Important Covid-19 Information
Oral Health Care during Phases 2 and 3 of the COVID-19 Response (August 18, 2020)
As British Columbia continues in phase 3 of the government’s COVID-19 response, the interim guidance document for oral health care providers has been updated to ensure patients continue to receive safe and timely care. The updated document replaces the previous guidance and expectations published on May 15, titled “Transitioning Oral Healthcare to Phase 2 of the COVID-19 Response Plan". Please read the updated document at the link below:
Amendments have been made throughout the document to provide clarity and align with subsequently published authoritative guidance. The key updates in this version include:
- Revised patient and staff screening protocols
- Increased detail related to screening for suspected or confirmed COVID-19 positive patients and patients vulnerable for severe expression of COVID-19
- Updated personal protective equipment (PPE) for patients and providers (including a table outlining PPE by procedure and COVID-19 status of patient)
- Precautions for patients with suspected or confirmed COVID-19
A comparison document showing a markup of changes between May 15 and August 18 guidance documents is available here.
Registrants are expected to read this guidance and follow the expectations within it as they continue with the provision of dental care. It is a comprehensive document that covers topics such as ongoing pandemic best practices, personal protective equipment, and infection prevention and control principles and strategies. It consolidates existing regulatory standards, guidance and expectations with recommendations and considerations from government and other authoritative agencies for the treatment of patients during the COVID-19 pandemic. Our role as the regulator is to provide clear signposting to the current guidance provided by those higher authorities.
Thank you in advance for your attention to this important publication. As always, if you have any questions or concerns, please do not hesitate to contact the College of Denturists of British Columbia. Otherwise, I look forward to seeing you at the Annual General Meeting in September!
On June 30th, the BC Minister of Health and the Public Health Officer announced that residents of long term care (LTC) homes and assisted living (AL) centres could once again receive limited visitation by friends and family as well as the provision of essential services and personal care services. The BCCDC posted a document outlining the infection prevention and control parameters for these groups of visitors to access care homes while ensuring specific safety measures are in place to prevent the transmission of COVID-19 to vulnerable residents.
Given the critical nature of oral health care to citizens in these residences, oral heath care providers have been included in the list of essential services that have been granted access to LTC and AL. With this resumption of care, all oral health care providers are expected to be familiar and in compliance with the guidance set out by the BCCDC, the Public Health Officer, the administration of each facility and their respective oral health colleges. This includes appropriate point of care risk assessment, including self-screening measures for symptoms, pre-screening of patients and deferring care whenever either the care provider or the patient shows any signs of being unwell. Visits should be scheduled in compliance with administration protocols and should be limited to one care provider per patient at a time. All PPE, hand hygiene practices and social distancing guidelines set out by the BCCDC and the BC oral health colleges must be upheld at all times. Oral care should only be provided in residences where there are no active outbreaks of COVID-19.
Given the active and ever-changing nature of the COVID-19 pandemic, registrants are encouraged to remain apprised of current BC oral health care recommendations as posted by the Public Health Officer, BCCDC and the four BC oral health colleges. Should additional community outbreaks occur, the provision of oral care to vulnerable populations in LTC and AL will be reviewed and revised accordingly.
Following guidance sent by the College of Denturists of British Columbia (CDBC) to registrants on Friday May 15, 2020 about COVID-19, the BC Centre for Disease Control (BCCDC) published a new document called “Infection Prevention and Control Guidance for Community-Based Allied Health Care Providers in Clinic Settings.”
This document contains BCCDC’s authoritative guidance with respect to the use of N95 masks: these are only required for aerosol generating medical procedures with patients with suspected or confirmed COVID-19.
The guidance document we distributed on Friday has been updated to reflect this change (please see section 7. b ii: “Exposure prevention” and “9. Schedule of Changes”)
· BC’s oral health care colleges: Transitioning Oral Healthcare to Phase 2 of the COVID-19 Response Plan (updated May 15, 2020)
· BC health regulators: Providing In-Person Community Care During COVID-19: Guidance for Regulated Healthcare Providers (updated May 15, 2020)
On May 6, 2020, Premier Horgan outlined BC’s Restart Plan which lays out a 4-Phased approach to rebuilding a resilient economy and keeping the public safe.
We appreciate that registrants are very keen to return to work and care for their patients as soon as possible. However, the safety of patients, staff and health care professionals remains paramount.
Currently, we are in the process of developing consistent guidelines for community-based health providers in collaboration with the Provincial Health Office, other regulatory health profession colleges, and key stakeholders, to ensure that health care providers can operate safely under Phase 2 of BC’s Restart Plan. Phase 2 of BC’s Restart Plan is scheduled to begin in mid-May and includes the restoration of health-related services under enhanced protocols. Until these protocols are released, we recommend that registrants remain cautious and continue to comply with the current orders and direction of the Provincial Health Officer and the College of Denturists of British Columbia (CDBC).
