For dental professionals, the term ‘aerosol generating procedure’ (AGP) has been part of the infection control landscape for years, especially following the COVID-19 pandemic. AGP status has determined PPE requirements, shaped how clinical sessions are planned, and been incorporated into practice policies across the UK. That framework is now set to change.
The NIPCM
The National Infection Prevention and Control Manual (NIPCM), maintained by ARHAI Scotland, sets the standard for infection prevention and control across NHS healthcare settings in Scotland; however, Wales has also adopted the Scottish NIPCM directly, meaning the standard also applies to all healthcare organisations in Wales.
England also bases its own NIPCM on the Scottish manual, adapting and updating it independently, therefore, any significant change to the Scottish NIPCM has the potential to initiate changes in England as well.
What is being reviewed and why?
ARHAI Scotland has reviewed over 26,000 scientific papers published since 2000. The review has examined whether the categories ‘droplet’ and ‘airborne’ used to describe how infection spreads are still fit for purpose, and specifically whether the evidence supports the AGP framework as it currently stands.
The terms ‘droplet transmission’ and ‘airborne transmission’ are to be replaced with new definitions. AGPs will be withdrawn from upcoming guidance along with associated fallow times. There will no longer be a finite list of procedures to which specific precautions apply.
The World Health Organization and the US Centers for Disease Control and Prevention have undertaken parallel reviews, reflecting a broader international shift in how transmission is understood.
What will replace AGPs?
Rather than a fixed list of procedures, respiratory infectious agents will be categorised according to the hazard they pose. This becomes the starting point for determining which type of mask (a fluid-resistant surgical mask (FRSM) or a respirator) is required. The focus shifts from the procedure being performed to the infection risk the patient presents.
Other confirmed changes include consideration of vulnerable healthcare workers, personal choice to select RPE when an FRSM is indicated, and a requirement that masks be donned on room entry and worn throughout the time spent in a room with the patient.
ARHAI Scotland has confirmed that guidance on these is changing based on research evidence, and that the benefit of the changes outweighs any potential harm. Supporting resources and education are planned to be published alongside the changes.
What does this mean for dental practices?
Appendix 16 of the Scottish NIPCM explicitly lists dental procedures using high-speed devices such as ultrasonic scalers and high-speed handpieces as AGPs. Both the AGP classification and associated fallow times will be withdrawn under the new guidance.
The practical implications for dentistry will depend on how the new hazard-based framework is applied in dental settings and whether dental-specific guidance is updated accordingly. Precisely how this will translate into dental-specific requirements is yet to be confirmed.
Guidance changes are expected in August 2026 and are anticipated to impact Scotland and Wales.
What about England?
England maintains its own version of the NIPCM that is updated independently of the ARHAI review. At the time of writing this, NHS England has not announced an equivalent review.
We have therefore written to NHS England directly to ask whether a corresponding review is planned and will update practices should we receive a response. For now, dental practices in England should continue to follow existing guidance, including the current NIPCM for England and HTM 01-05.
Summary
Following the comprehensive review of respiratory transmission evidence, the withdrawal of the AGP framework represents a fundamental shift in how infection control will be approached in dental settings across Scotland and Wales, with potential implications for England to follow. Agilio is committed to being ahead of the curve, monitoring developments closely and engaging with emerging guidance so our customers are never left trying to interpret a new framework without support.
Once the revised guidance is published in August 2026, we will begin reviewing all relevant documents in our system and will communicate clearly to practices when updates are available and what, if anything, they need to do.
If you have any questions about what these changes might mean for your practice, please do not hesitate to get in touch.
