How has the COVID-19 (Coronavirus Disease 2019) pandemic impacted dental hygiene practices?

COVID-19 Pandemic Changes to Dental Hygiene Practices

The COVID-19 pandemic has fundamentally transformed dental hygiene practices through mandatory implementation of enhanced personal protective equipment (PPE), aerosol-generating procedure (AGP) protocols, and comprehensive infection prevention and control (IPC) measures that prioritize respiratory protection and droplet/aerosol mitigation to reduce mortality and morbidity from SARS-CoV-2 transmission.

Enhanced Personal Protective Equipment Requirements

Dental hygienists must now wear N95 or equivalent respirators (FFP2/FFP3) during all aerosol-generating procedures, replacing standard surgical masks that were previously acceptable. 1 This represents the most critical change, as dental procedures generate aerosols that can remain airborne for up to 3 hours and travel beyond 2 meters. 1

• Face shields must be used in addition to eye protection to cover the entire face, not just the eyes 1
• Long-sleeved disposable gowns are now considered minimal PPE for tracheostomy and high-risk dental care 1
• Gloves and eye protection remain mandatory, with consistent use reported by >96% of US dental hygienists throughout 2020-2021 2

A critical caveat: N95 respirator use peaked in February 2021 but subsequently declined despite ongoing transmission risk, representing a dangerous practice gap. 2

Pre-Procedure Patient Screening and Management

All patients must undergo COVID-19 screening before appointments, including symptom interviews and temperature checks, though this practice declined significantly after March 2021. 2

• Patient face masking is required in waiting areas and should only be removed during active treatment 2
• Antiseptic mouth rinses should be used immediately before procedures to decrease oral viral load in droplets and aerosols 1
• Physical distancing between patients in waiting areas must be maintained 2
• Chairside rapid testing for SARS-CoV-2 is urgently needed but not yet widely available 3

Important limitation: Screening has limited effectiveness since 75% of COVID-19 patients are asymptomatic. 3

Aerosol Mitigation Strategies

Dental hygienists must minimize aerosol-generating procedures and implement chemical oral biofilm control as an alternative to mechanical methods when possible. 1

• High-volume evacuation systems should be used during all aerosol-generating procedures 4
• Air filtration systems and physical barriers increased in use during 2020-2021 but declined in spring 2021 2
• Closed-circuit systems should be maintained whenever possible, as disconnection creates high-risk AGP exposure 1
• Treatment should be triaged to urgent cases only during acute pandemic phases, with elective procedures deferred 2-4 months 1

Environmental Disinfection Protocols

Operatory disinfection between patients and disinfection of frequently touched surfaces must occur after every patient encounter. 2

• Operatory disinfection was consistently reported by >96% of dental hygienists throughout the study period 2
• Frequently touched surfaces require enhanced disinfection protocols 2
• Dental prosthesis cleaning must be performed outside the oral cavity to minimize aerosol exposure 1
• Proper storage and cleaning protocols for toothbrushes and instruments are essential 1

Vaccination and Staff Protection

All dental staff, hygienists, and patients should be vaccinated against COVID-19 as the most effective pandemic control measure. 3

• COVID-19 vaccination status was significantly associated with improved IPC and PPE compliance 2
• Staff temperature checks at shift start were widely implemented but declined after March 2021 2
• PPE must be changed between patients to prevent cross-contamination 3

Practice Setting Considerations

Dental practice setting significantly influences IPC implementation, with hospital-based practices typically maintaining stricter protocols than private offices. 2, 4

• Supply availability of N95 respirators directly correlates with their use 2
• Community COVID-19 transmission levels should guide the intensity of IPC measures 2
• Only 61% of dentists implemented protocol changes despite widespread pandemic awareness, representing a critical public health gap 3

Critical Practice Gaps

Despite initial improvements, several concerning trends emerged in 2021 that increase transmission risk:

• Decline in N95 respirator use after February 2021 despite ongoing transmission 2
• Decreased patient screening, temperature checks, and surface disinfection after March 2021 2
• Reduction in physical barriers and air filtration use in spring 2021 2

These practices must be maintained regardless of perceived pandemic phase, as SARS-CoV-2 continues to mutate and asymptomatic transmission remains prevalent. 2, 3