Recommendations for the re-opening of dental services: a rapid review of international sources

Recommendations for the re-opening of dental services: a rapid review of international sources

The aim of this rapid review of international guidance was to support decision making concerning the planned re-opening and restructuring of dental services during the COVID-19 pandemic. The rapid review was conducted by the COVID-19 Dental Services Evidence Review (CoDER) Working Group; a collaborative group of researchers and clinicians from a range of UK institutions, led by Professors Jan Clarkson (University of Dundee) and Craig Ramsay (University of Aberdeen).

This rapid review collated and summarised guidance recommendations from 16 countries within five themes relevant to the re-opening of dental services: practice preparation, personal protective equipment, management of the clinical area, dental procedures, and cleaning and disinfection.

The level of detail reported in the guidance documents varied greatly across international sources and statements were not always supported by strong evidence. Most guidance sources recommended patient triage by telephone (some also recommended temperature screening at reception), and avoiding aerosol generating procedures if possible. Most sources recommended the use of class 2 filtering facepiece masks (FFP2, equivalent to N95) for non-COVID-19 cases undergoing AGPs and all suspected or confirmed COVID-19 cases undergoing any procedure. Surgical masks were recommended for non-COVID-19 cases not requiring AGPs. Sources also included recommendations on how to reduce the risk of transmission (e.g. use of pre-operative mouthwashes; high volume suction; rubber dam; and Personal Protective Equipment [PPE]), and cleaning and disinfection procedures. All sources emphasise the need to focus on activities that minimise risk (to staff/patients/public) but still support high-quality clinical care.

There is a need to consider the inter-relationship between the appropriate use of PPE (including donning and doffing), AGPs and interventions to reduce aerosol generation. This rapid review aimed at assisting policy and decision-makers in producing national guidance for their own settings. For more information see: