Aerosol Generating Procedures and their
Mitigation in International Dental GuidanceDocuments - A Rapid Review
24 July 2020

COVID-19 Dental Services Evidence Review (CoDER) Working GroupHow to cite this document:
Clarkson J, Ramsay C, Richards D, Robertson C, & Aceves-Martins M, on behalf of the CoDER Working
Group. Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents- A Rapid Review
https://oralhealth.cochrane.org/news/aerosol-generating-procedures-and-their-mitigation-internationalguidance-documents

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

PurposeThe aim of this rapid review was to assess how dental aerosol generating procedures(AGPs) were defined in international dental guidelines, what mitigation processes wereadvised and whether they were linked to COVID-19 epidemiology. The specific objectives
were:•Assess how aerosol generating procedures (AGPs) are defined and classified ininternational guidelines•

Identify what AGP mitigation is advised for both COVID and non-COVID patients•

Report recommended time gaps (fallow periods) between treating COVID and nonCOVID patients in the same surgery following provision of AGPs•

Identify any mitigating factors that allow reductions in the length of fallow periods.

•(Assess whether there is a relationship between COVID-19 epidemiology and WorldBank income status with PPE provision – to be reported later).

•(Assess the quality of linked evidence to recommendations – currently in progress tobe reported later).

The review was undertaken to inform the Scottish Dental Clinical Effectiveness Programme(SDCEP) Aerosol Generating Procedures in Dental Practice Rapid Review.
https://www.sdcep.org.uk/published-guidance/covid-19-practice-recovery/rapid-review-ofagps/
Key Messages•

This review reports on national recommendation for AGPs and their mitigationfrom 58 countries.

•

There is a highly variable level of details provided across international resources.

•

Just over half of the documents (56%) provide a definition of AGPs.

•

98% of countries state that AGPs can be provided for non-COVID patients.

•

94% of countries recommend the use of a face mask and goggles or a face shieldfor non-COVID patients.

•

Surgical masks are advised by 21 countries (33%) for non-COVID patients while
44 countries (70%) recommend the use of FFP2/N95 masks and 12 countries(19%) recommend the use of FFP3 masks.

•

82% of documents recommend the use of a pre-procedural mouthwash for nonCOVID patients.

•

48% of documents suggest a fallow period after the providing AGP treatment for
non-COVID patients, with times ranging from 2 to 180 minutes.

•

Most countries making recommendations for COVID patients advised the same
mitigation as for non-COVID patients.

•

There is a lack of evidence provided to support the majority of recommendationsin the documents.

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

The World Health Organization (WHO) declared the coronavirus disease (COVID-19) a
global pandemic on 11 March 2020. Since then dental services in affected countries havebeen severely curtailed. Though many practices have reopened following the initialoutbreak guidance continues to be reviewed particularly concerning aerosol generatingprocedures (AGP’s). Until very recently the primary mode of spread of the virus has been
considered to be via droplets and fomites. However, the potential for airborne transmission
has now been raised.1 This is important in relation to the safe remobilisation of dental
services as it impacts on the uncertainty that exists regarding the risk from and the use ofaerosol generating procedures in dentistry and any associated risk of the transmission of
SARS-CoV-2.
Process
In the first week of July 2020, we commenced a rapid review of recently produced guidance
and reports containing recommendations from international organisations and professional
bodies on the current requirements for safe remobilisation of dental services. Our methods
are based on the proposed approach for rapid reviews by the World Health Organisation(WHO) and the Alliance for Health Policy and Systems Research.2
This review is supplementary to the previous CoDER Rapid Review of Reopening of Dental
Services (16 May 2020). It summarises only the recommendations associated with theprovision of AGP’s. We conducted a grey literature search to identify relevant guidance
documents and liaised with the information scientist from Cochrane Oral Health (COH), wholast updated the regular Cochrane search for dental guidelines on 13 July 2020. We also
contacted an international network of oral health researchers and decision makers throughthe Global Evidence Ecosystem for Oral Health (GEEOH). The GEEOH was founded toreduce duplication of effort and create direct routes from evidence to policy and clinicalpractice and is currently coordinated by COH. Through this network World Dental
Federation (FDI) have shared a database of recently collated national guidance which
provided additional documents. Following publication of the Rapid Review of Reopening ofDental Services we were contacted by individuals and groups to assist with theidentification of documents for this review. The relationship between COH, the Scottish
Dental Clinical Effectiveness Programme (SDCEP) and our research group resulted in rapid
communication and assistance from several Chief Dental Officers and worldwide dental
policy leaders.
No language restrictions were applied to the searches and members of our research groupwere able to translate documents published in Dutch, French, German, Portuguese andSpanish with Google translate being used for other languages when necessary. Searches
continued to 13th July 2020 with data being extracted up to 15th July 2020.
Using a data extraction form developed a priori, information relating to specific AGP
recommendations and evidence linked to recommendations was extracted by a single
1

https://apps.who.int/iris/bitstream/handle/10665/333114/WHO-2019-nCoV-Sci_Brief-Transmission_modes2020.3-eng.pdf?sequence=1&isAllowed=y).
2 https://www.who.int/alliance-hpsr/resources/publications/rapid-review-guide/en/

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

reviewer. Data items included definitions of AGPs, recommendations on personal protective
equipment (PPE) and any procedural and environmental aerosol mitigation processes.
Findings
A total of 74 guidance documents from 72 countries, including four from the UK and twoeach from Kenya and the United States, were identified. Five documents were excluded(Hong Kong, South Korea, the Latin American Paediatric Association Guideline, Sweden
and Kenya) as they provided no information relevant to our objectives. We were unable tosource quickly or obtain translations of documents from seven countries (Albania, Bosnia
Herzegovina, Israel, Moldova, Nepal, Palestine, Turkey) before our deadline. Data relevantto the objectives were extracted from 63 guidance documents by members of the CoDER
working group. The main findings for each main objective are summarised below and adetailed summary of the documents from each of the countries is available in Appendix 1.
AGPs definition and list of procedures
Twenty one of the 63 documents (33%) provided a definition of aerosol generatingprocedures (AGPs), with 35 documents (56%) providing a list of procedures considered to
be AGPs. Eight documents provided references relative to AGP definitions with fiveproviding references for AGP procedures. Those procedures identified by more than 20% of
the documents as AGPs were high-speed handpieces (56%), 3-in-1 syringes (56%),
powered (sonic/ultrasonic) scalers (43%), slow speed handpieces (29%) and surgicalhandpieces (22%).
With the exception of Scotland, which at the time of writing did not permit AGPs in nonCOVID patients, all other documents (98%) indicate that AGPs can be performed in nonCOVID patients. However, a number suggest caveats to their use. Many recommend
limiting the use of AGPs where possible, with 13 documents (21%) only recommending
performing AGPs for dental emergencies. Only four documents provide references related
to the provision of AGPs. Additional information comparing AGP procedures for COVID andnon-COVID patients is available on a country by country basis in Appendix 2. Fifty-eight(92%) of the documents suggested providing treatment for suspected of confirmed COVID
patients. Of these, 22 suggested treating emergencies only, with 16 indicating thesepatients should be seen in specialised clinics or hospital and not a general dental practice.
None of the recommendations for confirmed COVID patients were based on evidence.
PPE Recommendations
For the management of AGPs in non-COVID patients, five documents (Bolivia, Ecuador,
Philippines, Portugal and Spain) recommend double gloving. Fifty nine of 63 countries(94%) specify the use of a face mask, with 91% specifying the use of goggles or a faceshield. All of those countries specifying goggles or a face shield also specified the use of aface mask. Five countries (Costa Rica, Dominican Republic, Myanmar, Portugal and the
Ukraine) do not specify a particular type of mask for use with non-COVID patients. Surgicalmasks are advised by 21 countries (33%) for non-COVID patients while 44 countries (70%)
recommend the use of FFP2/N95 masks and 12 (19%) the use of FFP3 masks. Of the 21
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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

countries recommending a surgical mask, 10 suggest the use of FFP2/N95 masks if
available. Nine of the 44 countries that advise FFP2 masks for non-COVID patients suggest
the use of FFP3 masks where available. Only 19 documents make specific reference to theneed for fit testing of FFP2/3 masks. The use of surgical gowns is advised by 42 countries(67%) and surgical caps/hats by 32 countries (51%), with 21 countries (33%)
recommending using disposable aprons and 11 countries (17%) also recommending theuse of shoe covers.
Of the documents providing recommendations for the treatment of COVID-19 patients, amajority (54%) recommended the same level of facemask as when treating non-COVID
patients, with only 12 documents suggesting the specification should be upgraded.
Procedural mitigation
Aerosol mitigation procedures included mouthwashes, rubber dam and high-volume
suction. 82% of documents recommend the use of a pre-procedural mouthwash with a viewto reducing bio-aerosols for non-COVID patients. The two most commonly recommended
mouthwashes were hydrogen peroxide (38 documents) and povidone iodine (30documents), with many documents recommending the use of either of these twomouthwashes. Three documents recommend cetyl pyridinium mouthwash and threerecommend a mouthwash without stipulating the type. Ten documents provide links toreferences for this question and while both Paraguay and South Africa recommend
mouthwash use, they indicate that there is no evidence for the effectiveness ofmouthwashes.
The use of rubber dam was recommended for non-COVID patients by 46 (73%)
documents, with just six (10%) documents (China, France, Italy, Malaysia, the Philippines
and South Africa) providing evidence to support the recommendation.
While the use of high-volume suction is often a routine practice during dental treatment,
only 46 (73%) documents recommend use of high-volume suction for non-COVID patients.
Six (10%) documents (China, France, Italy, Malaysia, the Philippines and South Africa)
provide links to evidence for this recommendation.
Environmental mitigation
The general ventilation of the dental clinic for non-COVID patients is mentioned in 33 (52%)
of the included documents. The most common advice, provided in 15 documents thatmention ventilation, is to ensure that the room is well ventilated, including the opening of(exterior) windows and use of air conditioning. The Argentinian document recommends
turning the air conditioning off while others indicate that it can be used but not in therecirculating air mode. Six documents suggest the use of a negative pressure room or
unidirectional air flow, while the use of HEPA filtration is recommended by Guatemala,Honduras, India, Italy, Malaysia, Paraguay, Philippines, Poland and South Africa. Only the
Canadian document provides specific details on air changes per hour, including a detailed
table of the impact of different numbers of air changes. Of the 33 documents providing
information on general ventilation, only six provide any references.
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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
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Fallow period
Thirty of the 63 documents (48%) refer to a fallow period after providing AGP treatment for
non-COVID patients, with only two documents providing links to any references. Where
specific times are provided, these range from 2 to 180 minutes. Documents from eight
countries (Belgium, Canada, China, Croatia, England, Malaysia, Malta, Northern Ireland)
provide some possible mitigation factors to enable reduction of the fallow period. These
include opening windows, increasing the number of air changes per hour, the use of HEPA
filters and negative pressure room and minimising AGPs.
Of the documents reporting recommendations for the treatment of COVID-19 patients, most
(21/30) recommended the same duration of fallow period as when treating non-COVID
patients. Only 5 documents suggested that the time should be longer, with the Canadiandocument recommending 3 hours if information on air change per hour is unavailable.
Conclusion
This rapid review provides an overview of recommendations on AGPs and their mitigationfrom international guidance documents. It summarises specific elements of the identified
documents and highlights several key messages to assist policy and decision makers.
Across these international documents, for most of the statements there was limited or noreferenced, underpinning evidence.

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Working Group Members

Jan Clarkson,
Clinical Lead

Professor of Clinical Effectiveness, University of Dundee;
Director of SDCEP, NHS Education for Scotland (NES); JointCoordinating Editor, Cochrane Oral Health, University ofManchester

Craig Ramsay,
Methods Lead

Professor and Director, Health Services Research Unit
(HSRU), University of Aberdeen

Magaly Aceves-Martins

Research Fellow, HSRU University of Aberdeen

Miriam Brazzelli

Reader, HSRU, University of Aberdeen

Gareth Calvert

Consultant NHS Greater Glasgow and Clyde

Thibault Colloc

Dental Core Trainee, Oral and Maxillo-facial Surgery,
Aberdeen Royal Infirmary, NHS Grampian

Manas Dave

NIHR Academic Clinical Fellow in Oral and Maxillofacial
Pathology, University of Manchester

Anne-Marie Glenny

Professor of Health Sciences, Joint-Coordinating Editor,
Cochrane Oral Health, Division of Dentistry, University ofManchester

Beatriz Goulão

Statistical Research Fellow, HSRU, University of Aberdeen

Thomas J Lamont

Clinical Research Fellow/Hon. StR in Restorative Dentistry,
School of Dentistry, University of Dundee

Derek Richards

Specialist Advisor, SDCEP, University of Dundee

Philip Riley

Cochrane Oral Health, Division of Dentistry, University ofManchester

Clare Robertson

Research Fellow, HSRU, University of Aberdeen

Tanya Walsh

Cochrane Oral Health, Division of Dentistry, University ofManchester

Gavin J Wilson

Chief Dental Officer’s Clinical Fellow, NHS England and NHS
Improvement; StR in Oral Surgery, Leeds Dental InstituteHelen Worthington

Cochrane Oral Health, Division of Dentistry, University ofManchester

The COVID-19 Dental Services Evidence Review Working Group would like to thank andacknowledge the contribution of the following individuals for providing the advice andaccess to the international guidance documents necessary for this rapid review:
Colette Bridgman, Chief Dental Officer, Wales; Alonso Carrasco-Labra, Director, ADA
Science & Research Institute; Riana Clarke, National Clinical Director Oral Health, New
Zealand; Michael Donaldson, Chief Dental Officer, Northern Ireland; Tom Ferris, Chief
Dental Officer, Scotland; Sara Hurley, Chief Dental Officer, England; Paulo Melo, COVID19 Task Team Chair, FDI World Dental Federation; Timothy Ricks, Chief Dental Officer, US
Public Health Service; James Taylor, Chief Dental Officer, Canada; Benoit Varenne, Dental
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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
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Officer, World Health Organization. Thanks also to Tif Qureshi for providing access to someinternational guidance documents.
The COVID-19 Dental Services Evidence Review Working Group are grateful to for the help
and support provided by Shona Floate, University of Glasgow; Anne Littlewood, and Laura
MacDonald from Cochrane Oral Health; David Felix, Postgraduate Dental Dean, NES andcolleagues from NES’s Clinical Effectiveness workstream: Samantha Rutherford; Douglas
Stirling; Michele West; Linda Young.

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Appendix 1. AGPs summary table by country
Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Country
Argentina

Definition
Many of the dental
procedures produce
aerosols representing a
potential route for thetransmission of
infectious diseases.

Non COVID-19

Face mask - surgicalmask, or N95 or FFP2 ifavailable

Yes

Disposable apron

High volume suction

General ventilation.
AGPs proceduresshould be
undertaken inclosed places,
especially incommunity clinics.
Air conditioning is
prohibited

60 minutes

Surgical gown

Mouthwash - 30
seconds with PovidoneIodine (10%) of aconcentration between
0.2 - 2%, or hydrogen
peroxide (10 vol) halfwith warm water. Spitwithout rinsing

Face mask - N95 or
FFP2

As non COVID-19

As non COVID-19

As non COVID-19

Treat under standard
precautions

Social distancing in
the waiting roomNot reported

Pre-procedural
mouthwash

Limit high-touchitems that cannot be

SourceMinistry of Health Ministerio de Salud
Argentina COVID-19
Recomendaciones Para
Odontologia
Date of first publication
10/06/2020
Latest update
No updatehttps://www.fdiworlddent
al.org/sites/default/files/
media/documents/covid19_recomendaciones_p
ara_odontologia.pdf

List of AGP
instruments andproceduresHigh speed
handpieces, slow
speed drill, 3-in-1
syringe, powered
scalers

Fit test required
Goggles/face visor

COVID-19

Fit test required
Goggles/face visor

Permitted treatment
Non COVID-19
patients: suggests
emergency treatment
should be prioritised
but treatment is not
limited to emergencies

Surgical gown
Surgical cap/hat

COVID-19 patients:suggests only urgent
treatments andavoiding AGPs asmuch as possible.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
Australia
SourceAustralian Dental
Association
Page 9 of 69

Definition
COVID-19 is spread via
respiratory droplets
when an infected
person sneezes orcoughs, (within 1m) of

Non COVID-19

Face mask - Fluidresistant surgical maskthat block particles of 3
microns or lessProtective eyewear(reusable or disposable)

Yes

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

Date of first publication
Various publication dates
and updates
https://www.ada.org.au/
Covid-19-Portal/DentalProfessionals

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

another or via contact
routes, where thedroplets land on asurface and aretransferred by touch.
There's a risk thatairborne transmission
may occur if thedroplets areaerosolised whencertain procedures are
performed.

conform to AS/NZS
1337

ABHR for patients

easily cleaned (e.g.
Toys, Magazines)

List of AGP
instruments andprocedures
Use of high-speed
handpieces, 3-in-1
syringe, powered
scalers, lasers

Disposable apron
Rubber dam - Only
provide treatment that
does not generate
aerosols or whereaerosols are controlled
by using dental dam

Confirmed cases:
For provision ofurgent/emergency
treatment ensure
airborne
precautions which
include treatment ina negative pressure
room.

