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Eversmile OrthoFoam & WhiteFoam

Posted by Stella Pascale on Sunday, 28 June 2020 21:22


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IFDH June eNews COVID-19 & More

Posted by Stella Pascale on Sunday, 28 June 2020 20:34

 


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Sanmari Botha 1975 - 2020

Posted by Stella Pascale on Thursday, 18 June 2020 08:11

It is with great sadness that I have to inform the OHASA Members of the passing of one of our colleagues

Sanmari  was born on 29th November 1975 and passed away on the weekend.

Sanmari stayed in Port Elizabath at the time of her death. 

She qualified at Stellenbosch University in 1996 and  she worked at the Medicross in Port Elizabeth until opening her own practice in December 2019.

Sanmari was a Eastern Cape Branch member for a number of years and served on the EC Branch committee – we will miss her.

While there is nothing that we can say to help ease the family's sorrow,

take comfort in the knowledge that there will always be tomorrow.

We cannot comprehend just how sad they must be feeling, 

the pain within their heart takes time to start the healing.

Let the memories of the years you have shared

wash over your heart and soul 

Let the knowledge that you are in our prayers

help you to console.

Let His spirit fill you with strength and love

may it help the pain decrease

as each day that brings a glorious dawn

create an inner peace.

 

With our sincerest and deepest condolences for your loss

 OHASA Executive and Branch Committees

CAPP Oral B Webinar 11 June 2020 - Peri-Implant Complications

Posted by Stella Pascale on Monday, 1 June 2020 20:16

Oral-B & CAPP cordially invite you to join us for our next FREE CME Live Stream event on 11th of June 2020.

 

When: 11th of June 2020:  2pm Dubai | 6pm Singapore | 8pm Sydney

 

Speaker: Prof. Axel Spahr, Australia (Dr. med. dent. habil., MRACDS {Perio})

 

Topic: Peri-Implant Complications – Aetiology, Pathogenesis, Prevention and Treatment

 

Abstract:

The replacement of missing teeth with restorations anchored on endosseous dental implants is a common treatment option, attractive for dentists and much sought-after by patients. The number of dental implants placed worldwide is increasing continuously, resulting in an impressively and aggressively growing implant market. The number of implant manufacturers is also increasing, providing us today with a huge range of different implant types/shapes, lengths, diameters and surfaces. Unfortunately, the increasing number of implants is accompanied by an increasing incidence of peri-implant mucositis and even worse, peri-implantitis, leading to the disintegration of a formerly successfully osseo-integrated dental implant and eventually to implant loss. Therefore, great endeavour has been made during recent years to identify and validate materials and techniques suitable for implant maintenance as well as potential factors associated with peri-implant complications and protocols for the treatment of peri-implant diseases.

 

Lecture Objectives:

- structure and special features of peri-implant tissues

- important factors for implant failure or implant complications

- materials and techniques for the maintenance of dental implants

- prevention and treatment approaches for peri-implant mucositis and peri-implantitis

- an algorithm for implant maintenance based on the current evidence

 

Price: FREE

 

CME: 1 CE Credit (ADA CERP) – Recognised by MOHAP, DoH-Abu Dhabi, DHA & GCC Authorities for 1 CME

 

Register in advance for this webinar: https://us02web.zoom.us/webinar/register/WN_DN8HoX9CQAOGyBYt3daf6g

 

After registering, you will receive a confirmation email containing information about joining the webinar.

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Speakers CV

Prof. Axel Spahr, Australia

CV: Prof. Spahr is Head of Discipline Restorative and Reconstructive Dentistry and Subject Area Periodontics as well as Deputy Head of School at The University of Sydney Dental School. He is also Head of the Department Periodontics at the Sydney Dental Hospital. Axel is the former Head of Periodontics at the University of Ulm in Germany and has worked at various international universities and research facilities. He has additional training in microbiology, molecular biology, extensive experience in basic science research, animal research and clinical research. Prof. Spahr’s research interest includes periodontal regeneration, bone regeneration, periodontitis and systemic diseases, antimicrobial therapy as well as dental implants and peri-implant diseases. He has led large externally funded research projects and is collaborating with leading international research groups and companies in the field of periodontology, implantology and bone regeneration.

 

Yours sincerely,

CAPP

www.cappmea.com

+971551128581

HPCSA - Protecting the Public and Guiding the Professions

Posted by Stella Pascale on Thursday, 28 May 2020 09:44

Risk Assessment & Intervention with Fluoride Varnish Webinar 21 May 2020

Posted by Stella Pascale on Friday, 15 May 2020 06:26


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Dental Protection COVID-19 Relief

Posted by Stella Pascale on Thursday, 7 May 2020 07:01

For immediate release

06 May 2020

Covid-19: Dental Protection announces two months’ free membership

A package of support – the equivalent of the next two months of membership for free - has been set out by Dental Protection for members in private practice that have experienced a significant drop in their workload and a dramatic fall in income due to Covid-19.

All members working in the private sector either full time or part time will be eligible for two months of subscription relief. Members will be contacted in order to obtain the necessary information to make their subscription relief payment. This subscription relief will be paid to members by electronic funds transfer.

Alternatively, members who choose to stop practising completely - even for a short period during this crisis – can instead opt to become a deferred member of Dental Protection. They will not pay a subscription during this time and they may return as an active member on the same terms when they resume practice at a later date. It is important to note that while membership is deferred members will not be entitled to the benefits of membership if they carry out any clinical activity including providing telephone triage for patients with urgent needs.

Dr Alasdair McKelvie, Head of Dental Services for South Africa at Dental Protection, said:

 “As colleagues and as a fellow dental professional, we want to support members during these unprecedented times.

“Above all else we want to reassure members that Dental Protection is here for them through good times and bad.  As a mutual organisation we know there has never been a more important time for us to use our discretionary powers to step in and offer the assistance members need.

“This is not going to be an easy time for any of us, but we are going to get through it.

 

“We hope that the subscription relief being offered will make a difference to members during this time. We will also continue to monitor the situation closely and we will keep the support provided by subscription relief under review in the months ahead.”

