Kempston Dental Practice Cold Sore Policy

This policy is reinforced with any booking confirmation and reminder messages so every patients is able to view this policy before hand.

Our Commitment to Infection Prevention and Control

As part of our Infection Prevention and Control (IPC) protocols, and in line with GDC Standards for the Dental Team (particularly Standard 5, which requires us to have effective safeguards to maintain patient and staff safety) and national infection control guidance (Health Technical Memorandum 01-05), we ask all patients to follow this policy regarding cold sores.

What Is a Cold Sore?

A cold sore is caused by the Herpes Simplex Virus (HSV-1), a highly contagious virus that is very common in the UK. Cold sores typically progress through several stages, tingling, blistering, weeping/ulceration, and finally scabbing/crusting, before the skin has fully healed. The virus remains present, and the area remains infectious, at every stage until the scab has completely gone and the skin underneath has healed.

Why We Cannot Treat Patients With an Active Cold Sore or Scab

Dental and hygiene treatments frequently involve close contact with the mouth and lips, and many procedures, including scaling, polishing, and the use of handpieces or ultrasonic instruments, generate aerosols and splatter. This creates a specific risk with cold sores:

• Stretching or manipulating the lips during treatment can cause a scab to crack or split open, even if it appears dry or “healed over.”
• If the scab opens, the fluid released is heavily laden with virus. Aerosol-generating procedures (AGPs) can then spread the virus through the air and onto surfaces, exposing other parts of the patient’s own face (including the eyes, where infection can be serious), as well as other patients and members of our dental team.
• Once released into the clinical environment, the virus is difficult to fully contain, even with our standard infection control precautions (PPE, aerosol mitigation, and surface decontamination in line with HTM 01-05).

For this reason, our policy is that patients with a visible cold sore, at any stage, including the scabbed/crusted stage, should not attend for non-emergency dental or hygiene treatment. We ask that you rebook your appointment for after the scab has fully gone and the skin has healed.

Our Policy

1. If you notice a cold sore developing before your appointment, please contact the practice as soon as possible so we can rebook you free of charge.
2. Patients with an active cold sore, including one that has scabbed over, will be asked to rebook their appointment. We will not carry out routine or hygiene treatment until the scab has fully gone and the area has healed, because of the risk of the scab reopening during treatment and spreading infection to other parts of the patient’s body, to staff, and to other patients.
3. If you attend your appointment with a visible cold sore or scab without having told us in advance, we will need to reschedule your appointment on the day and there will be a charge.
   • Hygiene appointments attended in this way will be rebooked and charged at the full appointment fee, as the appointment slot cannot be reallocated at short notice.
   • We would always encourage you to call ahead if you notice a cold sore, as this allows us to rebook you without charge and offer the appointment to another patient.
4. Discussing the risks and clinician discretion: If a patient attends for an appointment with a visible cold sore, the risks outlined in this policy must be discussed with the patient by the treating clinician before any treatment is considered. The operator (dentist, hygienist, or therapist) is entitled to decline to treat the patient and reschedule the appointment if they judge this to be the safest course of action. Where an appointment has instead been rescheduled because the patient did not notify the practice in advance, per point 3 above, the full appointment fee set out above will still apply.
5. Clinical judgement for dental appointments with a Dentist (non treatment based): Where a patient attends with a cold sore, the treating dentist will use their clinical judgement to assess, on a case-by-case basis, whether a non-aerosol-generating procedure can safely be carried out instead, for example, an examination or a procedure that does not involve the area of the lips affected by the cold sore. This will only go ahead if, in the dentist’s clinical opinion, it will not risk causing the scab to crack, stretch, or bleed. If there is any risk of this happening, treatment will be postponed.
6. Essential/urgent treatment (e.g. toothache): There may be occasions, such as a patient presenting in pain, where treatment is essential and cannot reasonably be postponed.
   • All reasonable steps will be taken to minimise the risk of spreading the virus, such as using a barrier dressing over the cold sore, avoiding unnecessary contact with or stretching of the affected area, and adapting the treatment technique where possible.
   • The patient must be made aware of the risk of spreading the virus to themselves and others before treatment proceeds.
   • A note must be made in the patient’s clinical record confirming that the risks were discussed with the patient and the precautions taken.
7. Emergency/urgent dental problems (e.g. significant pain, swelling, or trauma) will still be assessed under point 6 above. Where treatment cannot safely be delayed, our clinicians may ask to protect the cold sore with a barrier dressing (such as a cold sore plaster, which we can provide) to help minimise the risk of cross-infection.

Helping Us Help You

• Please tell our reception team as soon as you notice a cold sore developing, even if it is before the “scab” stage, the sore is contagious from the earliest tingling stage onwards.
• If you are unsure whether it is safe to attend, please call us. Our reception team will check with your dentist or hygienist/therapist and advise you.
• Please do not attend with an active or scabbed cold sore “just in case it’s fine”, this puts you, our team, and other patients at risk, and will result in your appointment being rescheduled.

We understand that cold sores can appear at short notice and that rebooking is inconvenient. This policy exists to protect your own health (avoiding self-spread of infection to your eyes or other areas) as well as the health of our staff and other patients, and reflects our duty of care under the Health and Safety at Work etc. Act 1974, COSHH Regulations (control of biological agents), and GDC infection control expectations. We appreciate your understanding and cooperation.

If you have any questions about this policy, please contact our reception team on [[email protected]]([email protected]).