Source	Initiation of Reopening phase	Defined cases of Covid-19	Procedure of Screening and referrals	Retraining staff	Tele-dentistry (voice/video consultation)	Pharmaceutical leverage	Defining emergency, urgency and routine procedure	Minimizing exposure – Staff, patients.	Defining allowed procedures
Country: USA Source: Centre of disease control & Prevention. Guidance for Dental Settings: Interim Infection Prevention and Control Guidance for Dental Settings During the COVID-19 Response Updated on May 19, 2020. https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html	–	Link to symptoms consistent with Covid-19. Https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html	Refer the patient to a medical facility, or call 911	Provide (Dental healthcare professional)DHCP with job- or task- specific education and training on preventing transmission of infectious agents, including refresher training. Ensure that DHCP are educated, trained, and have practiced the appropriate use of PPE prior to caring for a patient.	Telephone screen all patients for symptoms consistent with COVID-19. If the patient reports symptoms of COVID-19, avoid non-emergent dental care. Delay dental care until the patient has recovered. Telephone triage all patients in need of dental care.	None	The urgency of a procedure is a decision based on clinical judgement and should be made on a case-by-case basis. American Dental Association: What Constitutes a Dental Emergency Https://success.ada.org/~/media/CPS/Files/Open%20Files/ADA_COVID-1919_Dental_Emergency_DDS.pdf?_ga = 2.253879752.110187285.1584496315–1622146531.1565271894	Engineering Controls Hygiene Universal Source Control Using Personal Protective Equipment (PPE) Environmental Infection Control Sterilization and Disinfection of Patient-Care Items.	–
Country: USA Source: American Dental Association, USA Return to Work Interim Guidance Toolkit May 7, 2020	Return to Work Interim Guidance Toolkit May 7, 2020	–	Screening form provided to be filled a day prior and on the appointment day. Positive responses → deeper discussion with the dentist before proceeding with elective dental treatment. Referral should see list of State and Territorial Health Department Websites for specific area's information. Also include employee's screening chart.	None	Follow CDC's Phone Advice Line Tool for Possible COVID-19 Tool for tele-triaging. Https://www.cdc.gov/coronavirus/2019-ncov/hcp/phone-guide/index.html. The toolkit does not talk about tele consultation.	None	The toolkit does not elaborate triaging the patient and the type of treatments to be prioritized. The ADA recognizes that as of May 1, 2020 the Centre for Disease Control (CDC) recommends postponement of elective procedures, surgeries, and non-urgent dental visits.	Front desk staff can wear masks and goggles, or face shields, or offices can install a clear barrier. Keep staff level in operatory to the minimum required along with the implication of other Infection control protocols.	–
Country: India Source: Ministry Of Health and Family Welfare, India	Closed in the CONTAINMENT ZONE; In the RED ZONE, Emergency dental procedures can be performed. ORANGE AND GREEN ZONE- dental consults, Emergency and Urgent treatment procedures only.	–	Telephone screening is encouraged as the first point of contact between the patient and the dentist or reception office is encouraged	Train administrative personnel working in the reception of patients on hand hygiene, social distancing, use of facemask, for them and incoming patients. Educate all HCW on proper selection and use of PPE. Psychological support and morale-boosting. Staff should rotate to avoid long working hours, should ensure proper nutrition and sleep. All staff and dentist must use surgical attire in the dental office, and all personal clothing should be avoided.	Telephone screening Current medical history and past history particularly pertaining to symptoms of Severe Acute Respiratory Illness (fever AND cough and/or shortness of breath) or All symptomatic ILI (fever, cough, sore throat, runny nose).	None	Emergent→ Fast spreading infections of facial spaces/Ludwig Angina/Acute cellulitis of dental origin/Acute Trismus. Uncontrolled bleeding of dental origin. Severe uncontrolled dental pain, not responding to routine measures. Trauma involving the face or facial bones. Urgent Care: Children→ Acute Pulpitis, Dental abscess, Dentoalveolar trauma, Pain of cavitation needing temporization, Unavoidable Dental Extractions. Adults→ Pain of pulpal origin not controlled by Advice, Analgesics, Antibiotics (AAA), Acute dental abscess of pulpal/periodontal/endo-perio origin/Vertical fracture teeth, Completion of ongoing root canal treatment (RCT) Temporization of cavitation approximating pulp, Broken restoration/fixed prosthesis causing sensitivity of vital teeth/endangering to pulpitis/significant