END

Notes to editors

Counselling service

Our counselling service is provided by our trusted partners ICAS, who offer a personalised and professional service tailored specifically to your requirements and delivered by experienced qualified counsellors.

ICAS's telephone counselling provides immediate access to support 24 hours a day, 7 days a week, and face-to-face counselling sessions can be arranged near to you and at your convenience, all funded by Dental Protection.

The service is entirely independent and confidential. 

Dental Protection members can call ICAS now on +44 3300 241 021   and quote their Dental Protection membership number to book a free session.

For further information contact: Patricia Canedo at patricia.canedo@medicalprotection.org +44(0)7976 378216.

About Dental Protection

Dental Protection is a registered trademark and a trading name of The Medical Protection Society Limited (“MPS”). MPS is the world’s leading protection organisation for doctors, dentists and healthcare professionals. We protect and support the professional interests of more than 300,000 members around the world. Membership provides access to expert advice and support and can also provide, depending on the type of membership required, the right to request indemnity for any complaints or claims arising from professional practice.

Our in-house experts assist with the wide range of legal and ethical problems that arise from professional practice. This can include clinical negligence claims, complaints, medical and dental council inquiries, legal and ethical dilemmas, disciplinary procedures, inquests and fatal accident inquiries.

Our philosophy is to support safe practice in medicine and dentistry by helping to avert problems in the first place. We do this by promoting risk management through our workshops, E-learning, clinical risk assessments, publications, conferences, lectures and presentations.

MPS is not an insurance company. All the benefits of membership of MPS are discretionary as set out in the Memorandum and Articles of Association.

 

 

 

Patricia Canedo

Press Officer

+44 (0)797 637 8216

medicalprotection.org

 

 

Level 19 | The Shard | 32 London Bridge Street | London SE1 9SG | UK
A member of The Medical Protection Society Limited group of companies


P Please consider the environment before printing this email

 

>> Read more about our policy recommendations here.

 

Promotion of Oral-B CME LiveStream Webinar - 14th May 2020

Posted by Stella Pascale on Thursday, 7 May 2020 06:54

Oral-B & CAPP cordially invite you to join us for our next FREE CME Live Stream event on 14th May 2020.

 

When: May 14, 2020 14:00 Dubai

Time: 2pm Dubai | 6pm Singapore | 8pm Australia (Duration 1 hour)

Speaker: Dr. Alice Huynh (Specialist Periodontist), Australia

Topic: Perio After Lockdown: Pain Presentations and Management in a COVID-19 World

Abstract: In the current COVID-19 climate, our dental practices are severely affected and post-lockdown, the types of cases coming through the door will be quite different to what one would see on a day to day basis. In light of that, this talk aims to give you some back-to-basics knowledge regarding treatment of periodontal emergencies that you may encounter, as well as general pain aspects related to periodontal treatment that you may be faced with on a daily basis.

Price: FREE

CME: 1 CE Credit (ADA CERP) – Recognised by MOHAP, DoH-Abu Dhabi, DHA & GCC Authorities for 1 CME

 

Register in advance for this webinar:

https://cappmea.com/course/perio-treatment

 

After registering, you will receive a confirmation email containing information about joining the webinar.

----------

Speakers CV

Dr. Alice Huynh (Specialist Periodontist )

Alice is a registered specialist periodontist, specializing in periodontal treatment and dental implants, with a particular interest in soft tissue surgery.

 

Alice gained critical experience in working with medically compromised patients at the Alfred Hospital, where she also developed an interest in surgery. Since then, she has worked in private practices in Melbourne and embarked on her specialty training in periodontics at the University of Melbourne.

Alice is a member of the Australian and New Zealand Academy of Periodontists, the Australian Society of Periodontology, International Team for Implantology and the Australian Dental Association. Alice is a casual lecturer for the ITI, various ADA events and examiner for the Melbourne Dental School.

 

Yours sincerely,

CAPP

www.cappmea.com

+971551128581


Attachments:

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HPCSA COVID-19 Guidelines | Dental Assisting, Dental Therapy and Oral Hygiene Board

Posted by Stella Pascale on Thursday, 7 May 2020 06:37

Protecting the public and guiding the professions

eBulletin | 6 May 2020
 
Dear Ms Pascale 

Globally we are currently facing extraordinary challenges in the wake of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is the virus strain that causes coronavirus disease 2019 (COVID-19), a respiratory illness.

COVID-19 has developed in record time into a serious human pandemic and economic crisis of global dimensions, and we in South Africa are also observing its evolution with much anxiety, concern and uncertainty.

As a result, dental professionals (under the ambit of the Board, i.e. dental assistants, dental therapists and oral hygienists) across the country have had to react rapidly and implement appropriate safety measures to help contain the spread of SARS-CoV-2 that causes this disease.

Since the start of the pandemic, the HPCSA as a Regulatory Council has issued numerous communiques (18 March 2020, 25 March 2020, 26 March 2020  and 27 March 2020) providing general advice to professionals on how to manage the COVID-19 pandemic. This also includes referring professionals to the National Department of Health and the National Institute of Communicable Diseases (NICD)clinical guidelines for healthcare workers, as well as information provided by these sites on frequently asked questions, a quick reference infographic and information on communicable diseases to assist healthcare professionals. 

The HPCSA is concerned about the well-being of dental healthcare professionals and those under their care and recommends following the NICD directives when dealing with COVID-19. Moreover, the HPCSA urges professionals to also take care of their own health and to seek help when needed. Furthermore, the departments of Health and of Employment and Labour and the National Institute for Communicable Diseases amongst others provided detailed guidelines for workplaces and the public. This communique serves to supplement these guidelines whilst contextualising measures specific for dental settings.

As a regulator, the Professional Board for Dental Assisting, Dental Therapy and Oral Hygiene, has an important responsibility towards patients and professionals, as well as a social responsibility to protect the health and well-being of all persons in South Africa. As a Board we take all obligations seriously and has participated through various platforms to assist in the development of practice guidelines.

