MDA Safety Advisory to Dental Practitioners in the Current Escalating Concern of COVID - 19 Infection.
(Updated 04.04.2020)

IMPORTANT: Please kindly read our advisory together with:
(i) Guidelines on COVID-19 Management in Malaysia No. 5/2020 updated 24th March 2020 from the office of Director – General of Health Malaysia
(ii) Garis panduan pengendalian isu-isu berhubung penularan jangkitan wabak COVD-19 di Perkhidmatan Kesihatan Pergigian Bil. 2/2020, from Oral Health Program, Ministry of Health Malaysia.
(iii) MDA Contingency Plans COVID-19 during Movement Control Order updated 28th March 2020 where only emergency cases and avoidance of aerosol producing treatment are observed.
(iv) Guidelines on Infection Control in Dental Practice, 2017, from Malaysian Dental Council
(v) Code of Professional Conduct, 2014, from Malaysian Dental Council

1. STAFFS AND GENERAL AREAS. Do keep all your staffs aware and updated of the current
situations. All staffs, dental practitioners, including patients and accompanying persons are to observe proper hand hygiene and to always practice cough and sneeze etiquette (provide good visual signage). Staffs who are unwell should seek medical attention. Keep the clinic waiting area well-ventilated. All public areas of the clinic and contact surface area including door knobs, handles and desks are to be cleaned regularly (3-4 times a day) with standard disinfectants. Practice social – distancing of at least 1 meter at waiting area and other general areas.

2. SCHEDULING APPOINTMENTS. Schedule appointments well to avoid overcrowding of waiting area if possible. Limit the number of accompanying family members or friends and if possible, avoid bringing children or the elderly to the clinic unnecessarily. You may consider calling your patients in advance before their appointment to enquire on their health status, travel history and possible contact with COVID-19 patients.

3. SCREENING AND TRIAGING. Screen (including temperature taking) all your patients and their companions as they arrive. Visitors are to put on surgical mask when droplet precaution is needed, such as in coughing and sneezing (symptoms of respiratory tract infection). Prepare adequate hand sanitizers for patients’ use as they walk in. Provide good visual signage requesting patients to declare symptoms, travel history or contact with a confirmed case. Kindly request your patients (and accompanying person) to fill up the Health Declaration Form (refer to attached document in this website). Staffs at the triage area and registration counter should wear surgical mask and face shield (if not other physical barrier is present). Additional PPEs for staffs performing screening includes isolation gown and gloves.

4. WHEN SHOUD YOU SUSPECT COVID-19? Remember that it is not always possible to identify patients with COVID-19 early because some have mild or unusual symptoms. COVID-19 is to be suspected when a patient presents with the following:
(a) Acute respiratory infection (sudden onset of respiratory infection with at least one of: shortness of breath, cough or sore throat) with or without fever
AND
(b) Travelledto/residedinforeigncountrywithin14daysbeforetheonsetofillness OR close contact1 in 14 days before illness onset with a confirmed case of COVID- 19 OR attended an event associated with known COVID-19 outbreak.
1close contact defined as:
i. Health care associated exposure without appropriate PPE (including providing direct care for COVID-19 patients, working with health care workers infected with COVID- 19, visiting patients or staying in the same close environment of a COVID-19 patient).
ii. Working together in close proximity or sharing the same classroom environment with a COVID-19 patient.
iii. Traveling together with COVID-19 patient in any kind of conveyance
iv. Living in the same household as a COVID-19 patient

If all the criteria above are met, kindly request them to PUT ON A SURGICAL MASK (if patients’ condition permits) and wait in an area more than 1 m away from those in the waiting area (do explain why this is necessary). The dental practitioner on duty should be informed immediately if such patients are received. It is advisable to request that they postpone their appointments and refer them to seek medical attention as soon as possible or if they are in need of urgent dental treatment (refer to Annex 3). The area should be disinfected after the patient has left.

If only criteria (a) is met kindly request them to PUT ON A SURGICAL MASK and advise patient to seek medical attention if this has not been made and consider postponing non urgent dental procedure (remember that we are dealing inside the oral cavity most of the time). Advise them to be responsible by taking measures / practices (Annex 6a, Annex 10b of Guidelines on COVID-19 Management in Malaysia No. 5/2020):
- Stay at home and monitor body temperature to look out for fever (> 38oC), symptoms of cough and/or breathing difficulty for the next 14 days. Seek medical advice immediately if not feeling well.
- Be contactable at all time by their family / friends.
- Limit visitors to their house.
- List the names of those visiting who comes to visit.
- Always practice good cough and sneeze etiquette
- If develop any symptom, always wear facemask. If they do not wear face mask, close their
mouth and nose with tissues when coughing or sneezing. Throw the tissues into closed
dustbin and immediately WASH HANDS with soap or hand sanitiser
- Limit distance with healthy person (s) to at least 1 meter
- Wear face mask when going out of their room and avoid contact with others
- Open all windows in their house to ensure good ventilation
- Do not share utensils, tableware and personal hygiene items

The dental practitioners’ discretion on this matter is prudent (we do not want to miss a case of acute odontogenic infection that may also present with fever and sometimes with shortness of breath). Please refer the Code of Professional Conduct published by MDC, if such decision of not treating a patient is made. On this note, do ensure proper explanation to the patient is made and document the discussion in the records.

5. IN THE DENTAL SURGERY. Dental practitioners and the dental surgery assistants need to don appropriate PPEs which include surgical masks, isolation gown, gloves and goggles / face shield. Always maintain a high standard of Universal Infection Control Precaution (hand hygiene, management of aerosol generating procedures, sterilisation of instruments and handling of sharps and injections.
General Statement

This advisory is only for guidance to members, who should stay up-to-date about all local developments and guidelines in regard to the COVID-19 pandemic and apply accordingly based on their clinical judgment, experience and clinical facilities, specifically patient evaluation, and treatment during this trying times. The intention is to minimise any possibility of transmission of the coronavirus to patients and / or the dental team to the best extent possible, and to ensure safety our family members. MDA cannot be held responsible for any oversight and will continue to update the advisory as best as we can.

From the President and council members of MDA