TL;DR: A written staff illness and return-to-work policy protects your patients, your team and your schedule. For an Ontario dental practice, the policy has to fit at least two main rulebooks: the Royal College of Dental Surgeons of Ontario (RCDSO) infection prevention and control standard, which says when sick staff must stay home, and Ontario's Employment Standards Act, which governs sick leave and what evidence you can ask for.
Does your practice have a written answer to the question "Should I come in today?" Most teams don't. They have a habit, and the habit usually involves a hygienist texting the office manager at 6:45 a.m. and someone guessing. As of October 2026 there is a timely reason to fix that. On September 25, ADA News reported that the U.S. Centers for Disease Control and Prevention (CDC) had added a viral respiratory infections section, covering SARS-CoV-2, influenza and RSV, to its infection control guidance for healthcare personnel. Dentists are excluded from that update, because the CDC keeps separate dental recommendations. The American Dental Association (ADA) said the update may still serve as a reminder for dental employers to revisit their employee health policies.
The ADA's checklist is a useful starting point for any practice owner in Toronto, Vaughan or Scarborough. The legal and regulatory substance, though, has to come from Ontario. This guide shows how to build a policy that does both.
What the ADA Suggests Practice Owners Review
According to ADA News, the update may serve as a reminder for dental employers to:
- Update employee health policies.
- Review employees' vaccination and immunity documentation.
- Establish protocols for exposure response and illness reporting, including for pregnant team members.
- Create return-to-work procedures for infectious diseases.
- Align occupational health procedures with dental-specific CDC recommendations and applicable legal requirements.
- Educate team members about policies and changes.
The ADA points to the CDC's dental recommendations and applicable legal requirements. For an Ontario practice, the closest equivalents are the RCDSO standard and the Employment Standards Act, 2000 (ESA). Let's take them in turn.
What Does the RCDSO Standard Say About Sick Staff?
The RCDSO's Standard of Practice, Infection Prevention and Control in the Dental Office, was approved in November 2018 and replaced the 2010 version. It is the standard currently linked from the College's infection prevention and control (IPAC) page. The College reminds members that failing to comply with a published standard could result in allegations of professional misconduct, so the illness section is not optional reading.
When staff must stay home
The standard is specific. Oral health care workers who have a severe respiratory illness with fever, acute viral gastroenteritis with vomiting and diarrhea, or acute conjunctivitis must not attend the dental office until their symptoms have subsided and the period of communicability has passed. It gives a concrete example: staff should not attend for 24 to 48 hours after acute vomiting and diarrhea resolve.
When staff may work with precautions
Staff with an upper respiratory illness such as a common cold must take the precautions needed to prevent transmission to patients and colleagues, and diligent hand hygiene is especially important. Staff with herpes simplex infections such as cold sores must pay particular attention to hand hygiene and avoid touching the affected area. The standard notes that a mask may help remind them not to touch the lesion. Areas of dermatitis should be covered, in addition to wearing gloves.
Immunocompromised team members
The standard recognizes that immunocompromised staff are at increased risk of infection and severe complications, and may shed viruses such as influenza for longer. Where feasible, it says their job functions and associated exposure risks should be considered. Handle this one privately and individually. It is a conversation, not a line in the group chat.
How Ontario's Sick Leave Rules Fit In
The RCDSO tells you when someone shouldn't be in the operatory. The ESA governs what happens to their job and pay while they're out. According to the Ontario government's guide to the ESA:
- Most employees can take up to 3 days of unpaid, job-protected sick leave each calendar year once they have worked for the employer for at least 2 consecutive weeks.
- Unused days cannot be carried over to the next calendar year.
- If an employee takes only part of a day, the employer can count it as a full day of leave.
- Employees must tell the employer before starting the leave, or as soon as possible after starting it.
- As of October 28, 2024, employers cannot require a medical note for ESA sick leave. Employers may require evidence that is "reasonable in the circumstances", which depends on factors such as the length of the leave, whether there is a pattern of absences, whether evidence is available and what it costs.
- If an employment contract gives a greater right or benefit than the ESA sick leave standard, the contract terms apply instead. The guide says whether a contract is greater depends on the facts of each case.
One nuance matters for dentistry. The ESA guide notes that certain professionals may not take sick leave where doing so would be professional misconduct or a dereliction of professional duty, and it gives health practitioners as an example. Get advice on how that applies to the regulated professionals on your team before you write it into policy.
Pro Tip: Remove "doctor's note required" from your handbook, onboarding package and any text templates in the next 30 days. Old wording tends to survive in forgotten places, and the ESA prohibition on requiring a medical note has applied since October 28, 2024.
The Business Problem: Three Days of ESA Leave vs. a 48-Hour Exclusion
Here is the tension practice owners feel. The RCDSO standard says staff with certain illnesses must not attend the office, while ESA sick leave gives most employees three unpaid, job-protected days a year. A hygienist who catches two stomach bugs and a bad flu in one winter can hit that limit quickly. If staying home costs pay, some people will be tempted to come in "feeling mostly fine." That is exactly the behaviour the standard is trying to prevent.