SARS-CoV-2 is a new strain of the coronavirus group and as such the pool of knowledge surrounding the virus and its attributes is rapidly evolving. So too is the literature, and as such it is understandably difficult for the Board to provide a set of guidelines that are lasting, as the disease epidemiological and pathological profile is dynamic and ever-changing. However, the Board will provide a set of generic guidelines and recommendations that may be used in practice, in addition to the universal precautions on infectious disease management protocols once the national lockdown is eased or uplifted. It is essential to recognise and acknowledge that these guidelines may in the future become obsolete as research generates new information about this disease, its diagnosis, pathology, treatment and prevention.

Members of the Board for Dental Assisting, Dental Therapy and Oral Hygiene have provided input, or collaborated with the National Department of Health, dental associations and educators to develop guidelines. We urge professionals to follow the guidelines issued by these structures such as the South African Dental Association (SADA) and the National Institute for Communicable Diseases (available at www.nicd.ac.za). Please refer to the reference list to access some of these guidelines.

Protecting the patient and the dental team

As a Board we caution that dental professionals might be more susceptible than other professionals to contracting and transmitting the virus owing to their prolonged and close proximity to patients; the generation of aerosols, possible spatter of patients’ secretions, saliva or blood; aerosols generated by high-speed handpieces and ultrasonic devices; and through pathogenic microorganisms attached to the various dental instruments. We therefore recommend that dental professionals avoid treating patients suspected of having already contracted the virus. This is in itself a challenge as some patients are asymptomatic and unaware of their status. Considering the high risk of transmission in dentistry, all patients must be treated with due diligence to infection control protocols and with specific preventive measures pertaining to SARS-CoV-2.
 

Treatment of patients

Whilst healthcare has been defined as an essential service in terms of the Disaster Management regulations, clear guidelines specific to dentistry were not provided. Additionally, there were recommendations from professional associations and bodies nationally and internationally to limit dental treatment to “emergencies”. It is difficult to define what is a dental emergency, as patients are individuals with their own needs, pain thresholds etc., and thus the definition of a dental emergency becomes subjective. The Board trusts that professionals will use their clinical acumen, apply sound clinical reasoning, and due diligence in assessing and triaging patients as emergencies, non-emergency and elective treatment cases.

A list of recommendations for dental professionals to help limit the transmission of SARS-CoV-2 in their practices, whether it be in private or public sector, include standard measures such as thorough and regular hand-washing; use of appropriate protective masks, gloves and eyewear; and the need for strictly following all sterilisation and disinfection procedures. 

As it is almost impossible to distinguish between asymptomatic and non-contagious patients it is important to protect both patients and professionals. Therefore, it is essential that dental professionals (and even administrative staff) employ precautionary measures such as wearing extensive protective clothing (not limited to medical masks, caps, gloves, goggles or face shields, shoe covers up to the knee and surgical gowns). It is recommended that the use of ultrasonic aerosol-generating scaling and restorative handpieces be curtailed, and that hand instruments / non-aerosol generating handpieces  only be used for prophylaxis and restorations. It is also recommended that in the event of the need to perform an essential aerosol-generating procedure it is advised that dental dams and high-volume saliva ejectors be used. The Board also understands the difficulty in obtaining the appropriate PPE at reasonable prices and urges professionals to ensure that only quality assured PPE is purchased. There is ample evidence of a flood of fake, or inferior and sub-standard PPE which may supply minimal, or no protection to both patient and professional. The Board urges professionals to source PPE from reputable suppliers.

Additionally, the Board recommends that since intra-oral radiography stimulates saliva secretion and coughing, consideration should be given to the use of extra-oral radiography, if justified. Current evidence also suggests that the use of a pre-treatment mouthwash for patients may assist in decreasing the viral load of the aerosols generated. The pre-screening of patients prior to even entering the treatment facility is also recommended. This pre-screening is not limited to questions around travel history, but also screening for COVID-19 symptoms and the measuring of patient’s temperatures.
 

Reorientation of dental practices

Dental practices will have to be creative in the reorientation/redesign of their dental room setup in order to facilitate the implementation of the addition infection control measures. Cognisance must be given to sanitation areas, time between patients (settling of bio-aerosols), entrance and exit points etc.

The departments of Health and of Employment and Labour have issued guidelines on the Workplace Preparedness. Refer to the reference list provided for detailed guidelines.


Quarantine

Quarantine – which entails separating asymptomatic individuals potentially exposed to the disease from non-exposed individuals in order to slow down pathogen transmission – may be used. This may require considerable use of resources and infringement to human rights. Quarantine should be distinguished from isolation, which is the act of separating a diseased individual with a contagious disease from healthy individuals without the disease. Quarantine may be voluntary (e.g. asking contacts of infectious cases to stay at home or a designated facility for 14 days) or involuntary (i.e. using legal powers to enforce quarantine against a person’s will). Quarantine may be applied at an individual patient level or at the level of a group or community of exposed persons.


Dental Assisting Examinations

A number of dental assistants were to have sat for the Board dental assistant examination, as part of the requirements of their registration. The Board has taken steps to ensure that these professionals are able to retain their registration, and further details of the examination dates will be made available once there is certainty about the easing or end of the lockdown. 
 

Student Training

The Board understands that student training, and especially practical and clinical training has been compromised. The Board is engaging with the Department of Higher Education, the Council on Higher Education and the universities and universities of technology to ensure that student training is adapted but remains of a high standard. The Board will cooperate with Higher Education Institutions to ensure that alternate teaching and assessments methods are employed, and that adjustments are made to the programme to ensure that adequate, quality assured teaching and learning occurs, and that students graduate as competent professionals.
 

Annual Registration and Fees

The HPCSA has informed all professionals that the due date for annual renewals and payment of registrations has been extended from 1 April 2020 to 1 July 2020.  Professionals should ensure that their annual fees are paid by the 30 June 2020. Professionals are once again encouraged to utilise the online portal for the renewal of their registration, where they will also access their annual practising certificate. Professionals may also access their profile using the HPCSA mobile app that is available on: https://hpcsamobileapp.co.za/.

NB: All annual practising certificates which expired on 31 March 2020 are now valid until 30 June 2020.
 