CDBC is committed to providing timely updates as information becomes available. We remain cautiously optimistic that the protocols will be available before the 19th of May. However, this has not yet been confirmed.
Thank you for your understanding and patience. We know that this is a challenging time for everyone.
On March 23, 2020, Dr. Bonnie Henry, the Provincial Health Officer issued an update addressed to all regulated health professionals in British Columbia. Health professionals were asked to limit delivery of in-person services in community settings and this message remains current, despite the recent discussion of lifting some of these measures at a future date. To be clear, the message from the Provincial Health Office continues to be that “all non-essential and elective services involving direct physical contact with patients and clients should be reduced to minimal levels, subject to allowable exceptions, until further notice.”
Timelines of when non-urgent in-person care can resume remain unknown and this direction will be provided by the Provincial Health Officer at the appropriate time. In the meantime, stay the course, limit in-person services to patients who require emergency and/or essential services, and continue to consult the College of Denturists of British Columbia’s (CDBC) website for up to date information.
The CDBC will issue further communications to registrants providing more guidance and information as it becomes available.
We appreciate your efforts to protect your patients, staff and community. If you have any questions, please email firstname.lastname@example.org.
CDBC’s Mandate is Public Protection
The primary concern of the College of Denturists of British Columbia (CDBC) is that the public is being protected. That is our mandate and we take the role seriously.
B.C.’s Provincial Health Officer Dr. Bonnie Henry has made it clear that, during the COVID-19 crisis, health professionals who provide patient care should reduce their practice to emergency services only. If CDBC receives any complaints that a denturist is putting the public at risk, those complaints will be thoroughly investigated and appropriate action will be taken.
Complaints are resolved under the direction of our Inquiry and Discipline Committees, both of which include members of the general public. In all cases complainants are informed of the outcome of our investigations.
As the regulator of denturism, we expect the public will continue to have access to safe care for any emergent or essential denture care. Given the direction from Dr. Henry, our role is to conduct a fair and transparent investigation into every complaint and to impose serious consequences in the event that a registrant has been found to have committed misconduct. When there are concerns about public safety we can immediately suspend the registrant's practice and we would publish that fact on our public directory.
Thank you for your understanding in these very challenging times. As always, if you have any questions and/or concerns, please do not hesitate to contact CDBC
Yesterday, I shared a letter from Dr. Bonnie Henry, the Provincial Health Officer, to all health professionals regulated under the Health Professions Act regarding the provision of health care in community settings outside the hospital and public health facilities. If you haven’t already, I ask you to take the time to read this very important letter as it applies to all denturists in British Columbia.
The first expectation listed in the update reads as follows: “All non-essential and elective services involving direct physical contact with patients and clients should be reduced to minimal levels, subject to allowable exceptions, until further notice.”
The College of Denturists of British Columbia (CDBC) continues to recommend in the strongest possible terms, that all non-essential denture care be suspended until further notice. This is consistent with Dr. Henry’s message and her letter may provide additional clarity regarding the provision of care.
Should emergency and/or essential care be requested, we recommend fully assessing the patient’s needs and exploring other available options to address those needs before making the determination to provide in-person care. Should a denturist need to provide emergency and/or essential care, they must adhere to client pre-screening and stringent infection prevention and control protocols with the appropriate personal protective equipment. Social distancing protocols among patients and any dental personnel in common areas prior to and following the provision of care must be in place.
As you have likely heard through news reports, COVID-19 has significantly affected the dental community. There have been a number of positive tests among dental professionals with some developing severe symptoms. You may have also heard that a dentist has sadly passed away from complications associated with COVID-19. Our thoughts are with the family, friends and colleagues at this difficult time.
There is no question that it is more important than ever that all dental professionals heed the advice and recommendations of both Dr. Henry and their regulatory body. If we each do what is necessary, we will make a difference. A difference that will save lives.
This is a rapidly changing situation so we ask that all registrants make a regular habit of checking their emails and the CDBC website for the most up to date information.
I thank you for your attention to these communications and your continued professionalism in these extraordinary times. If you have any questions or concerns, please reach out to CDBC. While the office remains closed, all the staff are working remotely and are here to support you. Please email us or leave us a phone message and someone will get in touch with you as soon as possible. Know that we are in this together.
Lastly, CDBC has compiled a few questions and answers about Dr. Bonnie Henry’s update. They are as follows:
- In her update, Dr. Henry said: “All non-essential and elective services involving direct physical contact with patients and clients should be reduced to minimal levels, subject to allowable exceptions, until further notice.” What is considered to be non-essential or elective care during the COVID-19 pandemic?
- CDBC recognizes that our registrants have the training and expertise to make decisions and provide care based on the unique needs of each patient. However, in light of the extraordinary situation brought about by the COVID-19 pandemic, CDBC provided more detailed guidance in our correspondence of March 23, 2020.
- CDBC strongly recommends that registrants cease delivery of non-essential or elective care during the special situation of the COVID-19 pandemic. This is care that is neither emergent nor urgent.
- In general, emergent care is defined as immediate management or treatment of potentially life-threatening conditions.
- In general, essential (urgent) care is separate from emergency care and focuses on the management and treatment of conditions that require prompt attention.
- Henry said in making decisions regarding the reduction or elimination of non-essential and elective services, health professionals should be guided by their regulatory college and a series of principles, including “reciprocity”. What does reciprocity mean?
- Henry explained reciprocity by saying, “Certain persons or populations will be particularly burdened as a result of a reduction in non-essential services. As such, patients and clients should have the ability to have their health monitored and it be revaluated as required.”
- To follow this principle, CDBC recommends that registrants develop a plan for patients who have contacted your office requesting care that you have determined to be nonessential due to the COVID-19 situation. This is so you can take action should their needs change and they require essential (emergent or urgent) care.
- This plan may include giving them specific instructions to contact you should their condition change; providing ongoing follow up from your office to assess their condition; or immediately directing them to an alternate source of care, such as another health care professional or hospital.
- How should I screen my patients for COVID-19?
- Ask the patient if they are experiencing any symptoms of COVID-19, as described by the BC Centre for Disease Control (BCCDC), including cough, sneezing, fever, sore throat, and difficulty breathing.
- Ask about any recent travel outside of Canada.
- Ask about any contact with individuals who have a confirmed or presumptive diagnosis of COVID-19.
- Try to pre-screen patients by phone if possible.
- As suggested by BCCDC, individuals can use the COVID-19 BC Support App and SelfAssessment Tool to help determine if they need further assessment or testing for COVID-19
- What are the implications of providing hands-on care?
- When direct physical contact is required for the care of patients with presumptive or confirmed COVID-19, health professionals must use infection control practices. See CDBC’s Infection Control Policy, as well as the BCCDC’s page on COVID-19 Infection Control.
- If you are not able to ensure adequate infection control, do not provide care to the patient. Seek an alternate approach to meet their care needs (e.g. referral to another provider or facility).
COVID-19: Important Letter from the Provincial Health Officer Regarding Non-Essential Services for Health Professions
Frequently Asked Questions: What denture patients should know about COVID-19
I received care in a denture clinic after the Pacific Dental Conference but before attendees were directed to self-isolate. Should I be worried?
The Office of the Provincial Health Officer has advised that only conference attendees require self-isolation. In addition, all denturists are required to be in compliance with CDBC’s Infection Control Policy. This includes the use of gloves, masks and eyewear to keep the practitioner and the patient safe.
Where can I get more information about my risk of COVID-19?
You can use one or both of the two new public resources from the provincial government:
- A new COVID-19 self-assessment tool available at https://covid19.thrive.health/
- Dedicated 1 888 COVID19 phone service for information about COVID-19
This includes the latest information on travel recommendations and social distancing, as well as access to support and resources from the provincial and federal governments. British Columbians can reach service representatives seven days a week, from 7:30 a.m. to 8 p.m., by calling 1 888 COVID19. Information is available in more than 110 languages.
Why hasn’t CDBC shut down all denture clinics?
CDBC does not have the legal authority to require denture clinics to close. Our role is to alert our registrants that they must be in compliance with direction from the Provincial Health Officer and other government and public health directives.
We are strongly recommending that non-essential denture services be suspended during this time.
My denturist attended the Pacific Dental Conference. Can they still treat me or my family?
No. Anyone who attended the Pacific Dental Conference must self-isolate until March 22, 2020. They may not provide treatment during that time, and only from March 22 if they have not shown any symptoms of COVID-19.
Why did CDBC allow the Pacific Dental Conference to go ahead?
CDBC was one of many exhibitors at the conference but we did not organize or sponsor it, and have no authority to have prevented it.
We understand that the conference organizers worked from the best information that they had at that time. We and they are working together to ensure that patients are protected going forward, beginning with the self-isolation of all conference attendees until March 22.
Joint Communication from the College of Denturists of British Columbia (CDBC) and Denturist Association of British Columbia (DABC)
Further to the statement issued by the College of Denturists of BC ("CDBC") yesterday afternoon, both the DABC and CDBC would like to provide clarification regarding the provision of denture care in British Columbia:
- Anybody who attended the 2020 Pacific Dental Conference ("PDC") must immediately self isolate until March 22, 2020 as directed from Dr. Bonnie Henry, BC's Provincial Health Officer.