Your policy is where you resolve that tension deliberately, rather than case by case under pressure. Decisions worth making in writing:
- Paid sick days. Whether you offer any paid days beyond the ESA minimum, and how many. Write the terms down. According to the Ontario guide, whether a contract gives a greater right than the ESA standard depends on the facts of each case, so have the wording reviewed.
- Who decides. Name the person, usually the office manager or the owner dentist, who confirms whether a symptom falls into the "stay home" or the "work with precautions" category. This matters most on early-morning calls.
- Schedule coverage. A short list of who calls patients to reschedule, and in what order. This mirrors the RCDSO's advice to triage patients and reschedule those who are ill.
- Return criteria. Tie return to the standard's wording: symptoms have subsided and the period of communicability has passed, with the 24-to-48-hour gastrointestinal example spelled out.
How to Handle Immunization Records
The RCDSO standard says all oral health care workers should be adequately immunized against hepatitis B, measles, mumps, rubella, varicella, influenza, diphtheria, pertussis, tetanus and polio. It asks every worker to know their own immunization status and keep it up to date, in consultation with their physician or primary health care provider. It adds that baseline and annual tuberculosis skin testing may also be considered, and it points to the Canadian Immunization Guide for adult schedules.
The standard calls hepatitis B the most important vaccine-preventable infectious disease for all workers engaged in health care. It says the practice's immunization policy should include a record of hepatitis B vaccination and documented immunity by serology for all oral health care workers. Anti-HBs testing should be done 1 to 2 months after the 3-dose series is complete, and non-responders should complete a second series followed by retesting.
Immunization and serology records are sensitive health information. Keep them separate from general HR files, limit who can see them, and decide in your policy who holds them and for how long. If you're unsure how privacy law applies to employee health records in your practice, get advice rather than improvising.
Pro Tip: Add a hepatitis B immunity check to your onboarding checklist for every new hire who may be exposed to blood, body fluids or sharps injuries. It's far easier to collect at hire than to chase after an exposure incident.
Train It, Don't Just File It
A policy nobody has read doesn't protect anyone. The RCDSO standard says all oral health care workers must receive training that covers their exposure risks, IPAC strategies for their tasks, and the management of any work-related illness or injury. It says it is important that staff receive office-specific IPAC training at orientation, reviewed at least annually. It also says the Office Manual should include a process for recording attendance at staff meetings and continuing education.
That gives you a natural rollout plan. Walk through the new illness policy at a staff meeting, record who attended, store the policy in the Office Manual, and put an annual review on the calendar. The ADA's last item, educating team members about policies and changes, is the step most often skipped.
A One-Page Policy Outline You Can Adapt
- Purpose: protect patients and staff, consistent with the RCDSO IPAC standard.
- Reporting: who to notify, how, and by what time when you're unwell.
- Stay-home conditions: the RCDSO list, word for word.
- Work-with-precautions conditions: colds, cold sores and dermatitis, with the required precautions.
- Return to work: criteria, and who confirms them.
- Leave and pay: the ESA entitlement plus anything more generous you offer, with no medical-note requirement for ESA sick leave.
- Immunization records: what's collected, the hepatitis B serology record, storage and access.
- Exposure and illness reporting: including a confidential route for pregnant staff.
- Training and review: orientation, annual review and attendance records.
This guide is practical business information, not legal advice. Have an Ontario employment lawyer review your final policy, and check the RCDSO's current standards before you adopt it.
What does your practice do when a team member calls in sick at 7 a.m. with a full schedule? Has a written policy changed how often people come in unwell? Share your approach with other GTA practice owners, and find more practice management resources at EBIKO Dental.
Sources
- RCDSO Standard of Practice: Infection Prevention and Control in the Dental Office (approved November 2018)
- Government of Ontario: Your guide to the Employment Standards Act, Sick leave
- ADA News: No new dental requirements in updated CDC infection control guidance (September 25, 2026)
Frequently Asked Questions
Q: Can an Ontario dental practice require a doctor's note for a sick day?
Not as proof of entitlement to sick leave under the Employment Standards Act. Since October 28, 2024, Ontario employers have been prohibited from requiring a medical note for ESA sick leave, though they may ask for evidence that is reasonable in the circumstances. According to the Ontario guide, the ban applies only to proving entitlement to ESA sick leave, and medical documentation may still be needed in other situations, such as accommodation or return-to-work obligations.
Q: When should dental staff in Ontario stay home sick?
Under the RCDSO infection prevention and control standard, staff with a severe respiratory illness with fever, acute viral gastroenteritis or acute conjunctivitis must not attend until symptoms have subsided and the period of communicability has passed. For vomiting and diarrhea, the standard's example is 24 to 48 hours after symptoms resolve.
Q: How many sick days do Ontario dental employees get?
Most employees get up to 3 days of unpaid, job-protected sick leave per calendar year after 2 consecutive weeks of employment, and unused days don't carry over. An employment contract may give a greater right, which applies instead; whether it does depends on the facts of each case.