Alert: COVID-19 closures
The closure order from July 13 does not impact dental practices.
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):
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:
High chance of false negative results; negative results should be confirmed with a molecular test.
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?
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?
Why do the currently available tests give so many false-negative test results?
Should my staff and I get tested regularly?
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?
How much does it cost to get a test?
Why can’t I rely on serological testing to see if my patient has antibodies and is immune to COVID-19?
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?
Since rapid tests are already on the market, how do I determine which tests are reliable?
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?
How often will patients need to be tested?
Will testing patients before dental procedures cause them to think that the dental office is not a safe place to be?
Will training or specialized equipment be required for administering a rapid test?
Who on the dental team would be able to administer rapid tests to patients?
Would I need to get any permits or licenses to administer the rapid test in my dental office?
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