms of COVID-19 (but who can spread the virus to others without knowing it). The practice of dentistry frequently involves the use of instruments such as dental turbines, micro-motor or rotary hand pieces, ultrasonic scalers, and air-water syringes that create sprays containing droplets of water, saliva, blood, microorganisms, and other body fluids, particulates, and debris, all of which can contribute to the generation of aerosolized droplets and thus the transmission of SARS-COV-2. Performing or being present for aerosol-generating procedures performed on patients infected with SARS-CoV-2, even if the patient is not experiencing signs and/or symptoms of COVID-19, is a very high risk activity. Note that while OSHA’s occupational risk pyramid includes the performance of aerosol-generating procedures on known or suspected COVID-19 patients in the “very high risk” category, performing such procedures on patients with unknown SARS-CoV-2 infection status is still a very high risk activity in areas with ongoing community spread.
• The availability and ability of the employer to implement controls to protect workers from exposure to sources of SARS-CoV-2. Surgical masks are regularly used in dentistry to protect mucous membranes of the mouth and nose from droplet spatter, but they do not provide complete protection against inhalation of airborne infectious agents. Among the increased precautions dental practices may need to implement—potentially for the first time—in order to comply with existing OSHA standards is an OSHA-compliant respiratory protection program under the Respiratory Protection standard (29 CFR 1910.134). See the personal protective equipment (PPE) section of this page for further information.

While some dental practices may be able to safely reopen and resume operations, the consideration of anticipated risks and available controls may prompt other practices to remain closed or limit services to only those urgent or emergent procedures that cannot be delayed. OSHA recommends that dental procedures be performed on patients with suspected or confirmed COVID-19 only in emergencies.

Where such procedures are performed, appropriate controls must be implemented. And when engineering, work practice, and administrative controls are not feasible or do not provide sufficient protection, appropriate PPE must be provided and used properly.

OSHA recommends using a combination of standard precautions, contact precautions, and droplet precautions, including eye protection (e.g., goggles or face shields), to protect dentistry workers performing patient care in areas with ongoing community transmission. When workers have exposure when performing aerosol-generating procedures, use standard precautions, contact precautions, airborne precautions, and eye protection (e.g., goggles or face shields) to protect all workers.

*In dentistry, using dental turbines, micro-motor or rotary handpieces, ultrasonic scalers, and air-water syringes are examples of tasks that can generate aerosols. This list is not exhaustive; other procedures also may generate aerosols.

The CDC provides infection prevention and control recommendations for dental procedures during the COVID-19 pandemic.

Employers of dentistry workers are responsible for following applicable OSHA requirements, including OSHA’s Bloodborne Pathogens (29 CFR 1910.1030), Personal Protective Equipment (29 CFR 1910 Subpart I), and Respiratory Protection (29 CFR 1910.134) standards. See the Standards page for additional information on OSHA requirements related to COVID-19. OSHA’s Dentistry Safety and Health Topics page provides more information on standards relevant to dentistry in general.

OSHA’s Bloodborne Pathogens standard (29 CFR 1910.1030) applies to occupational exposure to human blood and other potentially infectious materials, including saliva in dental procedures. The Bloodborne Pathogens standard does not specifically apply to occupational exposure to respiratory secretions, although saliva may contain respiratory secretions (and, in dentistry, the standard applies to occupational exposure to saliva). Even when the standard does not apply, its provisions offer a framework that may help control some sources of the virus, including exposures to body fluids (e.g., respiratory secretions) not covered by the standard.

Elimination

In areas with ongoing community transmission of SARS-CoV-2 and based on assessment of current hazards, consider only emergency dental procedures and assess if elective procedures, surgeries, and non-urgent outpatient visits should be postponed.

Engineering Controls

When urgent or emergency dental care is needed, or when performing elective dental care during the pandemic, use engineering controls to shield dentistry workers, patients, and visitors from potential exposure to SARS-CoV-2. This includes placing easily decontaminated physical barriers or partitions between patient treatment areas (e.g., curtains separating patients in semi-private areas).

Dental offices should use high-evacuation suction, dental dams, and other methods to minimize aerosolization of droplets and capture and remove mists or aerosols generated during dental care. Consider use of local exhaust ventilation or equipping dental offices with this capability to capture and remove mists or aerosols generated during dental care. Learn more about ventilation.

If possible, use directional airflow, such as from exhaust fans, to ensure that air does not move from patient treatment areas into staff work areas. A qualified industrial hygienist, ventilation engineer, or other professionals can help ensure that ventilation removes, rather than creates, workplace hazards.

Administrative Controls

Complete a health screening assessment at the time of, or immediately prior to, patient check-in to determine whether a patient should be considered a suspected or confirmed COVID-19 case.

Use teledentistry (e.g., voice or video conference) options for non-emergency dental consultations.

Request that patients limit the number of visitors that accompany them to their dental appointment.

Advise patients, and anyone accompanying them, to wear cloth face coverings when entering the facility and at all times other than when undergoing treatment.

Consider extending operational hours or reducing the number of appointments to minimize the number of patients in the clinic at the same time.

Consistent with the general interim guidance described above, isolate patients with suspected or confirmed COVID-19 to prevent transmission of the disease to other individuals. For example, if a patient arrives with, or during treatment begins to experience, fever, cough, shortness of breath, or other symptoms consistent with COVID-19, isolate the patient until the patient can be sent home or to an appropriate medical facility to seek further care.

Restrict the number of personnel entering the patient treatment area.

