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COVID-19 Testing Resources

With various forms of COVID-19 tests available, it is important to understand how each type works, what results can tell (or not tell) a provider and how reliable test results can be. It is important to note that testing can be a valuable tool to assist dentists to determine the COVID-19 status of patients, but due to current availability and reliability rates, the California Department of Public Health (CDPH) dental guidance recommends that test results (based on availability and in accordance with state-issued policy) be used in conjunction with clinical evaluation and screening protocols to assess patient health. As of July 2020, CDPH has also released COVID-19 testing guidance describing available tests and detailing the state's testing priorities. 

While testing technologies are not at a level for dentists to solely rely on results to determine how to treat patients, certain types of COVID-19 tests may currently serve the following purposes, as outlined by the federal Centers for Disease Control (CDC):

  • Confirming infection within symptomatic individuals.
  • Confirming infection of asymptomatic individuals with recent known or suspected exposure to SARS-CoV-2.
  • Testing asymptomatic individuals without known or suspected exposure to SARS-CoV-2 that are in special or high-risk settings (e.g., long-term care facilities, correctional facilities).
  • Testing to determine resolution of infection (e.g., infected healthcare providers returning to work, discontinuation of home isolation) Note: antibody testing cannot be used to determine the resolution of infection and the EEOC prohibits an employer from requiring an antibody test.
  • Public health surveillance.

Currently, there are no FDA-approved tests for COVID-19. However, during declared public health emergencies, the FDA can issue emergency-use authorizations (EUAs). So far, the FDA has granted EUAs to more than 100 companies during the COVID-19 pandemic. Since tests currently on the market have not gone through the typical FDA approval process, the reliability and sensitivity of each type of test can vary significantly. Below is a chart illustrating current COVID-19 testing technologies:
 

Test Type  Common Name(s) Test Administration  What does it do? Processing Time  Reliability Use in dental office?
Molecular Diagnostic test, viral test, RT-PCR test Nasal swab
(throat and saliva also possible)
Shows whether patient has a current COVID-19 infection via fragments of viral RNA As quick as same day, as long as one week depending on lab capacity High reliability 1-2 days before symptom onset No, must be sent to a lab for processing
Serology Test Antibody Test Finger prick, blood draw Shows whether patient has been infected by COVID-19 in the past via antibody response to viral protein targets. Test does not prove immunity As quick as same day, as long as three days depending on lab capacity Must be 7-14 days after symptom onset. Reliability is questionable and a second test is usually needed for confirmation No, cannot use to diagnose current COVID-19 infection
Antigen Test Point of Care Test,
Rapid Test
Nasal or throat swab Shows whether patient has a current COVID-19 infection via detecting fragments of viral proteins One hour or less, potentially a few minutes

High chance of false negative results; negative results should be confirmed with a molecular test.

Its immediate results and simplicity to administer make it most suitable for dental office testing; however, in-office testing will not likely be widely recommended until tests are more reliable and accessible

Testing FAQs

While the COVID-19 pandemic continues to change rapidly, we can look to current testing technology to answer some of the common questions about testing in dental settings:

Is COVID-19 testing within a dentist’s scope of practice?

  • While CDA does not anticipate an official statement from the Dental Board of California, the California Dental Practice Act states that the scope of practice of a dentist includes all necessary related procedures needed to provide dental treatment. Testing prior to proceeding with care falls within this definition, however, a dentist must be appropriately trained prior to administering a COVID-19 test. Tests administered by a dentist and test results should be noted in the patient’s dental record.

Since there are different types of tests, what considerations are there for dentistry? 

  • When thinking about the benefit of testing and the types of tests available, it is important to focus on the primary purpose for the test. Public health and physicians are primarily testing for viral particles or antigens to identify people who are infected with SARS-CoV-2. This allows them to ensure individuals get the care they need early on, isolate from others and allows tracking of transmission and disease rates. For this purpose, the best test is one that produces low false positives.  Every false positive in medicine sets additional, potentially resource intensive actions into motion, so a low false positive rate is essential.

