Resources for dental professionals

During the COVID-19 pandemic additional guidelines have been designed to keep yourself, your team and your patients safe. These include looking at the whole practice and implementing measures to minimise the risk of spreading COVID-19. In addition to the Guidelines, the levels of restriction on dental practice will change according to the current environmental risk assessment and it's important to understand what each of these levels mean for you and your practice. 

Critical Information & Resources

  ADA Dental Service Restrictions in COVID-19

A framework outlining the ADA's recommendations in relation to the continuation of dental services.

  Covid-19 Decision Trees

Decision trees for patient management during COVID-19 restrictions.

  Managing PPE Resources

Key Resources for managing PPE during COVID-19.

  Managing COVID-19 in the Practice

The key reosurces for managing COVID-19 in your practice.

Infection Control

Infection control in dental practice has always been a cornerstone of ensuring your practice is safe. This is the responsibility of the treating practitioner. Below are some general infection control resources as well as some additional measures to be mindful of during the COVID-19 pandemic. 
  Infection Control FAQs

Answers to some of your most frequently asked questions.

  Guidelines for Infection Control

This essential publication, which it is mandatory for every practice to have onsite, describes the infection control processes that dental practitioners and clinical support staff are obliged to implement.

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  Maintaining the Environment

Promoting and practising respiratory hygiene and cough etiquette and observing high standards of surface hygiene remain critically important.

  Infection Control Manual Template - MEMBER ONLY

The Infection control manual template takes all the hard work out of documenting your infection control processes and procedures.

  Practical Guide to Infection Control - MEMBER ONLY

This publication outlines the most effective practical procedures for implementing the ADA’s Infection Control Guidelines in a dental practice.

  Transmission Based Precautions

A guide to standard precautions and transmission based precautions, to be implemented where standard precautions alone may be insufficient to prevent infection.

  Hand Hygiene Audit

Hand Hygiene Audit template to assist you in becoming fully compliant with hand hygiene procedures.

  Faecal-Oral Transmission of COVID-19

Information regarding potential faecal-oral transmission of COVID-19 and its impact on environmental cleaning.

  Environmental Cleaning and Disinfection Guidance in the context of COVID-19

Environmental Cleaning and Disinfection Guidance in the context of COVID-19

  COVID-19 Risk Management Guidance

A comprehensive guide to help manage the COVID-19 risk in your practice.

  Australian Society of Orthodontists - Level 2 Restrictions

Recommendations from the Australian Society of Orthodontists on COVID-19 Level 2 Restrictions.     

  Australian Society of Orthodontists - Level 3 Restrictions

Recommendations from the Australian Society of Orthodontists on COVID-19 Level 3 Restrictions.     

HR Support

HR Resources are available to ADA Members Only.

We understand that restrictions on the services you can provide will profoundly affect your cash-flow and the staffing requirements of your practice, and may result in the practice temporarily closing. It is a difficult and uncertain time for everybody and ensuring that the practice team are treated fairly and with respect is important and will aid in our efforts to return to business as the restriction levels lower. 

The ADA's HR Advisory Service is available to members and provides individual advice to guide you through any changes you need to make.
  HR FAQs

Answers to some of your most frequently asked questions.

  COVID-19 - Amendments to the Fair Work Act

A guide to the amendments made to the Fair Work Act 2009 (Act) in response to the COVID-19 pandemic.

  JobKeeper and Amendments to the Fair Work Act – FAQ

Answers to the most frequently asked questions on the governments new JobKeeper scheme

  JobKeeper 'One in, all in' rule

Further clarification around the JobKeeper scheme and the question of 'One in, all in'.

  Information for Practice Owners

Information provided by the ADA HR Advisory Service team to assist practice owners in responding to potential changes in practice operations due to the COVID-19 health crisis.

  Information for Employees

Information provided by the ADA HR Advisory Service team to assist employees in responding to potential changes in practice operations due to the COVID-19 health crisis.

  HR - WA State System

Relevant HR advice for Western Australia State System employers and employees regarding COVID-19.

  Redundancy Fact Sheet

Information on dismissals for reasons of redundancy under the Fair Work Act 2009.

  COVID-19 Jobs - Expressions of Interest

Information on state health departments seeking expressions of interest from dental practitioners to assist with their response to COVID-19.

HR Template Letters

A series of template letters for practices not qualified for the JobKeeper scheme to use when communicating with the Dental Team regarding working arrangements during the COVID-19 pandemic.

HR Template Letters - JobKeeper Qualified

A series of template letters for practices qualified to the JobKeepers scheme to use when communicating with the Dental Team regarding working arrangements during the COVID-19 pandemic.