Fallow time

Linkedevidence

Face shields are analternative to protective
eyewear but do notprotect from inhaled
microorganisms andmust be worn inconjunction with asurgical mask
Surgical gown

COVID-19

Face mask - Level 2/3
surgical mask or
P2/N95 respirator
Fit test required

Permitted treatment
Non COVID-19:
suggest taking
standard precautions

Protective eyewear(reusable or disposable)
conform to AS/NZS
1337

COVID-19: suggests
AGPs are avoided forsuspected COVID-19
patients. Urgent or
emergency treatment
only for confirmed
patients in a dedicated
COVID-19 centre or
hospital

Face shields are analternative to protective
eyewear but do notprotect from inhaled
microorganisms andmust be worn inconjunction with asurgical mask

High-level evacuation
Pre-procedural
mouthwash 1%
hydrogen peroxide

Not reported

Social distancing in
the waiting room

ABHR for patients

Limit high-touchitems that cannot beeasily cleaned (e.g.
Toys, Magazines)

Mouthwash - 1%hydrogen peroxide

Regular general
ventilation of thesurgical room isadvisedSurgical gown
Disposable apron

Country
Austria

Definition
Not reported
List of AGP
instruments andPage 10 of 69

Non COVID-19

Face mask - Surgical
mask
Goggles/face visor

Not reportedNo

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

SourceAustrian Dental
Chamber

procedures
Not reported

COVID-19

Face mask - FFP1,
FFP2, or FFP3

As non COVID-19

As non COVID-19

Not reported

Mouthwash - 1%hydrogen peroxide

Rubber dam

Ensure room is wellventilated between
appointments

Date of first publication
03/04/2020
Latest update
04/05/2020
https://stmk.zahnaerztek
ammer.at/zahnaerztinne
n/informationen-coronavirus/

Permitted treatment
Non COVID-19:
Suggests providing
care with no further
specification

Definition
Not reported

SourceConseil de l’Art Dentaire
on behalf of the Service
Public Fédéral de Santé
Publique

List of AGP
instruments andprocedures
Not reported

Latest update
24/05/20
https://5199.f2w.fedict.be/sites/default/files/documents/2020-04-19_covid19_modification_202005
24_protocole_soins_dentaires.pdf

Surgical gown
Surgical cap/hat

Non COVID-19

COVID-19: suggests
treating patients in a
dedicated COVID-19
centre or hospital

Definition
Not reported

SourceCollege of Dentists of La
Paz

List of AGP
instruments andproceduresHigh speed
handpieces, slow

Face mask - Surgicalmask or FFP2 forpatients with medical
conditions at increasedriskHigh volume suction

Surgical gown

COVID-19

Not reported

Not reported

Not reported

Not reported

Non COVID-19

Double gloving

Mouthwash - rinse with
1% hydrogen peroxideor a 0.2% povidoneiodine mouthwash for 1
minute, (after iodine
allergy screening)

General ventilation

2 mins after
disinfecting theroom

Face mask - N95 or
triple layer mask
Goggles/face visor
Surgical gown

Yes

Fallow times can be
mitigated by size ofthe room, number ofdoors and windows,
wind andtemperature, any
General ventilation
system available,
any ventilator or
airing system

Goggles or face visor

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specifications

Country
Bolivia

Page 11 of 69

Goggles/face visor

COVID-19: Suggests
providing care with nofurther specification

Country
Belgium

Date of first publication
19/04/2020

Linkedevidence

Rubber dam

Disinfect surfaces
after treatment

NoAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

Date of first publication
01/05/2020

speed drill, 3-in-1
syringe

Latest update
No update

Permitted treatment
Non COVID-19:
suggests emergency
treatment

https://www.fdiworlddent
al.org/sites/default/files/
media/documents/protoc
olo_de_bioseguridad_para_la_aten
cion_a_pacientes_y_prevencion_del_covid19_en_clinicas_y_consul
torios_odontologicos.pdf

Definition
Not reported

SourceBiosafety Working Groupof the São PauloRegional DentistryCouncil

List of AGP
instruments andproceduresHigh speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe

Latest update
No update
http://www.crosp.org.br/u
ploads/arquivo/747df5ff505e7beff33c1a5ff5d6f12
a.pdf

Personal protective
equipment

Procedural mitigation

Surgical cap/hat

High volume suction

Environmental
mitigation

Fallow time

Linkedevidence

Disposable apron
COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Non COVID-19

Face mask - FFP2 or
N95 masks or superior.
Do not use surgicalmasks

Avoid any extra or
unnecessary
equipment

15 minutes

Fit test required

Mouthwash - 0.12%
chlorhexidine
digluconate; or,hydrogen peroxide 10
vol, diluted in aqueous
solution (1%)

Goggles/face visor

Rubber dam

Surgical cap/hat

High volume suction

COVID-19: suggests
emergency treatmentonly. COVID-19
patients should ideallybe treated in a highlevel health institution(hospital)

Country
BrazilDate of first publication
01/04/2020

COVID-19
statusPermitted treatment
Non COVID-19:
suggest providing carewith no further
specification. Treat all
patients as suspected
COVID-19

No

Disposable apron
COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Non COVID-19

Face mask - FFP2 or
FFP3 mask depending
on availability

Mouthwash - 1%hydrogen peroxide
specific mouthwash not
CHX

General ventilation

60 minutes

COVID-19: suggests
providing care with nofurther specification
Country
Bulgaria

Definition
Not reported

SourceRecommendations/instru

List of AGP
instruments andPage 12 of 69

Goggles/face visor

No

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

ctions from the crisis
headquarters of the
Bulgarian Dental Union

procedures
Not reported

Date of first publication
03/06/2020
Latest update
No updatehttps://bzs.bg/препоръки
-инструкции-откризисния-ща/Permitted treatment
Non COVID-19:
suggest providing carewith no further
specification.

COVID-19
status

Personal protective
equipment

COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Non COVID-19

Face mask - Surgicalmask or FFP2

Mouthwash - hydrogen
peroxide 1% or
povidone-iodine
solution 0.2%
mouthwash the day
before and/or on the
day of treatment

Not reported

Not reported

List of AGP
instruments andprocedures
Not reported

Goggles/face visor

Permitted treatment
Non COVID-19:
emergency treatment
only

Surgical cap/hat

Country
CanadaSourceRoyal College of Dental
Surgeons of Ontario
COVID-19: Managing

Page 13 of 69

Linkedevidence

COVID-19: suggests
providing care with nofurther specification

SourceOrdre National desChirurgiens Dentistes du
Burkina
Ministère de la SantéURL not available

Fallow time

Surgical cap/hat

Definition
Not reported

Latest update
Not reported

Environmental
mitigation

Surgical gown

Country
Burkino Faso

Date of first publication
Not reported

Procedural mitigation

Surgical gown – ifavailable

No

High volume suction

Wear rubber boots
COVID-19

As non COVID-19

As non COVID-19

Not reported

Not reported

Non COVID-19

Face mask - Level 2 or
3 surgical mask or N95
respirator

Not reported

Not reported

Not reported

COVID-19: emergency
treatment only. Unclear
if COVID-19 patientsare treated in regular
practice or a dedicated
COVID-19 centre or
hospital
Definition
Any dental procedure
where aerosolised
particles are expected
to be generated bydental instrumentation

Fit-test required
Eye protection OR faceshieldNo

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country
Infection Risks During Inperson Dental Care
Date of first publication
15/03/2020
Latest update
31/05/2020
https://www.rcdso.org/en-ca/rcdsomembers/2019-novelcoronavirus/covid-19-managing-infection-risksduring-in-person-care

AGP details

List of AGP
instruments andprocedures
high-speed, low-speed
and other rotary
handpieces, powered
scalers, and 3-in-1
syringes.

COVID-19
status

Personal protective
equipment

COVID-19

Face mask - N95
respirator
Fit-test required
Eye protection AND
face shield

Permitted treatment
Non COVID-19:
provide in-person care
for all deferred, nonessential, and elective
services, in addition to
emergency and urgent
care.

SourceDivision of Disease
Prevention and Control |Oral Health Department
Date of first publication
Not reported
Latest update
Not reported
http://www.colegiodentist
as.cl/inicio/wpcontent/uploads/2020/04/orientaciones-atencionPage 14 of 69

Definition
Aerosol-generatingprocedures in dental
practice are those thatinvolve the use of highspeed handpieces, 3in-1 syringes andpowered scalers

Protective gown

Permitted treatment
Non COVID-19:

Fallow time

Must avoid AGPs
whenever possible anduse the lowest aerosolgenerating options
when necessary.

The operatory mustbe left empty (withthe door closed) topermit theclearance and/or
settling of aerosols.
length of time thatthe operatory mustbe left empty (thefallow time) isdetermined by the
air changes perhour (ACH). The
aim is to achieve
99.9% removal of
airborne
contaminants(Detailed ACH tableprovided)

Depends on ACH
but if information
not available
minimum fallow
period is 3 hrs.

Avoid any extra or
unnecessary
equipment

Not reported

Treat suspected orconfirmed COVID19 patients in an
isolated room that
limits filtration of air
to the rest of theclinicNot reported

Mouthwash - 1% 1.5% hydrogen
peroxide or 1%
povidone-iodine for 60
seconds(acknowledges the lackof documented
evidence)
Rubber Dam
High volume suction

Non COVID-19

Face mask - FFP2 or
N95
Fit test required

Mouthwash - 1%hydrogen peroxide for
30 seconds prior todental care

Goggles/face visor

Rubber dam

Surgical gown
COVID-19

List of AGP
instruments andproceduresHigh speed
handpieces, 3-in-1
syringe, powered
scalers

Environmental
mitigation

Linkedevidence

Protective gown
(optional)

COVID-19: patients
who need urgent andemergency care thatcannot be delayed

Country
Chile

Procedural mitigation

As non COVID-19

As non COVID-19

No

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

odontologica-covid19.pdf

suggests providing
care with no further
specification

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Non COVID-19

Face mask - N95, N99

Mouthwash – type notspecified. Avoid using
the spittoon. Instead,
instruct the patient tocover mouth with thedisposable mouthwash
cup and then spit
mouthwash into thecup, then the nurse
should immediately use
strong suction to
reduce the generationof droplets andaerosols

If spatter exists
during practice, it
should be
performed in an
independent room30-90 minutes

Yes

COVID-19: Suggests
emergency treatmentonly. Unclear if patientsare treated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
China
SourceChinese Stomatological
Association - Chinese
Response to COVID-19
in Dental Field
Date of first publication
Not reported
Latest update
06/05/2020
URL not available

Definition
During dental practice,large quantities ofdroplets and aerosols
can be produced
through the oral powerdevice from patients'
saliva, blood andsecretions, which
poses high risk of adisease transmission
environment between
dentists and patients
List of AGP
instruments andproceduresHigh speed
handpieces, powered
scalers
Permitted treatment
Non COVID-19:
suggests emergency
treatment only
COVID-19: suggests
AGPs are not provided

Page 15 of 69

Goggles/face visor
Surgical gown
(disposable isolation
suits)
Disposable surgical
cap/hatRubber dam
High volume suction

Maintain airflow andmake fresh air
infuse ceaselessly
indoor by opening awindow or using air
purification device
Twice daily (noonand end of day),disinfection byirradiation withultraviolet lamp for
30-60 minutes, thenopen the window for
General ventilation
for at least 30
minutes
Surface disinfection
after eachtreatment.
500 mg/L-1000 mg/L chlorinecontaining
disinfectant, (non-Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

corrosion resistantsurfaces) or, 75%
ethanol anddisposabledisinfection wipes

Country
Colombia

Definition
Not reported

SourceMinistry of Health andSocial Protection(Ministerio de Salud yProtección Social
Bogotá)List of AGP
instruments andproceduresHigh speed
handpieces, slow
speed drill, 3-in-1
syringe

Date of first publication
May 2020
Latest update
No update

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

https://www.minsalud.go
v.co/Ministerio/Institucion
al/Procesos%20y%20pro
cedimientos/GIPS31.pdf

COVID-19: Suggests
emergency treatmentonly. Unclear if patientsare treated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
Costa Rica

Definition
Not reported

SourceMinistry of Health(Ministerio de Salud
Costa Rica)

List of AGP
instruments andproceduresHigh speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe

Date of first publication
27/03/2020
Latest update
Page 16 of 69

COVID-19

Not reported

Not reported

Not reported

Not reported

Non COVID-19

Face mask - FFP2 or
N95 respirator

Mouthwash chlorhexidine (0.2%) or
Povidone Iodide (2.0%)
or hydrogen peroxide(1.5%) for one to two
minutes

Not reported

Not reported

Fit test required
Goggles/face visor
Surgical gown

No

Rubber dam

Surgical cap/hat
Disposable apron
COVID-19

As non COVID-19

As non COVID-19

Not reported

Not reported

Non COVID-19

Face mask (type notreported)

Mouthwash - preprocedure mouthwash
with 1% hydrogen
peroxide (10 cubic
centimetres diluted in
one litre of water)

Not reported

Not reported

Not reported

Not reported

Goggles/face visor
Surgical gown
Surgical cap/hat
COVID-19

Not reported

Rubber dam
Not reported

YesAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

No update

Permitted treatment
Non COVID-19:
suggest providing carewith no further
specification

https://www.ministeriode
salud.go.cr/sobre_minist
erio/prensa/docs/lineami
entos_odontologos_v2_2
7032020.pdf

Country
Croatia
SourceCroatian Chamber ofDental Medicine
Date of first publication
04/05/2020
Latest update
No updatehttps://www.hkdm.hr/nov
ost/1836/Smjernice-iprotokoli-za-otvaranje-irad-ordinacija-dentalnemedicine-i-dentalnihlaboratorija

Country
Denmark
SourceSUNDHEDSSTYRELSE
N, Danish Health Board

COVID-19: Suggests
emergency treatment
only in a dedicated
COVID-19 centre or
hospital
Definition
Not reported

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Non COVID-19

Face mask - N95 or
FFP2

Procedures thatgenerate large amounts
of aerosols (e.g. highspeed handpieces, 3in-1 syringes, powered
scalers) should be
avoidedKeep windows open
to ventilate the area
and / or turn on
General ventilation

Not reported

No

List of AGP
instruments andproceduresHigh speed
handpieces, 3-in-1
syringes, powered
scalers,

Goggles/face visor
Surgical cap/hat

Mouthwash chlorhexidine 0.20%
solution rinse for 60 s
and gargle for 15 s
Hydrogen peroxide(H2O2) 1% (one percent
hydrogen peroxide) gargling for 15 seconds
and rinsing for 30
seconds

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital
Definition
Aerosols are formed byprocedures using
instruments with waterand air
List of AGP
instruments andPage 17 of 69

COVID-19
statusDisinfect clinic with
UV air disinfection
system if fitted(wavelength 254nm). Protect
materials andliquids sensitive to
UV radiation. Use
only at night when
there are no people
in the premises

Rubber dam
COVID-19

Face mask - FFP3
Goggles/face visor
Surgical cap/hat
Shoe covers

Not reported

Not reported

Not reported

Non COVID-19

Face mask - The mask
must retain at least 98%
of microorganisms (typeII), but does not have to
be R type. Must bechanged regularly and

In order to prevent the
spread of infection fromasymptomatic patientsrequiring an AGP, a
test for SARS-CoV-2
may be prescribed inadvance of theprocedure. The

At the end oftreatment, thetreatment roommust be briefly
ventilated before
the next patient

Not reportedNo

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

Date of first publication
18/04/20

proceduresHigh speed
handpieces, slow
speed drill, 3-in-1
syringe, powered
scalerLatest update22/04/20
https://www.sst.dk/da/ud
givelser/2020/haandterin
g-af-covid-19_-kritiskfunktioner-i-tandplejen

COVID-19
status

Personal protective
equipment

Procedural mitigation

always after eachpatient

procedure must bescheduled so that test
responses are available
before performing the
AGP

Goggles/face visor Visor or goggles can be
multiple use, cleaned
and disinfected(according to the
manufacturer's
instructions) between
each patient. In case of
supply difficulties, fullface visors can be usedalone (except for
surgical procedures).
Ordinary glasses andmagnifying glasses canbe used if they aredesigned for protection.

