27 March 2020

In dental care – in drilling, for example – the patient’s secretions bring aerosol into the environment. If the patient has a respiratory track infection, they might infect the nursing staff and the nursing staff might in turn infect other patients. You must not go to dental care while sick.  

The guideline has been completed in co-operation with the Department of Virology at the University of Helsinki and the expert at HYKS’s oral and maxillofacial diseases clinic and the Finnish Institute for Health and Welfare THL. 

 Guideline for oral health clients 

  • Do not go to dental care, if 
  • you have respiratory track infection symptoms, such as a fever, a cold, a cough or  
  • you are in coronavirus quarantine or 
  • you have in the last two weeks been in close contact with a person who has the coronavirus infection or 
  • you have returned from a trip abroad during the last two previous weeks, instead, please cancel your reservation. That way you protect the other patients and the nursing staff from infection. 
  • If you have symptoms of respiratory track infection and your need for oral health is urgent, contact via telephone and in accordance with the local instructions the reception of the health centre’s oral health department or the dentists on call. Tell of your respiratory track infection symptoms and explain why you are in urgent need of care. 
  • Also follow the current guidelines issued by the authorities. 

 Guideline for oral health units and professionals 

  • Take into account the Finnish Ministry of Social Affairs and Health’s instruction Preparing for the coronavirus situation in oral health care (PDF) 
  • Personnel cannot come into work if they have respiratory track infection symptoms. 
  • Those returning from abroad are to arrange the time of their return to work and their absence from work together with their employer.  
  • The current instructions on the directing of employees who have fallen ill and who have treated unprotected those with the COVID-19 infection are confirmed from the National Institute for Health and Welfare’s website: Instructions when suspecting an infection caused by coronavirus COVID-19. 
  • Patients who require non-urgent care and have respiratory track infection symptoms or patients who are in quarantine or have returned from a trip abroad in the two previous weeks are not to be admitted into care. 
  • The patients are to be notified in the reminder message about the appointment that they must cancel the appointment if they have respiratory track infection symptoms. Someone who has just returned from abroad can be asked to contact the service so that the appointment can be rescheduled. 
  • Patients who require urgent care and have respiratory track infection symptoms are directed to seek care from a health centre’s oral health appointment desk or a dentist emergency clinic. 
  • The usual precautions are followed in the patient work. Special attention is paid to good hand and surface hygiene and the careful use of protective equipment. 
  • The protective equipment included in the usual precautions are surgical mask for mouth and nose, safety goggles, protective gloves made of natural rubber or nitrile rubber and, if necessary, a hairnet. 
  • The protective equipment is changed and the safety goggles (of both patient and personnel) are disinfected patient-specifically 
  • With the protective gloves on, you may only touch the patient and the treatment instruments. 
  • Hands are always washed with water and soap when arriving to the workplace, before and after eating and after going to the bathroom and whenever, for example, there is visible dirt on the hands. 
  • Hands are disinfected with an alcoholic hand disinfectant before and after putting on a mouth and nose mask and also before and after taking the mask off.  
  • The mouth and nose mask and the facial area must not be touched with hands that have not been disinfected.  
  • Hands are always disinfected with an alcoholic hand disinfectant before putting on gloves and after taking them off. This is also done if there is a need to change the protective gloves in the middle of the work. The model solution of the Finnish Institute of Occupational Health: Taking off the protective gloves (PDF).
  • The order in which the protective equipment is put on and taken off 

Putting on the protective equipment 

  1. Disinfect your hands
  2. Put on the mouth and nose mask (and after this, the hairnet if necessary)
  3. Disinfect your hands
  4. Put on the safety goggles
  5. Disinfect your hands
  6. Put on the protective gloves

 Taking off the protective equipment 

  1. Take off the protective gloves
  2. Disinfect your hands and forearm area
  3. Take off the safety goggles (and then the hairnet)
  4. Disinfect your hands
  5. Take off the mouth and nose mask
  6. Disinfect your hands 

Instruction on protecting yourself when treating patients who require urgent care and who have or are suspected to have coronavirus 

The contact, droplet and air precautions are to be followed in the care. The treatments are done so that the formation of droplets and aerosols is completely avoided or the forming is minimized. Aerosols are formed especially when using a drill, an air and water syringe and an ultrasonic dental calculus removal device. 

