COVID-19 Information

COVID-19 Informed Consent Form

Updated Practice Guidelines

To our Chestnut Dental Family: 
We hope you and your family are in good health.  While our community has been through a lot over the last few months and many things have changed, one thing remains the same: Our commitment to you and your safety.

Our office strictly follows infection control recommendations made by the American Dental Association (ADA), the U.S. Centers for Disease Control and Prevention (CDC) and the Occupational Safety and Health Administration (OSHA).  We follow the activities of these agencies daily so that we are up-to-date on any new rulings or guidance that may be issued due to COVID-19.  Below, please read about the changes we have made to our offices and the dental appointment experience in response to COVID-19.

Increased Patient Safety Measures

  • Medical-grade HEPA air filters in each treatment room capable of removing particles smaller than the COVID-19 virus.
  • Use of KN95 respirator masks, gowns, and face shields; doctors and staff have been trained on proper wear of this new PPE.
  • Extensive training for doctors and staff on new protocols and procedures in response to the pandemic.
  • Every person who enters our office including doctors, staff, and patients are screened and temperatures taken to ensure we limit exposure to any risk factors for COVID-19. 
  • All of our treatment chairs are over 6 feet apart.
  • Patient appointments will be staggered and there will be longer appointment times with a waiting period between appointments.
  • Dental cleanings will be done without generating aerosol spray, helping to keep the air clear.
  • During appointments we will make frequent use of the rubber dam and high volume suction to reduce aerosol spray.  
  • Virtual waiting rooms, increased use of teledentistry.  
  • Patients will be asked to call if they develop symptoms within 48 hours of their dental visit, to allow for contact tracing.  
  • Re-scheduling appointments for patients who traveled outside of low-risk states until 14 days have passed.

New Dental Appointment Flow

Please respect and adhere to the following enhanced health and safety protocols.

Prior to Your Scheduled Appointment:

  • Please brush your teeth at home prior to coming to the office.
  • Please bring a mask or face covering (no masks with valves please).
  • Please call to reschedule your appointment if you or anyone in your family has had:
    • Contact with anyone who has diagnosed or suspected COVID-19 virus infection
    • A fever in the last 14-21 days
    • Flu-like symptoms such as upset stomach, headache or fatigue
    • Sore throat, cough, runny nose
    • Shortness of breath or difficulty breathing
    • Loss of smell or taste
    • Travel outside of Massachusetts in the last 14 days.
  • We are asking patients to only be accompanied by one person.  Please do not bring siblings, friends, or relatives unless they are comfortable waiting in the car.  Patients 18 years and older should enter the building unaccompanied when possible.

Upon Your Arrival at the Office:

  • 30 minutes prior to your appointment you will receive a text on your phone from our office. 
  • Respond to that text with the number "5" when you arrive at our office.  You will receive a text confirming your arrival.  Please wait in your car until we call or text you to come in.
  • Please put on your mask and approach our office.  For patients under 18 we ask that one responsible adult comes with them to the door to sign our consent forms.  You will be greeted by a dental assistant who will take your temperature (and the temperature of any adult with a patient).  The waiting rooms are closed and only being used to screen patients. 
  • After temperature checks (must be below 100.0 F to enter) and completing any necessary forms, we ask patients to come in for their appointment alone whenever possible to facilitate social distancing.  We will communicate any necessary information to a parent or responsible party when a patient under 18 comes in alone.  If necessary, one parent/guardian/caretaker can accompany a patient.     

During Treatment

  • Dental treatment rooms will be completely disinfected before each patient is seated, and public areas including restrooms will be cleaned frequently throughout the day.  
  • All treatment rooms have high-volume air filtration and purification units.  The units are capable of removing particles smaller than the COVID-19 virus.
  • Our team strictly follows guidelines set forth by the CDC, ADA, and OSHA in regards to personal protective equipment (PPE) and office sterilization.

Checking Out After Your Appointment

  • A text will be sent or a call made at the end of the appointment.  Then all patients will be escorted out of the office by a dental assistant and reunited with their responsible adult.  
  • We will call you to coordinate payment and schedule your next dental appointment.

We welcome any questions you have.  Thank you for your support and patience during our closure.  We look forward to seeing you again as our patients, neighbors, and friends!

COVID-19 Screening

Have you or anyone in your family/household had: 

  • Contact with anyone confirmed or under investigation for the COVID-19 virus?
  •  A fever within the last 14-21 days?
  •  Flu-like symptoms such as gastrointestinal upset, headache, or fatigue?
  •  Sore throat, cough, runny nose?
  • Shortness of breath or other difficulties breathing?
  •  Loss of Smell or Taste?
  • Travel outside of Massachusetts within the last 14 days?
  • Heart, lung, or kidney disease, diabetes, or any autoimmune disorder?

COVID-19 Informed Consent

We are and have always followed the state and federal recommendations on universal personal protection and disinfection protocols to limit transmission of all diseases in our office and continue to do so.  Despite our utmost careful attention to sterilization, disinfection and use of personal barriers, there is still a chance that you could be exposed to an illness in our office.  We have taken measures to provide as much social distancing as possible, but due to the nature of the procedures we provide, it is not possible to maintain social distance between patients and staff at all times.  

I understand that due to the visits of other dental patients, the characteristics of the virus, and the characteristics of the dental procedure, that I may have an increased risk of contracting the virus by being in the dental office.

If my age is over 65 or I have an underlying medical condition I understand I am at higher risk of complications if exposed to COVID-19. 

Although we are doing everything possible to minimize risk of disease transmission, do you accept the risk and consent to treatment?               Yes___      No___

Patient Name: _______________________ Date: ________________________

Signature (Patient or Guardian) _______________________________________________________