Permitted treatment
Suggests testing every
patient for COVID-19
before providing careand postponing any
appointment while thepatient is COVID-19
positive

Environmental
mitigation

Fallow time

Linkedevidence

Rubber dam

Surgical gown - longsleeve disposable coatand long-sleeve cuff
Disposable apron

Country
Dominican Republic

Definition
Not reported

SourceMinistry of Health

List of AGP
instruments andprocedures
Slow speed drill, 3-in-1
syringe, intra-oralradiography

Date of first publication
Not reported
Latest update
Not reported
https://www.fdiworlddent
al.org/sites/default/files/
media/documents/recom
endaciones_para_la_gui
a_de_apertura_de_los_s
ervicios_odontologicos_
Page 18 of 69

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: suggests
providing care with no

COVID-19

Not reported

Not reported

Not reported

Not reported

Non COVID-19

Face masks – type notspecified but should beaccording to treatment

Mouthwash - 1%hydrogen peroxide
mouthwash, 0.2%
Povidone iodine orcetylpyridinium or any
other effective
mouthwash. Keep inmouth 30 seconds andspit

General ventilation

5-10 minutes

Fit test required
Goggles/face visor
Surgical gown
Surgical cap/hat
Disposable apron

Avoid wearing
jewellery andaccessories

High volume suction

Shoe covers
COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

No

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

en_la_republica_dominic
ana_debido_a_la_pande
mia_covid-19.pdf

further specification. No
restriction for COVID19 patients except
triage prior to treatment
to identify higher risk
and take precautions.

Country
EcuadorDefinition
Avoid procedures thatinvolve the generationof aerosols, that isparticles generated
while using a manual
cutting instrument, arubber dam, low-speed
rotating instruments,
little irrigation or
refrigeration in highspeed rotating
instruments, avoiding
the use of air-sprayfrom the syringe triple
and replace it withdrying cotton swabs or
gauze.

SourceMinistry of Health
Date of first publication
28/05/2020
Latest update
No updatehttps://www.fdiworlddent
al.org/sites/default/files/
media/documents/protoc
olo_para_atencion_odon
tologica_durante_la_em
ergencia_sanitaria_por_
covid_-_19.pdf

List of AGP
instruments andproceduresHigh speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe, powered
scaler, intra-oralradiography
Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: Suggests
providing care with noPage 19 of 69

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Non COVID-19

Double gloving

General/naturalventilation

10 minutesNo

Fit test required

Mouthwash – preprocedure 0.2%
Povidone or 1%hydrogen peroxide for
30 seconds

Goggles/face visor

Rubber dam

Surgical gown

High volume suction

Face mask - N95 orequivalent

Avoid jewellery andaccessories

Surgical cap/hat
Disposable apron
COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Non COVID-19

Face mask - Surgicalmask

Mouthwash – one
minute mouth rinse
prior to starting any
dental procedure, suchas mouth rinses
containing 1%hydrogen peroxide or
0.2% - 1% Povidone or
0.05% - 0.1%
cetylpyridinium chloride

Not reported

Starting from theend of the patient
appointment 45 minNofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
Estonia

Definition
Not reported

SourceMinistry of Health

List of AGP
instruments andprocedures
Not reported

Date of first publication
07/02/2020
Latest update
21/05/2020
URL not available

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: Suggests
AGPs are not provided

Country
Finland

Definition
Not reported

SourceSector of administrationof the Ministry of Social
Affairs and Health

List of AGP
instruments andproceduresHigh speed
handpieces, slow
speed drill with air andwater cooling, 3-in-1
syringe, powered
scalers

Date of first publication
Not reported
Latest update
01/06/2020
https://thl.fi/fi/web/infektio
taudit-jarokotukset/taudit-jatorjunta/taudit-jataudinaiheuttajat-ao/koronavirus-covidPage 20 of 69

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

4 handed dentistry withhigh volume suction
recommended
COVID-19

Not reported

Not reported

Not reported

Not reported

Non COVID-19

Face mask - ff AGPs
used, FFP2 or FFP3
respirator or surgicalmouthpiece (class 2R)

Mouthwash - 1-1.5%hydrogen peroxide
spray or iodine
Betadine (10 mg/ml)
spray for 1 minuteNot reported

Not reported

Not reported

Following aerosol
generation,
personnel
remaining in theroom must wear a
respirator for atleast 30 minutes

Full face visor can beused instead of goggles

COVID-19

Rubber dam

Surgical cap/hat

High volume suction

Face mask - FFP2 or
FFP3

PTG or KKTT
examination is used for
imaging. Intraoral
images are taken only if
PTG or KKTT imaging
is not possible.

Goggles with sideprotection, face shieldYes

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

19/ohje-suunterveydenhuollonyksikoille-covid-19epidemian-aikana

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
FranceDefinition
Not reported

SourceHaute Autorité de Santé(HAS)

List of AGP
instruments andproceduresHigh-speed
handpieces, 3-in-1
syringe, powered
scaling, air polishers

Date of first publication
14/05/2020
Latest update
25/05/2020
https://www.hassante.fr/jcms/p_3184961/fr/mesures-etprecautions-essentielleslors-des-soins-buccodentaires-apres-ledeconfinement

Country
Germany
SourceInstitut der Deutschen
Zahnärzte
Date of first publication
Not reported

Page 21 of 69

COVID-19
statusList of AGP
instruments andprocedures
Not reported
Permitted treatment
Non COVID-19:

Procedural mitigation

Environmental
mitigation

Surgical gown – A longsleeved disposable
liquid-impervious jacket

Fallow time

Linkedevidence

after the end oftreatment.

Surgical cap/hat

Non COVID-19

Face mask - FFP2
Goggles/face visor
Surgical gown for AGPs
where rubber dam can’t
be used, surgicalextraction or ultrasonicscale (high risk of body
fluid projections)
Surgical cap/hat

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital
Definition
Not reported

Personal protective
equipment

Disposable apron for
AGPs with rubber dam
or conservative
treatment (low risk ofbody fluid projections)

Dental air polishing is
not advised
The dentist should
consider the mostefficient way to reduceaerosols
Contra-angle should be
preferred to turbine
Use water coolingsystem to a minimum
Mouthwash

General ventilation
Do not use AGPs ina room without
windows unlesshaving a fresh air
handling unit
(FAHU)

15 minutes window
opened and door
closedYes

No consensus
regarding air
conditioning
systems

Rubber dam
High volume suction

Shoe covers
COVID-19

As non COVID-19 but
shoe covers not advised

As non COVID-19

As non-COVID-19

As non-COVID-19

Non COVID-19

Face mask - surgicalmask

Only use of water or air
on 3-in-1 syringes, useof slow speed

Not reported

General ventilationof clinical room for
30 mins

Goggles/face visor

Mouthwash - 30ml
1.5% hydrogen
peroxide (or equivalent)for 1 minute before
treatmentNoAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

Latest update
24/04/2020 (version 3)

suggests providing
care avoiding AGPs
using low speed
instrumentation

https://www.idz.institute/publikationen/sonstiges/system-vonstandardvorgehensweisen-fuer-zahnarztpraxenwaehrend-dercoronaviruspandemie.html

Definition
Not reported

SourceInstructions for dental
employees in dentists
and patients

List of AGP
instruments andprocedures
Not reported

Date of first publication
Not reported

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

https://www.fdiworlddent
al.org/sites/default/files/
media/documents/odigies_pros_odontiatroys_erg
azomenoys_se_odontiatr
eia_kai_astheneis_0.pdf

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
GuatemalaDefinition
Dental treatments
involve the use of
equipment that
produces aerosols(drops of saliva andblood less than 5

SourceEstomatologic Callege of
GuatemalaPage 22 of 69

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

As non COVID-19

Not reported

As non COVID-19

Mouthwash – 1%
Peroxide for 30
seconds

Not reported

Not reported

Linkedevidence

Rubber dam
High volume suction
COVID-19

COVID-19: Suggests
providing care avoiding
AGPs using low speed
instrumentation.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
GreeceLatest update
Not reported

COVID-19
statusFace mask - FFP2
Goggles/face visor
Surgical gown
Surgical cap/hat
Shoe covers

Non COVID-19

Face mask FFP2/FFP3 or
N95/KN95 for up to 8-10
hrs
Fit test requiredNo

Rubber dam
High volume suction

Surgical cap/hat
Shoe covers

COVID-19

As non COVID-19

As non COVID-19

Not reported

Not reported

Non COVID-19

Face mask - N95 or
FFP2

General ventilation

Fit test required

Mouthwash - 1%hydrogen peroxide or
0.2% Povidone Iodine
for 1 minute

Fallow period
recommended but
time not reported

Goggles/face visor

Rubber dam

Surgical gown

The use of air
renewal or filtering
devices using
original HEPA filters
or by plasma they
can also represent

YesAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

Date of first publication
01/05/2020

micrometers indiameter that, in asuspected or positivecase, are loaded withviruses

Latest update
No updatehttps://www.fdiworlddent
al.org/sites/default/files/
media/documents/protoc
olo_de_bioseguridad_od
ontologica_con_enfasis_
en_covid-19.pdf

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Surgical cap/hat

High volume suction

a measure ofcontagion control
cross between
patient and patient.
The air conditioning
should ideally beturned off, unless it
has a filter andextractor

Disposable apron
Shoe covers

List of AGP
instruments andproceduresHigh speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe, powered
scaler, intra-oralradiography

Fallow time

Linkedevidence

negative pressureroom
Air disinfection
treatments by air
using ozone or rays
type C ultraviolet(UV-C), although
effective against
other coronaviruseshave not beenstudied against
SARS-CoV-2. Highdoses, could be
harmful. The roomshould be vacatedduring use. Follow
the manufacturer's
recommendations ineach case. If using
UV-C sources, thecomplete coverageof all surfaces must
be ensured

Permitted treatment
Non COVID-19:
suggests emergency
treatment only
COVID-19: Suggests
emergency treatmentonly. Unclear if patientsare treated in regular
practice or a dedicated
COVID-19 centre or
hospital

Avoid jewellery andaccessories

Country
Honduras

Definition
Not reported
List of AGP
instruments andPage 23 of 69

COVID-19

Not reported

Not reported

Not reported

Non COVID-19

Face mask - N95 or
FFP2

Mouthwash - 1%hydrogen peroxide or
0.2% Povidone Iodine
or water with salt

General ventilation HEPA filters andnegative pressureroom

Goggles/face visor

Not reported
YesAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

SourceCollege of Dental
Surgeons of Honduras

procedures
Not reported

Date of first publication
Not reported
Latest update
Not reported
http://www.cop.org.pe/w
pcontent/uploads/2020/04/PROTOCOLO-DEBIOSEGURIDAD-PARAEL-CIRUJANODENTISTA.pdf

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

Definition
Not reported

SourceDental Council of India

List of AGP
instruments andprocedures
Not reported

Latest update
No update
http://www.dciindia.gov.in/Admin/NewsArchives/
Dental%20Clinics%20Pr
otocols%20Final.pdf

Personal protective
equipment

Environmental
mitigation

Fallow time

Linkedevidence

Not reported

No

Surgical gown
Surgical cap/hat

Avoid jewellery andaccessories

Disposable apron
Shoe covers
COVID-19 unclear if patients are treated

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: Suggests
treating patients in a
dedicated COVID-19
centre or hospital

Non-COVID

Recommended during
all aerosol (preferablycompletely avoid) andnon-aerosol based
dental procedures, if
carried out.
Face mask - triple layer
surgical mask and N95
respirator
Goggles/face visor (bothto be used, fitting
goggles with a soft
tissue seal)
Disposable gowns(change daily)
Suitable head caps
Shoe covers

Page 24 of 69

Procedural mitigation

COVID-19: unclear if
patients are treated

Country
India

Date of first publication
05/07/2020

COVID-19
statusMouthwash Preoperative 1%hydrogen peroxide. Do
not use a spittoon. Use
the same sink that had
been used for washing
the hands and face
Rubber dams and highvolume saliva ejectors

High volume suction

General ventilation If possible, use
directional airflow,such as from fans,
to ensure that air
moves through staff
work areas before
patient treatmentareas – not thereverse. A qualified
industrial hygienist,
General ventilationengineer, or otherprofessionals canhelp ensure that
General ventilation
removes, rather
than creates,
workplace hazards.
Fumigate clinics
and other areas at
the end of the day
as permanufacturer’s
instructions basedon the type andAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

area of the dental
clinical room.
Fumigation is doneon daily basis inclinical or highcontact areas andbiweekly in nonclinical or low
contact areas.

Country
Ireland

Definition
Not reported

SourceIrish Dental Association

List of AGP
instruments andprocedures
Not reported

Date of first publication
Not reported
Latest update
15/05/2020
https://www.hpsc.ie/az/respiratory/coronavirus/novelcoronavirus/guidan
ce/infectionpreventionan
dcontrolguidance/dentals
ervices/GuidanceManagingInfectionRiskDentalServicesCOVID19.pdf

Country
Italy

Page 25 of 69

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

COVID-19

As non COVID-19
except FFP3 instead of
triple layer surgicalmask

As non COVID-19

As non COVID-19

Not reported

Non COVID-19

Face mask - FFP2

Mouthwash notrecommended

Not reported

Room clearance
time after AGP is
not required unlessa patient has known
or suspected
COVID-19

Fit test required
Eye protection
Disposable apron

Rubber dam
High volume suction

Surgical cap/hat andshoe covers notrecommended
COVID-19

As non COVID-19

As non COVID-19

Increased General
ventilation by
opening window ormechanical method.

60 minutes after an
AGP is performed
on a patient withknown or suspected
COVID-19 in aroom that is notmechanicallyventilated the roomshould be vacatedfor 60 minutes after
completion oftreatment before
cleaning
commences.

Non COVID-19

Face mask - FFP2

Minimise proceduresthat can produce
aerosols. Prioritise
minimally invasive

Shoes must be
cleaned and10-15 minutes

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital

Definition
Not reported but refers

No

Goggles and face visor

YesAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

SourceAll major Italian dental
associations – available
from the Italian
government website
Date of first publication
30/05/2020
Latest update
No update
http://www.salute.gov.it/p
ortale/news/p3_2_1_1_1.jsp?lingua=italiano&men
u=notizie&p=dalministero&id=4835

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

to published protocols
for AGPs

Single use gown (water
resistant)disinfected at theend of the day

List of AGP
instruments andprocedures
Not reported

Single use cap/hat

restorative procedures(hand instrumentsonly).

