Many saw the waning stage of the COVID-19 pandemic as imminent. Unfortunately, COVID-19 cases have increased since October, 2020. As a response, more testing options are being offered to the public.
Implementing safety procedures at a dental practice keeps your patients and staff safe. Almost 70 percent of dentists in the country seek to conduct in-office COVID-19 testing.
In this article, Paul Jackson, principal researcher for Benco Dental, shares the Centers for Disease Control and Prevention (CDC) and American Dental Association (ADA) recommendations on COVID-19 testing. The following information can help safely and efficiently manage dental practices as the coronavirus continues to spread globally.
What is needed to conduct testing at a dental practice?
COVID-19 is a virulent respiratory disease that can affect practices dramatically. People who over age 80 with hypertension and heart disease are most vulnerable to the disease. Thirty-nine to 40 percent of the deaths include those in nursing homes.
Most are familiar with these numbers. However, because a person is more contagious soon after exposure, the virus is more infectious even before a person shows some symptoms or a test detects the virus.
How do these factors impact a practice?
The problem: those at the practice maybe infected with COVID-19 but not show any symptoms. Such an incident may endanger dentists, patients, and the dental team.
What does a dentist need to know about COVID-19 testing?
Below, find helpful information regarding exposure and detection of COVID-19:
1. The R0
The R0 (pronounced as “R naught”) indicates how contagious a transmissible virus is. It refers to a population of people who have not been infected by the virus, or received any vaccinations.
In 1918, 50 million people were killed during the global outbreak of the swine flu (H1N1 virus). It was estimated that the R0 value of the 1918 pandemic was between 1.4 and 2.8.
When a new strain of H1N1 recurred in 2009, it was reported that the R0 value changed to 1.4 and 1.6. When vaccines and antiviral drugs became available, the outbreak became less lethal.
According to research, the R0 for COVID-19 is between 1.4 and 5.7. This data suggests that a person with COVID-19 can transmit the coronavirus to 5 to 6 people. In addition, at least 82 percent of the population needs to be immune to COVID-19 to prevent its spread with vaccination and herd immunity.
However, for those who are asymptomatic from the coronavirus, the R0 is unknown.
2. Sensitivity and specificity
It is crucial to evaluate which type of COVID-19 test to conduct at a dental practice. Do so by understanding two essential concepts in medical testing: sensitivity and specificity.
Sensitivity shows how often a test accurately produces a positive result for people who have the disease. A susceptible test will flag almost everyone who has the disease and not form several false-negative results.
Specificity measures the ability of the test to reflect a negative result for people who do not have the disease.
What are the types of COVID-19 tests?
Following are the types of COVID-19 tests, to help decide which serves best for a practice.
| Type of test | What it detects | Procedure | Point-of-care (POC) availability | Turnaround time |
| RT-PCR testing | It can detect if a person has the SARS-CoV-2 through the presence of an antigen. | Specimens are collected through nasopharyngeal or oropharyngeal swabs. | No. It must be carried out in the laboratory. | Approximately 48 hours. * Receiving results may take longer depending on the testing lab’s capacity. |
| RT-LAMP testing | It has a higher specificity than RT-PCR in detecting the SARS-CoV-2. | Samples are collected through nasopharyngeal or oropharyngeal swabs. | Yes. It can be conducted even in airports and rural hospitals. | 30 minutes |
| Antigen testing | It diagnoses respiratory pathogens like influenza viruses and respiratory syncytial viruses. | Specimens are collected through a lower nasal swab. | Yes. It can be done at POC. | Approximately 15 minutes |
| Antibody testing | It identifies the presence of antibodies in the blood after infection. The test does not determine if a person is currently infected. Instead, it detects if one had past contamination with SARS-CoV-2. | Blood samples are extracted from the person who was infected with the SARS-CoV-2. | Yes. It can be done at POC. | Antibodies are commonly traceable 1 to 3 weeks after symptoms relapse. |
All the tests mentioned are approved by the FDA and utilized worldwide. Those planning to administer a test at a dental practice should choose a test that can be performed at Point of Care (POC). Note that tests are helpful, yet they still have their respective limitations.
What’s the best strategy for a dental practice?
Given that safety regulations are ever-evolving, there is no guarantee as to the best strategy across all practices. However, the CDC and ADA have provided safety recommendations that all dental clinics must follow.
CDC guidelines for pre-screening dental patients:
- Conduct a pre-visit screening via phone call;
- Ask the patient to notify the office if infected;
- Request they limit the number of companions to only those necessary;
- Advise patients that they must wear face masks when they visit the clinic; and
- Perform a temperature check upon entering the office.
In addition to wearing full PPE, all staff members must undergo weekly testing.
Dentists must also abide by the ADA guidance on COVID-19 testing at their clinics. Dental staff must thoroughly assess each test and see which best fits their requirements.
Authorized dentists are qualified to conduct COVID-19 diagnostic tests within their practice once they possess a Clinical Laboratory Improvement Amendments (CLIA) waiver license.
To obtain a CLIA waiver, dentists must apply and pay a $150 application fee. The ADA is currently requesting that the U.S. Congress dismiss the certificate requirement or, at least, the application fee.
The world is still discovering the full impact of COVID-19 and its implications. Constant changes in safety guidelines suggest that everyone should stay current with the COVID-19 testing recommendations and regulations. Also, visit shop.benco.com to access useful and relevant resources for your practice.
Sources:
https://wwwnc.cdc.gov/eid/article/12/1/05-0979_article
https://wwwnc.cdc.gov/eid/article/26/7/20-0282_article
https://www.cms.gov/Regulations-and-Guidance/Legislation/CLIA
https://www.ada.org/en/publications/ada-news/2020-archive/april/ada-advises-dentists-to-follow-science-backed-guidance-regarding-covid-19-testing
