No. If the patient (traveller) is self-isolating in the same household as the family member, you are not to treat the family member until they have finished their mandatory self-isolation. If there is a safe and completely isolated section of a home where the traveller can self-isolate, then other people living there do not have to self-isolate as well. This also applies to anyone else who is in the residence where that individual is isolating e.g., roommates.  

As of Nov 9, 2020, the NS Government has updated their restrictions and the Order. People travelling into Nova Scotia from outside Atlantic Canada for non essential reason must self-isolate alone or with others who are self-isolating for the same period. If there are other people in the same household, they must also self-isolate for the full 14 days as well. 

We have consulted with the CMOH on this question. He has advised that someone in close contact with a denturist clinic staff member has experienced fever or cough or two (2) of the other identified symptoms:

1. Employee can go to work at the denturist clinic, but self-monitor **.
2. If symptoms present, employee must call 811 and arrange for a test and self-isolate until results come in.

IF someone in close contact with a denturist office staff member has tested positive for COVID-19: 1. Employee cannot go to work as anyone identified as a close contact of a known COVID case has to themselves be tested and isolate for 14 days.

** With respect to employees going to work and self-monitoring for symptoms; this is the minimum standard. Denture clinics can have a more stringent office policy whereby an employee remains at home until the test results are known.

Essential workers are workers, such as truck drivers, who have been exempted from self-isolation requirements when arriving in Nova Scotia.  This exemption applies even if the essential worker has travelled outside of Canada.

Rotational workers are residents of Nova Scotia who work in another part of Canada.  If rotational workers travel outside of Canada, they must respect all self-isolation requirements under Nova Scotia’s Health Protection Act. Rotational workers, such as workers in the oil fields, may receive oral health care treatment within 14 days of returning to Nova Scotia from their work within Canada, however any rotational worker that has travelled outside of Canada cannot receive oral health treatment within 14 days of being outside of Canada.

Essential workers, however, such as truck drivers, can receive oral health care treatment within 14 days of returning from a trip outside of Canada.

For both essential workers and rotational workers triage and manage oral health care needs by tele-dentistry whenever possible. Oral health care providers are to use their clinical judgement regarding the scheduling of appointments and treatment performed. While rotational workers and essential workers may book an appointment within 14 days of returning to Nova Scotia, they are not exempt from pre-screening and screening and must pass these requirements to be treated at a denture clinic.

The Chief Medical Officer of Health has made an Order under the Health Protection Act of Nova Scotia, allowing some groups of workers and other individuals to be exempt from the 14-day self-isolation period when arriving in Nova Scotia.  The following groups and individuals are exempt from the 14-day requirement:
Healthy workers in the trade and transportation sector who are employed in the movement of goods and people across the Nova Scotia border by land, air, or water, including truck drivers, crew, maintenance and operational workers on any plane, train or food production plants;

People travelling into Nova Scotia for essential health services and one accompanying support person;

Canadian military personnel, Coast Guard and RCMP; and

First responders, including police, fire and EHS paramedic workers.

Triage and manage the oral health care needs of essential workers by tele-dentistry whenever possible. While these individuals are not required to self-isolate for 14 days, they must pass pre-screening and screening requirements to be treated in a denturist clinic..  The Chief Medical Officer of Health notes that screening protocols are the best control measure.  With COVID-19 testing, there is the issue that a single negative test is not a good way to screen out COVID-19 given the limitations of our current testing technology when testing asymptomatic individuals (up to 20% false negative).

It is recommended to perform non- aerosol generating procedures whenever possible for individuals with a self-isolation exemption.

If an aerosol generating procedure is necessary, the office must:

  • Schedule the patient at the end of the day; or
  • Institute airborne precautions; or
  • Refer to an office that can implement airborne precautions.

On September 11 the Chief Medical Officer of Health, Dr. Robert Strang, indicated that rotational workers who reside in Nova Scotia but work outside the Province may attend necessary (urgent and routine) medical appointments, including oral health appointments, without waiting for 14 days after returning to Nova Scotia.

A rotational worker is a resident of Nova Scotia who has a set schedule where they alternate between living in Nova Scotia and working in another Canadian Province or territory in Canada, such as an Alberta oil worker. The directive only applies to rotational workers who travel to another province or territory in Canada to work. It does not apply to rotational workers who work outside of Canada.  If a rotational worker has travelled outside of Canada, they must wait 14 days from the date that they return to Canada to book an appointment, unless they have an emergency.  Triage and manage the oral health care needs of rotational workers by tele-dentistry whenever possible. While these individuals are not required to self-isolate for 14 days, they must pass pre-screening and screening requirements to be treated in a denturist clinic.  The Chief Medical Officer of Health notes that screening protocols are the best control measure.  With COVID-19 testing, there is the issue that a single negative test is not a good way to screen out COVID-19 given the limitations of our current testing technology when testing asymptomatic individuals (up to 20% false negative).

It is recommended to perform non- aerosol generating procedures whenever possible for individuals with a self-isolation exemption.

If an aerosol generating procedure is necessary, the office must:

  • Schedule the patient at the end of the day; or
  • Institute airborne precautions; or
  • Refer to an office that can implement airborne precautions.

The oral health regulators take direction from the CMOH when situations such as this arise. The CMOHs in the Atlantic Provinces are in regular contact with each other. As long as there is no community transmission of COVID-19 in the higher risk zone, then people who have been in that  zone are to self-monitor their health and do the on-line assessment https://covid-self-assessment.novascotia.ca/en.  Work restrictions are not necessary.