COVID-19: Suggests
providing care with nofurther specification.
Minimise proceduresthat can produce
aerosols. Prioritise
minimally invasive
restorative procedures(hand instrumentsonly). Unclear if
patients are treated inregular practice or a
dedicated COVID-19
centre or hospital
Definition
Partially

SourceMinistry of Health,
Director of Healthcare
Services, Oral HealthServices

List of AGP
instruments andprocedures
3-in-1 syringe

Latest update
No updatehttps://www.health.go.ke/
wpPage 26 of 69

Mouthwash - hydrogen
peroxide solution 1% orPovidone-iodine 0.2%
for 1 minute followed byanother mouthwash
with chlorhexidine 0.20.3% for 1 minute

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

Country
Kenya

Date of first publication
24/03/2020

COVID-19
statusPermitted treatment
Non COVID-19:
suggests emergency
treatment only

Linkedevidence

Natural General
ventilation/air
renovation for 10-15
minutes. If air
conditioning isused, filters need to
be changed once a
week

Rubber dam
High volume suction
COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Not reported

Double gloving

Rubber dam

Not reported

Not reported

Face masks - N95 for
hospital staff

High volume suction

Not reported

Not reported

Reported that there isno evidence that double
gloving is effective forthe management ofsuspected or confirmed
cases

Non COVID-19

Face shield
Disposable apron
Waterproof footwear
COVID-19

As non COVID-19

Rubber dam
High volume suction

COVID-19: Suggests
emergency treatmentonly. Unclear if patientsare treated in regular

Fallow timeNo

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

content/uploads/2020/06/Guidelines-for-DentalPracticce-with-respectto-COVID-19Pandemic.pdf

practice or a dedicated
COVID-19 centre or
hospitalCountry
KosovoDefinition
Not reported

SourcePractical guidelines for
dentistry professionals in
the private sector during
the COVID-19 virus
pandemic

List of AGP
instruments andproceduresHigh speed
handpieces, 3-in-1
syringe, powered
scalerDate of first publication
Not reported
Latest update
Not reported
http://osk-ks.org/wpcontent/uploads/2020/05/Rekomandimet-e-OSKper-ordinancat-private1.pdf

Permitted treatment
Limit use of AGPs
Non COVID-19:
suggests providing
care with no further
specification

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Non COVID-19

Face mask - N95

Mouthwash - 1%hydrogen peroxide for
30 seconds

General ventilation natural ventilation
avoid use of air
conditioning

Not reported

No

Goggles/face visor
Surgicalgown/protective clothing
Shoe covers
recommended forpatients on entering
clinicRubber dam
High volume suction

COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Not reported

Non COVID-19

Face mask - surgicalmasks and N95

Improve General
ventilation in thedental surgery:opening windows,
General ventilationfan, air cleaner,
HEPA Room Filter

There is a need toobserve areasonable turnovertime between
patient anddisinfection ofclinical contact
surfaces

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
Malaysia

Definition
Not reported

SourceMalaysian Dental
Association Safety
Advisory to Dental
Practitioners during thecurrent Concern of
COVID - 19 Infection in
the initial relaxation

List of AGP
instruments andprocedures
Not reported

Goggles/face visor
Surgical gown
(waterproof)

Mouthwash - 1%hydrogen peroxide or
0.2% Povidone
preoperative
antimicrobial
mouthwash

Permitted treatment
Non COVID-19:
suggests providing

Surgical cap/hat

Rubber dam

Page 27 of 69

High volume suction

Surface disinfection
procedures with 6271% ethanol, 0.5%hydrogen peroxide

YesAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

phase of Movement
Control Ordercare with no further
specification

Date of first publication
Not reported

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital

Latest update
01/05/2020
https://mda.org.my/home/wpcontent/uploads/2020/05/MDA_advisory_COVID1
9_relaxation_phase_MC
O.pdf
Country
Malta

Definition
Not reported

SourceOffice for the Deputy
Prime Minister. Ministryfor Health

List of AGP
instruments andproceduresHigh and slow speed
handpieces, powered
scalers, 3-in-1
syringes,gagging/retching due tointra-oral radiography
or an infected patient
coughing

Date of first publication
Jun-20Latest update
No updatehttps://deputyprimeminist
er.gov.mt/en/healthpromotion/covid19/Documents/mitigation-conditions-andguidances/Guidance_De
ntalPractices_12Jun20.pdf

Page 28 of 69

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

or 0.1% sodium
hypochlorite. Other
biocidal agents
such as 0.05-0.2%
benzalkonium
chloride have also
been suggested but
were reported bysome to be lesseffective
COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Non COVID-19

PPE requirements
stratified based on low
medium and high risk
procedures.

Mouthwash, If AGP 1%hydrogen peroxide,
0.2% Povidone or a
combination of
Chlorhexidine (0.50.12%) + CPC (0.011%) rinse prior totreatment.

General ventilation Keep windows open
during procedure if
no other means ofGeneral ventilation.
Ensure space iswell ventilated.
Windows must be
closed if there is an
air purification
system in place
which is turned on.

20 minutes to keep
the window open
after procedure
prior tocommencing
disinfection andreprocessing of theclinical area. If noGeneral ventilationof windows, 30
minutes. If air
purification offers 6
air changes hourly,
clinic can bedisinfected after 15
minutes of restingtime.

Face mask - N95 orother respirators thatoffer a higher level ofprotection should be
used. If not available, acombination of asurgical mask and fullface shield/visor should
be used.

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

Goggles/full face visor

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicatedShoes should be clinicalshoes which are kept on
premises anddisinfected after every
use, if not disposable
shoe covers should beworn.

Surgical cap/hat for
medium risk procedures
Disposable apron

Rubber dam
High volume suction

Consider the use of
upper-room
ultraviolet
germicidal
irradiation as an
adjunct to higher
General ventilation
and air cleaning
rates

No

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

COVID-19 centre or
hospital

COVID-19

Face mask - N95 orother high levelrespirator

Procedural mitigation

Environmental
mitigation

Fallow time

Schedule patient forlast appointment of
the day and cleansurfaces after thepatient is dismissed
and before first
patient of themorning with
Sodium
Hypochlorite

Not reported

Mouthwash (type notreported)

Not reported

Not reported

As non COVID-19

Not reported

Not reported

Not reported

60 minutes

Goggles/face visor

Mouthwash - 1%hydrogen peroxide or
Povidone iodine

As non COVID-19

As non COVID-19

Not reported

As non COVID-19

Goggles with sideprotection, face visor
Surgical gown covering
full length of arms
Surgical cap/hat
Country
MexicoDefinition
Not reported

SourceMinistry of Health

List of AGP
instruments andproceduresHigh speed
handpieces, 3-in-1
syringe

Date of first publication
21/05/2020
Latest update
21/05/2020
https://www.fdiworlddent
al.org/sites/default/files/
media/documents/recom
endaciones_para_la_pra
ctica_odontologica_ante_covid-24.pdf

Face mask - N95
Goggles/face visor

No

Surgical gown
COVID-19

Face mask - N95
Goggles/face visor
Surgical gown

Permitted treatment
Non COVID-19:
emergency treatment
only

Shoe covers

COVID-19: emergency
treatment only. Patientscan be treated inpractice withappropriate PPE,
otherwise patients mustbe treated in adesignated COVID-19
centre or hospitalCountryMontenegro

Definition
Not reported

SourceDental Chamber ofMontenegro Protocol for
providing dental
treatment during the
COVID-19 epidemic

List of AGP
instruments andprocedures
Not reported

Page 29 of 69

Non COVID-19

Linkedevidence

Permitted treatment
Non COVID-19:

Non COVID-19

COVID-19

Face mask - N95 /FFP2

No

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

Date of first publication
Not reported

suggests providing
care with no further
specification

Latest update
Not reported
https://www.fdiworlddent
al.org/sites/default/files/
media/documents/protok
ol_za_pruzanje_stomatol
oskog_lijecenja_tokom_
epidemije_covid19_0.pdf

Definition
Not reported

SourceOrdre national desmédecins dentists du
Maroc

List of AGP
instruments andprocedures

Latest update
21/05/2020
https://drive.google.com/f
ile/d/1x8n1etxPIVI_rq7_
Z7oG_wjQIHq2BaB3/view

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Non COVID-19

Face mask FFP2/N95/KN95

Use slow speed drill
instead of high speed
handpieces. Limit thewater cooling system toa minimum when using
handpieces

No AGP in
treatment room
window unlessadequate General
ventilation available

15 mins following
AGPs

No

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
MoroccoDate of first publication
21/05/2020

COVID-19
statusGoggles/face visor
Surgical gown - fortreatments with high riskof body fluid projections

High speed
handpieces, 3-in-1
syringe, powered
scaling, air polishers
Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

Disposable apron - fortreatments with high riskof body fluid projections

Mouthwash - 1%hydrogen peroxide or
0.2% Povidone-iodine

Air cooling systemshould be limited
when AGPs are
performed

Rubber dam
High volume suction

COVID-19

As non COVID-19

As non COVID-19

As non COVID-10

As non COVID-19

Non COVID-19

Face mask - N95 or
FFP2

Mouthwash - 1%hydrogen peroxide or
0.2% Povidone Iodine
or water with salt

Not reported

Not reported

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
MozambiqueDefinition
Not reported

Goggles/face visor

Page 30 of 69

NoAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

SourceMinistry of Health

List of AGP
instruments andprocedures
Surgical hand pieces
and powered scalers

Date of first publication
20/03/2020
Latest update
No updatehttps://www.fdiworlddent
al.org/sites/default/files/
media/documents/protoc
olo_de_atendimento_no
s_servicos_de_estomato
logia_covid-19.pdf

SourceMyanmar Dental
Association

List of AGP
instruments andprocedures
3-in-1 syringe

https://www.fdiworlddent
al.org/sites/default/files/
media/documents/recom
mendations_to_member_dental_surgeons.pdf

Environmental
mitigation

Fallow time

Linkedevidence

Rubber dam
COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Not reported

Non COVID-19

Face mask - medical
mask for both patients &attendants (type notspecified)

Since intraoral
radiographs stimulate
saliva and cough, use
extra-oral panoramic
radiography and cone
beam radiographs

Not reported

Not reported

COVID-19
suspected shouldbe treated in wellventilated room as
the last patient toavoid the disease
spread anddisinfection should

Not reported

Goggles/face visor

Preoperative
antimicrobial mouthrinse should be given to
the patient before any
procedure to reduce
microbe load

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: Suggests
emergency treatment
only

Rubber dam
High volume suction
COVID-19

Page 31 of 69

Procedural mitigation

COVID-19: Suggests
emergency treatmentonly. Unclear if patientsare treated in regular
practice or a dedicated
COVID-19 centre or
hospital
Definition
Not reported

Latest update
No update

Personal protective
equipment

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

Country
MyanmarDate of first publication
23/03/2020

COVID-19
status

Not reported

Not reportedNo

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Not reported

Not reported

No

Negative pressureroom

Not reported

Yes

General ventilation

After treating aprobable or COVIDpositive patientwhen aerosol
generatingprocedures haveoccurred, the roomshould remainclosed for a standdown period of 20

be done as soon as
the procedures are
finished
Country
Netherlands

Definition
Not reported

SourceThe Royal Dutch Dental
Association

List of AGP
instruments andprocedures
Not reported

Date of first publication
21/04/2020
Latest update
29/06/2020
https://www.knmt.nl/sites/default/files/20200629_l
eidraad_mondzorg_coro
na_clmc_v_4.0.pdf
Country
New Zealand
SourceDental council, Ministryof Health
Date of first publication
05/01/2020
Latest update
06/09/2020
https://www.dcnz.org.nz/
assets/Uploads/COVID/L
evel1guidelines9Jun20.pdf

Page 32 of 69

Guidance does
not explicitly
specify non
COVID-19 or
COVID-19
patients

Permitted treatment
Suggests providing
care with no further
specification. Unclear if
COVID-19 patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital
Definition

COVID-19: Suggests
emergency treatmentonly. Unclear if patientsare treated in regular
practice or a dedicated
COVID-19 centre or
hospitalType II/R or Type II +face visor

1% hydrogen peroxidefor 1 minute. (3% H2O2
with water) preprocedural rinses
Rubber dam
High volume suction

large mist vacuum

Non COVID-19

List of AGP
instruments andproceduresHigh speed
handpieces, 3-in-1
syringe, air polishing,powered scalers
Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

Face mask - FFP2
reserved only for thosepatients with COVID-19
symptoms or confirmed
COVID-19

PPE recommended for
non-COVID-19 patientsis independent of using
AGPs

Mouthwash
Rubber dam

Face mask - surgicalmask (level 2 or above)
Goggles/face visor
Surgical gown
COVID-19

Face mask - N95 or
FFP2Long sleeve impervious
gowns

Preferably use a slow
speed handpieces that
operates at ≤ 40000
rpm, and where
possible turn the chip
air off, to minimise theaerosol generated
during the procedure.

Surgical cap/hat

Mouthwash

Disposable apron

Rubber dam

Full face visor overgoggles or prescription
glasses

Negative pressureroomAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryCountry
NorwaySourceNorway Dental HealthService – FHI(Folkehelseinstituttet)
Date of first publication
03/12/2020
Latest update
26/05/2020
https://www.fhi.no/nettpu
b/coronavirus/helseperso
nell/rad-tiltannhelsetjenesten/#tannbehandling-av-pasientersom-ikke-er-mistenktsannsynlig-ellerbekreftet-med-covid19

AGP details

Definition
Aerosol-generatingprocedures include
certain procedures
involving the patient’s
airways
List of AGP
instruments andproceduresHigh speed
handpieces, slow
speed drill, 3-in1
syringe, powered
scalers, air polishingdeviceCOVID-19
statusNon COVID-19

Personal protective
equipment

Procedural mitigation

Shoe covers

High volume suction

Face mask - surgicalmask type II or IIR

Mouthwash - 1%hydrogen peroxide(H2O2) for at least 1
minute before dental
treatment

Goggles/face visor
Surgical cap/hat
Disposable apron

COVID 19

Face mask - FFP2 or
FFP3
Goggles/face visor
Surgical gown
Surgical cap/hat

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

SourceOdontologic Associationof Panama
Date of first publication
16/03/2020

Page 33 of 69

Definition
Dental procedures
which generate mistingof saliva outside thepatients’ oral cavity are
considered as AGP
List of AGP
instruments andprocedures

Fallow time

Linkedevidenceminutes prior tocleaning.
Not reported

Not reported

General ventilation
system and size ofthe treatment room

Fallow period statedbut time notreported

General ventilation

Not reported

Yes

Rubber dam/low
suctionHigh volume suction

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
PanamaEnvironmental
mitigation

Minimise use of
handpieces; ultrasonicscaler or aero-polishingdevices should not be
used, suction andcotton rolls to dry
Mouthwash - 1%hydrogen peroxide(H2O2) for at least 1
minute before dental
treatment
Rubber dam/High volume suction

Non COVID-19

Face mask - N95, KN95
or FPP2 mask for
AGPs. Surgical facemask for non AGPs
Fit test required

Mouthwash preparatory rinse with
1.5% hydrogen
peroxide or 0.2%
iodine-povidone for 3
seconds

Goggles/face visor

High volume suction

Surgical gown

AGPs conducted in
an isolated room to
avoid circulating air
to the rest of thepractice
Avoid jewellery andaccessories

Yes

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

Latest update
16/05/2020

High speed
handpieces, intra-oralradiography

URL not available

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Surgical cap/hat
Disposable apron
COVID-19

Not reported

Not reported

Not reported

Not reported

Non COVID-19

Not reported

Mouthwash - 1 %hydrogen peroxide or
0.2% Povidone Iodine
or water with salt

General ventilation

60 minutes – lowrisk AGP

COVID-19: Suggests
emergency treatment
only in a dedicated
COVID-19 centre or
hospitalCountry
Paraguay

Definition
Not reported

SourceMinistry of Health

List of AGP
instruments andproceduresHigh speed
handpieces, slow
speed drill, 3-in-1
syringe, intra-oralradiography

Date of first publication
Not reported
Latest update
07/05/2020
https://www.mspbs.gov.py/dependencias/portal/ad
junto/0f3634Protocoloatencionodonto
logica.pdf

High volume suction

UVlight/Ozonisation/fu
migation/ fogging

120 minutes moderate risk AGP
180 minutes – highrisk AGP

Notes that as of thedate of this report,none of theaforementioned has
conclusive scientificevidence regarding
covid-19 in thedental officeenvironment anddoes replace thecleaning anddisinfection
procedures of thearea.

