Covid-19 FAQs

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What is COVID-19?

 

COVID-19 is caused by a novel (new) air-borne coronavirus, SARS-CoV-2, that current thinking suggests is transmitted by droplet and aerosol contamination and close contact (less than 2 metres) with an infected person or through touching contaminated surfaces.

Whilst much has been learnt about SARS-CoV-2 since it was first notified to the World Health Organisation at the end of December 2019, much remains unknown. Consequentially there is a lack of high-quality evidence of how best to protect the dental workforce and their patients. The FGDP has proposed a risk-based approach to a safe return to a suitable dental practice until new evidence emerges. This approach also supports the national objective of reducing transmission of COVID-19 in the community and takes account of those who may be at higher risk of serious infection.

 

The new variants of the SARS-CoV-2 virus present a particular challenge, although it is thought that the variants are not any more deadly than the earlier versions.

 

The overwhelming majority of pathogens in dental practice are blood-borne viruses (BBVs) such as hepatitis B, HIV, hepatitis C and vCJD. Historically there have been extremely robust infection control procedures for dealing with BBVs but much less robust procedures for airborne viruses and contact viruses. Additions to standard infection control procedures are therefore considered necessary during the COVID-19 pandemic and possibly beyond.

 

What is the incubation period for COVID-19?

The incubation period for COVID-19 averages 5 days and can be up to 14 days, during which time patients are thought to be infectious even though they may be asymptomatic. It is now known that around 30% of people who have the virus are asymptomatic, meaning that a significant number of patients attending a dental practice may be either asymptomatic or they may be carrying or incubating the virus. This applies equally to clinicians, team members, patients, and members of the public. There may also be individuals who choose to conceal their symptoms to access treatment.

Dental practices must therefore treat all patients as if they are infected and apply appropriately strict protocols for the protection of patients, clinicians, and team members.

In addition, all dental practice team members are advised to ‘behave as if they have COVID

 

 

What are the symptoms of COVID-19?

 

The three most prevalent symptoms of COVID-19 are:

  • Fever (a temperature over 37.8 degrees centigrade)

  • A new persistent cough

  • Loss of taste and smell

 

Other symptoms that are not usual to the individual and have recently started may also indicate COVID-19, even in the absence of the common symptoms listed above.

 

The following symptoms have been identified in patients who test positive for COVID-19 (frequency is in brackets) and if present should prompt the individual to have a test:

 

  • Loss of appetite (49-84%)

  • Sputum production (28-33%)

  • Aches and pains (11-44%)

  • Sore throat (11-13)

  • Diarrhoea (5-24%)

  • Nausea/ vomiting (5-19%)

  • Headache (6-70%)

  • A new skin rash/discolouration of fingers or toes (<10%)

 

It is well established that respiratory viruses are more prevalent in the colder months of the year and it is inevitable there will be confusion about whether symptoms are due to the common cold, influenza, or COVID-19. It is therefore imperative that everyone with any of the symptoms above has a test for COVID-19. 

 

 

Which patients can and can’t be seen in general dental practices?

 

Only patients who are asymptomatic and whose household members are also all asymptomatic for COVID-19 can be seen.

 

You cannot see patients who are:

 

  • Self-isolating because they have one or more of the published symptoms of COVID-19 .

  • Awaiting the results of a COVID-19 test.

  • Are part of a household in which another member is self-isolating because they have one or more of the published symptoms of COVID-19.

  • Are quarantining because they have returned from a country on the UK government’s list of non-exempt countries.

  • Have been contacted by Test and Trace and told to self-isolate.

 

No treatment can be provided in dental practice for these patients until the end of the self- isolation or quarantine period. 

 

Can I treat clinically extremely vulnerable patients?

On 4th November, the Department of Health and Social Care updated the list of patients who are clinically extremely vulnerable. These patients will again be receiving a letter from the government telling them to shield and to stay at home all the time, except for in certain specific circumstances, such as attending a medical appointment. All non-emergency dental appointments for these patients should be postponed during the lockdown. If an extremely clinically vulnerable patient is in urgent need of emergency dental treatment, they should be seen as the first patient of the day.

Clinically extremely vulnerable patients:

  • People with solid organ transplants

  • Specific cancers:

    • People with cancer who are undergoing active chemotherapy.