Continuing Professional Development

Healthcare professionals have a responsibility to continually update their professional knowledge and skills for the end benefit of the patient or client. To this end, the HPCSA has implemented a Continuing Professional Development (CPD) programme. Every professional is required to accumulate 30 Continuing Education Units (CEUs) per twelve-month period (in the case of dental assistants 15 CEUs are required) and five of the units must be on ethics, human rights and medical law. Each CEU will be valid for 24 months from the date on which the activity took place (or ended, in the event of post-graduate studies) after which it would lapse. This means that professionals should aim to accumulate a balance of 30 / 60 CEUs by the end of their second year of practise, and thereafter top-up the balance through additional CPD as each 24-month validity period expires. Mandatory random audits are conducted to ensure compliancy. Once a professional’s name has been selected, they are required to submit a CPD portfolio to Council within 21 days. However, all audits have been suspended for the foreseeable future. 

Professionals are encouraged to continue to engage in CPD activities during this period. Various activities, both formal and informal, accredited and non-accredited, can be undertaken. These activities include, but are not limited to, online meetings, webinars, seminar presentation, reading journal articles, attending formal online workshops and studies.  A search of the internet reveals numerous low-cost or free CPD activities that have been made available during this period.


Economic impact

The Board understands that it is devastating for any dental practice to be shut down for such a long time. The Board recognises the economic impact of the lockdown, and in general the decline in revenue that can be expected currently and in the future. Whilst the government and some financial institutions has offered some fiscal relief, this may be insufficient. The Board urges professionals to carefully review their employment contracts and finances in the face of uncertainty.


Conclusion

As a Board we remain optimistic and there will be positives to be taken away from this global crisis. We have already seen suggestions and developments from professionals within the ambit of the profession, as well as professionals assisting and collaborating with one another  to address and overcome challenges, and this is commendable. It is more important than ever that we stay safe, respecting social distancing and hygiene recommendations, remain calm, show solidarity with the governments and stand by one another. Everyone’s health is our outmost priority and we are convinced we will overcome this obstacle together. 

We wish all of you, your families and your staff a safe and successful return to normal activity. Please take care of your loved ones, your colleagues, your patients and your family and friends.
 
Dr TA Muslim
Chairperson
Professional Board for Dental Assisting, Dental Therapy and Oral Hygiene

Health Professions Council of South Africa 

 

Dental practice COVID-19 safety guidelines


In order to keep yourself, your dental practice and your patients safe we have compiled a list of procedures and precautionary measures that you can implement.
 

1. Disinfection/Sterilisation

There are three principal modes of virus spread, all of which are relevant to the field of dentistry;
  • Airborne spread—owing to exposure to bodily fluids and generated droplets, spatter and aerosols;
  • Contact spread—owing to contact with bodily fluids, patient materials, contaminated dental instruments and environmental surfaces; and
  • Contaminated surface spread—since coronaviruses can persist on various surfaces for a prolonged time (depending on the type of surface) and could contaminate the entire dental practice.
Effective and strict disinfection measures in both dental practice settings and public areas should be rolled out. The practice should be cleaned and disinfected regularly in accordance with current safety protocols, as should the public areas and appliances, including door handles, chairs, desks and pens. Proper recirculation of reusable instruments and items should be undertaken, with appropriate instrument pre-treatment, cleaning, sterilisation and storage should be done in line with approved practices.
 

2. Patient evaluation

Screening patients using a standardised structured questionnaire, measuring the patient’s body temperature and then taking adequate steps to address the results. It is strongly recommended that a contact-free infra-red forehead thermometer be used.

The following set of screening questions can help identify potential infection. This list is not exhaustive, and should be adapted to suit your needs, in keeping with current research and guidelines:
  • Do you have a fever or have you experienced a fever within the past 14 days?
  • Have you experienced a recent onset of respiratory problems, such as a cough or difficulty in breathing, within the past 14 days?
  • Have you, within the past 14 days, travelled to areas with documented COVID-19 cases?
  • Have you come into contact with a patient with confirmed COVID-19 infection within the past 14 days?
  • Have you come into contact with people who had recent fever or respiratory problems within the past 14 days?
  • Have you recently participated in any gathering, meetings, or had close contact with many unacquainted people?   
Following the screening questionnaire:
  • If the patient replies yes to any of the screening questions, and the body temperature is below 37.3°C, you can postpone the treatment until 14 days after the exposure event.
  • If the patient replies yes to any of the screening questions, and the body temperature is 37.3°C or higher, then the  patient should be advised on immediate quarantine, and you should report the case to the infection control department of the hospital or the local health department. The method and place of quarantine should be as per the current guidelines mandated by the government.
  • If the patient replies no to all the screening questions, and the body temperature is below 37.3°C, you can treat the patient with extra protection measures and do your best to avoid spatter or aerosol-generating procedures.
  • If the patient replies no to all the screening questions, but his or her body temperature is 37.3°C or higher, the patient should be directed to the nearest appropriate facility for further medical care.

3. Hand Hygiene

The Board recommends following, the two-before and three-after hand hygiene guidelines for dental professionals, which is:
  • before patient examination;
  • before dental procedures;
  • after touching the patient;
  • after touching the surroundings and equipment that have not been disinfected; and
  • after touching the oral mucosa, damaged skin or a wound, blood, bodily fluid, secretion or saliva etc.
NOTE: Everyone should take extra care to avoid touching their own eyes, mouths and noses.
 

4. Personal Protective Measures

The following protective measures are recommended:
  • Standard protection in the clinical settings: Disposable working caps, surgical masks and working clothes, protective goggles or face shields, and disposable latex or nitrile gloves.
  • Advanced protection for dental professionals: Additional disposable isolation clothing or surgical clothes over working clothes in addition to standard protection.
  • Strengthened protection for being in contact with patients with suspected or confirmed COVID-19.

5.  Pre-procedural mouth rinse

It is recommended that pre-procedural mouth rinses containing oxidative agents such as 1% hydrogen peroxide or 0.2% povidone-iodine be used for the purpose of reducing the salivary load of oral microbes. It must be noted that chlorhexidine may not be effective at killing the SARS-CoV-2 virus.
 

6.  Rubber dam isolation

The use of dental dams can significantly minimise the production of saliva- and blood-contaminated aerosol or spatter, particularly when high-speed handpieces and dental ultrasonic devices are used. The use of a dental dam could reduce airborne particles by 70% within a 1 m radius of the operational field. High-volume evacuators for suction should be used (for aerosol and spatter) during the procedures along with regular suction. 
 