Minimize aerosol-generating procedures and take all appropriate precautions to protect workers. Avoid aerosol-generating procedures altogether if appropriate precautions are not available.

Minimize the number of staff present when performing aerosol-generating procedures. When performing necessary aerosol-generating procedures, it is particularly important to exclude any staff members not necessary for the procedure itself.

Increase the frequency of room and equipment cleaning and disinfection; at a minimum, ensure rooms and equipment are cleaned in between patients.

Safe Work Practices

When performing dental care, workers should follow all appropriate precautions for dentistry and healthcare workers, as well as ensuring appropriate bloodborne pathogen standards are followed when encountering saliva and blood.

Minimize using, or do not use, dental handpieces and air-water syringes. The use of ultrasonic scalers is not recommended during this time. Prioritize minimally invasive/atraumatic restorative techniques (hand instruments only).

If aerosol-generating procedures are necessary for dental care, use high evacuation suction and dental dams to minimize droplet spatter and aerosols.

Perform as many tasks as possible in areas away from patients and individuals accompanying patients (e.g., do not remain in a patient care area to perform charting, sterilization, or other tasks).

Workers should avoid touching their faces, including their eyes, noses, and mouths, particularly until after they have thoroughly washed their hands after completing work and/or removing PPE.

Train and retrain workers on how to follow established health and safety protocols.

Personal Protective Equipment

Dentistry employers must provide, and dentistry workers must use, proper PPE when exposed to potential sources of SARS-CoV-2 in the workplace. SARS-CoV-2 can be spread by pre-symptomatic and asymptomatic persons. Employers should account for these risks in their hazard and risk assessments. Workers may need more protective PPE ensembles when performing aerosol-generating procedures in areas with ongoing community transmission, as compared to the PPE ensembles that may be needed for routine patient care in areas where transmission of COVID-19 has subsided. See OSHA’s PPE standards at 29 CFR 1910 Subpart I.

Employers must determine what types of PPE their workers need to perform their jobs safely, in the context of other elements of the hierarchy of controls, and based on their latest hazard assessment updates. In this guidance, OSHA offers recommendations that employers may wish to consider for PPE ensembles for dentistry during the COVID-19 pandemic:

Recommended PPE ensembles for dentistry

† Note that disposable N95 filtering facepiece respirators and certain cartridges for elastomeric respirators may be adversely affected by an increase in moisture and spray from certain work tasks. During extended procedures in which aerosols or other splashes/sprays of water, saliva, or other body fluids could cause moisture to collect in/on a filtering facepiece respirator, OSHA recommends using a surgical N95 or an R95, P95, or better filtering facepiece; elastomeric respirator with an appropriate cartridge; or powered air-purifying respirator (PAPR). Also consider utilizing a face shield in addition to a respirator in such settings.

In areas of ongoing community SARS-CoV-2 transmission, during aerosol-generating procedures conducted on patients assumed to be non-contagious, dental practitioners and any support staff who enter the patient treatment area during the procedure should use N95 respirators or respirators that offer a higher level of protection, such as other disposable filtering facepiece respirators, PAPRs, or elastomeric respirators, if available. Respirators must be used in the context of a respiratory protection program under 29 CFR 1910.134, which includes medical evaluations, training, maintenance, and fit testing. If a respirator is not available due to supply chain shortages, first consider alternatives such as other NIOSH-approved respirators, expired NIOSH-approved respirators, or respirators certified in other countries.

OSHA’s Respiratory Protection Safety and Health Topics page provides additional information about respiratory protection programs, including training, fit testing, and compliance resources for small businesses.

When removing potentially contaminated PPE, such as an N95 respirator, do not touch the outside of the respirator without wearing gloves.

CDC has developed strategies for optimizing the supply of PPE, including specifically for:

• Gowns
• Eye protection
• Face masks
• N95 respirators
• Gloves

Further Information

Cleaning and disinfection in dentistry:

Routine cleaning and disinfection procedures (e.g., using cleaners and water to pre-clean surfaces prior to applying an EPA-registered, hospital-grade disinfectant for appropriate contact times as indicated on the product’s label) are appropriate for SARS-CoV-2 in dentistry and healthcare settings, including those patient-care areas in which aerosol-generating procedures are performed.

When performing dental procedures, if necessary, follow standard practices for disinfection and sterilization of dental devices contaminated with SARS-CoV-2, as described in the CDC Guideline for Disinfection and Sterilization in Healthcare Facilities, 2008 and Guidelines for Infection Control in Dental Health Care Settings – 2003. In some dental procedures, appropriate cleaning and disinfecting techniques from bloodborne pathogen practices should be used, including protecting vacuum lines with liquid disinfectant traps and high-efficiency particulate air (HEPA) filters or filters of equivalent or superior efficiency and which are checked routinely and maintained or replaced as necessary.

Refer to List N on the EPA website for EPA-registered disinfectants that have qualified under EPA’s emerging viral pathogens program for use against SARS-CoV-2.

Note that workers who perform cleaning and disinfection in dental care may require PPE and/or other controls to protect them simultaneously from chemical hazards posed by disinfectants and from human blood, body fluids, and other potentially infectious materials to which they have occupational exposure in the healthcare environment. Employers may need to adapt guidance from this Dentistry workers and Employers section, the Environmental Services Workers and Employers section, and the interim guidance for workers and employers of workers at increased risk of occupational exposure, in order to fully protect workers performing cleaning and disinfection activities in healthcare workplaces.