Last updated on November 24, 2020
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:
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, and test results should be noted in the patient’s dental record.
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 the 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.
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.
The CDC currently does not recommend regular testing of nonsuspected COVID-19 cases (no symptoms and no “close contact” exposure), and because 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 nonexposed dental team member.
Refer to CDA’s Symptoms/Positive Test for COVID-19 Flowchart to guide you through the process of reporting symptoms and positive tests for COVID-19.
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.
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.
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 and any tests that do have EUAs have not been cleared for use on individuals who are asymptomatic. 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.
You can check which devices have an emergency-use authorization by the FDA here. Please note that at this time there are no rapid tests approved for use on asymptomatic individuals. CDA will continue to keep dentists updated once a reliable rapid test is available for dental office use at the CDA Newsroom.