During this pandemic, dental hygienists are conflicted between two colleges … the Royal College of Canadian Dental Surgeons of Ontario and the College of Dental Hygienist of Ontario. Due to the conflicts between the colleges, it is extremely difficult to comprehend the different guidelines that have been provided making it extremely difficult to make proper ethical decisions for our patients for the foreseeable future. These conflicting messages are resulting in dentist employers wanting us to immediately go to work, under the impression it is as business as usual with respect to capacity. 

It will be difficult to ensure the “public's safety” when our own safety hasn’t been fully addressed.  Due to these conflicting guidelines, individual dental practices are taking this as an opportunity to return to normal capacity.  The main concern  is how  registered dental hygienists are now suddenly considered essential under the amended Directive #2, when they were not initially.  Most importantly, why are RDHs now being expected to follow RCDSO guidelines and not our own College resulting in  dentists requesting us to begin “business as usual”  and threatening job loss action if we do not comply. Under the Occupational Health and Safety Act - we have a right to refuse unsafe work - this scenario is unsafe to HCP and to patients and to public health in general.

On May 25th, 2020 CDHO’s guidelines were updated with a statement “Under the government - declared state of emergency and directive #2, only health professionals providing emergency/urgent care fall into this category of essential services. Routine dental hygiene care is not considered an emergency or urgent service and is to be postponed until the government declares that non-essential services can be resumed.” 

Then on May 26th, 2020  the RCDSO made a statement  and revised on May 31st, 2020 keeping the statement “In accordance to Directive #2, dentists in Ontario are currently permitted to provide in-person care for all deferred, non-essential, and elective services, in addition to emergency and urgent care.” 

Since CDHO never amended their stance, one can see the confusion created. 

The one main document that has been excluded from all of these “guidelines” has been the reference to “Directive #2 for Health care providers issued under section 77.7 of the health protection and promotion Act.” which states that health services for the people of Ontario, should be gradually restarted based on the reduction of COVID-19 activity. The document also states “where possible, health care providers are encouraged to limit the number of in-person visits for the safety of health care providers and patients. Health care providers are to continue to monitor COVID-19 spread in their community and to carefully and gradually restart the services. The gradual restart of services should be carried out in coordination with, and adherence to guidance from, applicable health regularly colleagues.” The Health Protection Act also stated that “ Activities that have higher implications for morbidity/mortality if delayed too long. This requires considering the differential benefits and burdens to patients and patient populations as well as available alternatives to relieve pain and suffering.” Although dental hygiene services are important to a person's overall preventative health care, it does not directly impact morbidity and mortality if delayed too long. Therefore, it makes logical sense, and considering the hierarchy of hazards controls, dental hygiene should be limited until further lifting of state of emergency. Dental practices should be focusing on procedures that will alleviate pain not managed by medications.  FUrther, any guidelines should not be solely based on Ministry Directives, but on evidence based infection control practices and best patient outcomes.

As important as our position is as dental hygienists, we must focus on the morbidity/mortality piece, have a tiered approach to re-entry that allows for safe care and optimal outcomes for all - patients and HCPs.  Given the ongoing PPE shortages, and difficulty in allocating supplies we must focus on conserving what we have access to.  The slow re-entry will allow a controlled safe environment whereas “return to normal capacity” will be harmful.  

Allow patients to come to the dental office to get major treatment done, slowly allowing patients to see their hygienist for recall exams, bitewings, perio exam, and then move forward with hand scaling through a tiered approach.. At each stage of re-entry, we need to track patients and HCP for  symptoms and wait 14 days(at minimum) before moving to the next stage. There also needs to be room given to adjust based on rates of COVID in the community given many communities have differing degrees of cases.As the government announces a decrease in COVID-19 cases let us gradually open up more services in the dental office. 

We ask for a collaborative approach to provision of guidelines that place public health safety first.