A year of research and collaboration supporting the phased reopening of primary oral health care service delivery in Nova Scotia during the COVID-19 pandemic: March 2020 to March 2021

Abstract

Executive Summary: The timing of this report marks just over one year since the province of Nova Scotia, in response to the COVID-19 global pandemic, announced the closure of all but emergency oral health services in March 2020. Oral health providers were among the first to appreciate the gravity of the situation. The transmission of COVID-19 through respiratory droplets meant that aerosol generating procedures (AGPs) used for routine oral health care posed a risk to oral health care providers and to those seeking care. It was generally accepted that standard precautions for infection prevention and control (IPC) were going to be insufficient. A collaboration evolved amongst regulators of oral health professions, oral health profession member organizations and practitioners, the Nova Scotia Department of Health and Wellness (NSDHW), dental educators and researchers to address the complexities of shutting down oral health services, to guide the anticipated phased reopening and to prepare for possible subsequent pandemic waves. Through a Nova Scotia Rapid Response COVID-19 Health Research Coalition research grant, our small team of clinicians and researchers supported regional and national oral health care initiatives through the following objectives:

Objective I: Expand and strengthen knowledge translation/exchange both regionally and nationally: Regional networking resulted in concrete program evaluation and dissemination of return-to-work strategies for Nova Scotia oral health care providers. Nationally, resources are shared and exchanged through our Association of Canadian Faculties of Dentistry network. Investigators represent Nova Scotia and Dalhousie University in three national initiatives (funded by the Canadian Institutes of Health Research and the Canadian Immunity Task Force) exploring COVID-19 related experiences of oral health providers, educators, students and related staff.

Objective II: Explore Nova Scotia oral health care providers’ uptake of Return to Work (RTW) guidelines: The influence of evidence-based guidelines and related education on RTW practices of NS dentists, Registered Dental Assistants and Registered Dental Hygienists during a phased return to work plan was explored through surveys undertaken at two critical RTW phases. The provincial multi- stakeholder coalition was effective in establishing and communicating comprehensive guidelines and web-based education to ensure a phased and unified re-integration of oral health services in NS in the early months of the pandemic.

Objective III: Catalogue current best evidence of COVID-19 relevant to oral health care delivery: A standardized search strategy, summarized and disseminated weekly, led to the creation of a catalogue of over 600 articles and online documents to guide safe responses to COVID-19. Most were single studies, narrative reviews, and editorials from experts. A small number of systematic reviews consistently summarized weak evidence to support queries.

Objective IV: Compare RTW protocols to inform local policy and procedures: Over fifty protocols from relevant provincial, national and international jurisdictions and institutional jurisdictions were reviewed. Differences in timing of re-opening and high variability in community rates of COVID-19 infection and risk made it challenging to systematically compare protocols. Protocols specific to clinical teaching settings demonstrated inconsistent interpretation of evidence in the application of evolving standards.