Yes the Dental Board of Australia has published the restrictions.
 

The use of standard precautions (including hand hygiene, PPE, safe use and disposal of sharps, routine environmental cleaning, reprocessing of instruments and equipment, respiratory hygiene and cough etiquette, aseptic technique, and waste management) is the principal way we minimise the transmission of infections in any healthcare setting, including dental practice, and are applied to everyone, regardless of their perceived or confirmed infectious status.  They ensure a basic level of infection prevention and control.  Standard precautions are used when undertaking treatments or procedures where there is handling of blood, body fluids (e.g. saliva), non-intact skin, and mucous membranes. 
 
Transmission based precautions (contact, droplet or airborne) are used in addition to standard precautions when there is suspected or confirmed presence of infectious agents that are not effectively contained by standard precautions alone.  The type of transmission based precaution required is dependent on the route of transmission of  the infectious agent:

• Contact precautions
  • are used when there is a risk of direct/indirect transmission of infectious agents e.g. highly contagious skin infections/infestations such as methicillin-resistant staphylococcus aureus (MRSA) and vancomycin resistant enterococcus (VRE)
  • Direct transmission occurs when infectious agents are transferred from one person to another, without a contaminated intermediate object or person.
  • Indirect transmission involves the transfer of an infectious agent through a contaminated intermediate object (fomite) or person.
• Droplet precautions
  • are used when there is a risk of transmission through large respiratory droplets (>5 microns) or mucous membrane contact with respiratory secretions, generated by a patient who is coughing, sneezing, or talking. e.g. influenza, norovirus, pertussis, meningococcus.
  • Transmission via large droplets requires close contact as the droplets do not remain suspended in the air and generally only travel short distances. As the droplets do not travel over long distances, special air handling and ventilation are not required.
  • The droplets can contaminate horizontal surfaces close to the patient, and the hands of healthcare workers can become contaminated through contact with these surfaces.
• Airborne precautions
  • are used when there is risk of transmission through small respiratory droplets (<5 microns) that remain infective over time and distance when suspended in air. e.g. measles, chickenpox, tuberculosis
  • Transmission via small droplets can result due to inhalation by susceptible individuals who have not had face-to-face contact with (or been in the same room as) the infected individual.

 
The WHO has confirmed that coronavirus responsible for SARSCoV2 or COVID-19 is spread primarily through droplets generated when an infected person coughs, sneezes or speaks, however transmission can also occur by touching a contaminated surface and then touching the eyes, nose or mouth before washing your hands. While this would suggest that droplet precautions are required for patients identified as positive to COVID-19, most dental treatments are identified as aerosol generating procedures, and therefore the Australian Guidelines for the Prevention and Control of Infection in Healthcare (2019)[1], states that “if a patient requires care under droplet precautions but an aerosol generating procedure is undertaken, then droplet precautions should be increased to airborne precautions for at least the duration of the procedure.”
 
The Center for Disease Control and Prevention advice for Dental Settings[2] states that there is currently no data available to assess the risk of SARS-CoV-2 transmission during dental treatments, or to determine whether dental healthcare professionals are adequately protected when providing dental treatment when using Standard Precautions, however they have referenced the Occupational Safety and Health Administration’s Guidance on Preparing Workplaces for COVID-19[3] which places dental practitioners in the very high exposure risk category, as their jobs are those with high potential for exposure to known or suspected sources of the virus that causes COVID-19. 

The CDC concluded that when practicing dentistry in the absence of Airborne Precautions, the risk of SARS-CoV-2 transmission during aerosol generating dental procedures cannot be eliminated, and provided the following recommendation:

• Avoid aerosol generating procedures whenever possible. Avoid the use of dental handpieces and the air-water syringe. Use of ultrasonic scalers is not recommended during this time. Prioritize minimally invasive/atraumatic restorative techniques (with hand instruments only).
• If aerosol generating procedures are necessary for emergency care, use four-handed dentistry, high evacuation suction and dental dams to minimize droplet spatter and aerosols. 