    • People with lung cancer who are undergoing radical radiotherapy.

    • People with cancers of the blood or bone marrow such as leukaemia, lymphoma or myeloma who are at any stage of treatment.

    • People having immunotherapy or other continuing antibody treatments for cancer

    • People having other targeted cancer treatments that can affect the immune system, such as protein kinase inhibitors or PARP inhibitors.

  • People who have had bone marrow or stem cell transplants in the last 6 months or who are still taking immunosuppression drugs.

  • People with severe respiratory conditions including all cystic fibrosis, severe asthma, and severe chronic obstructive pulmonary disease (COPD).

  • People with rare diseases that significantly increase the risk of infections (such as severe combined immunodeficiency (SCID), homozygous sickle cell).

  • People on immunosuppression therapies sufficient to significantly increase risk of infection.

  • Adults with Down’s syndrome.

  • Adults on dialysis or with chronic kidney disease (Stage 5).

  • Women who are pregnant with significant heart disease, congenital or acquired.

 

 

What risk assessments do we need to undertake?

 

You will need to undertake risk assessments for:

  • Every patient you see at your practice during the pandemic

  • All clinicians and all team members

  • Your practice

 

To understand how to undertake risk assessments, take our CPD courses in the New Patient Journey and Risk Assessments Demystified

 

 

What is an Aerosol Generated Exposure (AGE)?

 

The Faculty of General Dental Practice (UK), the FGDP guidance issued in June created the descriptor ‘aerosol generated exposure’ or AGE. An AGE is then further qualified as being a low-risk AGE (breathing, speaking, coughing, and sneezing or activating the gag reflex, some dental treatments) and a high-risk AGE (dental treatment that creates an aerosol). A high-risk AGE equates to what we have come to describe as an Aerosol Generating Procedure or AGP. This is very helpful as it stratifies risk and allows a risk-based approach to the selection of appropriate PPE. Take a look at our course here.

 

 

What are high-risk AGEs?

 

High-risk AGEs are procedures that include (but are not limited to) the use of:

 

  • The air turbine.

  • The three in one air/water syringe when use of air and water is combined.

  • High-speed electric handpiece operating at > 60,000 rpm.

  • Surgical motors with irrigant/irrigation.

  • Ultrasonic scalers and Piezo handpieces.

  • Sandblasting, air abrasion, air polishing.

 

Practices may also wish to consider whether there may be a risk of aerosol generation when using endosonic handpieces and rotary endodontic handpieces.

 

 

How do I transport and clean my work uniform/scrubs?

 

All team members must be provided with adequate surgery-only uniform/scrubs and/or reception uniform for each working day.

Surgery-only uniform/scrubs must be worn under a disposable or re-usable gown and must be changed daily and laundered daily.

Clinical team members must not travel to and from work in uniform/scrubs.

Rooms or areas should be available for team members to change into and out of uniforms or scrubs.

Uniforms/scrubs should be transported home in a pillowcase.

The scrubs and the pillowcase must be laundered immediately on return home (or at the practice if the facility is available) and separately at 60c or at a higher temperature if the fabric allows.

They must be laundered separately to other items and the washing machine must be no more than half-full. They should then be tumble-dried and/or ironed. Take a look at our course here.

 

 

Can we open the drawers in our surgery during high and low risk AGEs?

 

Opening drawers is a tricky one! Actually we have been advised for many, many years that we should not open drawers during treatment due to the risks associated with any droplets in the air falling on clean materials in a drawer, so this isn’t technically a new ‘requirement’. However, realistically we all know that this isn’t always followed.

COVID-19 however poses a whole new risk level, especially while there is still much to learn about how it is spread and also while it is circulating in the community. For that reason, we should keep all drawers closed during treatment, whether this is for a high-risk AGE or a low-risk AGE. The differentiation between high and low risk levels of AGEs is very important because it acknowledges that there is no such thing as ‘no AGE’ because of speaking, breathing, coughing etc. That’s the reason theatres still cannot open, and we have to wear masks in enclosed areas in public.

So, the answer is the ‘no opening drawers’ rule’ applies whatever you are doing. Take a look at our course here.

 

 

I work as a dental nurse and I have recently developed symptoms of Covid-19. Can I still attend work?

No. You must not attend work and must immediately self-isolate and get yourself a test organised. Take a look at our course here.