7.  Handpieces

High-speed dental handpiece with no anti-retraction valves may suck in and expel debris and fluids. Microbes may further contaminate the air and water tubes within the dental unit and thus potentially cause cross-infection as well.
Therefore anti-retraction high-speed dental handpieces which can significantly reduce the backflow of oral bacteria and viruses into the tubes of the dental unit. As a result, it is strongly recommended that dental handpieces without an anti-retraction function should not be used at this time.
 

8. Medical waste

Waste, including disposable PPE, should be regarded as infectious medical waste and should be appropriately and timeously discarded. Proper recirculation of reusable instruments and items should be done, with appropriate instrument pre-treatment, cleaning, sterilisation and storage should be done in line with approved practices. Refer to the Department of Health Practical Manual for Implementation of the National Infection Prevention and Control Strategic Framework.
 

9. Ventilation

The dental treatment room and other facilities, such as waiting rooms, should be adequately ventilated. Whilst the use of air conditioning is discouraged, but should they be a necessity then approved hospital-quality multi filtration systems (a filtration system that includes a pre filter, true HEPA filter, carbon filter and a UV-C light) should be sourced and regularly changed.

Whilst the Board acknowledges that none of these precautions can prevent or resolve COVID-19 on their own, all of them can contribute to keeping your dental practice, staff and patients safer and healthier—whether there is an ongoing viral epidemic or not.
 

References

  1. Centre for Disease control (CDC). https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
  2. Department of Health.COVID-19 Disease: Infection Prevention and Control Guidelines Version 1 - April 2020. http://www.health.gov.za/index.php/component/phocadownload/category/626
  3. Department of Health Practical Manual for Implementation of the National Infection. Prevention and Control Strategic Framework. http://www.health.gov.za/index.php/component/phocadownload/category/626#
  4. Department of Labour. https://www.labourguide.co.za/workshop/1773-covid-19-guideline-mar2020/file
  5. National Institute for Communicable Diseases. https://www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-guidelines/
  6. National Institute of Communicable Disease. Covid- 19 Guidelines. www.nicd.ac.za/diseases-a-z-index/covid-19/covid-19-guidelines/
  7. National Department of Health. Corona Virus (Covid-19) – Updated. www.health.gov.za/
  8. Medical Council of New Zealand. Current Standards. www.mcnz.org.nz/our-standards/
  9. General Medical Council. Ethical Guidelines. www.gmc- uk.org/ethical-guidance/ethical-hub
  10. Department of Health Practical Manual for Implementation of the National Infection. Prevention and Control Strategic Framework. https://hpcsa.us12.list-manage.com/track/click?u=8aa3e80c93c3f7b79b1fbd470&id=027f847a00&e=653d49fffb 

Level 4 Preliminary Guidelines and Restrictions

Posted by Stella Pascale on Sunday, 3 May 2020 19:37

 

As a reminder, when treating patients, all patients should be treated as potentially being COVID-19 positive. Patients presenting with symptoms or are COVID-19 positive, should only be seen with relevant PPE and only for the management of pain and sepsis.
As dental practitioners, we are part of the economy and this is it important for us to be able to rebuild our practices which have been as hard-hit as any other business. And as dental practitioners, we are considered providing essential services. As a result, we have been able to continue to treat emergency patients as required. With the implementation of level four restrictions, we are now able to expand the scope to include essential treatment as well as emergency therapies. The purpose of level 4 is to enable the economy to start to get back on its feet.
What provide essential services. Essential services are deemed to be any service that is not only taking care of pain and sepsis but also any disease or dental problem that may lead to future pain, sepsis, and any other pathological process. This includes any treatment deemed essential to reduce the risk of further breakdown which may have a deleterious effect on the patient’s future. This does not include any treatment that is deemed elective such as cosmetic procedures or implant procedures that can be put off until such time as we have reduced the risk of cross-contamination of our clinicians and patients.
During delivering of emergency and essential services, avoid AGPs as far as possible. The strictest PPE guidelines should be followed by the clinician and supporting staff.
The focus of dentistry during level 4 is on the management of pain, disease and pathology. Although examination and assessment of patients may reveal incipient lesions or a desire for cosmetic dentistry or full/partial rehabilitations, these are not treatments that are suitable for level 4. Discussion and information sharing may be appropriate so that these treatments can be scheduled for levels 3, 2 or 1.
Where a procedure falls within the scope of a specialist dental field. That Procedures should as far as practical possible be performed by the best-qualified person in that line of dentistry available and it is therefore advised that specialised work be performed by a specialist or any person that has excelled and is recognised as an expert in a certain field. This would ensure the highest standard of care and protecting the patient against undue exposure to the virus, providing safe quality care in a safe environment. The one-stop treatment protocol.
No procedure should be performed outside the scope of practice of your speciality and reference in this regard should be made to the SADA 2016 Coding Journal.

 

 

1. General Dentistry
Dental practitioners should avail themselves for remote consultations throughout lockdown. Patients should be consulted in person if further investigation and/or management is necessary or where the lack of treatment may result in harm, infection or in future complications.
As with level 5, dental treatment during level-4 lockdown should be limited to emergency cases or cases where withholding treatment will lead to more serious complications (for example, progressing caries).
No elective treatment should be offered, nor should treatment that can be postponed (without harm to the patient’s health) be attempted during level 4.
COVID-19 positive patients should be treated in specialised environments such as laminar flow, HEPA filtered (H13, H14) hospital theatres, or specially designed AIR.
AGPs should be avoided as far as possible. If an AGP is inevitable, the procedure should be performed under rubber dam isolation with close approximation of a high-volume evacuation (HVE) suction for limited, short intervals only. The operator should be equipped with the correct PPE (head cap, eye protection, nose and mouth protection and water-resistant gown).
Precautionary rinses or sprays: For all the procedures listed below, it is recommended that the patient must rinse their mouth immediately with 0.5 % H2O2 (or 1% for 2 periods of 30 seconds each.) Povidone-iodine rinses (0.2%), as well as nasal spray, can also be of benefit, providing the patient is not allergic to iodine.
General anaesthesia (GA) should only be considered in the treatment of emergencies. Hospital rules and regulations applicable to level 4 apply. The merit and scope of work along with its associated risks should be discussed with the anaesthesiologist and theatre management.
Sedation (inhalation/ intravenous) should only be considered in cases where treatment justifies the use of sedation. Apply extreme caution regarding infection control measures to ensure a safe environment and outcome for both patient and dental staff. This includes full PPE, sterilization of all equipment used, including sedation machines, pipes and masks. No evidence is available on the safety of sedation or GA in COVID-19 positive patients.
Scope of Treatment
a) Diagnostics