Practice Policies

In order to implement the newly established guidelines, practice policies should be developed so that staff and clinicians understand how to practically implement these changes. These policies look at how staff and clinicians can determine the COVID-19 risk of each patient, the other risk factors that should be considered and the ways to operate in a consistently safe manner. Each practice should also have an exposure response plan so that all team members know how to behave and react in the situation where there is a COVID-19 exposure. 
  ADA Guidelines for Teledentistry

A guide on the appropriate use of teledentistry to provide urgent dental consultation. 

  COVID Safe Plan - MEMBER RESOURCE

A template COVID-19 safe plan to assist with returning to work and preventing the further spread of COVID-19.

  Dental Practice Treatment Guidelines

A template set of treatment guidelines for your dental practice during the COVID-19 pandemic.

  Triaging and Care Prioritisation

A quick-guide for practices to assist triaging and care prioritisation.

  Rubber Dam for Restorative Dentistry

A guide to the use of rubber dams in restorative dentistry.

  COVID-19 Risk Factors

Additional information for dental practitioners when considering risk factors for the contraction and severity of COVID-19 and infection.

  Exposure Response Plan

A template Exposure Response Plan for your dental practice.

  Practice Start Up

A checklist to assist you if starting up practice following hibernation due to the Covid-19 pandemic.

  Practice Hibernation and Mothballing Checklist

If you have decided to put the practice into hibernation for the time being then this checklist should help ensure everything is mothballed and ready for your return.

  Activities During Downtime

A guide to activities that can be undertaken by the practice team during periods of downtime.

Posters for your Practice

Below are some posters to place in your waiting room and in other publicly visible areas in your practice so that patients and staff are aware of what behaviour and symptoms to be mindful of. 
  Identifying the Symptoms Poster

A poster you can display in your waiting area and/or the door of your practice directing patients to notify staff if they may be at risk of carrying COVID-19.

  Cough Etiquette Poster

A poster you can display in your waiting area to inform patients and staff of correct cough etiquette.

  Hand Hygiene Poster Suite

A collection of posters demonstrating approved procedure to ensure hand hygiene, including how to hand wash or hand rub and the five moments of hand hygiene, as well as how to set up your work area.

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PPE and Stock

There's some confusion surrounding the requirements of PPE during the COVID-19 pandemic. Understanding the precautions and whether you need to consider droplet or aerosol-based precautions will depend on the patients COVID-19 risk and the type of procedure being performed. Worldwide, PPE supply is diminished due to an unprecedented demand. It's important to be mindful of the PPE you require in the context of your practice and in the wider environment.

What role do masks have in COVID-19?

COVID-19 is spread via respiratory droplets when an infected person sneezes or coughs, or by aerosol spread (within 1m) of another person, or via contact routes, where the droplets land on a surface and are transferred by touch. 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).
 

Why do we wear masks?

Masks protect the mucous membranes of the nose and mouth, and they protect the skin of the face and neck from splashes of material. This is why masks rated for healthcare require splash protection, according to the level of risk of splashes of fluid. Masks must be worn wherever there is the possibility of splashing, splattering, or spraying of blood, saliva, or body substances, or where there's a probability of inhalation of aerosols with the potential for transmission of airborne pathogens. Masks also prevents contamination of the working area with the operator’s respiratory or nasal secretions and organisms.

What PPE is required during the COVID-19 pandemic?

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. 

Can I re-use or sterilise masks?

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.

Can I use a P2/N95 respirator?

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.

What is the difference between P2 and N95 Respirators?

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.

How well do P2/N95 respirators work, and what is fit-checking and fit-testing?

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.
 

Can I re-use a P2/N95 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). 

Can I wear a visor or face shield?

Face shields and a 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 or a surgical repirator. They can be worn in conjunction with a surgical mask or respirator for eye protection. A surgical mask may also have a visor already attached to it. 

What should I do if I run out of hand sanitiser?

For routine dentistry, wash effectively with liquid soap and water. Surgical antimicrobial soaps (e.g. 2% or 4% chlorhexidine hand wash or povidone iodine) can be used for oral surgery, but it is not necessary to use these for non-surgical dental work. If handwashing more often, use a moisturuizer more often as well, to prevent the development of skin irritation.

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.

Can you clarify the use of gowns during COVID-19 level 2 service restrictions?

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.
 

What do I do if I have completely run out of masks or other PPE?

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.

Can't the ADA relax the standards?

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.
  Where to find PPE - MEMBER RESOURCE

Information regarding which suppliers stock each item of PPE.