 

 

How do I get tested for COVID-19?

 

You can have a swab test to check if you have coronavirus (COVID-19). You can either:

  • Choose to take the test in your local area at the designated testing centres OR

  • Order a home test kit via this link

 

If you have trouble with your internet, please call 119 if you are in England, Wales or Northern Island and 0300 303 2713 if you are in Scotland.  Lines are open 7 am to 11pm every day.

 

Please see further guidance here.

 

I am a fully private dental practice. Are my staff eligible for an NHS COVID-19 test?

Yes, the NHS COVID-19 test is available to everyone who have symptoms for coronavirus (i.e. a high temperature, a new, continuous cough or loss or change to your sense of smell or taste).

 

See the guidance here.

 

I work in a dental practice and a member of my household has got symptoms of COVID-19. They are awaiting their test results.  Can I continue to go to work?

 

No. You should not attend work and must immediately self-isolate if you or any member of your household have symptoms.

 

See the guidance here.

 

How long should I self-Isolate for?

 

If you have tested positive for coronavirus or have symptoms, you will need to self-isolate for at least 10 days.  You will also need to self-isolate for 10 days if you have been told to self-isolate by NHS Test and Trace.

 

See the official guidance here.

 

 

Do I have to self-isolate if I was wearing a face covering or face mask?


Practice team members who are providing care to or are in close contact with a patient who subsequently tests positive for COVID-19 and are wearing the correct PPE appropriately in accordance with the current infection prevention and control (IPC) guidance, will not be considered as a contact for the purposes of contact tracing and isolation.

 

If there has been a breach of recommended PPE during the care then the team member would be considered a contact and should self-isolate as advised. In non-patient facing areas, IPC precautions may unintentionally be less stringently adhered to. If IPC precautions have been compromised, or PPE has been worn incorrectly or breached, the team member should be considered a contact and should self-isolate as advised.


A risk assessment should be carried out by a designated person in the workplace before they return to work. See the guidance at https://www.gov.uk/government/publications/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings/covid-19-management-of-exposed-healthcare-workers-and-patients-in-hospital-settings.

 

What is NHS Test and Trace?  Does it apply to private dental practices?

 

The NHS Test and Trace is a service:

  • To ensure that everyone who develops symptoms of coronavirus can be tested quickly.

  • To help trace close recent contacts of anyone who tests positive for coronavirus and notify them that they must self-isolate (if necessary) to stop the spread of virus.

 

NHS Test and Trace applies to everyone including private dental practices. See the guidance here.

 

What does close contact mean?

 

Close contact means:

  • having face-to-face contact with someone less than 1 metre away (this will include times where you have worn a face covering or a face mask)

  • spending more than 15 minutes within 2 metres of someone

  • travelling in a car or other small vehicle with someone (even on a short journey) or close to them on a plane

 

See the guidance here.

 

I tested positive for COVID-19 and returned to work after a 10-day period of self-isolation, but I have got new COVID-19 symptoms. What should I do?

 

  • If you develop new COVID-19 symptoms at any point after ending your first period of isolation;

  • Go home immediately, if you are at work or out in a social setting when you develop symptoms.

  • Do not go to work, if you are at home when the symptoms develop.

  • Get a PCR test as soon as possible. Note: PCR tests are most sensitive when performed in the first 3 days after the first symptom. 

  • Self-isolate at home until you receive the results.

  • If the PCR test is negative, you may return to work.

  • Perform daily lateral flow tests for 10 days.

 

 

If I was previously tested positive with COVID-19, do I still need to get tested following 10 days of self-isolation?

 

You can return to normal activities including work if after 10 full days of self-isolation your symptoms have gone, or if the only symptoms you have are a cough or anosmia, which can last for several weeks.

 

If you still have a high temperature after 10 days or are otherwise unwell, stay at home and seek medical advice.

See the guidance here.

 

 

What are the symptoms of coronavirus in children? 

 

The main symptoms of coronavirus are:

  • a high temperature

  • a new, continuous cough – this means coughing a lot, for more than an hour, or 3 or more coughing episodes in 24 hours

  • a loss or change to sense of smell or taste – this means they cannot smell or taste anything, or things smell or taste different to normal

What to do if your child has symptoms:

If your child has any of the main symptoms of coronavirus:

  1. Get a test to check if they have coronavirus as soon as possible.

  2. Stay at home and do not have visitors until you get the test result – only leave your home to have a test.

 

Anyone you live with, and anyone in your support bubble, must also stay at home until you get the result.

