key: cord-0778967-s0ig5x3h
authors: Feldman, Cecile A.; Fredericks-Younger, Janine; Subramanian, Gayathri; Gennaro, Maria Laura; Coker, Modupe; Fine, Daniel
title: SARS-CoV-2 screening to augment dental office and patient safety
date: 2022-01-24
journal: J Am Dent Assoc
DOI: 10.1016/j.adaj.2021.12.011
sha: aaa784670b41208e56766412da1a17ec2fa7bfc5
doc_id: 778967
cord_uid: s0ig5x3h

nan

Commentary 1 SARS-CoV-2 screening to augment dental office and patient safety 2 3

The COVID-19 pandemic underscores the need to address potential risk of transmission of 4 infectious diseases among dental healthcare workers (DHCWs) and patients. As with the emergence of other novel pathogens, infection control protocols have dramatically changed 1 6 over the last two years. Prior to the 1980s, dentists rarely wore eye protection, masks or gloves.

Our experience with HIV changed that. Today, our protocols include enhanced personal 8 protective equipment (PPE), environmental disinfection, and ventilation upgrades. 2

During the height of the COVID-19 pandemic, dental offices were forced to close, depriving 11 patients of essential healthcare services. As offices began reopening, both DHCWs and patients 12 were hesitant to return. Despite low dental office transmission of the SARS-CoV-2 virus 3 , worry 13 still exists. Today, almost two years since the pandemic began, our workforce is greatly 20 safer if they were tested weekly for COVID-19, 54.5% indicated feeling safer if their co-workers 21 were tested and 68.0% indicated feeling safer if patients were tested prior to start of treatment.

These survey results are unpublished at this time but survey data can be made available by 23 written request to the corresponding author.

In addition, 21 patients participating in a COVID-19 pilot study were asked about their perceptions of COVID-19 testing in dental offices. Patient preferences strongly favored ongoing 27 COVID-19 testing. When asked 28 does knowing that all patients are tested make you feel safer when coming for your dental 29 appointment, 94.7% said yes, does knowing that your dental and office staff are regularly tested 30 make you feel safer, 100% said yes. When asked if you had a choice going to a dental office

where patients and staff are tested or not tested, 89.5% preferred an office that tested. And 32 when asked to rate on a 5-point Likert scale does taking a COVID-19 test before treatment 33 make you feel more or less comfortable going to the dentist, with 1= a lot more comfortable, 34 through 5 = a lot less comfortable, the mean score was 1.63 (SD=0.68), suggesting that patients 35 would likely favor a dental office that performed regular SARS-CoV-2 screening.

Measures that increase perception of DHCW and patient safety may enhance access and triage and testing, has become standard practice in many healthcare environments but is not 46 widely adopted in dentistry. Factors such as testing availability, cost, convenience, administrative burden of CLIA waiver certification and result-reporting, as well as understanding 48 the rationale for testing and its acceptance, may influence adoption of screening for SARS-CoV-symptomatic workers and patients, it does not identify infected but asymptomatic individuals. In contrast, the more protracted turnaround time for the PCR gold standard tests may identify 74 patients with very low viral loads that have been out in the community through peak infectivity 75 before being directed to quarantine, especially if asymptomatic. Worse, this may result in misconception that the rapid antigen tests are less useful because of lower accuracy as 79 compared to PCR-based testing. 16 In fact, the rapid turnaround POC delivery and lower sensitivity may be the key features that enhance the rapid test's usefulness.

A high negative predictive value (NPV), a high percentage of true negative test results to all 83 those who test negative, provides assurance that the risk of contracting an infectious disease 84 from a patient or co-worker would be minimal, given how unlikely it is that the patient or co- sense of safety. PCR viral testing, perceived to be the more accurate, can also be used in a 170 dental office to identify potentially infectious workers and patients but will likely also identify 171 individuals who are not infectious but have sub-threshold viral loads or remnant viral particles.

Rethinking Covid-19 Test Sensitivity -A Strategy for

The authors wish to thank Veerasathpurush Allareddy, Cyril Meyerowitz, MaryAnn McBurnie, Ellen Funkhouser, Pat Ragusa, Sara Gill and Julie Chapman-Green for their guidance and assistance.

This investigation was supported by NIDCR/NIH awards X01 DE030407 and National Dental PBRN infrastructure awards, U19 DE028717 and U01 DE02872. The opinions and assertions in this article are those of the authors and are not to be construed as necessarily representing the views of the organizations the authors are affiliated with, the organizations that participate as network regions or the National Institutes of Health.