COVID-19 Dental Infection Control: OSHA & CDC Guidelines

On March 16, 2020, the American Dental Association (ADA) recommended that dentists suspend all non-essential procedures and limit care to urgent and emergency dental treatments during the COVID-19 outbreak.

OSHA advises that emergency dental care for suspected or confirmed COVID-19 patients should only occur if adequate PPE and precautions are available.

Dental employers should:

• Monitor updates on virus spread and testing availability

• Follow phased guidelines under Opening Up America Again

• Adjust protocols based on evolving local, state, or federal health guidance

Exposure Risk Levels in Dental Work

OSHA classifies dental work into four exposure risk categories:

Refer to OSHA’s Risk Pyramid for further classification.

Infection Prevention Protocols

Until more is understood about COVID-19 transmission, OSHA recommends a layered approach for dental care:

For Non-Aerosol Procedures on Healthy Patients:

• Standard, contact, and droplet precautions

• Eye protection (goggles or face shield)

For Suspected/Confirmed COVID-19 Cases or Aerosol-Generating Procedures:

• Airborne precautions

• NIOSH-approved respirators (e.g., N95, R95, or PAPR)

• Full PPE ensembles per OSHA standards

Aerosol-generating devices include dental turbines, micro-motor handpieces, ultrasonic scalers, and air-water syringes.

For current clinical control recommendations, refer to CDC guidance.

How OSHA and CDC Guidelines Compare

CDC and OSHA guidance may appear different, but both aim to:

• Support workplace safety

• Ensure compliance with federal standards, including:

  • Bloodborne Pathogens (29 CFR 1910.1030)

  • Respiratory Protection (29 CFR 1910.134)

  • PPE Standards (29 CFR 1910 Subpart I)

Employers must also consider OSHA enforcement flexibilities regarding PPE shortages and respirator use.

Hierarchy of Controls for COVID-19 in Dentistry

1. Elimination

Limit services to only urgent or emergency procedures to reduce exposure risks. Elective dental care should be postponed.

2. Engineering Controls

• Use physical barriers between patient areas

• Implement local exhaust ventilation where possible

• Maintain directional airflow to move air away from patients and toward staff areas

3. Administrative Controls

• Screen patients via phone triage or teledentistry

• Isolate symptomatic individuals immediately

• Limit staff exposure during aerosol-generating procedures

• Avoid unnecessary personnel in treatment rooms

4. Safe Work Practices

• Use high-volume suction and dental dams to reduce aerosols

• Minimize use of ultrasonic scalers and air-water syringes

• Avoid patient-side tasks like charting or sterilization

• Follow strict hand hygiene and face-touching avoidance

Train and retrain staff regularly on updated protocols.

Personal Protective Equipment (PPE)

Important: PPE should be part of a complete Respiratory Protection Program including medical evaluation, fit testing, and training.

Cleaning and Disinfection

• Use EPA-registered, hospital-grade disinfectants (see List N)

• Clean all surfaces before applying disinfectant

• Sterilize equipment per CDC’s 2008 Disinfection Guidelines

• Use HEPA filters or equivalent in vacuum lines

• Train staff on handling both chemical disinfectants and infectious materials

Key OSHA Regulations Relevant to Dentistry:

• Bloodborne Pathogens Standard (29 CFR 1910.1030)

• Respiratory Protection Standard (29 CFR 1910.134)

• PPE Requirements (29 CFR 1910 Subpart I)

More info: OSHA’s Dentistry Safety Page

Additional Resources:

• CDC Infection Control Guidelines for Dental Settings

• OSHA COVID-19 Dentistry Guidance