Dental hygienists wary of new protection guidelines say they feel like 'guinea pigs'

Dental hygienists say new provincial health guidelines around protective wear for safety during dental procedures are confusing at best and may not go far enough, despite the provincial health officer's reassurances that patient screening provides an added layer of protection.

Many provinces, like Alberta, recommend dentists and assistants to wear N95 masks, or the equivalent, for any service that produces aerosols, but that's not necessary under new BCCDC guidelines published late Friday.

Provincial Health Officer Dr. Bonnie Henry said careful pre-screening should be used to weed out infected patients, and mask and face protections should keep people safe during procedures.

But the possibility of a leaky mask or an asymptomatic patient concerns members of the B.C. Dental Hygienists Association. 

A shortage of N95 masks and other protective wear has dogged this sector's plans to reopen and the B.C. Dental Association says it's reviewing the newest provincial guidelines on behalf of its members.

The College of Dental Surgeons of B.C. guidelines, based on guidance from The B.C. Centre for Disease Control, published last Friday, May 15, stipulate that an N95 mask and eye protection is needed, plus gloves and a gown for any "aerosol generating" procedures, but only with patients who have suspected or confirmed COVID-19.

But it does not say that level of protection is needed for other patients, despite the fact some may be asymptomatic.

As of May 19, the College of Registered Dental Hygienists of Alberta recommend full PPE, including a N95 respirator or the equivalent, a level three mask and a face shield in combination, for all dental procedures during a pandemic.

The Alberta college cites the Centers for Disease Control's guidance for dental settings on page 16 as the basis of its recommendations.

"It should be assumed that all clients can transmit disease. Until further evidence is available on the transmission of COVID-19 through aerosols, the CRDHA recommends that fitted N95 masks or equivalent are utilized for ALL dental hygiene treatment. If appropriate PPE is unavailable, oral health services must not be performed."

In a statement, a spokesperson for the college said the plan is intended to guide a "careful restart," but the college "does not expect any dental professional to provide treatment unless, in their professional opinion, it is safe to do so" for patients and the dental team.

Last week, the B.C. Dental Association advised patients that dental offices would not be opening regular practices May 19 — the initial provincial target date — and full dental services would resume as it becomes safe, depending on access to personal protective equipment. Despite that, some offices are opting to open this week.

Andrea Burton, the executive director of the Dental Hygienists Association, said each individual dentistry office is a business and the owners in each case decide what works for them. 

BC hygienists feel 'a little bit like guinea pigs.'

Burton described the new guidelines released Friday as confusing and too vague.

"Why are we the ones that are being asked to go back to work with less [suggested protective gear] than what they have in Alberta? Dental hygienists in British Columbia feel a little bit like guinea pigs. Maybe it's fine. But maybe is a tough word when you are talking about your health."

Burton said that while some dental offices are reopening, others are waiting a few weeks to see how things go.

Health officials have said the key will be pre-screening patients to make sure they do not have symptoms.

In an interview, Henry said for most procedures, even on a person infected with COVID-19, "you can safely provide care" wearing a mask and face protection, such as goggles or a face shield.

But it is the level of mask that hygienists want clarified.

Vancouver dental assistant Megan Cymbaluk said N95 masks were such a "hot commodity" that her employer was proactive and found alternate respirator-type masks that painters would use that can be wiped down and sanitized between appointments.

"That is what we felt comfortable with. Then, to find out that we are not needing [that level] of mask for all-day wear or every patient is a little bit shocking," she said.

Cymbaluk said she is not convinced she is safe with a regular surgical mask, even with an additional face shield, given how close she works all day to droplets from dental patients' mouths.

"There are gaps between your eyebrows, on the side by your temples — and on the sides of your cheeks — it's not an airtight seal," she said.

While her office pre-screens, she worries about asymptomatic COVID-19 carriers.

"We don't have access to proper testing. Our main defence is word of mouth and a handheld thermometer," she said.

Cymbaluk said she is not sure if she will remain in the dentistry profession now.

"I'm not sure if this is a job that I could realistically continue doing — walking into that level or risk every day and to not be sure if I'm bringing anything home with me."