The patient’s contacts with other patients must be kept as minimal as possible. A separate waiting space is to be reserved for the patient. When coming into the waiting space from outside and when going from the waiting space to other spaces, the patient wears a surgical mouth and nose mask and protective gloves. The patient is instructed on how to use alcoholic hand disinfectant. Personnel who are in contact with the patient outside the treatment room wear surgical mouth and nose masks and abide by good hand hygiene. 

Protecting the personnel in dental care procedures 

  • In the care, the following protective equipment is used: a filtering respirator of either FFP2 or FFP3 class, a long-sleeved single-use liquid-repellent protective coat, a hairnet, safety goggles or a face mask (visor) and protective gloves made of natural rubber or nitrile rubber.  
  • All protective equipment is changed patient-specifically. 
  • Hands are always washed with water and soap when arriving to the workplace, before and after eating and after going to the bathroom and whenever, for example, there is visible dirt on the hands. 
  • The protective equipment is put on before the patient is allowed into the treatment room. 
  • You must ensure in advance that the respirator adheres to the user’s face and that the personnel’s health is good enough for the use of the respirator. You must be patient and wear the respirator for the duration of the procedure without touching it. 
  • Of all the protective equipment for the head, the respirator is put on first so that it can be taken off last. The instruction of the Finnish Institute of Occupational Health: Putting on a respiratory protective equipment (PDF). 
  • The respirator is taken off without touching the filter’s outer surface and outside the treatment room.  
  • The protective coat is tied at the back so that the strings do not stain the user, the treatment instruments or the environment. When taking off the coat, the neck strap and the tied waist strings are ripped off and the coat it peeled off so that the coat’s outer side is collected inside the balled-up coat. 
  • The protective gloves must be so long that they go well over the protective coat’s sleeves. 
  • When taking off the protective equipment, the hands are disinfected with an alcoholic hand disinfectant before the taking off equipment starts and after each piece of equipment is taken off. If there is a need to change the protective gloves in the middle of the work, the gloves are taken off, the hands are disinfected and the new gloves are put on. The model solution of the Finnish Institute of Occupational Health: Taking off the protective gloves (PDF).
  • The order in which the protective equipment is put on and taken off: 

Putting on the protective equipment 

  1. Disinfect your hands
  2. Put on the protective coat
  3. Put on the respirator and check that it is tight
  4. Disinfect your hands
  5. Put on the hairnet
  6. Put on the safety goggles or face mask (visor)
  7. Disinfect your hands
  8. Put on the protective gloves and pull the gloves’ cuff on top of the protective coat’s sleeves

 Taking off the protective equipment 

  1. Take off the protective gloves and coat
  2. Disinfect your hands
  3. Take off the safety goggles or face mask
  4. Take off the hairnet
  5. Disinfect your hands
  6. Only take off the respirator after you are out of the treatment room
  7. Disinfect your hands 

 Intermediate cleaning after the treatment  

  • In the intermediate cleaning, special attention is paid to the cleaning of all the contact surfaces of the patient and nursing personnel.  
  • The surfaces are cleaned with alkaline all-purpose cleaner. 
  • The cleaning cloths used in the cleaning are either single-use or they are put into wash after each use. 
  • Additionally, the contact surfaces are treated with a disinfectant. 
  • The surface disinfection must be done carefully.
  • Waste generated during the treating of the patient is put in a separate waste bag, which is then closed immediately and disposed of by placing it in a waste container.
  • Textiles are washed in 60–90 C temperature. 

 Obligation to give urgent care to those who need it 

  • The obligation is a provision of the section 15 of the law on health care professionals, wherein it is recognised that a health care professional must always help a person who requires urgent care. The contents of the help have not been defined. For example, the help can be directing the person to urgent care in public health care.  
  • The section 50 of the Health Care Act on the urgent care relates to public health care. 
  • The units treating people with the COVID-19 infection must have the sufficient readiness and competence needed for giving the care.   

Further information viestinta@ttl.fi 

The guidelines of the Finnish Institute of Occupational Health (FIOH) are drawn up together with the Ministry of Social Affairs and Health (SMAH) and the Finnish Institute for Health and Welfare. We also follow the publications of the European Centre for Disease Prevention and Control (ECDC) and the World Health Organization (WHO).

European Centre for Disease Prevention and Control (ECDC), COVID-19

World Health Organization (WHO), coronavirus