Updates on the PDA Interim Guidelines

on Infection Prevention for CoVid-19 Pandemic

(Part 6)

While the pandemic is ongoing, the important thing is for dental practitioners to use personal protective equipment (PPE). There are several levels of PPEs and each level corresponds to the level of protection needed.

  • Level one (1) PPE is recommended to staff members who are at the reception area and have minimal risk and will not enter the treatment areas nor participate in direct treatment of the patient.

Level one (1) PPE consists of wearing of scrub suit/shirt, surgical mask, protective eyewear (not goggles).

  • Level two (2) PPE is recommended to staff members who are tasked to prepare instruments in non- contaminated areas, clean tools in non-contaminated areas and move around areas near or adjacent to treatment areas but are not exposed directly to patients getting treatment.

Level two (2) PPE is also recommended for staff and healthcare  providers (HCP) who will be providing services to patients and level 2 PPE consists of undergarment/scrub shirt/suit, water repellent gown, surgical mask, protective eyewear (not goggles), head cover and non-sterile examination gloves.

  • Level three (3) PPE is recommended to staff and HCP who are directly involved with patient care and in contact with patients in the treatment areas where active dental care are expected. This is also recommended for persons responsible for post-treatment disinfection and removal of instruments from patient treatment areas.

Level 3 PPE consists of under  garment/scrub  shirt/suit,  water repellent surgical gown (preferably ankle length and neck length), properly test-fitted respirator masks (NIOSH N95 or FFP), protective eyewear or goggles, head cover, face shield sterile surgical under gloves taped to wrist cuffs of gown and non-sterile examination overgloves.

  • Level four (4) PPE is recommended to persons with continuous or frequent exposure to highly contagious or airborne transmissible pathogens. This is what is commonly called as coverall and is impractical for dental office use.

Level 4 PPE consists of undergarment/scrub suit, single-piece, water-proof, head-to-toe (or ankle length) fitted suit with adjustable fit hood, undergloves taped to wrist cuffs, sealed and fitted goggles, face shield, fitted respirator mask and over-gloves.

Surgical masks are key part of the PPE. Surgical masks differ from N95 Filtering Facepiece Respirators (FFPR) in a number of ways. Medical masks do not tightly seal to the face. They are made from flexible material with a filter, which is thinner than that of the N95 FFPR, and they are meant to be exposed at the back edges for breath to escape, rather than the complete seal provided by the N95 FFPR.

 Medical masks are made with varied filtering capabilities, and for this reason, they come in different grades. Medical masks, when at quality standards, are 3-ply, with a water resistant outer layer and a middle layer composed of electrets material such as polyethene or melt-blown polypropylene that is similar to that of the N95 FFPR, but not as thick. Electrostatic-based filters are a type of material that traps respiratory droplets and other particles by electrostatic charge attraction and therefore can have a relatively large pore size for good airflow/breathability.

Electrostatic filters make the medical masks and N95 FFPRs more effective than cloth masks. The ability of a medical mask (or cloth mask) to filter particles critically depends on the proportion of air that passes through the filter rather than through gaps around the mask, which is not filtered at all.

For this reason, reducing the number and size of gaps by adjusting a medical mask to fit closely to the wearer’s face will surely enhance its ability to protect against Covid.