If any Oral Healthcare Provider or office staff member fails the daily screening, they must exclude themselves from work, i.e., be instructed not to come to work, or be sent home. They must contact 811 and arrange for COVID-19 testing. They must await results of the testing and be cleared by Public Health before they can return to work.

Please Refer to joint Return To Work Guidelines for the full listing of staff screening symptoms and risk factors.

The oral health regulators take direction from the CMOH when situations such as this arise. The CMOHs in the Atlantic Provinces are in regular contact with each other. As long as there is no community transmission of COVID-19 in the higher risk zone, then people who have been in that  zone are to self-monitor their health and do the on-line assessment https://covid-self-assessment.novascotia.ca/en.  Restrictions on dental care are not necessary.

Hierarchy controls state the importance of pre-screening and screening. Therefore, all offices must continue to ensure patients pass the screening questions for COVID-19 symptoms and COVID-19 risk factors. 

The importance of screening cannot be over-emphasized, and this provides a good example of why it is important to perform pre-screening (telephone screening) prior to the office visit, as well as a re-screening on the day of the appointment. Screening helps to identify patients who are possibly infected with COVID-19 before they enter a clinic, receive care and possibly transmit the virus in the process.

If during the screening process, the patient has COVID-19 symptoms or they respond “yes” to any of the risk factors, protocols in the COVID-19 Return to Work Guidelines for the Oral Health Professions of Nova Scotia (Joint RTW Guidelines) must be followed.

As with all patients, it is important to use risk mitigation methods and risk reduction methods, including appropriate patient care decisions regarding when to use AGPs versus non-AGPs. You will find a list of Additional Considerations for all Procedures in Section 2.3 (CDHNS) and Section 1.2 (Denturists and PDBNS) that are intended to keep everyone safe while providing oral health care.

DHCPs must always use appropriate PPE, particularly during a global pandemic such as COVID-19. If an AGP procedure is being performed, then a fit-tested N95 respirator or the equivalent (as approved by Health Canada), or a surgical mask and face shield must be worn, as well as a surgical gown/lab coat and gloves.

If a dental office is identified by Public Health as a source of original exposure for a COVID-19 case, or a source of exposure of others by a COVID-19 case, the dental office will be contacted by Public Health.

If you have been contacted by Public Health, in addition to co-operating with them you should ensure that you and your staff continue to monitor for symptoms through diligent daily screening.

All DHCPs and office staff must screen themselves daily for symptoms and risk factors. DHCPs who develop any new or worsening symptoms of COVID -19 must exclude themselves from the workplace and call 811.

If a dental office is identified by Public Health as a source of original exposure for a COVID-19 case, or a source of exposure of others by a COVID-19 case, the dental office will be contacted by Public Health.

If you have been contacted by Public Health, in addition to co-operating with them, you should ensure that you and your staff continue to monitor for symptoms through diligent daily screening.

All DHCPs and office staff must screen themselves daily for symptoms and risk factors. DHCPs who develop any new or worsening symptoms of COVID-19 must exclude themselves from the workplace and call 811.

Nova Scotia Public Health states, “You should wear a non-medical mask if you have respiratory symptoms (like coughing or sneezing) and you’ll be in close contact with other people, or if you’re going out to access medical care or other essential health services.” https://novascotia.ca/coronavirus/staying-healthy/#masks
In addition, patients are encouraged to use hand sanitizer or wash their hands when entering and exiting a dental office. Further, patients are encouraged to wait outside the dental office or practice social distancing in the waiting room while waiting their turn for dental treatment.

Patients wearing a non-medical mask will obviously need to take it off prior to starting their treatment. In this case patients, should wash their hands or use hand sanitizer immediately prior to taking their mask off.

Lab coats are long-sleeved garments that are intended to be patient-specific items of protective clothing and must be removed prior to seeing the subsequent patient. Lab coats are to be worn over regular clinic clothing, such as uniforms or scrubs, during AGPs or during procedures likely to generate splatter or droplets. Lab coats should be closed to the neck if possible, with buttons, zippers or other fasteners. The length of the lab coat can vary, but the length of the lab coat sleeves should be full arm length, not short sleeves. It is preferred if the lab coat sleeves could be tucked inside the treatment gloves, but if this is not possible, then proper hand hygiene must include the wrists and any exposed skin on the forearms.

Commercial and surgical grade N95 respirators are of similar structure and design. The main difference between the two grades is that commercial N95 respirators are not tested for fluid resistance of any type. Therefore, surgical grade respirators are preferred for patient care. If surgical N95 respirators are not available and there is a risk that the worker may be exposed to high velocity droplets or splatters of blood or body fluids, a face shield or surgical mask must be worn over the commercial N95 respirator to provide the fluid resistance necessary. Always check to ensure that your respirator is fluid resistant, and, if it is not, create fluid resistance by adding a surgical mask or full-face shield as mentioned above. This will also facilitate the possibility of re-using the N95 respirator, as it will protect it from becoming moist or visibly soiled requiring its disposal. DHCPs are to use their own judgement regarding when to replace their mask.

If you practice in an open concept office with no physical barriers between chairs and you are performing an AGP, you must only have the patient being treated in the space and no others. This does not apply if providing a non-AGP and social distancing measures can be met.
An office may consider installing barriers such as a plexiglass barrier between chairs in order to treat more than one patient at a time when performing an AGP.

The importance of screening cannot be over-emphasized. Screening helps to identify patients who are possibly infected with COVID-19 before they enter a clinic, receive care and possibly transmit the virus in the process. Pre-screening (telephone screening) should be done prior to the office visit, as well as in-office screening during the appointment and must include COVID-19 symptoms and COVID-19 risk factors.

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