  • Requires HVE and adequate PPE.
  • Examination and assessment of patients can be done as part of early diagnosis of possible disease and pathology. This includes essential intraoral radiographs, which should be limited to diagnosis and treatment verification.
  • Extra-oral radiographs are encouraged where they may assist in the diagnostic process.

 
b) Restorative

  • Requires limiting aerosol and working under rubber dam, with HVE and adequate PPE.
  • Treatment of carious lesions which are approaching the pulp and may result in devitalisation of the tooth with subsequent pain and infection, if left untreated.
  • Treatment of symptomatic and painful carious and crack lesions.
  • Treatment of broken or chipped teeth or restorations causing soft-tissue trauma, even if the teeth are asymptomatic.

 
c) Fixed Prosthodontics

  • Requires limiting aerosol and working under rubber dam, with HVE and adequate PPE.
  • In extreme situations where single teeth are broken down or cracked to the point that a bonded composite or amalgam restoration is impossible, an indirect restoration may be considered. This requires very careful assessment and judgement by the clinician and is a last resort. Use of long-term provisional crowns are also an option to consider.
  • Where previous indirect restorations have fractured resulting in food traps, periodontal disease and caries, these should be replaced, using the protocol outlined above.
  • Re-cementation and re-bonding of loose crowns or bridges on vital or non-vital teeth should be carried out to prevent devitalisation, caries, loss of coronal seal and further complications. This is applicable to permanent or provisional restorations.

 
d) Removable Prosthodontics

  • Requires HVE and adequate PPE.
  • Denture repairs may be undertaken with laboratories exercising full COVID-19 protocols. New removable prostheses should be delayed until the threat is reduced.
  • Chair-side repairs of removable dentures should be carried out where these prostheses are essential for the patient’s well-being.
  • The use of temporary soft liners is not encouraged as this will necessitate follow-up appointments.

 
e) Implants

  • Requires limiting aerosol with HVE and adequate PPE.
  • Fractured and poorly fitting implant abutments may lead to food impaction, infection around the implant and pain. As very little aerosol is generated during implant restoration, the abutment may be replaced to preserve the implant and prevent complications. Fully integrated implants may be considered for restoration in order to stabilise occlusion and maintain correct dental relationships and function.
  • Guidelines for implant placement by general dentists will be governed by the same protocols as periodontists with the same absolute planning and procedure protocols.
  • Periodontal disease is covered in its own section as described by our periodontist colleagues.

 
f) Trauma and Extractions

  • Requires HVE and adequate PPE.
  • Dental trauma and soft-tissue damage must be managed as a dental emergency with the applicable endodontic and surgical protocols.
  • Teeth with a poor prognosis which are painful may be extracted, taking all necessary infection control safeguards into account. Asymptomatic hopeless teeth should be monitored and extracted only when it becomes an emergency or at a later stage.

 
g) Endodontics

  • Requires limiting aerosol under rubber dam, with HVE and adequate PPE.
  • All endodontic treatment should be performed under rubber dam isolation. AGPs should be avoided as far as possible. If an AGP is inevitable, the procedure should be performed under rubber dam isolation with close approximation of a high-volume evacuation for limited, short intervals only. In addition, it is advised to douse tooth under isolation for 30 seconds with 1% H2O2 prior to instrumentation.

 
Only cases included in these criteria may be treated. Defer all other treatments
 

  • Emergency root canal treatment in cases presenting with irreversible pulpitis, facial swelling or acute pain or infection should be performed.
  • An endodontic obturation can be done provided the obturation is performed during the emergency visit (single visit) and in line with conditions mentioned above. Where the obturation phase of treatment can be postponed, practitioners are encouraged to do so. The exception is for cases where withholding further treatment might cause harm or complications.
  • Endodontic management of dental trauma should only be done in cases where postponement of treatment may pose a risk of harm/loss of a tooth. The objective in the treatment should be limited to reducing the immediate pain and risk and not to complete treatment that can be postponed.
  • Vital pulp therapy (for example treatment of complicated crown fractures, pulpotomy treatment or direct pulp capping) is allowed in cases presenting with reversible pulpitis or where the lack of treatment will result in irreversible pulpitis/infection.

 
h) Paediatric Dentistry

  • Requires limiting aerosol under rubber dam, HVE and adequate PPE.

 
Only patients included under the following criteria may be treated. Defer all other treatments.

  • Cavities causing pain/trauma to adjacent soft tissue, the ART or Interim Therapeutic Restorations (ITR) with limited aerosol are the treatments of choice.
  • Extraction is the treatment of choice for primary teeth associated with acute pain, abscess formation, facial swelling and cellulitis.
  • Endodontic treatment on primary teeth (pulpotomy and pulpectomy) should only be performed if extraction of the tooth may have long-term consequences (Refer to Endodontic section for more options).
  • Management of trauma: Refer to Endodontic section for more options).

 
i) Periodontal Treatment/Oral Medicine

  • Requires limiting aerosol with HVE and adequate PPE.
  • Diagnostic services enabling the clinician to perform essential treatment.
  • Management of periodontal diseases/infection.
  • Management of peri-implant diseases.
  • Supporting Periodontal Therapy (SPT) restricted to hand instrumentation: Periodontal maintenance of patients with a history of periodontal disease.
  • The nature of oral medicine is such that a biopsy is often required to provide a definitive diagnosis. The diagnosis speaks to management. AGPs can be greatly reduced whilst practising within the scope of oral medicine, hence, dentists should be allowed to practice oral medicine fully.
  • Implant placement and associated procedures may only be carried out if delaying the implant placement may be deemed detrimental to the patient’s final outcome or may lead to further destruction and damage to the supporting structures. This may only be done as part of a procedure that includes the elimination of teeth due to pain, and sepsis that may lead to increased bone destruction if left unchecked.
  • Procedures following extraction at time of treatment for pain and sepsis that reduce the loss of biological tissue and hence reduce the possibility of requiring further invasive and costly grafting procedures in future.