    In dentistry, however, it is important to know if the patient needing dental treatment is COVID-19 negative so treatment can proceed; dentistry is trying to detect those who are not infected with SARS-CoV-2 virus. This means that dentistry needs to avoid using a test that has a high false negative rate. Every false negative in dentistry potentially increases the risk of disease transmission to others, so a low false negative rate is essential.

    Additionally, for monitoring the extent of spread that has occurred in a community, researchers and public health officials may test to detect antibodies.

    These differences mean that dentistry will be looking through a different lens and responding differently in the testing environment than will medicine or public health – though we anticipate that continued work on COVID-19 testing will eventually produce a test or tests that can reliably be used in all environments that will benefit from testing.

I’ve heard that the nasal swab test diagnostic test hurts, is that true?

  • On April 29th, the CDC removed its preference for nasopharyngeal swabbing for testing. Those who were tested prior to May reported painful testing that could induce tears, bloody noses, and sneezing on the provider administering the test. The tests available at many community testing centers are now known to be pain-free and very comfortable.

Why do the currently available tests give so many false-negative test results?

  • Testing technology is continuing to evolve as researchers learn more about the virus. In particular, researchers are learning more about how the sample is collected, stored and processed affects the results. A weak test medium or the wrong method of transportation can alter the result. There are ongoing efforts to understand these elements more completely to address the current shortcomings of all three test modalities depicted in the chart above.

Should my staff and I get tested regularly?

  • The CDC currently does not recommend regular testing of non-suspected COVID-19 cases (no symptoms and no “close contact” exposure), and since you cannot rely solely on the result of a test due to differences in availability and reliability, it might not provide additional valuable information for the health of the non-exposed dental team member.

What should I do if a patient or dental team member reports symptoms or a positive test result?

Should I ask my patients to get tested prior to dental appointments?

  • The answer to this is not a simple yes or no, but depends on a number of factors, including the procedure the patient needs, the community transmission rate and whether tests are readily available. If tests are not readily available, it may be logistically difficult to do this for most patients. However, if community transmission rates are high and tests sites are easily accessed, it may begin to make sense before some procedures. It will take your professional judgement to evaluate a number of factors – and certainly, as testing is easier, quicker and more reliable, this decision will become easier, too.
  • Most importantly, dental teams should be implementing a suite of screening protocols, including telephone questionnaires prior to the date of the appointment and temperature checks to help identify people who may be in the early stages of the disease and do not recognize they are ill.
  • Additionally, because test results are not a reliable source for determining COVID-19 status at this time, dentists should not change PPE or infection control protocols on the basis that the patient has received a negative test result. Please also note that if a local authority requires testing prior to certain dental procedures, dental offices must comply with local mandates.

How much does it cost to get a test?

  • Public health testing, conducted through local health departments, as has been occurring in San Francisco, Sacramento and several other communities are provided at no cost. This is, in part, due to the Families First Coronavirus Response Act (FFCRA), which is federal legislation that was signed into law on March 18, 2020. This law mandates that anyone can receive free COVID-19 tests for the duration of the public health emergency, regardless of insurance plan type or lack of insurance.

Why can’t I rely on serological testing to see if my patient has antibodies and is immune to COVID-19?

  • The absolute sensitivity of the serology test is unknown. Patients tested early after an infection may not have enough detectable antibodies despite active infection, and not all patients will develop a detectable antibody response to a SARS-CoV-2 infection. Additionally, it is unknown how long antibodies will remain present in the body system after infection, whether the presence of antibodies confer immunity to infection, and if so, for how long.
  • Since it is still unknown whether a positive serology test means that a patient has an active infection or is immune from the disease, proper infection control and PPE measures should be taken.

I’m getting ads from companies that are selling test kits to dental offices. Which COVID-19 tests can I administer in my dental office right now?