difficulty in mastication, Unavoidable Dental Extractions/Post extraction complications, Already prepared teeth/implant abutments to receive crowns, Peri-implant infections endangering stability, Pericoronitis/Operculectomy, Oral mucosal lesions requiring biopsy, Long-standing cysts and tumours of the jaw with abrupt changes, Sharp teeth/Trigeminal neuralgia, Orthodontic wire or appliances, piercing or impinging on the oral mucosa, Orthodontic treatment causing Iatrogenic effects, Delivery of clear aligners, Patients on skeletal anchorage	All asymptomatic healthcare workers involved in the care of suspected or confirmed cases of COVID-19 are advised to take HCQ prophylaxis after medical consultation. Display visual alerts at the entrance of the facility and in strategic areas (e.g., waiting areas or elevators) about respiratory hygiene, cough etiquette, social distancing and disposal of contaminated items in trash cans. Appropriate PPE and ensure it is accessible to HCW. For appointments that do not result in aerosols, and need examination only wear a triple layer surgical mask and protective eyewear/face shield and gloves. Wear N95 face masks, protective eyewear/face shields and gloves along with coverall for High Risk and very high-risk procedures. To increase the shelf life of N95 masks, cover them with a surgical mask and discard only the surgical mask. When examining moderate risks patients the treating doctor will require all PPE as high risk except that the coveralls can be substituted with surgical gowns. Practice non-aerosol generating procedures. Encourage rubber dam. The 4-handed technique is beneficial for controlling the infection. Encourage all to download the Arogya Setu App.	–
Country: India Source: Dental Council of India. Updated: May 7, 2020	Opening of Dental practice should be based on directions as per orders of the local administration.	–	Screening th patients by asking the symptoms of coronavirus. Referral should be made to government hospital or designated hospital.	Train and retrain workers on how to follow established protocols.	Telephonically appoint patients and triage them according to their level of dental care; i.e. Emergency, urgent and elective care.	Primary care dental triage should focus on the provision of the three as: a. Advice; b. Analgesia; c. Antimicrobials (where appropriate).	EMERGENCY (Situations which increase the patient's death risk) • Uncontrolled bleeding. • Cellulitis leading to intra-oral or extra-oral edemas, and potential risk of damage to airways • Facial bones trauma, which may damage the patient's airways. URGENT (situations which require priority care but do not increase the patient's death risk) • Acute dental pain (Pulpitis). • Pericoronitis. • Alveolitis. • Dental or periodontal abscesses. • Dental care needed for another critical medical procedure. • Cementation fixed prosthodontics or crowns. • Biopsies. • Adjustments of orthesis and prosthesis that cause pain and compromise chewing function. • Changing intracanal medication. • Removal of extensive dental caries or restorations that cause pain. • Mucositis. • Dental trauma with avulsion or luxation.	Dentists should take strict personal protection measures and avoid or minimize operations that can produce droplets or aerosols. Four-handed technique is beneficial for controlling infection. The use of saliva ejectors can reduce the production of droplets and aerosols.	–
Country: Australia Source: Australian Dental Council Updated on may 8, 2020 Https://www.dentalboard.gov.au/News/2020-05-08-COVID-19-update-to-dental-practitioners-8-May.aspx Rest of the precaution is followed as per to “Managing COVID-19 guideline”, Last updated on March 25, 2020.	May 7, 2020 AHPPC agreed to moving dental practice to level 1 restrictions.	–	Provided a pre-screening checklist.	Training the team on how to screen for patients at risk of COVID-19.	Call all patients the day prior to the planned appointment and ask ➢ Returned from overseas or interstate travel in the past 14 days ➢ Felt unwell, including but not limited to symptoms of COVID-19 such as fever, cough, sore throat or shortness of breath ➢ had any contact with a confirmed or suspected case of COVID-19 in the past 14 days.	None	Level 1 Restrictions imply: Defer non-urgent treatment for people who DO meet epidemiological or clinical symptom criteria for COVID-19 risk. Urgent dental treatment for people who DO meet epidemiological or clinical symptom criteria for COVID-19 risk or confirmed as a COVID-19 case.	20–30 s pre-procedural mouth rinse with either: • 1% hydrogen peroxide • 0.2% povidone iodine • 0.2% chlorhexidine rinse (alcohol free) • an essential oil mouth rinse (alcohol free)	All dental treatments using standard precautions for people who do not meet epidemiological or clinical risk factors for COVID-19 infection transmission.
