Call for unified infection prevention and control guidelines for Ontario dental offices.

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Dear respected Health Minister Christine Elliott, Premier Doug Ford, and Public Health Ontario;

 We write to you to draw your attention to the discrepancies in the return to work guidelines between the Royal College of Dental Surgeons of Ontario (RCDSO) and the College of Dental Hygienists of Ontario (CDHO). This is an issue that affects every Ontarian who seeks dental services, as well as the dedicated dental healthcare workers providing these services. Today, we write to you both as anxious members of the public, and as concerned dental healthcare professionals.

Both of these governing bodies have provided Infection Prevention and Control (IPAC) guidelines for a “safe” return to providing essential and elective dental procedures to dental clients. The RCDSO and CDHO have each declared their own guidelines are in accordance with current public health standards; however the two sets of guidelines do not align and in fact have some very concerning differences. As healthcare providers who routinely work together, how are dentists and registered dental hygienists supposed to assure their clients are being adequately protected when we are operating under different guidelines? Not only do these discrepancies potentially risk the health of our clients and associates, but they also create unjust stress to dental professionals and create toxic work environments. We fear colleagues may be left to make unethical decisions based on what their employer (typically the dentist) deems acceptable according to their own guideline, or risk the consequence of being out of work.

There are many discrepancies, one example of these includes the treatment of clients using Aerosol Generating Procedures (AGPs). Currently, under the CDHO guidelines registered dental hygienists must not provide any AGP unless they are in an enclosed operatory with a sealed door, and are wearing a new N95 mask (along with other PPE). Dentists however, under the RCDSO guidelines, may use AGP (as long as the client has screened negative for covid-19) while in an operatory that is not enclosed, wearing a N95 mask OR level 2-3 surgical mask. While some dentists have already enclosed their operatories in an abundance of caution, others will refuse to do so as their own governing body does not require it. This stark difference, among others, has created a great deal of confusion, uncertainty, and mistrust. Since both parties claim to be in accordance with public health standards, how does one determine which guideline is best in reducing the risk of covid-19 transmission?

Another important note is the requirement from the CDHO to use a new N95 mask for every AGP appointment (RCDSO gives the option of a N95 or level 2-3 surgical mask). In the online CDHO council meeting on June 5, 2020 the CDHO admitted they are aware of the global shortage of PPE. How can we be expected to provide non-essential dental services if we do not have access to the PPE our governing body is requiring? The public expects the same high quality care they received prior to covid-19, yet dental hygienists cannot use the instruments needed to achieve those same results. Should we really be resuming non-essential dental treatments during a PPE shortage, especially when our governing bodies can’t agree on which PPE is necessary?

We urge you for your assistance in this important matter. What we need is for these governing bodies to collaborate together (seeking appropriate guidance and mediation as necessary) to create one consistent guideline based on current evidences and public health standards. Members of the CDHO have been informed that the RCDSO and CDHO had a “constructive meeting” on June 10, 2020 for discussions, yet no changes to either guideline were made. Dentists and dental hygienists work together, with the same goal in mind for their clients. We must provide universal infection control measures in order to achieve this goal. Why is it acceptable to have two separate guidelines for one shared workplace with the same clientele? How are members of the public supposed to make informed decisions about seeking dental care if they don’t know which information to trust? As healthcare professionals we have a duty to provide safe care, and as governing bodies the RCDSO and CDHO (whose mandates respectively are to work in the interest of the public and to protect the public) have a duty to uphold their own mandates. We need cohesive leadership, and it needs to be in the best interest of the public. Publishing two different sets of guidelines is NOT in the best interest of the public.

This is a pressing issue. One that unfortunately was present pre-pandemic, but now more than ever it is of utmost importance to call for these two governing bodies to collaborate and approve ONE guideline, or to seek immediate mediation to do so. Our “new normal” must include a unified approach to infection prevention and control, both now and moving forward post-pandemic.  

Respectfully,

Registered Dental Hygienists of Ontario