This is not the first coronavirus pandemic this century. In 2003 we had Sudden Acute Respiratory Syndrome caused by SARSCoV1. A retrospective review[4], outlined measures to reduce the risk of cross infection with coronavirus in the dental setting, including the identification of patients with SARS through targeted screening questions, pre-procedural rinsing, hand hygiene, PPE, rubber dam isolation and recommended that “aerosol-generating procedures should be avoided as much as possible if rubber dam isolation is not feasible. Some of these procedures include ultrasonic scaling, root-surface debridement, and high- or low-speed drilling with water spray.” These measures were adopted in both the ADA Managing COVID-19 Guidelines and ADA Dental Service Restrictions documents. A conclusion of this article was that while no dental healthcare worker was affected in either a nosocomial or dental setting, this was thought to be due to the use of universal infection control measures and/or the low degree of viral shedding in the prodromal phase of SARSCoV1.

While both SARSCoV2 and SARSCoV1 demonstrate high viral loads in posterior oropharyngeal saliva samples, SARSCoV1 viral load was found to peak at 10 days after symptom onset.  In comparison, SARS CoV2 has the highest viral load on presentation, suggesting that SARS-CoV-2 can be transmitted easily, even when symptoms are relatively mild. This finding could account for the fast spreading nature of this pandemic, with efficient person-to-person transmission noted in community and health-care settings.[5]

Yes, you should be directing patients to use alcohol-based hand rub, or washing their hands with soap and water when they enter the practice.

COVID-19 is spread via respiratory droplets when an infected person sneezes or coughs, (within 1m) of another or via contact routes, where the droplets land on a surface and are transferred by touch. There's a risk that airborne transmission may occur if the droplets are aerosolised when certain procedures are performed, such as the use of high-speed drills, ultrasonic scalers, triplex syringes, particle beams and hard tissue lasers.
 
A Level 2 or 3 Surgical Mask, or P2/N95 respirator may be worn when caring for patients on droplet precautions (for example, undertaking urgent procedures on medium risk patients with no aerosols being generated).
 

This depends on the COVID-19 risk of the patient and the prescribed treatment. If the patient has a low risk of having COVID-19, and the procedure does not involve aerosol or aerosol is minimised with the use of rubber dam and high volume suction, then standard universal precautions plus the additional COVID-19 measures (pre-operative rinse and additional environmental cleaning) are sufficient. 

While it might seem like the obvious solution, according to the Dental Board of Australia and manufacturers of these products, masks are typically labelled as a single-use item and cannot be reprocessed.

The filtration abilities of a surgical mask start to deteriorate after around 20 minutes of continuous use as a result of moisture on the inner and outer surfaces of the mask. It is not necessary to change it after this time if you are in the middle of a procedure which goes for a longer period. However, masks should be changed between patients.

Steam sterilising renders the mask ineffective by altering the charge on the microfibers that are responsible for particle filtration, causes degradation of the mask straps, renders the splash protection useless, and causes parts of the mask to disintegrate or melt, and release some toxic vapours.

Yes, but you must check that they are suitable for health care use and they must be fitted correctly. You will find information on how to fit check a P2/N95 mask here. P2/N95 masks will not seal effectively unless you are clean shaven.

The terms P2/N95 respirator are used interchangeably to cover both US and European standards. They have the same level of protection for particles in the same size range as most viruses (0-.1-0.3 microns). N95 respirators are used for oil free aerosols where P2 respirators are tested with paraffin oil. European standards refer to filtering face piece (FFP) masks and in that scheme, FFP2 matches with N95.

A correctly fitted P2/N95 respirator will block 99% of total viral influenza particles, but effectiveness drops to 66% if poorly fitted (e.g. not matched to the size and shape of the face). A poorly fitted P2/N95 mask performs little better than a poor fitting surgical mask.