 

Can I contract COVID-19 twice?

A study by published by Public Health England on February 3rd 2021 indicated that antibodies produced following natural infection may protect most people against subsequent infection for at least 6 months. However, with the emergence of more transmissible strains of the virus, the risk of reinfection also increases. It is important for all members of the dental team to continue to adhere to the measures put in place to protect themselves and their patients.

See the statistics here.

 

 

Are lateral flow tests mandatory for all dental practices?

 

The Innova SARS-CoV-2 Antigen Rapid Qualitative Test has been rolled out to all patient-facing staff delivering NHS services in primary care. This is also applicable to NHS dental practices. The tests are voluntary, but staff should be encouraged to be involved in regular testing to benefit their colleagues and patients.

See the guidance here.

 

Do I need to self-isolate for 10 days as advised by NHS track and trace if I have had a negative PCR test and no symptoms?

If an unvaccinated or partially vaccinated staff member is notified as a contact of a COVID-19 case, by NHS Test and Trace, they must self-isolate as advised unless they are exempt (unable to be vaccinated due to medical reasons or are taking part or have taken part in a clinical trial for a COVID-19 vaccine).

From 16 August, staff members notified that they are a contact of a COVID-19 case are not required to self-isolate if they are fully vaccinated.  However, if you develop symptoms:

  • If you are at work or out in a social setting when you develop symptoms, go home immediately.

  • If you are at home when you develop symptoms, stay at home, and do not go to work.

  • Get a PCR test as soon as possible. Note: PCR tests are most sensitive when performed in the first 3 days after the first symptom. 

  • Self-isolate at home until you receive the results.

  • If the PCR test is negative, you may return to work.

  • Perform daily lateral flow tests for 10 days.

If your PCR test is positive

 

  • Self-isolate at home for 10 days.

  • Note your isolation period extends from the day your first symptom started (or the day of your PCR test if you are asymptomatic) through to a full 10 days after this first day.

 

Government guidance states that fully vaccinated household contacts do not need to self-isolate with you, provided they do not work in a healthcare environment or in social care. 

 

If you get a positive lateral flow test:

 

  • Self-isolate immediately.

  • Get a PCR test and isolate until you get the result.

  • If your PCR test is positive, you must self-isolate for 10 days after your test.

  • If your PCR test is negative, you can go back to work.

  • Continue to perform lateral flow tests for the next 10 days.

 

If a member of your household develops symptoms or has a positive PCR test result:

 

  • Do not go to work.

  • Get a PCR test and self-isolate until you get the result. 

  • If your PCR test is negative, you may return to work.

  • Perform a lateral flow test every day before you go to work and upload the results to the Test and Trace portal.

  • If one of your lateral flow tests is positive, self-isolate immediately and arrange another PCR test.

  • If your PCR test is positive, self-isolate at home for 10 days.

 

 

Can I have a PCR test if I tested positive for COVID-19 in the last 90 days but have been in contact with someone who has tested positive for COVID-19 and have no symptoms?

No. If you have tested positive for COVID-19 in the last 90 days you should not have a PCR test and should only undertake daily LFD antigen tests as it is possible for PCR tests to remain positive for some time after COVID-19 infection as the test can pick up inactive viral fragments (which are not infectious).

See the guidance here.

I am a self-employed dentist who is pregnant, can I decide not to stop working?

If you are pregnant and working in a dental practice, it is right that you wear a mask and adhere to current infection control guidance at all times, no matter your gestation.

 

Pregnant members of the dental team should be risk assessed to identify current controls and any areas for improvement required in practice. Where correct infection control measures including the use of appropriate PPE, hand washing and social distancing are maintained, the dental environment is considered safe.

 

See official guidance here - https://bda.org/advice/Coronavirus/Pages/faqs.aspx

 

We have appropriate protocols in place in our dental practice. Do I need to self-isolate if a member of the dental team tests positive for COVID-19?