Country: Canada Source: Royal college of Ontario, Canada. COVID-19: Managing Infection Risks During In-Person Dental Care May 31, 2020	Return-to-Practice Office Manual have been provided to Corporate Member pdas on Friday, May 29, 2020.	COVID-19 Patient Screening Guidance Document prepared as per to who guideline of Covid-19 case definition. Updated on may 17, 2020. Results of which categorises a person Covid-19 screen positive/negative however is not equivalent to a confirmed diagnosis of COVID-19.	COVID-19 Patient Screening Guidance Document published on May 17, 2020. Refer to suspected cases should be made to primary care provider or Telehealth Ontario	Dentists must ensure that clinical staff are trained in and use proper donning and doffing procedures for PPE.	Dentists must ensure that patients are triaged and appointments are scheduled by phone or via tele dentistry (not in person or via walk-in).	None	Though the practice has resumed for all the procedures. may 22, 2020 update categorized: Emergency →oral-facial trauma • cellulitis or other significant infection, especially if compromising the patient's airway • prolonged bleeding • pain that cannot be managed by over-the counter medications. Urgency → severe dental pain from pulpal inflammation • pericoronitis or third-molar pain • surgical post-operative osteitis, dry socket dressing changes • abscess or localized bacterial infection resulting in localized pain and swelling • tooth fracture resulting in pain, pulp exposure or causing soft tissue trauma • extensive caries or defective restorations causing pain • dental trauma with avulsion/luxation • final crown/bridge cementation if the temporary restoration is lost, broken or causing gingival irritation • biopsy of a suspicious oral lesion or abnormal oral tissue • replacing a temporary filling in an endodontic access opening for patients experiencing pain • snipping or adjusting an orthodontic wire or appliance piercing or ulcerating the oral mucosa • treatment required before critical medical procedures can be provided • suture removal • denture adjustments or repairs when function is impeded • other procedures that in the dentist's professional judgement are necessary in order to minimize harm to patients and/or relieve pain and suffering. Non-emergent care → recall examinations and routine radiographs • routine dental cleanings and preventive therapies • orthodontic procedures other than those to address acute issues (e.g. Pain, infection, trauma) • extraction of asymptomatic teeth • restorative dentistry, including treatment of asymptomatic carious lesions • cosmetic dental procedures, including teeth whitening.	Dentists should post signage in common areas (e.g., at the main entrance and in the waiting area) communicating relevant expectations for patients, including any requirements for: a. Hand hygiene (e.g., a requirement to wash and/or sanitize hands upon entry to the practice); b. Respiratory hygiene (e.g., a requirement to wear a mask within the practice); and c. Physical distancing (e.g., a requirement to maintain a minimum distance of 2 m, except as required for the provision of care). 15 Dentists should also post signage at the entrance to the office and at reception describing the signs and symptoms of COVID-19. Dentists are advised to consider installing physical barriers at key contact points to reduce the spread of droplets, including reception (e.g., a plexiglass shield).	Dentists are permitted to provide in-person care for all deferred, non-essential, and elective services, in addition to emergency and urgent care.