Permitted treatment
Non COVID-19:
suggests urgent andemergency treatment
only
COVID-19: Suggests
urgent and emergency
treatment only. Unclear
if patients are treated inregular practice or a
dedicated COVID-19
centre or hospital

Page 34 of 69

Rubber dam

HEPA filters andnegative pressure
room

COVID-19

Not reported

As non COVID-19

As non COVID-19

As non COVID-19

No

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Country
Peru

Definition
Aerosols are defined as
particles that measureless than 50um
diameter

Non COVID-19

Face mask - surgicalmask

Mouthwash - Hydrogen
peroxide or Povidoneiodine

Avoid any extra
equipment/accessories

Not reported

Yes

SourceMinistry of Health
Date of first publication
Not reported
Latest update
Not reported
https://cdn.www.gob.pe/
uploads/document/file/71
6209/DIRECTIVA_SANITARIA_N_100-MINSA2020-DGIESP.pdf

List of AGP
instruments andproceduresHigh speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe, powered
scaler, intra-oralradiography

Fit test required
Goggles/face visor
Surgical gown

Rubber dam
High volume suction

Surgical cap/hat
Disposable apron
COVID-19

As non COVID-19 but
wear N95 or FFP2
instead of surgical facemask

As non COVID-19

As non COVID-10

Not reported

Non COVID-19

Double gloving of nonsterile examination overgloves. Gloves should
be tapped to the wrists

Mouthwash - 1%hydrogen peroxide or
0.2% Povidone isrecommended at thestart and during entire
procedure, since
SARS-CoV-2 may bevulnerable to oxidation.
Rinse initially for 60
seconds, swab inchildren and patients
who are unable to rinse

AGPs can only be
conducted in anegative pressureroom. AGPs canonly be conductedin a negative
pressure room.

5 minutes (negative
pressure room only)

Permitted treatment
Non COVID-19:
suggests urgent andemergency treatment
only
COVID-19: Suggests
urgent and emergency
treatment only. Unclear
if patients are treated inregular practice or a
dedicated COVID-19
centre or hospitalCountry
Philippines
SourcePhilippine Dental
Association Science
Committee
Date of first publication
Not reported
Latest update
31/05/2020

Page 35 of 69

Definition
Dental procedures
which generate mistingof saliva outside thepatients’ oral cavity are
considered as AGP
List of AGP
instruments andproceduresHigh speed
handpieces, 3-in-1

Face mask - N95 or
FFP
Fit test required
Goggles/face visor
Surgical gown

Air flow in theoperatory andwaiting area should
be away from you
and your staff.

YesAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

https://www.fdiworlddent
al.org/sites/default/files/
media/documents/interim_guidelines_on_infection_prevention_during_covi
d-19_pandemic.pdf

syringe, powered
scalerPermitted treatment
Non COVID-19:
suggests emergency
treatment only
COVID-19: Suggests
emergency treatmentonly. Unclear if patientsare treated in regular
practice or a dedicated
COVID-19 centre or
hospital

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Surgical cap/hat

Rubber dam

Open windows or
use mechanical
General ventilation
to increase airchangesHigh volume suction

Clinic staff should
ensure that infected
air to be deliveredout should besterilized so as not
to infect otherindividuals where
infected air is blownout.
The US CDC
advises dental
clinics to consider
using HEPA air
filtration units
DURING and
AFTER AGP to
reduce particle anddroplet counts.
CDC advises
placing HEPA filter
beside the patient’s
chair, NOT BEHIND
the dental healthworker.
Ultra Violet
Germicidal
Irradiation (UVGI) an establishedmeans ofdisinfection and canbe used to preventthe spread ofcertain infectious
diseases.

Page 36 of 69

Fallow time

Linkedevidence

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Ultra Violet
Germicidal
Irradiation (UVGI) an establishedmeans ofdisinfection and canbe used to preventthe spread ofcertain infectious
diseases.

Country
PolandDefinition
Not reported

SourceThe Polish Dental
Association

List of AGP
instruments andprocedures
Not reported

Date of first publication
08/04/2020
Latest update
NA
https://doi.org/10.5114/jos.2020.94168

Country
Portugal
SourceDirecao Geral da Saude(Directorate General of
Health)Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

As non COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Non COVID-19

Face mask - FFP2 or
FFP3 (depending on therisk of the patient)

Mouthwash - 1%hydrogen peroxide
solution, 0.2%
Povidone iodine
solution, or 0.2% chlorhexedine-alcohol
solution

HEPA 14 filters
recommended as
general ventilation
method.

Room General
ventilationsuggested, but nospecific time
provided.

Goggle/face visor
Surgical Gown
Surgical cap/hat

UV light and Ozone
mentioned as
optional

Yes

Rubber dam
High volume suction

COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Non COVID-19

Double gloving

Mouthwash

General ventilation

Not reported

Face masks (type notspecified)Rubber dam

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital
Definition
AGPs are defined as
any procedures thatinvolve a rotating
instrument or an airwater syringe
List of AGP
instruments andPage 37 of 69

COVID-19

Goggles/face visor
Surgical gown
Surgical cat/hat

High volume suction

NoAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

Date of first publication
01/05/2020

procedures
Not reported

Latest update
No update

List of permitted
treatment
Non COVID-19:
suggests providing
care with no further
specification

https://www.omd.pt/covid-19/procedimentos/

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Disposable apron
Shoe covers
COVID-19 Urgent
treatments only

As non COVID-19

As non COVID-19

As non COVID-19

Not reported

Non COVID-19

Face mask - disposable
surgical mask (changed
after each patient). If a
standard N95, FFP2,
FFP3 mask orequivalent is used, thespecific rules of use
apply (change to a
maximum of 4 hours).

Limit use of particle andaerosol generatingprocedures andequipment
if absolutely necessary,
they are scheduled at
the end of the workingday

Dental interventions
are provided only inrooms with
automatic or naturalventilation (window)

Open door / window
for at least 15
minutes, after eachpatient

As non Covid-19

As non Covid-19

COVID-19: Suggests
urgent and emergency
treatment only
Country
Romania

Definition
Not reported

SourceNot reported
Date of first publication
25/05/2020

List of AGP
instruments andprocedures
Not reported

Latest update
Not reported

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

https://www.dsptimis.ro/d
ata_files/content/legislati
e-covid/files/ordin-8732020.pdf

Surgical cap/hat

Mouthwash - both
before and at end oftreatment for at least 30
seconds using 1% or
1.5% hydrogen
peroxide or Povidone
iodine 0.2% -10 %(watch out for allergic
reactions)

Disposable gown

Rubber dam

Shoe protection

High volume

Face mask - FFP2 /KN95 or FFP3
(standard or equivalent)

As non Covid-19

Goggles/face visor(protective screen) will
be disinfected after
each patient or, if they
are disposable, will be
replaced.

COVID-19: Suggests
providing care with nofurther specification

COVID-19

Goggles/face visor
Surgical gown - nonsterile waterproof longsleeved surgical gown
Page 38 of 69

NoAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Mouthwash - 1%hydrogen peroxide or
0.2% - 1% povidone or
0.05% - 0.1%
cetylpyridinium chloride
for 60 seconds

Not reported

45 minutes

No

Surgical cap/hat disposable waterproof
cap
Disposable waterproof
apron/cape
Disposable protective
boots or disposable
waterproof coveralls
Country
Singapore

Definition
Not reported

SourceMinistry of Health
Circular 132/2020 –Gradual resumption ofdental services after
COVID-19 circuit breaker
periodList of AGP
instruments andprocedures
Not reported

Date of first publication
14/02/2020
Latest update
21/05/2020
https://www.healthprofes
sionals.gov.sg/docs/libra
riesprovider11/defaultdocument-library/mohcir-no132_2020_21may20_dental-services-after-cbperiod67b93be2bc2542d
18c675325ab75f730.pdf

Permitted treatment
Non COVID-19:
suggesturgent/emergency
dental care prioritised
but a wide range ofdental procedures with
AGPs are permitted
only where no otheroption is possible

Face mask - surgicalmask

Rubber dam
High volume suction
4-handed dentistry
COVID-19

Not reported

Not reported

Not reported

Not reported

Non COVID-19

Face mask - FFP2/N95

Mouthwash – 1%
Hydrogen peroxide

General ventilation– large extractor

Not reported

COVID-19: suggests
AGPs are not provided

Country
Slovakia

Definition
Not reported

SourceMethodological
guidelines of the ChiefExpert for the
Department of Dentistry

List of AGP
instruments andprocedures
Not reported

Page 39 of 69

Non COVID-19

Fit test required
Goggles/face visor
Surgical gown (change
after each AGP)

Rubber dam
High volume suction

NoAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

for the provision ofhealthcare during the
COVID-19 pandemic

Permitted treatment
Limit use of high speed
handpieces, powered
scalers, and air
polishers

Date of first publication
20/05/2020
Latest update
No updatehttps://www.health.gov.sk/?covid-19-metodickeusmernenia

COVID-19
status

Personal protective
equipment

COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Not reported

Non COVID-19

Face mask - FFP2/N95
for up to 4 hours wear

Not reported

Not reported

Not reported

Not reported

Not reported

10 minutes

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital

List of AGP
instruments andprocedures
Not reported

Goggles/face visor

Permitted treatment
Non COVID-19:
Prioritise those withproblems orundergoing a course oftreatment. Routine care
not obviously restricted
but not encouraged.
Limit AGPs where
possible

Surgical cap/hat

Page 40 of 69

Linkedevidence

Non COVID-19:
suggests providing
care with no further
specification

SourceExpert recommendations
for the treatment ofpatients in dental clinics
during the release ofmeasures in the field ofdentistry in the context of
COVID-19https://www.gov.si/assets/ministrstva/MZ/DOKU
MENTI/Koronavirus/Zob
ozdravstvo/Strokovnapriporocila-zaobravnavo-pacientov-vzobozdravstvenihordinacijah-v-casu-

Fallow time

Shoe covers

Definition
Not reported

Latest update
No update

Environmental
mitigation

Surgical cap/hat

Country
Slovenia

Date of first publication
06/05/2020

Procedural mitigation

COVID-19: patients,
treated at selected
emergency dental
clinics and limited toemergency care

Surgical gown – water
repellent

COVID-19

Face mask - FFP3 or
FFP2 mask
Goggles/face visor –disinfect after eachpatient
Surgical gown –waterproof and should
be changed after eachpatient
Surgical cap/hat

NoAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
statussproscanja-ukrepov-napodrocju-zobozdrav.docx
CountrySouth Africa
SourceSADA (South African
Dental Association)
Dental Protocol in
Response to the COVID19 Pandemic – A South
African Private Practice
Perspective
Date of first publication
May-20Latest update
No updatehttps://cdn.sada.co.za/fil
es/clinicalresources/downloads/cor
onavirus/SADA%20DEN
TAL%20PROTOCOL%2
0IN%20RESPONSE%20
TO%20THE%20COVID1
9%20PANDEMIC%2020
20.pdf?v=202006301124
02

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Utilise lowest aerosolgenerating equipment
and instrumentation
when delivering any
type of restorative or
hygiene care.

General ventilation

Not reported

Yes

Shoe covers alternatively use special
disinfectable footwear
Definition
Any patient andmedical care procedurethat results in the
production of airborne
particles (aerosols)
List of AGP
instruments andprocedures
3-in-1 syringe, powered
scalers, high and slow
speed hand pieces withor without water
coolant, surgical handpieces, high speed
hand pieces,maxillofacial and oral
surgery where highspeed devices areused, lasers.
Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: Suggests
providing care with nofurther specification.
Dentists need toassess theirenvironment to assure
optimal isolation andgeneral ventilation, andsee the patient at theend of the day.
Otherwise, thesepatients need to be
seen in a specificPage 41 of 69

Personal protective
equipment

Non COVID-19

Face mask – FFP2/N95
Fit test required
Goggles, glasses withside protection and faceshields. Disinfect with
70% isopropyl after
each procedure.
Surgical gown
(disposable andreusable) and coveralls.
Must meet the following
criteria: sterile if
reusable, long sleevesto cover arms and water
resistant. Cloth gowns
are not recommended,as they are not water
resistant. Commerciallyavailable reusable
gowns should be water
resistant, washable andsterilisable according to
manufacturer's
recommendations.
Surgical cap/hat patient could be
provided withdisposable headwear.
Additional hair cover isrecommended whenworking in a sterile or
high-risk environment
with long hair andbeards.
Plastic aprons are notrecommended for dental
and surgical purposes

Mouthwash - thepatient must rinse theirmouths immediately
with hydrogen peroxide(1% for 2 periods of 30
seconds each) or
Povidone-iodine rinses(0.23% to 1%) as wellas nasal spray.
Although notscientifically tested orproven, we strongly
suggest that the patient
use the same rinsing
procedure as before
contact at thecompletion of theappointment
The use of Listerineand chlorhexidine is notsupported by theliterature
Rubber dam
High volume suction
Postoperative
sanitation

Perform disinfectant
fogging only for
extraordinary
circumstances andpurposes in patientcare areas.
Disinfectant fogging
recommendations
refer to the sprayingof chemicals, suchas formaldehyde or
phenol-based
agents, todecontaminate
environmental
surfaces or disinfectthe air in healthcare facilities.
Newer technologies
involving fogging forroom
decontamination
fogging-typeapplications, suchas ozone mists orvaporised hydrogen
peroxide, havebecome available
and are preferred.

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
statusCOVID clinic or
hospital, not in a
regular practice

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Keep appointments
short

Optimal patientisolation

Not reported

COVID-positive or
suspected positive
patients need to bescheduled for the endof the day or referred toareas where they canbe managed safely (adedicated facility or ahospital theatre
environment
recommended)

General ventilation Remember to factor
in enough time forGeneral ventilation
specific attention to
your own
environment anddisinfection of thetreatment area
between cases

Mouthwash - preprocedural 1%hydrogen peroxide,
0.2% Povidone iodine
or 0.05 cetylpyridinium
chloride. 0.1%
mouthwash for 30
seconds. Avoid the useof spittoons and use
disposable cups.

General ventilation- Althoughnumerous systems
are available for air
filtration, none
present concretescientificeffectivenessagainst SARSCoV2. Methods
include:- ozone purification- purification withchlorine dioxide- use of

Linkedevidence

because they do notprovide full body andarm cover.
Shoe covers
Patient could be
provided withdisposable overshoes
and shoe covers. It issuggested thatovershoes and shoecovers should be single
patient use.
COVID-19

Country
Spain
SourceSpanish National
Dentistry Council
Date of first publication
13/04/2020
Latest update
01/05/2020
https://www.consejodentistas.es/comunicacion/act
ualidad-consejo/notasPage 42 of 69

Definition
Interventions thatgenerate aerosols are
considered riskier
includingtracheotomies, alloperative activity that
requires high-speed
rotary instruments,
phases in carving inprosthodontics, surgery
that involves thegeneration of aerosols(implantology,
osteotomy, etc.),

Non COVID-19

As non COVID-19

Double gloving>2mts No face mask.
1-2mts surgical facemask. <1mts FFP2 facemask.
If AGP, use FFP2 mask
and in specific cases
consider using FFP3
masks
Fit test - After hand
wash, put on the mask,

Rubber dam
High volume suction

15 minutes between
patients

Yes

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

de-prensaconsejo/item/1783-planestrategico-de-accionpara-clinicas-dentalesdurante-el-periodo-dedesescalada.html

certain phases inorthodontics (removalof brackets andpolishing) etc.

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

then adjust and fit test in
nose and chin.

The usual work clothes
and footwear must be
exclusively for work,
avoiding the use ofstreet clothes orfootwear in the office. It
is important to avoid
wearing rings,
bracelets, pendants,
watches or other items,
since they behave likereservoirs of COVID 19

hypochlorous acid
- purification by
generation ofhydroxyl radicals(OH)- use of UVC
radiation- use of negative
pressure or highpressure,associated with
HEPA (HighEfficiency
Particulate Air)filters

Goggles/face visor certified eye protectors
based on the UNE-EN
166: 2002 standard forprotection against
liquids can be integral
glasses against drops orface shields against
splashes.