  Putting on and Removing PPE

A poster from the National Health and Medical Research Council (NHMRC) demonstrating the correct sequence for putting on and removing PPE.

  Conserving Mask Stock

A range of ADA-recommended measures that can be used to conserve your remaining masks you have left while ensuring that you, your staff, and your patients are kept safe.

  Which Mask and When

An outline of the regulatory requirements around mask use and guideance on which mask to use, and when.

Marketing and Patient Communication

These Resources are available to ADA Members Only.

The Covid-19 pandemic has been an unprecedented situation for dental practices and our patients. With most of the restrictions on dental practices now lifted, it's important to let patients know that practice doors are open and they can safely return to see their dentist.
  Reopening the Books Webinar

Our panel of dental pratice marketing experts, share with you effective marketing strategies and practical business tips to help you rebuild your book as restrictions ease.

  COVID-19 Recovery Plan

A Covid-19 recovery plan for dental practice owners.
 

  Members Media Release

A media release and supporting document to assist members in communicating to patients that they can now safely return to see their dentist.

  Media Assets - Level 1

A range of assets for your practice to assist you in communicating the move to Level 1 and what it means for patients.

Financial Support

Changes to working arrangements will directly affect your finances. The ADA have included links below to a range of resources to help manage your finances for the weeks and months ahead. We also advise that you contact your accountant and financial adviser so that you can have direct advice during this time.  Additionally, the government is releasing different packages to support members of the community and we will update you as they become available 

How am I going to make ends meet while I don’t have an income?

The government, lenders and some landlords have introduced provisions to protect those that are vulnerable during the COVID-19 pandemic. Please look at the resources below to see what is currently available.
  COVID-19 Government Assistance Guide

A business guide from Australian Chamber of Commerce and Industry to financial and regulatory assistance from government during the COVID-19 pandemic. 

  Choosing a Financial Adviser

Guides to help you to find a financial adviser to assist you in managing your finances appropriate to your requirements.

  Jobkeeper Payment Guide

A brief employer guide to the new JobKeeper wage subsidy from the Australian Chamber of Commerce and Industry.

  JobKeeper and Government Support

Information on government support for individuals including the JobKeeper scheme.

  Commercial Leasing During COVID-19

Information regarding the National Cabinets mandatory code of conduct on commercial leasing during COVID-19.

  Small Business Loans and Repayments

Information for practice owners regarding business loan repayment support.

  Managing Individual Financial Obligations

Information to guide individual practitioners in managing their financial obligations.

  Cashflow and Debt Management for Practice Owners

Information to guide practice owners in assessing cashflow and managing debt.

Mental Health Support

The COVID-19 pandemic affects everybody and their ability to earn an income, have security and socialise. As a result, there are many members of our community who are struggling with their mental health. Below is a link to resources and advice that are available. The ADA understands that we are all part of a wider community and now more than ever it is important to reach out to your colleagues, check-in and stay connected.

Since COVID-19 I’m experiencing anxiety and loneliness. Are there some things that I can do?

We definitely encourage you to reach out to your community and the ADA. We would also recommend: 

1. Managing your exposure to media and social media; ensure your information comes from trusted sources, like the ADA and Department of Health.

2. Being physically active, eating nutritious foods and creating routines the best you can.

3. Being socially active with friends and family by phone or video through newer tools like Skype.

4. Remaining "calm yet cautious" and seeking support if you need it.

5. Being kind to others, and yourself.

Is there someone I can talk to straight away?

If you would like to speak to someone immediately, you can call Lifeline on 13 11 14 or BeyondBlue on 1300 224 636.

Are there support services for Dentists?

Each state has different support services avaiable. You can find yours HERE.
  Mental Health Support

Information on mental health support and advice available in each state or terrritory.

  Online Assessment

Online assessments to help you to understand any mental health symptoms you may have and direct you to appropriate support.

COVID.TV

Access to episodes of COVID.TV: a series of short and to the point updates on the latest news and issues arising from the COVID-19 pandemic.
  Episode 1 - Introduction

An introduction to COVID.TV from ADA CEO Damian Mitsch.

  Episode 2 - Patient Management and Decision Making Under Level 3 Restrictions

Dr Dominic Aouad talks us through the ADA's decision tree and some of the implications of Covid-19 and Level 3 restrictions.

  Episode 3 - Dental Service Restrictions

Dr Sharon Liberali discusses restrictions in light of the Covid-19 pandemic.

  Episode 4 - Transmission Based Precautions

Dr Sharon Liberali provides additional information regarding standard based precautions and additional transmission based precautions in light of Covid-19.

  Episode 5 - Safety and Quality

An introduction to the ADA's new online safety and quality program.

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