 

If members of the dental team are wearing the correct PPE in accordance with the current IPC guidance, they will not be considered as a contact for the purposes of contact tracing and isolation. They will also not be required to self-isolate for 10 days (organisations have agreed the standards for PPE specification, fit testing and regimes of use for clinical and care activities).

See the guidance here.

 

Can a member of staff return to work after 10 days self-isolation if a member of their household is still experiencing symptoms of COVID-19?

If you stayed at home for 10 days because you live with someone who had symptoms or tested positive for COVID-19, you can return to your usual activities including work on the 11th day as long as you have had no symptoms and have not had a positive test result. You must continue to abide by the Government’s coronavirus advice.

See the guidance here.

 

Can we stop following the guidance in our Standard Operating Procedures once we have had the vaccine?

No, having the vaccine greatly reduces the risk of catching Coronavirus which is great news.

However, it may take a few weeks for the vaccine to get working in your system so it’s very important to follow guidance to ensure you don’t catch the virus whilst your body is still vulnerable.

Once you have immunity, your risk of catching the virus is greatly reduced but you could potentially still spread the infection to others which is why it’s very important to continue to adhere to the guidance in your SOP’s.

 

 

Can I enforce the “No vaccine, No work” policy on my employees?

If staff refuse vaccination, employers should seriously consider the employee’s reasons and try to address any concerns and clarify any misconceptions about the vaccines. Employers in the UK currently have no statutory right to oblige an employee to be vaccinated against COVID-19 virus without their consent, but it may be theoretically possible for an employer to require vaccination through a well drafted contract of employment and policies. Legal aspects with respect to discrimination, data protection and health and safety duties must be considered as part of any changes in contractual arrangements implemented by an employer. It is important to discuss any proposed changes with a Human Resource Consultant or your indemnifier.

 

 

Can I return to work even if my GP has advised me to shield as I am clinically vulnerable?


Yes. Shielding advice was paused from the 1st of April 2021. All clinically extremely vulnerable people are advised as a minimum, to follow the same guidance as everyone else.

Staff who are clinically extremely vulnerable should be risk assessed and where possible amendments should be made to keep them safe.

See the guidance here.

 

Can I not see a patient who refuses to wear a mask? 

No. Treatment cannot be refused, but the practice may need to make reasonable adjustments to ensure both staff and patients are protected.

NHS England and the BDA offer specific advice on managing patients who do not follow the government guidance on face coverings. The advice states:

For the small number of patients who may not follow this guidance we fully support practices in ensuring that they can take all reasonable steps to identify practical working solutions with the least risk to all involved. Practices should undertake a risk assessment which should consider, for example:

Offering the patient a mask if the patient is willing to wear one

  • Booking the patient into a quieter appointment slot, or in a separated area

  • Providing care where possible via a remote appointment.

 

See the guidance here.

Can vaccinated members of the dental team carry out AGP’s without enhanced PPE (FFP3 mask, disposable/reusable gown, and aprons) if a patient has evidence of a negative lateral flow test undertaken immediately prior to treatment?

No. The accuracy of lateral flow tests (LFT) is heavily reliant on the test being administered correctly. LFTs are very operator-sensitive and inherently less reliable than PCR tests. They are difficult to do correctly and can provide both false positives and false negatives. If a patient has an inaccurate negative LFT result they could still be infected but asymptomatic.

The majority of my patients have now had both doses of the vaccine and can provide evidence of vaccination. The dental team are also fully vaccinated so is it still necessary to wear enhanced PPE?

Yes. Whilst a completed course of the COVID-19 vaccination provides good levels of protection, the vaccines are not 100% effective and it is still possible to contract and/or spread the COVID-19 virus. It is important to continue to enforce the infection control measures including the use of appropriate PPE in practice.

Why can’t we relax on the measures in dental practice now since things are going back to normal?

It is important to keep the current measures in place as all of the measures together keep team members and patients safe.

Although infection rates are much reduced, the virus hasn’t gone away and the Swiss Cheese Respiratory Pandemic Defence Model provides a very helpful explanation of why multiple protective measures are still needed. One protective measure on its own (e.g. vaccination) may not be enough to provide adequate protection, but all of the recommended measures together create stronger and more resilient protection against the COVID-19 virus. Dental practices should continue to implement recommended guidance to ensure they are providing a safe environment for their team members and patients and to help ensure long term success in the fight against the virus.