AGPs are categorisedby No AGPs, AGP and
AGPs with high risk ofspillage.
List of AGP
instruments andproceduresHigh speed
handpieces, 3-in-1
syringes, powered
scalers, surgicalhandpieces, hardtissue lasers, airpolishers

Surgical gown
Surgical cap/hat

The Spanish
Society for
Environmental
Health (SESA)
advises against
chlorine dioxide andozone indisinfecting the air
against thecoronavirus.
The Ministry of
Health in in Spain,
does notrecommend
hypochlorous acid.
The use of UVCrays in the dental
field is not indicatedWhile hydroxyl
radical generating
systems are
effective with otherviruses, it is not yet
documented for
SARS-Cov-2

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification. AGPs areclassified as low,
medium and high risk
depending on PPE
COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital

COVID-19

Page 43 of 69

Fallow time

As non COVID-19

Avoid mouthwash

As non COVID-19

Not reported

Linkedevidence

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Country
Switzerland

Definition
Not reported

Non COVID-19

List of AGP
instruments andprocedures
Not reported

Mouthwash - 1.5%hydrogen peroxide
solution or Povidoneiodine solution
mouthwash for 30
seconds

General ventilation– windows oradequate General
ventilation system

At least 15 minutes
for complete airingof room post AGP

No

SourceSwiss Dental Association

Face mask - surgicalmask or FFP2 mask if
rubber dam can’t be
used

As non COVID-19

Up to 30 minutes

Date of first publication
17/04/2020
Latest update
28/05/2020
https://www.sso.ch/filead
min/upload_sso/5_Newsletter/2020/Covid-19Positionspapier4-6-F.pdf

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalCountry
Tunisia

Definition
Not reported

SourceConseil National d’Ordredes Médecins Dentistes
de la Tunisie

List of AGP
instruments andprocedures
Not reported

Date of first publication
12/04/2020

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification

Latest update
11/05/2020
https://cnomdt.tn/docs/rel
atedInfo/protocolecovid4-cnomdt-26.pdf

Page 44 of 69

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital

Goggles/face visor

Rubber dam
High volume suction
COVID-19 Only in case ofabsolute
emergency that
can’t bepostponed

Face mask - FFP2 worn
for up to 30 minutes
following last AGP andas long as patient is in
the room

As non COVID-19

Forbidden to treat
patient in a room
without window oradequate General
ventilation system

Goggles/face visor
Surgical gown

Non COVID-19

Face mask - FFP2
Goggles/face visor
Surgical gown
Surgical cap/hat

Use slow speed drill
instead of high speed
handpieces

15 minutes

Mouthwash - hydrogen
peroxide or Povidoneiodine
Rubber dam wheneverpossibleHigh volume suction

COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

No

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Country
United Arab Emirates(Dubai)Definition
Not reported

Non COVID-19

Face mask - N95

Designated room,
HEPA filter

20 minutes between
appointments

No

Goggles/face visor

Mouthwash - 1%hydrogen peroxide or
0.2% Povidone iodine

Surgical gown for AGPs

Rubber dam

Separate shoes forclinical activities

High volume suction

COVID-19

Not reported

Not reported

Not reported

Not reported

Non COVID-19

Face mask - FFP3 for
AGPs

Windows in neutralpressure rooms
should be opened,or extractor fansthat vent to theexterior should be
used as air passing
externally will behighly diluted and is
not considered to
be a risk. The
greater the numberof air changes perhour (General
ventilation rate), thesooner any aerosol
will be cleared. to
be a risk

Negative pressureroom: 20 minutes

As non COVID-19

As non COVID-19

SourceDubai Health Authority
Date of first publication
2/06/2020
Latest update
No updatehttps://services.dha.gov.
ae/sheryan/wps/portal/ho
me/circulardetails?circularRefNo=CI
R-202000000236&isPublicCircul
ar=1&fromHome=true

Country
UK - England
SourceOffice of the Chief Dental
Officer, England
Date of first publication
06/04/2020
Latest update
No updatehttps://www.england.nhs.
uk/coronavirus/wpcontent/uploads/sites/52/
2020/06/C0575-dentaltransition-to-recoverySOP-4June.pdf

List of AGP
instruments andprocedures
Not reported
Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification
COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital
Definition
Aerosol generatingprocedures (AGPs) aredefined as any medical
and patient care
procedure that resultsin the production of
airborne particles(aerosols).

Goggle/face visor
Surgical gown
Rubber dam/low suction
High volume suction

List of AGP
instruments andproceduresHigh-speed handpieces
and high speed
surgical handpieces,
powered scalers, 3-in-1
syringe
Permitted treatment
Non COVID-19:
Suggests providing
care with no further

Page 45 of 69

Fit test required

COVID-19

As non COVID-19

As non COVID-19

Neutral room: 60
minutesNo

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Non COVID-19

Face mask - FFP3

Rubber dam
High volume suction

After providing an
AGP, it isrecommended thatthe room is left
vacant with the door
closed for 20
minutes in anegative pressure
isolation room or 60
minutes in a neutralpressure room
before cleaning anddecontamination

No

Fit test required

General ventilation(Windows may be
opened)specification. Whilst in
sustained community
transmission treat all
patients as high risk.
Treatment with extra
care and PPE,
minimise APGs
COVID-19: Suggests
emergency treatment
only in a dedicated
COVID-19 centre or
hospitalCountry
UK - Northern Ireland

Definition
Not reported

SourceHealth and Social Care
Board

List of AGP
instruments andproceduresHigh speed
handpieces, powered
scalers, 3-in-1 syringe,
slow-speed drill with
coolant spray (e.g.
surgical extractions),
air abrasion and air
polishing

Date of first publication
06/04/2020
Latest update22/06/2020
http://www.hscbusiness.
hscni.net/pdf/Preparation%20for%20the%20Reestablishment%20of%20
the%20GDS%20Updated%2022%20June%2020
20.pdfPermitted treatment
Non COVID-19:
suggests emergency
treatment only
COVID-19: Suggests
emergency treatmentonly. Unclear if patientsare treated in regular
practice or a dedicated
COVID-19 centre or
hospital

Page 46 of 69

Goggles/face visor
Surgical gown

If your practice hasan air flow systemor equivalent in
place
manufacturers
guidance should besought regarding
the possible
reducing air settling
time with 6 airchangesrecommended prior
to cleaning anddecontamination

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryCountry
UK - Scotland
SourceScottish Dental ClinicalEffectiveness
Programme
Date of first publication
25/05/2020
Latest update
06/12/2020
http://www.sdcep.org.uk/
wpcontent/uploads/2020/06/SDCEP-ResumingGeneral-DentalServices-FollowingCOVID-19-ShutdownUpdate-120620.pdf

AGP details

Definition
Aerosol generatingprocedures (AGPs) aredefined as any medical
or patient care
procedure that resultsin the production of
airborne particles(aerosols).

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

COVID-19

As non COVID-19

As non-COVID-19

As non-COVID-19

As non-COVID-19

Non COVID-19

No AGP related advice/recommendations

No AGP related advice/recommendations

No AGP related
advice/recommenda
tions

No AGP related
advice/recommendations

COVID-19

No AGP related advice/recommendations

No AGP related advice/recommendations

No AGP related
advice/recommendations

No AGP related
advice/recommendations

Non COVID-19

Face mask - FFP3 or
FFP2Mouthwash mentioned
but document indicateslack of evidence
regarding COVID-19

Space
appointments toensure social
distancing. Book at
the end of a session
Schedule time forprocedure and time
for decontamination(to include air
clearance in an
appropriate room)

60 minutes when airchanges per hour
(ACPH) is notknown. Expert
infection control
team advice should
be sought whencalculating times. If
the patient has
evidence of
immunity(laboratory) or ofbeing non-infected

Linkedevidence

No

List of AGP
instruments andprocedures
3-in-1 syringe, highspeed handpieces,
powered scalers
Permitted treatment
Non COVID-19:
suggests urgent androutine treatment but
no AGP treatment.
COVID-19: suggests
AGP treatment in a
dedicated COVID-19
centre or hospitalCountry
UK - Wales
SourceChief Dental Officer,
Wales
Date of first publication
08/06/2020
Latest update
No update

Page 47 of 69

Definition
AGPs are proceduresthat create aerosols (airsuspension of fine (≤5μm) particles
List of AGP
instruments andproceduresHigh speed
handpieces, airpolishers, powered
scaler, air polishing,

Fit test - Copies of fit
test certificates (where
issued) and records offit tests (pass and fail)for each staff member
and each mask typeshould be retained by
the practice.

Rubber dam
High volume suction

Yes

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

https://gov.wales/sites/default/files/publications/20
20-06/standardoperating-process-for-non-covid-19-dentalcentres-providingaerosol-generatingprocedures-in-wales.pdf

Slow speed drill, 3-in-1
syringe)

Full face shield if FFP is
not water resistantPermitted treatment
Non COVID-19:
suggests providing
care with no further
specification

Surgical gown

COVID-19: Suggests
providing care with nofurther specification.
Treat patients in a
dedicated COVID-19
centre or hospital

Page 48 of 69

COVID-19
status

Personal protective
equipment

Disposable apron - Only
if gown is not water
repellent

Procedural mitigation

Environmental
mitigation

Fallow time

Negative pressureroom with known airchanges per hour(laboratory) andthere is no
possibility of
infection on the dayof treatment, thepatient may betreated withstandard infection
control measureswith no additional
settle time. Leave
the room for 60
minutes after an
AGP.

General ventilation Windowless
surgeries with no airchanges should not
be used.
Windows should be
open whereappropriate (thismay not beappropriate whereclosed environment,
negative pressure
systems are inplace).
Air conditioning
which recirculates
air into the surgery
should be switched
off if it is linked toother practice areas
Air conditioning thatremoves air fromthe environment
should be switchedon (venting ofextractor fans must
be assessedalongside the risk ofcontamination ofother areas) with
notices placed atthe vents. Seek
advice in relation to
air conditioning as
required. (Seekadvice forwindowless
surgeries as these

Measurements canbe taken by healthand safety/ infection
control teams todetermine airchanges per hourfor each surgery
and the exact timeneeded. If this hastaken place, recordsof measurements
and advice should
be kept.
The current
recommended time
for negative
pressure rooms is
20 minutes. If a
negative pressureroom then with 12+
air exchanges leavefor 20 minutes

Linkedevidence

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

should not routinely
be used for AGP
Air purifiers anddevices to improve
air quality can beconsidered but
there is insufficientevidence on theireffectiveness inrelation to COVID19 at this time. If
practices wish toconsider thesepieces ofequipment, theyshould seek advice(contact the dental
COVID-19 lead who
will ask for advice
from the local
Infection Prevention
Control Teams).
Any decision should
be clearly
documented andretained by thepractice for possible
future reference.
The default position
otherwise is tofollow the guidancedescribed above
Fogging techniques(with e.g.
hypochlorous acid)are not currently
recommended

Country
UkrainePage 49 of 69

Definition
Not reported

COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

As non COVID-19

Non COVID-19

Face mask – type notspecified4-handed dentistry

General ventilation

20-30 minutes

NoAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

SourceNational Academy ofMedical Sciences of
UkraineList of AGP
instruments andprocedures
Not reported

Date of first publication
08/05/2020

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification. Minimise
AGPs

Latest update
No update
http://amnu.gov.ua/spilnirekomendacziyi-duinstytut-stomatologiyi-tashhelepno-lyczevoyihirurgiyi-namn-ukrayinyi-go-asocziacziyastomatologiv-ukrayinyshhodoprotyepidemichnyhzahodiv-vstomatologichnyhzakladah-ohor/
Country
Uruguay
SourceMinistry of Health
Date of first publication
Not reported
Latest update
Not reported
https://www.gub.uy/minis
terio-saludpublica/sites/ministeriosaludpublica/files/documentos/noticias/MSP_RECOMENDACIONES_ODONTOLOGOS_HIGIENISTAS_DENTALES.pdf

Page 50 of 69

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Goggles/face visor

Mouthwash

Quartz Lamps

Surgicalgown/protective suit

Rubber dam

COVID-19

Not reported

Not reported

Non COVID-19

Face mask - N95 or
FFP2

Surgical cap/hat

Mouthwash - 70%
alcohol, 3% hydrogen
peroxide or 10 volumes(medical hydrogen
peroxide) or
iodopovidone pre- andpost-treatment

Disposable apron

High volume suction

Not reported

Not reported

Fallow time

Linkedevidence

High volume suction
Not reported

Not reported

COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital

Definition
The practice ofdentistry, as well as theuse of dental
instruments andequipment, cangenerate aerosols that
contain droplets ofwater particles, saliva,
blood, microorganisms
and other wastes.
These biologicalmaterials settle on theenvironment and work
surfaces, dental carepersonnel and thepatient
List of AGP
instruments andprocedures

Goggles/face visor
Surgical gown

COVID-19No

Not reported

Not reported

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Non COVID-19

Face mask - surgicalface mask, N95 or
KN95

Rubber dam

Not reportedNo

Fit test required for N95
and KN95. Annual fit
testing requirement
lifted and currently
unavailable

Use hand scaling
instead of ultrasonicscaling

Until further
evidence
demonstrates aclear answer, the
ADA is not making
a recommendation
on waiting for a
specific time period
to begin cleaning
the operatory.

Not reported

As non COVID-19

High speed
handpieces, 3-in-1
syringe, intra-oralradiography
Permitted treatment
Non COVID-19:
suggests emergency
treatment only
COVID-19: Suggests
providing care with nofurther specification.
Treat in a dedicated
COVID-19 centre or
hospitalCountry
USA

Definition
Not reported

SourceAmerican Dental
Association (ADA)

List of AGP
instruments andprocedures
Not reported

Date of first publication
24/04/2020
Latest update
06/09/2020
https://success.ada.org/~/media/CPS/Files/Open%20Files/ADA_Return_t
o_Work_Toolkit.pdf?utm_campaign=covid-19Return-to-WorkToolkit&utm_medium=e
mail&_hsmi=86924194&_hsenc=p2ANqtz_HVpP4Wh9sKaPxqGZI
A1G9Ro1coYT29m3pRX
N1TDeZSaIr3__PzyReYsAnmYdx6fX_rJ
mFesmgepGb1_VhbsxZ
6Zu6g&utm_content=86
Page 51 of 69

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification.
COVID-19: Suggests
providing care with nofurther specification.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospitalHigh volume suction

Goggles/face visor
Surgical gown (clinicaljudgement)
Surgical cap/hat (clinicaljudgement)
Shoe covers (clinicaljudgement)
COVID-19

As non COVID-19

As non COVID-19

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

Country
USA

Definition
Not reported

Non COVID-19

Mouthwash

Yes

List of AGP
instruments andprocedures
Avoid use of dental
handpieces, 3-in-1
syringe, powered
scalers

General ventilation systems thatprovide air
movement in aclean-to-less clean
flow direction… are
better at protecting
staff and patients.

Not reported

SourceCenters for Disease
Control and Prevention(CDC)

Face mask - N95 or a
respirator that offers ahigher level ofprotection such as otherdisposable filtering facepiece respirators,
powered air-purifying orelastomeric respirators.