j) Oral Hygiene Related Procedures

  • Requires limiting aerosol under rubber dam, with HVE and adequate PPE.
  • Fissure sealants under rubber dam for teeth at high risk for developing dental caries
  • Vital bleaching procedures – only home treatment – not in-office procedures.
  • Fluoride treatment where applicable (as prevention method only).
  • De-sensitization of exposed roots where patients are experiencing symptoms.
  • Scaling and polishing eliminating the use of aerosol-producing equipment (only hand scalers should be used—no ultrasonic scalers).

 
2. Orthodontics
Scope of Treatment

  • More routine orthodontic procedures may now be conducted
  • Scheduling of patients should give appropriate consideration to the following:

o    Prioritisation of appointments according to need of care

o    Minimisation of length of appointments

o    Adjustment of the workflow to reduce inter-patient contact

o    Allowance for adequate time between patients for preparation of the clinical environment

o    AGPs should be avoided, or modified to be kept to a minimum.

o    Debonding procedures should be postponed where possible unless postponement will compromise the teeth in any way (for example decalcifications).

o    Should the postponement of debonding not be possible, consideration should be given to the use of hand instruments to avoid aerosol generation. This may require the patient to return for completion of the removal of bonding material.

  • Should it be necessary to use aerosol-generating procedures, proper PPE should be used and High- Volume Evacuation protocols should be employed.

 
3. Periodontology, Implantology and Oral Hygiene
When treating patients, all patients should be treated as potentially being COVID-19 positive patients. Patients presenting with symptoms or are COVID-19 positive, should only be seen with relevant PPE and only for the management of pain and sepsis.
 
As dental practitioners, we are part of the economy and this is it important for us to be able to rebuild our practices which have been as hard-hit as any other business.
 
As dental practitioners, we are considered essential services. As a result, we have been able to continue to treat emergency patients as required. With the implementation of level four restrictions, we are now able to expand the scope to include essential treatment as well as emergency therapies. The purpose of level 4 is to enable the economy to start to get back on its feet.
 
What are essential services? Essential services are deemed to be any service that is not only taking care of pain and sepsis but also any disease or dental problem that may lead to future pain, sepsis, and any other pathological process. Should also include any treatment that is deemed essential to reduce the risk of further breakdown which may have a deleterious effect on the patient’s future. This does not include any treatment that is deemed elective such as cosmetic procedures or implant procedures that can be put off until such time as we have reduced the risk of cross-contamination of our patients.
 
During delivering of Emergency and ESSENTIAL services avoid aerosol producing procedures as far as possible. The strictest PPE guidelines should be followed by the clinician and supporting staff.
 
Within the Level 4 restriction recommendations, Emergency and essential treatment to address dental infections, sepsis and pain are key.
 
Scope of Treatment
Periodontological procedures that can be done during this level include (but are not limited to):
a) Diagnostics

  • Services enabling the clinician to perform essential treatment

 
b) Infection Management

  • On-going management of periodontal diseases or infection

 
c) Disease Management

  • Management of peri-implant diseases

 
d) Supportive Periodontal Treatment (SPT)

  • Supportive therapy is restricted to hand instrumentation
  • Periodontal maintenance of patients with a history of periodontal disease

 
e) Biopsies

  • The nature of oral medicine is such that a biopsy is often required to provide a definitive diagnosis. The diagnosis speaks to management. Aerosol forming procedures can be greatly reduced whilst practising within the scope of Oral Medicine and hence we feel that Oral Medicine Specialists should be allowed to practice Oral Medicine fully.

 
f) Implant Placement and Associated Procedures

  • These may only be carried out if delaying the implant placement may be deemed detrimental to the patient’s final outcome or may lead to further destruction and damage to the supporting structures. This may only be done as part of a procedure that includes the elimination of teeth due to pain and sepsis that may lead to increased bone destruction if left unchecked.

 
g) Ridge Preservation

  • Procedures following extraction at time of treatment for pain and sepsis that reduce the loss of biological tissue and hence reduce the possibility of requiring further invasive and costly grafting procedures in future.

 
h) Oral Hygiene Related Procedures

  • Requires limiting aerosol under rubber dam, with HVE and adequate PPE.
  • Fissure sealants under rubber dam for teeth at high risk for developing dental caries.
  • Vital bleaching procedures – only home treatment – not in-office procedures.
  • Fluoride treatment where applicable (as prevention method only).
  • De-sensitization of exposed roots where patients are experiencing symptoms.
  • Scaling and polishing eliminating the use of aerosol-producing equipment (only hand scalers should be used—no ultrasonic scalers).

 
4. Prosthodontics
Prosthodontic treatment should be performed under the umbrella of Expanded Care, which encompasses emergency and urgent care as well as minimal aerosol-producing procedures, where withholding or delaying treatment will lead to more serious complications.
 
No elective treatment should be offered, nor should treatment that can be postponed (without harm to the patient’s health) be attempted during level 4.
 
Prosthodontists should avail themselves for remote consultations throughout lockdown. Patients should be consulted in person if further investigation and/or management is necessary or where the lack of treatment may result in harm, infection or in future complications.
 
COVID-19 positive patients should be treated in specialised environments such as laminar flow, HEPA filtered (H13, H14) hospital theatres, or specially designed AIR.
 
Note: Appropriate PPE sterilization and patient preparation measures must be adhered to strictly, as defined in the preamble. All AGPs should be performed under rubber dam isolation. Prior to any procedure, prosthodontic patients must use pre-operative oral rinses.
 