Country: United Kingdom Source: National Health Survey, United Kingdom. COVID-19 guidance and standard operating procedure Delay phase. Updated May 18, 2020.	The provision of all routine, non-urgent dental care including orthodontics has been stopped in England until further notice. The reopening task has not yet begun.	Public Health England (PHE) has defined the current case definition for COVID-19, and provided guidance on testing and case reporting. Link from the parent article is provided. Patients who are possible or confirmed COVID-19 patients – including patients with symptoms (new, persistent cough or high temperature or anosmia (a loss of or change in your normal sense of smell or taste).	Screening Do you have a new, continuous cough? Do you have a high temperature (37.8C or over)? Does anyone in your household have a new, continuous cough or a high temperature? If you or anyone in your household has tested positive for coronavirus, are you still in the self/household isolation period? Anosmia (a loss of or change in your normal sense of smell or taste).	Dental care professionals working in urgent care settings should be trained in all aspects of infection prevention and control (IPC) and fully familiar with HTM01 05 for decontamination. Training should include donning (putting on) and doffing (taking off) PPE.	Under SOP remote management: Remotely (eg by telephone or video link) risk assess and triage those patients contacting the service for urgent dental care, to determine patient group, urgency of dental problem and associated UDC needs.	Advice, analgesia, antimicrobials where appropriate. SDCEP guidance on drugs for the management of dental problems during the COVID-19 pandemic. http://www.sdcep.org.uk/published-guidance/acute-dental-problems-Covid-19/.	Life-threatening emergencies, eg airway restriction or breathing/swallowing difficulties due to facial swelling • trauma including facial/oral laceration and/or dentoalveolar injuries, for example avulsion of a permanent tooth • oro-facial swelling that is significant and worsening post-extraction bleeding that the patient cannot control with local measures dental conditions that have resulted in acute and severe systemic illness • severe dental and facial pain: that is, pain that cannot be controlled by the patient following self-help advice • fractured teeth or tooth with pulpal exposure dental and soft tissue infections without a systemic effect suspected oral cancer • oro-dental conditions that are likely to exacerbate systemic medical conditions.	Keep staff safe through regular risk assessments. As few staff as possible should be allocated to see patients, particularly those shielded, to minimize contacts without compromising the safe delivery of care.
Country: MALTA, Europe. Source: Guidance for Dental Practices in Malta - COVID-19 March 18, 2020	–	None	Screened using a forehead thermometer, instructed to use alcohol hand rub. The questions should confirm once again whether over the previous 14 days clients have: − been abroad or close contact with any patient presenting respiratory symptoms, − been in contact with anyone who has developed COVID-19 − themselves had any symptoms of coughing/fever/shortness of breath during the past fortnight. Referral to 111.	Clearly define tasks and support each other to ensure that duties are carried out safely and responsibly	Patients should be contacted over the phone and evaluated for Covid-19 status.	None	Limit dental procedures to emergency cases and postpone non-urgent appointments and treatment.	Clinicians should wear PPE which includes disposable surgical masks, protective eyewear/face-shields and disposable gloves. Practise four-handed dentistry. Hand-pieces used should be anti-retraction handpieces. Hand instrumentation. Pre-rinse with 1% hydrogen peroxide or 0.2% povidone.	Limit dental procedures to ones that do not create aerosols and airborne particles
Country: SINGAPORE Source: MOH circular 132/2020 gradual resumption of dental services after Covid-19 circuit breaker period Updated: May 21, 2020	PHASE ONE (“SAFE RE-OPENING”) from 1st June Non-essential dental services which were deferred can also resume in a controlled and gradual manner.	–	–	–	Physical visits should continue to be avoided where possible	–	Not defined, MOH has instructed healthcare providers to triage and prioritise the resumption of services for patients or clients with more urgent medical needs first.	Clinic staff, as employees of the dental clinic, should be equipped with the appropriate Personal Protective Equipment (PPE) while continuing to provide care to all patients. Four-handed dentistry. Workplaces and services that are in operation are required to deploy Safe Entry to log the check-in of employees and visitors. Staff with mobile phones are also encouraged to download and activate the Trace Together app	Aerosol generating procedures (agps) present a higher risk of transmission of the virus and should only be undertaken where no other option is available. The use of hand instrumentation should be highly prioritized.