924194&utm_source=hs_automation

Date of first publication
Not reported
Latest update
17/06/2020
https://www.cdc.gov/coronavirus/2019ncov/hcp/dentalsettings.html

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification. Treat all
patients as high risk
with extra care and
PPE if necessary
COVID-19: Suggests
providing care with nofurther specification.
Avoid AGPs if possible.
Unclear if patients aretreated in regular
practice or a dedicated
COVID-19 centre or
hospital

Fit test – dental healthcare personnel shouldbe medically cleared
and fit tested if using
respirators with tightfitting face pieces
Goggles, protective
eyewear with solid sideshields or a full faceshieldGown or protective
clothing

Rubber dam
High volume suction

Consider the use of
a HEPA air filtration
unit while thepatient isundergoing and
immediately
following an AGP to
reduce aerosol
concentrations andincrease theeffectiveness of theturnover time. Placethe HEPA unit near
the patient’s chair
but not behind the
DHCP.
Consider the use of
upper-room
ultraviolet
germicidal
irradiation as an
adjunct to higher
General ventilation
and air cleaning
rates
Ensure to accountfor the time required
to clean anddisinfect operatingrooms between
patients when

Page 52 of 69

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Country

AGP details

COVID-19
status

Personal protective
equipment

Procedural mitigation

Environmental
mitigation

Fallow time

Linkedevidence

calculating yourdaily patient volume
COVID-19

Face mask - N95 or
higher level respirator
Fit test

AGPs should ideallytake place in an
airborne infection
isolation roomNot reported

Goggles/face visor
Surgical gown
Country
Zimbabwe

Definition

SourceZimbabwe Dental
Association COVID-19
Dental Practice
Recommendations/GuidelinesList of AGP
instruments andproceduresHigh speed
handpieces, 3-in-1
syringe and scaler use

Date of first publication
Not reported

Permitted treatment
Non COVID-19:
suggests providing
care with no further
specification. AGPs
undertaken withstandard precautions

Latest update22/04/2020
https://www.fdiworlddent
al.org/sites/default/files/
media/documents/covid19_dental_practice_reco
mmendations_guidelines.pdf

Non COVID-19

Not reported

Not reported

Not reported

Not reported

COVID-19

Face mask – ideally
N95

Manage emergency
without the generationof aerosol

Not reported

Not reported

Goggles/face visor
Protective gown

No

Mandatory use ofhydrogen peroxide
mouth rinse before
dental procedures
Rubber dam

COVID-19: Suggests
emergency treatment
only with AGPs if
possible. If AGP
required, undertake
proper COVID-19
precautions. Unclear if
patients are treated inregular practice or a
dedicated COVID-19
centre or hospital

Non COVID-19 refers to patients who are presumed to have negative COVID-19 status; COVID-19 refers to patients with suspected or confirmed positive COVID-19 status.
ABHR, alcohol-based hand rub, ACH, air changes per hour; AGP, aerosol generating procedure; HEPA, high-efficiency particulate air; HVAC, heating ventilation and air
conditioning
Page 53 of 69

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

Appendix 2. AGP reported by country
CountryAGPs
reported

List of AGP
instruments orproceduresHigh speed
handpieces, slow
speed drill, 3-in-1
syringe, powered
scalers

Treatment
recommendation for
Non COVID-19 patients
Suggests prioritising
emergency treatment but
treatment is not limited toemergencies

Treatment
recommendation for
COVID-19 patients
Suggests urgent treatments
only and avoiding AGPs asmuch as possible. Unclear
if patients are treated inregular practice or a
dedicated COVID-19 centre
or hospitalCountry: Argentina
Source: Ministry of Health - Ministerio de Salud Argentina COVID-19
Recomendaciones Para Odontologia
Date of first publication: 10/06/2020
Latest update: No update

Yes

Yes

High speed
handpieces, Surgicalhandpieces, 3-in-1
syringe, Powered
scalers (sonic/
ultrasonic), Air
polishers, Lasers

Suggests taking standard
precautions

No

None reported

Suggests providing carewith no further
specification

Suggests AGPS are
avoided for suspected
COVID-19 cases. Urgent or
emergency treatment only
for confirmed cases in a
dedicated COVID-19 centre
or hospital, not in a regular
practice
Suggests providing carewith no further specification

No

None reported

Suggests providing carewith no further
specification

https://www.fdiworlddental.org/sites/default/files/media/documents/covid19_recomendaciones_para_odontologia.pdf
Country: Australia
Source: Australian Dental Association
Date of first publication: Various publication dates and updates
https://www.ada.org.au/Covid-19-Portal/Dental-Professionals

Country: Austria
Source: Austrian Dental Chamber
Date of first publication: 03/04/2020
Latest update: 04/05/2020
https://stmk.zahnaerztekammer.at/zahnaerztinnen/informationencorona-virus/
Country: Belgium
Source: Conseil de l’Art Dentaire on behalf of the Service Public
Fédéral de Santé Publique
Date of first publication: 19/04/2020
Latest update: 24/05/20
https://5199.f2w.fedict.be/sites/default/files/documents/2020-0419_covid-19_modification_20200524_-protocole_soins_dentaires.pdf

Page 54 of 69

Suggest treating patients ina dedicated COVID-19
centre or hospital, not in a
regular practiceAerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported

List of AGP
instruments orproceduresHigh speed
handpieces, slow
speed drill, 3-in-1
syringe

Treatment
recommendation for
Non COVID-19 patients
Suggests emergency
treatment only

Treatment
recommendation for
COVID-19 patients
Suggests emergency
treatment only but patientsshould ideally be treated ina high level healthinstitution (hospital)

Country: Bolivia
Source: College of Dentists of La Paz
Date of first publication: 01/05/2020
Latest update: No update

Yes

Yes

High speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe

Suggests providing carewith no further
specification

Suggests providing carewith no further specification

No

None reported

Suggests providing carewith no further
specification

Suggests providing carewith no further specification

No

None reported

Suggests emergency
treatment only

Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

https://www.fdiworlddental.org/sites/default/files/media/documents/proto
colo_de_bioseguridad_para_la_atencion_a_pacientes_y_prevencion_del_covid19_en_centreas_y_consultorios_odontologicos.pdf
Country: Brazil
Source: Biosafety Working Group of the São Paulo Regional DentistryCouncil
Date of first publication: 01/04/2020
Latest update: No update
http://www.crosp.org.br/uploads/arquivo/747df5ff505e7beff33c1a5ff5d6f
12a.pdf
Country: Bulgaria
Source: Recommendations/instructions from the crisis headquarters of
the Bulgarian Dental Union
Date of first publication: 03/06/2020
Latest update: No update
https://bzs.bg/препоръки-инструкции-от-кризисния-ща/Country: Burkino Faso
Source: Ordre National des Chirurgiens Dentistes du Burkina
Ministère de la Santé
Date of first publication: Not reported
Latest update: Not reported
URL not available

Page 55 of 69

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported

List of AGP
instruments orprocedures

Treatment
recommendation for
Non COVID-19 patients

Treatment
recommendation for
COVID-19 patients

Country Canada

Yeshigh-speed, low-speed
and other rotary
handpieces, powered
scalers, and 3-in-1
syringes.

in-person care for all
deferred, non-essential, andelective services, in addition
to emergency and urgent
care.

Patients who need urgent andemergency care that cannot
be delayed

YesHigh speed
handpieces, 3-in-1
syringe, powered
scalers

Suggests providing carewith no further
specification

Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

YesHigh speed
handpieces, powered
scalers

Suggests emergency
treatment only

Suggests AGPs are notprovided in COVID-19
patients

Yes

High speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe

Suggests providing carewith no further
specification

Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

Source Royal College of Dental Surgeons of Ontario COVID-19: MANAGING
INFECTION RISKS DURING IN-PERSON DENTAL CARE
Date of first publication 15/03/2020
Latest update 31/05/20
https://www.rcdso.org/en-ca/rcdso-members/2019-novel-coronavirus/covid-19-managing-infection-risks-during-in-person-careCountry: Chile
Source: Division of Disease Prevention and Control | Oral Health
Department
Date of first publication: Not reported
Latest update: Not reported
http://www.colegiodentistas.cl/inicio/wpcontent/uploads/2020/04/orientaciones-atencion-odontologica-covid19.pdf
Country: China
Source: Chinese Stomatological Association - Chinese Response to
COVID-19 in Dental Field
Date of first publication: Not reported
Latest update: 06/05/2020
URL not available
Country: Colombia
Source: Ministry of Health and Social Protection - Ministerio de Salud yProtección Social Bogotá
Date of first publication: May 2020
Latest update: No update
https://www.minsalud.gov.co/Ministerio/Institucional/Procesos%20y%20
procedimientos/GIPS31.pdf

Page 56 of 69

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported

List of AGP
instruments orproceduresHigh speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe

Treatment
recommendation for
Non COVID-19 patients
Suggests providing carewith no further
specification

Treatment
recommendation for
COVID-19 patients
Suggests emergency
treatment only treated in a
dedicated COVID-19 centre
or hospitalCountry: Costa Rica
Source: Ministry of Health - Ministerio de Salud Costa Rica
Date of first publication: 27/03/2020
Latest update: No update

Yes

Yes

High speed
handpieces,Powered scalers(sonic/ultrasonic)

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

YesHigh speed
handpieces, Surgicalhandpieces, Slow
speed drill, 3-in-1
syringe, Powered
scalers (sonic/
ultrasonic)

Suggest testing every
patient for COVID-19
before providing care

Suggest postponing any
appointment while patient is
COVID-19 positive

Yes

Slow speed drill, 3in-1 syringe, intraoral radiography

Suggests providing carewith no further
specification

Yes

High speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe, powered

Suggests providing carewith no further
specification

Suggests providing carewith no further specification
except triage patients prior
to treatment to identify
higher risk and takeprecautions. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital
Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a

https://www.ministeriodesalud.go.cr/sobre_ministerio/prensa/docs/linea
mientos_odontologos_v2_27032020.pdf
Country: Croatia
Source: Croatian Chamber of Dental Medicine
Date of first publication: 04/05/2020
Latest update: No update
https://www.hkdm.hr/novost/1836/Smjernice-i-protokoli-za-otvaranje-irad-ordinacija-dentalne-medicine-i-dentalnih-laboratorija
Country: Denmark
Source: SUNDHEDSSTYRELSEN, Danish Health Board
Date of first publication: 18/04/20
Latest update: 22/04/20
https://www.sst.dk/da/udgivelser/2020/haandtering-af-covid-19_-kritiskfunktioner-i-tandplejen
Country: Dominican Republic
Source: Ministry of Health
Date of first publication: Not reported
Latest update: Not reported
https://www.fdiworlddental.org/sites/default/files/media/documents/reco
mendaciones_para_la_guia_de_apertura_de_los_servicios_odontologic
os_en_la_republica_dominicana_debido_a_la_pandemia_covid-19.pdf

Country: Ecuador
Source: Ministry of Health
Date of first publication: 28/05/2020
Latest update: No update
Page 57 of 69

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported

List of AGP
instruments orprocedures
scaler, intra-oralradiography

Treatment
recommendation for
Non COVID-19 patients

Treatment
recommendation for
COVID-19 patientsdedicated COVID-19 centre
or hospital

No

None reported

Suggests providing carewith no further
specification

Suggests AGPs are notprovided in COVID-19
patients

Yes

High speed
handpieces, Slow
speed drill, 3-in-1
syringe, Powered
scalers (sonic/
ultrasonic)

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

YesHigh speed
handpieces, 3-in-1
syringe, Powered
scalers(sonic/ultrasonic), Air
polishers

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

No

None reported

Suggests providing care
avoiding AGPs using lowspeed instrumentation

Suggests providing care
avoiding AGPs using lowspeed instrumentation.
Unclear if patients aretreated in regular practiceor a dedicated COVID-19
centre or hospital

https://www.fdiworlddental.org/sites/default/files/media/documents/proto
colo_para_atencion_odontologica_durante_la_emergencia_sanitaria_po
r_covid_-_19.pdf
Country: Estonia
Source: Ministry of Health
Date of first publication: 07/02/2020
Latest update: 21/05/2020
URL not available
Country: Finland
Source: Sector of administration of the Ministry of Social Affairs and
HealthDate of first publication: Not reported
Latest update: 01/06/2020
https://thl.fi/fi/web/infektiotaudit-ja-rokotukset/taudit-ja-torjunta/taudit-jataudinaiheuttajat-a-o/koronavirus-covid-19/ohje-suun-terveydenhuollonyksikoille-covid-19-epidemian-aikana
Country: France
Source: Haute Autorité de Santé (HAS)
Date of first publication: 14/05/2020
Latest update: 25/05/2020
https://www.has-sante.fr/jcms/p_3184961/fr/mesures-et-precautionsessentielles-lors-des-soins-bucco-dentaires-apres-le-deconfinement
Country: Germany
Source: Institut der Deutschen Zahnärzte
Date of first publication: Not reported
Latest update: 24/04/2020 (version 3)
https://www.idz.institute/publikationen/sonstiges/system-vonstandardvorgehensweisen-fuer-zahnarztpraxen-waehrend-dercoronavirus-pandemie.html

Page 58 of 69

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
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CountryAGPs
reported

List of AGP
instruments orprocedures
None reported

Treatment
recommendation for
Non COVID-19 patients
Suggests providing carewith no further
specification

Treatment
recommendation for
COVID-19 patients
Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospitalCountry: Greece
Source: Instructions for dental employees in dentists and patients
Date of first publication: Not reported
Latest update: Not reported

No

Yes

High speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe, powered
scaler, intra-oralradiography

Suggests emergency
treatment only

Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

No

None reported

Suggests providing carewith no further
specification

Unclear if patients aretreatedNo

None reported

Suggests providing carewith no further
specification

Suggest treating patients ina specific COVID-19 centre
or hospital, not in a regular
practicehttps://www.fdiworlddental.org/sites/default/files/media/documents/odigies_pros_odontiatroys_ergazomenoys_se_odontiatreia_kai_astheneis_0.p
dfCountry: Guatemala
Source: Estomatologic Callege of Guatemala
Date of first publication: 01/05/2020
Latest update: No update
https://www.fdiworlddental.org/sites/default/files/media/documents/proto
colo_de_bioseguridad_odontologica_con_enfasis_en_covid-19.pdf
Country: Honduras
Source: College of Dental Surgeons of Honduras
Date of first publication: Not reported
Latest update: Not reported
http://www.cop.org.pe/wp-content/uploads/2020/04/PROTOCOLO-DEBIOSEGURIDAD-PARA-EL-CIRUJANO-DENTISTA.pdf
Country: India
Source: Dental Council of India
Date of first publication: 05/07/2020
Latest update: No update
http://www.dciindia.gov.in/Admin/NewsArchives/Dental%20Centres%20
Protocols%20Final.pdf

Page 59 of 69

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported
No

List of AGP
instruments orprocedures
None reported

Treatment
recommendation for
Non COVID-19 patients
Suggests providing carewith no further
specification

Treatment
recommendation for
COVID-19 patients
Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospitalCountry: Ireland
Source: Irish Dental Association
Date of first publication: Not reported
Latest update: 15/05/2020

No

None reported

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospitalYes

3-in-1 syringe

Suggests emergency
treatment only. Treat all
patients as high risk withextra care and PPE if
necessary

Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

YesHigh speed
handpieces, 3-in-1
syringe, powered
scalerSuggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

https://www.hpsc.ie/az/respiratory/coronavirus/novelcoronavirus/guidance/infectionprevention
andcontrolguidance/dentalservices/Guidance-ManagingInfectionRiskDentalServices-COVID19.pdf
Country: Italy
Source: All major Italian dental associations – available from the Italian
government website
Date of first publication: 30/05/2020
Latest update: No update
http://www.salute.gov.it/portale/news/p3_2_1_1_1.jsp?lingua=italiano&m
enu=notizie&p=dalministero&id=4835
Country: Kenya
Source: Ministry of Health, Director of Healthcare Services, Oral HealthServices
Date of first publication: 24/03/2020
Latest update: No update
https://www.health.go.ke/wp-content/uploads/2020/06/Guidelines-forDental-Practicce-with-respect-to-COVID-19-Pandemic.pdf
Country: Kosovo
Source: Practical guidelines for dentistry professionals in the private
sector during the COVID-19 virus pandemic
Date of first publication: Not reported
Latest update: Not reported
http://osk-ks.org/wp-content/uploads/2020/05/Rekomandimet-e-OSKper-ordinancat-private-1.pdf

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported

List of AGP
instruments orprocedures
None reported

Treatment
recommendation for
Non COVID-19 patients
Suggests providing carewith no further
specification

Treatment
recommendation for
COVID-19 patients
Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospitalCountry: Malaysia
Source: Malaysian Dental Association Safety Advisory to Dental
Practitioners during the current Concern of COVID - 19 Infection in theinitial relaxation phase of Movement Control Order
Date of first publication: Not reported
Latest update: 01/05/2020

No

Yes

High speed
handpieces, Slow
speed drill, 3-in-1
syringe, Powered
scalers (sonic/
ultrasonic), Intra-oralradiography

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

YesHigh speed
handpieces, 3-in-1
syringe

Suggests treating
emergencies only

Suggests emergency
treatment only. Patientscan be treated in practicewith appropriate PPE,
otherwise patients must betreated in a designated
COVID-19 hospital

No

None reported

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

https://mda.org.my/home/wpcontent/uploads/2020/05/MDA_advisory_COVID19_relaxation_phase_M
CO.pdfCountry: Malta
Source: Office for the Deputy Prime Minister. Ministry for Health
Date of first publication: Jun-20
Latest update: No update
https://deputyprimeminister.gov.mt/en/health-promotion/covid19/Documents/mitigation-conditions-and-guidances/Guidance_DentalPractices_12Jun20.pdf
Country: Mexico
Source: Ministry of Health
Date of first publication: 21/05/2020
Latest update: 21/05/2020
https://www.fdiworlddental.org/sites/default/files/media/documents/reco
mendaciones_para_la_practica_odontologica_ante_covid-24.pdf
Country: Montenegro
Source: Dental Chamber of Montenegro Protocol for providing dental
treatment during the COVID-19 epidemic
Date of first publication: Not reported
Latest update: Not reported
https://www.fdiworlddental.org/sites/default/files/media/documents/proto
kol_za_pruzanje_stomatoloskog_lijecenja_tokom_epidemije_covid19_0.pdf