Scope of Treatment
a) Fixed Prosthodontics
 

  • Requires limiting aerosol and working under rubber dam, with HVE and adequate PPE.
  • It is necessary to complete procedures with minimal to no aerosol production
  • The only procedures offered are ones where further maintenance is necessary, failure of which may lead to infection and/or further deterioration of the oral health and quality of life (QOL).


b) Removable Prosthodontics
The continuation or completion of procedures where further maintenance is necessary, failure of which may lead to infection and/or further deterioration of the oral health QOL.
c) Implant Therapy
Implant procedures related to complications where the prostheses are critical for the patients’ QOL.
d) Oncology & Craniofacial Trauma
All prosthodontic procedures that are related to the management of malignant and benign maxillofacial lesions that cannot be deferred.
e) TMD
Management of cases that cannot be otherwise managed pharmacologically.
f) Endodontics
Refer to the Endodontics guidelines under General Dentistry.
 
5. Maxillofacial and Oral Surgery
Like with level 5, level 4 also includes life-threatening and severe emergency procedures. During these severe emergency procedures, the necessary AGP is allowed, but it should be kept to a minimum. AGPs include extractions, incision and drainage of a facial or dental abscess with concomitant removal of the offending tooth/teeth, the use of power tools to place plates and screws in facial fractures and in orthopaedics for the same fracture management, use of scopes in general surgery, naso-sinus endoscopy and intubation for anaesthesia.
Level 4 sees a slight easing of measures and scope of working but only essential AGPs are still allowed, with recognition of additional safety to avoid the spread of vapour.
 
The Oro-Facial Sepsis Aspect
The following protocols are advised by the Scotland National Health System. This advice might change as new information becomes available. Please ensure that you are viewing the most recent version of this document by referring to www.sdcep.org.uk.]
 
 

 

 

Note: The notion that cases should be treated in a hospital should be avoided. Many of these cases can be treated in the surgical rooms—provided that this does not pose a public safety risk. This risk can be assessed through a multitude of individual factors, e.g., the air conditioning system, location of the rooms, outside ventilation, and more. The admission of a patient into a hospital, as evident from the outbreaks at Scotland’s St Augustine’s and Morningside Hospitals, indicate that at least 60 contacts are generated per patient admitted. Should a COVID-19 positive patient be admitted, this could lead to the total closure of the facility. This constitutes a devastating loss of healthcare capability and poses enormous public health risks. A procedure done in a surgical room, however, can be done with two contacts only, and contact would be limited to about one hour. Current testing protocols for hospitals would constitute that an admission of 48 hours dramatically increases the risk to the patient, healthcare workers, the facility and the public at large.
SASMFOS would therefore suggest the following: The management of the patient should be performed using the shortest and most efficient treatment protocol and the safest place of service possible. In the decision of the safest place of service, the surgeon should take into consideration the interest and safety of the patient, healthcare workers, general public health and the integrity and safety of healthcare services.
This also includes the individual hospital and surgical room factors as outlined in the document “Dental protocol in response to the COVID-19 epidemic—A South African private practice perspective” should be taken into consideration in determining the safest place of service.

Surgery During Level 4
The scope of maxillofacial and oral surgery is extensive, and we advise that each clinician will use their utmost discretion when confronted with an essential, urgent or emergent case. The appropriate PPE need to be used at all times, and the use of assistants as well as persons present in theatre—including trade representatives—should be limited where possible.
In the event that a patient requires a general anaesthetic for treatment, it is recommended that the surgeon and anaesthetist discuss the merit of each case and follow the recommendations as per the guidelines outlined in A Pragmatic Approach To Surgery During COVID-19, which was published by South Africa Society of Anaesthesiologists (SASA). Furthermore, the facility where the procedure will be undertaken must fulfil the recommendations for safe surgery during the COVID-19 period.

Scope of Treatment
Level 4 procedures for maxillofacial and oral surgery include trauma and acute musculoskeletal patients in the following categories:

 

A. Maxillofacial Trauma:

  1. Obligatory in-patients: Continue to require admission and surgical management e.g., significant mandibular and mid facial fractures and serious cervicofacial infections. We must expedite treatment to avoid pre-op delay and expedite rehab to minimise length of stay.
  2. Non-operative patients: Patients with injuries that can reasonably be managed either operatively or non-operatively e.g. condylar fractures. We must consider non-operative care if that avoids admission. Intermaxillary fixation (IMF) may also be considered in the office setting for amenable facial fractures with the use of IMF screws, resulting in minimising contacts, treatment time and avoiding admission to hospital.
  3. Day-cases: Surgery can be safely undertaken for a large number of conditions. Provision for day-case surgery must be made.
  4. Outpatient Local Anaesthetic clinics: Lacerations, biopsies for oral cancer and resolved dental abscesses
  5. First contact and clinics: Outpatient attendances should be kept to the safe minimum. Emergency Departments (ED) are likely to come under intense and sustained pressure and OMFS surgeons can make an important contribution by reducing the ED workload so that clinicians in ED can focus on medical patients. ED will change their system and will use triage at the front door and stream patients directly to OMFS Clinic before examination or diagnostics. Fracture clinics are likely to be asked to take all patients presenting with trauma (including wounds and minor injuries) straight from triage.
  6. Treatment of myofascial pain disorders: Consider as a level 3 service. Can be managed via remote consultation (telemedicine) in level 4, except where special investigations need to be performed during the workup of these patients or maintenance of therapy via infiltration is needed.
  7. Maxillofacial oncology: These are not deemed as extremely urgent except if they were urgent referrals in level 5.
  8. Dental emergencies and symptomatic infectious conditions: Offered only where further delay in treatment will negatively influence the outcome of treatment. Limit AGP as per standard protocol and additional measures suggested in the SADA protocol document.

B. Minor Oral Trauma

  1. Implant placement and associated procedures may only be carried out if delaying the implant placement may be deemed detrimental to the patient’s final outcome or may lead to further destruction and damage to the supporting structures. This may only be done as part of a procedure that includes the elimination of teeth due to pain and sepsis that may lead to increased bone destruction if left unchecked.
  2. Procedures following extraction at time of treatment for pain and sepsis that reduce the loss of biological tissue and hence reduce the possibility of requiring further invasive and costly grafting procedures in future

Attachments:

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