  • Some of the tests being advertised to dental offices are serological antibody tests that do not detect active COVID-19 infection and therefore are not able to help the dentist make a better decision about providing dental care to the patient. The rapid tests on the market at the time of this writing have a higher-than-acceptable rate of false-negative results and according to the FDA, should be confirmed with a molecular test which means that rapid tests are currently not useful for point-of-care use in dental offices. Additionally, dentists should employ a “buyer beware” mentality when purchasing testing kits, as there is a large “gray market” containing counterfeit products or testing kits that are not yet EUA certified by the FDA. It is important to note that EUA certifications do not go through the same rigorous review as typical FDA approvals. Once the national public health emergency declaration is removed, EUAs will no longer be valid unless manufacturers go through the regular FDA approval process.
  • CDA will keep members updated as the FDA continues to work with test developers to approve a point-of-care test that is readily available, reliably accurate and can be implemented in a dental office setting.

Since rapid tests are already on the market, how do I determine which tests are reliable?

  • You can check which devices have an emergency use authorization by the FDA here. However, it is important to research to see the reliability of tests before purchasing. CDA will continue to keep dentists updated once a reliable rapid test is available for dental office use at the COVID-19 Newsroom

If a reliable and rapid test that can tell whether a patient is currently infected does become available:

How will I get reimbursed for administering rapid tests?

  • It is unclear whether federal law mandates the coverage of COVID-19 tests for medical plans only or includes dental benefit plans, and at what rate rapid tests will be reimbursed. It is likely that testing will be covered exclusively under medical plans, similar to other diagnostic tests. Also similar to obtaining reimbursement for diagnostic tests, dentists may find it challenging to bill dental or medical plans for COVID-19 tests. CDA is advocating for the coverage of COVID-19 testing under dental plans, although coverage may be determined individually by each dental plan carrier.
  • Medi-Cal will likely cover testing for beneficiaries as it is classified as a medically necessary service, but DHCS has yet to release information about reimbursement rates or periodicity limits for the test.

How often will patients need to be tested?

  • If a reliable and rapid test becomes widely available, it may be possible that a dentist could test patients at or shortly before each dental appointment. However, because such reliable and rapid tests are not currently available, it’s not considered feasible at this time to test patients for each dental appointment.

Will testing patients before dental procedures cause them to think that the dental office is not a safe place to be?

  • Educating your patients is key during these times. Dental offices have always been safe, and the extra precautions taken during the COVID-19 pandemic create an even safer experience for patients. Testing patients prior to dental services provides yet another community checkpoint for patients to ensure they receive the proper care and to help mitigate further spread of the disease.

Will training or specialized equipment be required for administering a rapid test?

  • Until a widely available and reliable rapid test is on the market, the specifics about training, periodicity, and equipment required are not clear. However, we anticipate minimal training, perhaps limited to manufacturer instructions, and minimal PPE to be required for rapid tests.

Who on the dental team would be able to administer rapid tests to patients?

  • COVID-19 rapid test administration will be dependent on what types of samples are needed. Individuals eligible to administer a blood prick rapid test will be different compared to those qualified to perform a saliva swab test. CDA will continue to provide updates and guidance as technology develops.

Would I need to get any permits or licenses to administer the rapid test in my dental office?

  • If dentists are administering point of care COVID-19 tests to patients as opposed to sending test samples to an offsite lab for processing, they must obtain a Clinical Laboratory Improvement Certificate of Waiver (CMS-116 form) from the federal Centers for Medicare & Medicaid Services and laboratory registration from the California Department of Public Health.
  • There are currently fees associated with both federal and state permits. Organized dentistry is advocating to have fees waived should reliable and rapid tests become available for dentists to administer and process in their offices. CDA will continue to keep members updated on these efforts.

Resources

Center for Disease Control and Prevention. Guidance for Proposed Use of Point of Care Testing Platforms for COVID-19.

Center for Disease Control and Prevention. Overview of Testing for SARS-CoV-2.

Food and Drug Administration. Coronavirus Testing Basics.

California Department of Public Health. Healthcare Provider Guidance for COVID-19 Testing.

California COVID-19 Testing Taskforce. COVID-19 Serology Testing Indications.

University of Minnesota Center for Infectious Disease Research and Policy. Smart Testing for COVID-19 Virus and Antibodies.

Last updated: July 16, 2020