Preprocedural Pool Testing Strategy for Dentistry during the COVID-19 Pandemic

Abstract

Introduction: Aerosol-generating procedures (AGPs) put the dental health care professionals (DHCPs) at a greater risk for acquiring severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection. In late June 2020, the Centers for Disease Control and Prevention advised elective dental procedures provision to asymptomatic patients while mandating strict infection control protocol and suggested the use of preprocedural testing as an adjunct. A cost-effective method for mass preprocedural testing is pool testing, which has specificity and sensitivity similar to polymerase chain reaction. This article aims to assess the outcomes and utility of incorporating preprocedural testing protocol for SARS-CoV-2 in dental clinics before providing AGPs. Method: The patients who were recommended AGPs where rubber dam placement was not possible were advised to undergo preprocedural testing for SARS-CoV-2. Pool testing strategy was employed, and patients were asked to get tested 48 h before the day of the procedure. Results: Out of a total of 1,000 patients, who presented from June 2020 to late July 2020, 464 were recommended dental procedures. In 194 of 464, AGPs could not be performed under rubber dam isolation; therefore, the patients were advised to get a preprocedural pool test. In total, 111 patients deferred the procedure and testing. Out of 83 who got tested, 7 were positive for SARS-CoV-2, 5 of whom were tested in early June 2020 and 2 in late July 2020. Conclusion: Pool testing within its limitations can be a useful preprocedure test in asymptomatic low-risk patients for AGP in dentistry, especially when the disease prevalence is low or moderate (<10%). It has the potential of reducing testing costs significantly while conserving reagent and other resources. Preprocedure testing, however, also gives rise to certain ethical concerns that also need to be addressed. Knowledge Transfer Statement: The results of this study can be used by clinicians when deciding which preprocedure testing approach they wish to use when performing aerosol-generating procedures in asymptomatic patients with consideration of cost sensitivity and specificity values.

Dental care during COVID‐19 pandemic: Follow‐up survey of experts' opinion

“…As an adjunct, preprocedural real‐time polymerase chain reaction (PCR)‐based test for low‐risk asymptomatic patients attending AGP elective dental treatments might also be considered (Umer & Arif, 2021), while the utilization of preprocedural rapid serological tests should be discouraged due to the high frequency of false‐negative results (Tysiąc‐Miśta & Bulanda, 2020). In addition, it is still controversial whether real‐time PCR testing could be beneficial during a pandemic in dental settings.…”

Consequences of the pandemic on dental practices: a literature review

“…As a way to reduce the COVID-19 spread, Umer and Arif [16] advise dentists to test all patients 48 hours before the appointment, and that patients must remain in isolation until the time of care. To provide reliable and cost-effective testing for healthcare providers, the study used pooled testing, which can be used before dental care in asymptomatic low-risk patients and reduce the risk of spreading COVID-19.…”

“…2023;71:e20230046 CoV-2. It is also important to use the rubber dam for absolute isolation during procedures, thus reducing the amount of aerosol and saliva generated by up to 70% over a distance of up to 1 meter, as well as to perform the work with four hands, reducing the contamination of the clinical environment during consultation [8,[11][12][13][14][15][16][17][21][22][23][24][25][26]. If using a rubber dam is not possible, manual methods for performing the procedures are preferable, as the particles scattered by aerosols can travel at least 20 cm from the generating site [1,6,17].…”

The utility of pre-procedural COVID-PCR testing for dental aerosol generating procedures is questionable

“…Patients are scared of such testing, fearing that they will be labelled infection-positive. 15 Besides, an additional test would involve more time and money 20 , and, lastly, as most dental AGPs are carried out across multiple visits, the fear among patients that they will be subjected to COVID-19 testing at every visit created significant stress and anxiety among the patients.…”

“…10 Umer et al recommended pre-procedural COVID-19 pooled testing as a feasible and cost-effective approach to avoid transmission of infection in asymptomatic patients seeking dental treatment. 15 The current study was planned to assess the impact of mandatory pre-procedural COVID-19 testing on the infection status of dental healthcare workers (DHCWs) who also uses PPEs, and to determine the compliance of the patients who were offered pre-procedural COVID-19 testing.…”