- CDBC strongly recommends that all non-essential denture services be suspended immediately. This is not an order from the Ministry of Health but a strong recommendation from CDBC. The DABC and CDBC are working to clarify the definition of "non-essential" denture services and "emergent" denture services. As there are no clear definitions at this time, please use your best professional judgement and be mindful of social distancing.
- If you choose to provide services, you must perform a thorough pre-treatment risk assessment as suggested in CDBC's statement. If risks are identified, the patient's care must be postponed or referred to an appropriate provider.
- Asepsis must be adhered to as per CDBC's Infection Control Policy, and enhanced asepsis is strongly recommended. In addition, it is advised to disinfect the chair and immediate surroundings in front of each patient to instill confidence.
Please note that circumstances are evolving on a daily, if not hourly basis. If further direction is provided by the Ministry of Health, the above information may change, and we will keep all of our stakeholders informed. Thank you for your patience and understanding during this difficult time.
- Non-essential denture services to be suspended immediately
- Attendees of 2020 Pacific Dental Conference to self-isolate
To the denturists of the College of Denturists of British Columbia (CDBC):
In the words of our Prime Minister today, exceptional circumstances are calling for exceptional measures, and it is time to take every precaution to keep people safe.
In alignment with today’s direction from the Office of the Provincial Health Officer, CDBC is now able to offer the following recommendations and guidance in response to the COVID-19 pandemic. This guidance is in place until further notice and we will be in regular contact with you, knowing that this situation is rapidly changing.
Below are CDBC’s recommendations regarding the provision of denture care:
- Anyone who attended the 2020 Pacific Dental Conference must immediately self-isolate.
- CDBC strongly recommends that all non-essential denture services be suspended immediately.
- Management of emergent concerns by registrants must continue. Management may include referral to an appropriate facility.
- All registrants must perform a thorough pre-treatment risk assessment that includes risk to the denture patient, to the oral heath care provider and to the greater community before any treatment is undertaken. If risks are identified that cannot be immediately or sufficiently mitigated, the determined care must be postponed or referred to an appropriate provider. Pre-screening of denture patients by phone is preferable. Offices should develop a pre-screening protocol for patients who present in person.
- Care provided must be compliant with CDBC’s existing Infection Control Policy or the treatment must cease. Capacity to undertake appropriate personal protective equipment must be assessed before treatment can be initiated.
CDBC is also changing our business practices in response to this emerging situation. As a result, all in-person meetings have been suspended until further notice. All oral health care providers and CDBC employees must follow current advice from the Office of the Public Health Officer.
It is the responsibility of all of us as professionals to stay up to date with the requirements of public health agencies to keep ourselves, our staff and our patients safe.
Please note that CDBC is reviewing all the questions submitted to us and will be publishing our responses in keeping with the latest recommendations from public health experts.
COVID-19 - Important Health Care Worker Update from the Provincial Health Officer
The following message was sent to all health care workers on behalf of Dr. Bonnie Henry, provincial health officer.
Dear health care worker.
As we continue our efforts to slow the course of the COVID-19 pandemic, advice regarding public health measures in our communities and health care settings is evolving quickly. Further to the message that was sent out on Friday, March 13, 2020, please review the following updates for health-care workers.
Requests for Information related to COVID-19
We are experiencing a significant increase in questions and calls by patients, physicians, health-care workers, and the general public for information on COVID-19.
In an effort to manage the volume of calls, particularly at those centres staffed by our nurses and physicians, please triage all initial inquiries to the following websites: BCCDC COVID-19 for the Public, BCCDC COVID-19 for Health Care Professionals, and HealthLink BC 8-1-1.
We will also be implementing several new avenues for citizens to access advice and information related to COVID-19 including a Government of BC dedicated phone line for questions that are unrelated to the health status of persons who are symptomatic or unwell.
Self isolation advice
We are asking health-care workers who return form travel outside Canada and are not essential to the delivery of patient care to self isolate at home for 14 days.
Health care workers who return from travel and are essential to the delivery of patient care may return to work but should take additional precautions to reduce the risk to their patients, colleagues, and the public should they become symptomatic:
- Self-monitor daily for signs and symptoms of illness
- Wear a surgical mask at all times and in all areas of your workplace
- Follow Infection prevention and control protocols including diligent hand hygiene and the use of personal protective equipment when delivering patient care
- Reduce close contact with other health care workers and avoid shared spaces where possible
- Avoid close contact with others when travelling to and from work and between shifts
- Self-isolate at home on days when not required at their workplace.
Additional precautions may vary by facility, health-care setting, or workplace based on the patient population being cared for and risk assessments made by regional or local public health officials, infection prevention and control experts.
Please click here for a letter to Health Care Workers.
Thank you for your all that you are doing during this difficult and evolving situation. We will be providing regular updates to you and your employers, so please continue to check your email and visit the BCCDC website regularly.
Bonnie Henry, MD
Provincial Health Officer
Office of the PHO
Ministry of Health