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported
Yes

List of AGP
instruments orproceduresPowered scaling,
Use of handpieces,
air polishing, 3-in-1
syringe

Treatment
recommendation for
Non COVID-19 patients
Suggests providing carewith no further
specification

Treatment
recommendation for
COVID-19 patients
Suggests providing are withno further specification.
Unclear if patients aretreated in regular practiceor a dedicated COVID-19
centre or hospitalCountry: Morocco
Source: Ordre national des médecins dentists du Maroc
Date of first publication: 21/05/2020
Latest update: 21/05/2020
https://drive.google.com/file/d/1x8n1etxPIVI_rq7_Z7oG_wjQIHq2BaB3/vi
ew
Country: Mozambique
Source: Ministry of Health
Date of first publication: 20/03/2020
Latest update: No update

No

None reported

Suggests providing carewith no further
specification

Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospitalYes

3-in-1 syringe

Suggests providing carewith no further
specification

Suggests emergency
treatment onlyNo

None reported

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

https://www.fdiworlddental.org/sites/default/files/media/documents/proto
colo_de_atendimento_nos_servicos_de_estomatologia_covid-19.pdf
Country: Myanmar
Source: Myanmar Dental Association
Date of first publication: 23/03/2020
Latest update: No update
https://www.fdiworlddental.org/sites/default/files/media/documents/reco
mmendations_to_member_dental_surgeons.pdf
Country: Netherlands
Source: The Royal Dutch Dental Association
Date of first publication: 21/04/2020
Latest update: 29/06/2020
https://www.knmt.nl/sites/default/files/20200629_leidraad_mondzorg_cor
ona_clmc_v_4.0.pdf

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
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CountryAGPs
reported

List of AGP
instruments orproceduresHigh speed
handpieces, 3-in-1
syringe, Powered
scalers(sonic/ultrasonic), Air
polishers

Treatment
recommendation for
Non COVID-19 patients
Suggests providing carewith no further
specification

Treatment
recommendation for
COVID-19 patients
Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospitalCountry: New Zealand
Source: Dental council, Ministry of Health
Date of first publication: 05/01/2020
Latest update: 06/09/2020

Yes

Yes

High speed
handpieces, Slow
speed drill, 3-in-1
syringe, Powered
scalers (sonic/
ultrasonic), Air
polishers

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

YesHigh speed
handpieces, intraoral radiography

Suggests providing carewith no further
specification

Suggests emergency
treatment only in a
dedicated COVID-19 centre
or hospital

YesHigh speed
handpieces, slow
speed drill, 3-in-1
syringe, intra-oralradiography

Suggests urgent care andemergency treatment only

Suggests urgent care andemergency treatment only.
Unclear if patients aretreated in regular practiceor a dedicated COVID-19
centre or hospital

YesHigh speed
handpieces, surgicalhandpieces, slow
speed drill, 3-in-1
syringe, powered

Suggests emergency
treatment only

Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

https://www.dcnz.org.nz/assets/Uploads/COVID/Level1guidelines9Jun20.pdf
Country: Norway
Source: Norway Dental Health Service – FHI (Folkehelseinstituttet)
Date of first publication: 03/12/2020
Latest update: 26/05/2020
https://www.fhi.no/nettpub/coronavirus/helsepersonell/rad-tiltannhelsetjenesten/#tannbehandling-av-pasienter-som-ikke-er-mistenktsannsynlig-eller-bekreftet-med-covid19
Country: Panama
Source: Odontologic Association of Panama
Date of first publication: 16/03/2020
Latest update: 16/05/2020
URL not available
Country: Paraguay
Source: Ministry of Health
Date of first publication: Not reported
Latest update: 07/05/2020
https://www.mspbs.gov.py/dependencias/portal/adjunto/0f3634Protocoloatencionodontologica.pdf
Country: Peru
Source: Ministry of Health
Date of first publication: Not reported
Latest update: Not reported
https://cdn.www.gob.pe/uploads/document/file/716209/DIRECTIVA_SANITARIA_N_100-MINSA-2020-DGIESP.pdf
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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported

List of AGP
instruments orprocedures
scaler, intra-oralradiography
Hgh speed
handpieces, 3-in-1
syringe, powered
scaling

Treatment
recommendation for
Non COVID-19 patients

Treatment
recommendation for
COVID-19 patients

Country: Philippines
Source: Philippine Dental Association Science Committee
Date of first publication: Not reported
Latest update: 31/05/2020

Yes

Suggests emergency
treatment only

Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

No

None reported

Suggests providing carewith no further
specification

No

High speed
handpieces, 3-in-1
syringe

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital
Suggests urgent andemergency treatment onlyNo

None reported

Suggests providing carewith no further
specification

Suggests providing carewith no further specification

No

None reported

Suggests urgent andemergency care isprioritised but a wide
range of dental
procedures with AGPs are
permitted where no otheroption is possible

Suggests AGPs are notprovided in COVID-19
patients

https://www.fdiworlddental.org/sites/default/files/media/documents/interi
m_guidelines_on_infection_prevention_during_covid-19_pandemic.pdf
Country: Poland
Source: The Polish Dental Association
Date of first publication: 08/04/2020
Latest update: NA
https://doi.org/10.5114/jos.2020.94168
Country: Portugal
Source: Direcao Geral da Saude (Directorate General of Health)
Date of first publication: 01/05/2020
Latest update: No update
https://www.omd.pt/covid-19/procedimentos/
Country: Romania
Source: Not reported
Date of first publication: 25/05/2020
Latest update: No update
https://www.dsptimis.ro/data_files/content/legislatie-covid/files/ordin-8732020.pdf
Country: Singapore
Source: Ministry of Health Circular 132/2020 – Gradual resumption ofdental services after COVID-19 circuit breaker period
Date of first publication: 14/02/2020
Latest update: 21/05/2020

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported

List of AGP
instruments orprocedures

Treatment
recommendation for
Non COVID-19 patients

Treatment
recommendation for
COVID-19 patients

No

None reported

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

No

None reported

Suggests prioritisingthose with problems orundergoing a course oftreatment. Routine care
not obviously restricted
but not encouraged. Limit
AGPs where possible

Suggests patients aretreated at selected
emergency dental centres
and limited to emergency
care

Yes

High speed
handpieces, Surgicalhandpieces, Slow
speed drill, 3-in-1
syringe, Powered
scalers (sonic/
ultrasonic), Lasers

Suggests providing carewith no further
specification

Yes

High speed
handpieces, Surgical

Suggest providing carewith no further

Suggest providing care withno further specification.
Dentists need to assess
their environment to assure
optimal isolation andventilation, and see at theend of the day. Otherwise,
these patients need to be
seen in a dedicated
COVID-19 centre or
hospital, not in a regular
practice
Suggests providing carewith no further

https://www.healthprofessionals.gov.sg/docs/librariesprovider11/defaultdocument-library/moh-cir-no-132_2020_21may20_dental-services-aftercb-period67b93be2bc2542d18c675325ab75f730.pdf
Country: Slovakia
Source: Methodological guidelines of the Chief Expert for the
Department of Dentistry for the provision of healthcare during the
COVID-19 pandemic
Date of first publication: 20/05/2020
Latest update: No update
https://www.health.gov.sk/?covid-19-metodicke-usmernenia
Country: Slovenia
Source: Expert recommendations for the treatment of patients in dental
centres during the release of measures in the field of dentistry in thecontext of COVID-19
Date of first publication: 06/05/2020
Latest update: No update
https://www.gov.si/assets/ministrstva/MZ/DOKUMENTI/Koronavirus/Zob
ozdravstvo/Strokovna-priporocila-za-obravnavo-pacientov-vzobozdravstvenih-ordinacijah-v-casu-sproscanja-ukrepov-na-podrocjuzobozdrav.docx
Country: South Africa
Source: SADA (South African Dental Association) Dental Protocol in
Response to the COVID-19 Pandemic – A South African Private
Practice Perspective
Date of first publication: May-20
Latest update: No update
https://cdn.sada.co.za/files/centrealresources/downloads/coronavirus/SADA%20DENTAL%20PROTOCOL%20IN%20RESPONSE%20TO%20THE%20COVID19%20PANDEMIC%202020.pdf?v=20200630112402
Country: Spain
Source: Spanish National Dentistry Council
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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported

List of AGP
instruments orprocedures
handpieces, 3-in-1
syringe, Powered
scalers (sonic/
ultrasonic), Air
polishers, Lasers

Treatment
recommendation for
Non COVID-19 patients
specification. AGPs areclassified as low, medium,and high risk depending
on PPE

Treatment
recommendation for
COVID-19 patients
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

No

None reported

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

No

None reported

Suggests providing care,with no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

No

None reported

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

Date of first publication: 13/04/2020
Latest update: 01/05/2020
https://www.consejodentistas.es/comunicacion/actualidadconsejo/notas-de-prensa-consejo/item/1783-plan-estrategico-de-accionpara-centreas-dentales-durante-el-periodo-de-desescalada.html
Country: Switzerland
Source: Swiss Dental Association
Date of first publication: 17/04/2020
Latest update: 28/05/2020
https://www.sso.ch/fileadmin/upload_sso/5_Newsletter/2020/Covid-19Positionspapier4-6-F.pdf
Country: Tunisia
Source: Conseil National d’Ordre des Médecins Dentistes de la Tunisie
Date of first publication: 12/04/2020
Latest update: 11/05/2020
https://cnomdt.tn/docs/relatedInfo/protocole-covid4-cnomdt-26.pdf

Country: United Arab Emirates (Dubai)
Source: Dubai Health Authority
Date of first publication: 2/06/2020
Latest update: No update
https://services.dha.gov.ae/sheryan/wps/portal/home/circulardetails?circularRefNo=CIR-202000000236&isPublicCircular=1&fromHome=true

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
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CountryAGPs
reported

Country: UK - England
Source: Office of the Chief Dental Officer, England
Date of first publication: 06/04/2020
Latest update: No update

Yes

https://www.england.nhs.uk/coronavirus/wpcontent/uploads/sites/52/2020/06/C0575-dental-transition-to-recoverySOP-4June.pdf
Country: UK - Northern Ireland
Source: Health and Social Care Board
Date of first publication: 06/04/2020
Latest update: 22/06/2020

Treatment
recommendation for
Non COVID-19 patients
Suggests providing carewith no further
specification. Whilst in
sustained community
transmission, suggests
treating all patients ashigh risk. Treatment withextra care and PPE.
Minimise APGs
Suggests emergency
treatment only

Treatment
recommendation for
COVID-19 patients
Suggests emergency
treatment only in a
dedicated COVID-19 centre
or hospital

YesHigh speed
handpieces, Surgicalhandpieces, 3-in-1
syringe, Powered
scalers (sonic/
ultrasonic), Air
polishers

YesHigh speed
handpieces, 3-in-1
syringe, powered
scalers(sonic/ultrasonic)

Suggests urgent androutine treatment but no
AGP treatment.

Suggests AGP treatment ina dedicated COVID-19
centre or hospital

YesHigh speed
handpieces, Slow
speed drill, 3-in-1
syringe, powered
scalers (sonic/
ultrasonic), airpolishers

Suggests providing carewith no further
specification

Suggest providing care withno further specification andtreat patients in a specific
COVID centre or hospital,
not in a regular practice

http://www.hscbusiness.hscni.net/pdf/Preparation%20for%20the%20Reestablishment%20of%20the%20GDS%20Updated%2022%20June%202020.pdf
Country: UK- Scotland
Source: Scottish Dental Centreal Effectiveness Programme
Date of first publication: 25/05/2020
Latest update: 06/12/2020

List of AGP
instruments orproceduresHigh speed
handpieces, Surgicalhandpieces, 3-in-1
syringe, Powered
scalers (sonic/
ultrasonic)

Suggests emergency
treatment only. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

http://www.sdcep.org.uk/wp-content/uploads/2020/06/SDCEPResuming-General-Dental-Services-Following-COVID-19-ShutdownUpdate-120620.pdf
Country: UK- Wales
Source: Chief Dental Officer, Wales
Date of first publication: 08/06/2020
Latest update: No update
https://gov.wales/sites/default/files/publications/2020-06/standardoperating-process-for--non-covid-19-dental-centres-providing-aerosolgenerating-procedures-in-wales.pdf

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Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
24 July 2020

CountryAGPs
reported

List of AGP
instruments orprocedures
None reported

Treatment
recommendation for
Non COVID-19 patients
Suggests providing carewith no further
specification

Treatment
recommendation for
COVID-19 patients
Suggest providing care withno further specification andtreat patients in a dedicated
COVID centre or hospital,
not in a regular practiceCountry: Ukraine
Source: National Academy of Medical Sciences of Ukraine
Date of first publication: 08/05/2020
Latest update: No update

No

Yes

High speed
handpieces, 3-in-1
syringe, intra-oralradiography

Suggests emergency
treatment only

Suggest providing care withno further specification andtreat patients in a specific
COVID centre or hospital,
not in a regular practiceNo

None reported

Suggests providing carewith no further
specification

Suggests providing carewith no further
specification. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

YesHigh speed
handpieces, Slow
speed drill, 3-in-1
syringe, powered
scalers(sonic/ultrasonic)

Suggest providing carewith no further
specification. Treat all
patients as high risk, withextra care and PPE if
necessary

Suggests providing carewith no further
specification. Avoid AGPs if
possible. Unclear if patientsare treated in regular
practice or a dedicated

http://amnu.gov.ua/spilni-rekomendacziyi-du-instytut-stomatologiyi-tashhelepno-lyczevoyi-hirurgiyi-namn-ukrayiny-i-go-asocziacziyastomatologiv-ukrayiny-shhodo-protyepidemichnyh-zahodiv-vstomatologichnyh-zakladah-ohor/
Country: Uruguay
Source: Ministry of Health
Date of first publication: Not reported
Latest update: Not reported
https://www.gub.uy/ministerio-salud-publica/sites/ministerio-saludpublica/files/documentos/noticias/MSP_RECOMENDACIONES_ODONTOLOGOS_HIGIENISTAS_DENTALES.pdf
Country: USA
Source: American Dental Association
Date of first publication: 24/04/2020
Latest update: 06/09/2020
https://success.ada.org/~/media/CPS/Files/Open%20Files/ADA_Return_
to_Work_Toolkit.pdf?utm_campaign=covid-19-Return-to-WorkToolkit&utm_medium=email&_hsmi=86924194&_hsenc=p2ANqtz_HVpP4Wh9sKaPxqGZIA1G9Ro1coYT29m3pRXN1TDeZSaIr3__PzyReYsAnmYdx6fX_rJmFesmgepGb1_VhbsxZ6Zu6g&utm_content=86924194&utm_source=hs_automation
Country: USA
Source: Centers for Disease Control and Prevention (CDC)
Date of first publication: Not reported
Latest update: 17/06/2020
https://www.cdc.gov/coronavirus/2019-ncov/hcp/dental-settings.html
Page 68 of 69

Aerosol Generating Procedures and their Mitigation in International Dental Guidance Documents - A Rapid Review
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CountryAGPs
reported

List of AGP
instruments orprocedures

Treatment
recommendation for
Non COVID-19 patients

Country: Zimbabwe
Source: Zimbabwe Dental Association COVID-19 Dental Practice
Recommendations/Guidelines
Date of first publication: Not reported
Latest update: 22/04/2020

Yes

High speed
handpieces, 3-in-1
syringe and scaleruse

Suggests providing carewith no further
specifications. AGPs
undertaken with standard
COVID-19 precautions

https://www.fdiworlddental.org/sites/default/files/media/documents/covid19_dental_practice_recommendations_guidelines.pdf

Treatment
recommendation for
COVID-19 patients
COVID-19 centre or
hospital
Suggests emergency
treatment only without
AGPs if possible. If
procedure requires AGP,
undertake proper COVID19 precautions. Unclear if
patients are treated inregular practice or a
dedicated COVID-19 centre
or hospital

Non COVID-19 refers to patients who are presumed to have negative COVID-19 status; COVID-19 refers to patients with suspected or confirmed positive COVID-19
status
AGP, aerosol generating procedure

Page 69 of 69