Fit checking is the appropriate minimum standard at the point of use for healthcare workers using P2/N95 respirators. Fit checking is required when using a P2/N95 respirator to treat low risk and medium risk patients. Fit checking is performed by the practitioner every time they put on a P2/N95 respirator to ensure it is fitted correctly, and air is not leaking around the perimeter of the mask. A good seal must be achieved over the bridge of the nose and mouth, with no gaps between the respirator and face. Facial hair (beards and stubble) prevent an air-tight seal being obtained. No clinical activity should be commenced until a satisfactory fit has been achieved with the respirator.
 
The following Queensland Health PowerPoint presentation describes a fit-check procedure for a P2/N95 respirator:
https://www.health.qld.gov.au/clinical-practice/guidelines-procedures/diseases-infection/infection-prevention/transmission-precautions/p2n95-mask
 
Fit-testing is carried out to select the ideal respirator for each individual. A risk-management approach should be applied to ensure that staff working in areas with a significant risk of exposure are professionally fit -tested and are trained in how to correctly use the respirator including performing a fit-check at the time of use. Fit testing is conducted by an appropriately trained technician, using a qualitative or quantitative method to evaluate the fit of a specific make, model and size of respirator on an individual. The test verifies that the mask has achieved an adequate seal and that this seal is being maintained in reasonable challenge conditions such as when deep breathing, talking, when the head moves or when exertion occurs. No high-risk patient in the context of COVID-19 should be treated without a properly fit-tested respirator.
 

The answer is NO. P2/N95 surgical respirators are a one-time-use item. There is no acceptable or effective way to reprocesses these. The manufacturers do not recommend or support attempts to sanitize, disinfect, or sterilize them.

All methods that have been tried suffer from at least one of the following four problems: 

• they are not effective against the COVID-19 virus;
• they damage the respirator’s filtration;
• They affect the respirator’s fit to the face; 
• they create safety problems for the person wearing the respirator (e.g. off-gassing of chemicals into the breathing zone). 

Face shields and visors do not protect against aerosols as they have no filtration and do not meet the Standard required by the regulator, so they are not a suitable replacement for a surgical mask.

For routine dentistry it's completely appropriate to use 2% or 4% chlorhexidine hand wash (if you can source it) as a good alternative to ABHR, but washing effectively with soap and water is also completely appropriate.

There are other Antibacterial TGA approved handwash products also available including Povidone Iodine products (such as Betadine) which may be used with appropriate caution. For surgical procedures the ADA Infection Control Guidelines provide guidance on appropriate hand hygiene.

The use and type of PPE is determined by whether you are using standard precautions only or with transmission based precautions. This is outlined in the NHMRC guidelines.

In the context of COVID-19 you may wish to consider using a disposable gown for over street clothes, together with PPE for standard precautions (disposable gloves, level 2 surgical mask, eye protection), where you determine that there is a risk of contamination of your clothes with bodily fluid. “Bare below the elbow” principles should still apply for non-surgical treatment indications in low risk patients.

Impervious gowns are required for droplet/airborne transmission based precautions, as per the NHMRC guidelines. Droplet precautions, with the use of impervious gowns, are only expressly required for patients who are identified as moderate (suspect case) or high risk (probable case) of COVID-19, as per CDNA guidelines. Treatment of patients confirmed with COVID-19 would also require impervious gowns as part of the PPE due to airborne precautions, which is beyond that expected to be provided in an office based dental setting due to the need for dedicated airborne transmission based precautions including a negative pressure room.
 

If you’re unable to practice due to insufficient PPE, contact the ADA team on 02 8815 3333 or send an email to [email protected] and we’ll do everything we can to help you.

The ADA is not the regulator.  The Dental Board of Australia is the regulator and sets out the infection control requirements for registered dental practitioners. They require dentists practice in accordance with a range of standards and guidelines, including;

1. NHMRC Australian Guidelines for the Prevention and Control of Infection in Healthcare
2. AS/NZS 4815/4187
3. CDNA Guidelines
4. The ADA's Guidelines for Infection Control

The Dental Board has stipulated there will be no flexibility to the standard in relation to PPE and the ADA has requested the Board identify what their plan is to ensure dental practitioners can continue to treat patients through the shortage of masks.

In short, the ADA does not set the rules we help dental practitioners interpret and apply them.