Recommendations for the re-opening of dental services: a rapid review of international sources

The COVID-19 pandemic has resulted in the closure or reduction of dental services across the world. Now, attention is focussed on planning the re-opening and restructuring of dental services.

To support decision making, a group led by Professors Jan Clarkson and Craig Ramsay has conducted a rapid review of internationally produced guidance for re-opening dental services. 

Read the rapid review here.

Please note, this is a living document, and subject to revision.

This rapid review collates and summarises recommendations from the various sources identified within five themes relevant to the re-opening of dental services: practice preparation, personal protective equipment, management of the clinical area, dental procedures, and cleaning and disinfection. The review is not guidance. Given that we have only really known about COVID-19 for about 120 days, robust evidence is scarce. However, this review should assist policy and decision-makers in producing national guidance for their own settings.

The review is the work of a collaborative group of researchers and clinicians from a range of UK institutions, including the Scottish Dental Clinical Effectiveness Programme, NHS Education for Scotland, the Universities of Aberdeen, Dundee, and Manchester, and Cochrane Oral Health.

Notification of new potential sources of national guidance can be sent to Cochrane Oral Health.

Key messages:

  • This review reports on national recommendations for the restructuring and reopening of dental services from 16 countries.

  • There is a highly variable level of detail given across international sources.

  • Most sources recommend patient triage by telephone; some recommend also temperature screening at reception.

  • Most sources recommend avoiding aerosol-generating procedures (AGPs), if possible.

  • Most sources recommend surgical masks for non-COVID-19 cases not requiring AGPs.

  • Most sources recommend filtering facepiece class 2 (FFP2, equivalent to N95) masks for non-COVID-19 cases undergoing AGPs and all suspected or confirmed COVID-19 cases undergoing any procedure.

  • Sources include recommendations on how to reduce the risk of transmission (e.g. use of pre-operative mouthwashes; high volume suction; rubber dam; and Personal Protective Equipment [PPE]).

  • Most sources recommend cleaning and disinfection procedures.

  • Across sources, for most statements there is no referenced, underpinning evidence and some of them are unlikely to have strong (or any) research evidence.

  • All sources emphasise the need to focus on activities that minimise risk (to staff/patients/public) but still support high-quality clinical care.

  • There is a need to consider the inter-relationship between the appropriate use of PPE (including donning and doffing), AGPs and interventions to reduce aerosol generation.