This page outlines applicable guidance for dentists who are considering performing Antigen POCT in their practice. This guidance applies only to the performance of Antigen POCT for patients. Dentists with questions about testing for office staff are advised to seek independent legal advice to ensure compliance with statutory responsibilities, including those related to health and safety in the workplace.
A list of frequently asked questions is also available at the bottom of this page.
Point-of-care testing (POCT) refers to testing that employs an approved COVID-19 medical device for point-of-care use in which analysis is done at or near the point of specimen collection (also referred to as ‘rapid testing’).
Dentists who are considering conducting Antigen POCT in their practice must do so in keeping with applicable guidance set out by the Ministry of Health and Long-Term Care, the Chief Medical Officer of Health, and the Royal College of Dental Surgeons of Ontario, as well existing legal and professional obligations related to consent to treatment, record keeping, and infection prevention and control.
Ministry of Health: Requirements for the Performance of Antigen POCT
Dentists who are considering performing Antigen POCT must comply with the requirements set out by the Ministry of Health and Long-Term Care in the following document: COVID-19 Guidance: Considerations for Antigen Point-of-Care Testing.
This document sets out comprehensive guidance for the performance of Antigen POCT by healthcare workers, including requirements for eligibility, consent, privacy, and reporting.
Key elements of the Ministry’s guidance include (but are not limited to):
- Antigen POCT is appropriate for use in asymptomatic individuals only.
- Antigen POCT is used for screening purposes only and should not be used for diagnosis.
- Antigen POCT does not replace public health measures such as symptom screening, physical distancing, masking, and hand hygiene.
- Prior to initiating Antigen POCT, dentists should make their local public health unit aware that they will be doing so.
- Any positive results from Antigen POCT must be reported to the local public health unit, in accordance with the Health Protection and Promotion Act, 1990.
- Any positive results from Antigen POCT must be confirmed with laboratory-based polymerase chain reaction (PCR) testing.
RCDSO’s COVID-19 Guidance Document Continues to Apply
Because Antigen POCT is best thought of as a supplement to existing screening protocols, rather than a diagnostic tool, the result of an Antigen POCT does not alter the College’s existing guidance in respect to the provision of care. Dentists using Antigen POCT as a supplementary tool for patient screening must continue to meet all of the same requirements for the provision of oral health care, including requirements for the use of PPE, set out in the College’s existing COVID-19: Managing Infection Risks During In-Person Dental Care Guidance Document and accompanying FAQ.
RCDSO: Additional Guidance for the Performance of Antigen POCT
In addition to the guidance set out above, dentists performing Antigen POCT must also comply with the following:
- Dentists must ensure that all testing is done in accordance with dentists’ scope of practice and in compliance with any restrictions concerning the performance of controlled acts.
- This means that dentists performing Antigen POCT must only utilize approved techniques for specimen collection that are within dentists’ current scope of practice, including (as examples): deep and lower nasal collection as well as combined swabbing of throat and both nares. Dentists must not perform nasopharyngeal swabs for specimen collection as this is a controlled act and outside the scope of practice of dentistry.
- A limited exception to this requirement applies to dentists practising in hospital settings. The Provincial Government recently introduced new regulations that permit dentists practising in hospital settings to administer care that is outside of their normal scope of practice if certain conditions are met (for example: the care is necessary to respond to, prevent, or alleviate the effects of the COVID-19 pandemic, and the services provided are consistent with duties and/or privileges granted by the hospital). For more information concerning this limited exception, see the College’s COVID-19 Update: Expanded Scope of Care for Dentists in Hospital Settings news release.
- Dentists may offer Antigen POCT to patients as a supplementary screening tool, but patient choice concerning whether to be tested must be respected, and dentists must obtain informed consent from the patient prior to administering the test in keeping with legislative requirements and the College’s guidance.
- Dentists must not charge patients a fee for the performance of an Antigen POCT.
- Dentists who wish to offer Antigen POCT to staff are advised to seek independent legal advice to ensure compliance with statutory responsibilities, including those related to health and safety in the workplace.
- Royal College of Dental Surgeons of Ontario: COVID-19: Managing Infection Risks During In-Person Dental Care; COVID-19 FAQ
- Ministry of Health and Long-Term Care: COVID-19 Guidance: Considerations for Antigen Point-of-Care Testing, Version 4.0; COVID-19 Provincial Testing Guidance Update, Version 11.0
- Laboratory and Specimen Collection Centre Licensing Act, 1990
Is Antigen POCT mandatory in the dental office?
There is no requirement to institute Antigen POCT in a dental office. Should a dentist wish to offer this service for their patients, they must ensure that all Ministry and College requirements are met.
Who may be tested using Antigen POCT?
All patients must continue to be screened using the Ministry’s screening checklist.
Antigen POCT is only intended for asymptomatic patients who screen negative on the Ministry’s screening checklist.
Patients who screen negative on the Ministry’s checklist may be tested with Antigen POCT (with their consent).
Patients who screen positive on the Ministry’s checklist should not be tested with Antigen POCT. These patients must continue to be addressed according to the College’s COVID-19 guidance document.
What should I do if a patient tests positive using Antigen POCT?
A positive result for Antigen POCT is considered a preliminary positive.
Patients who receive a positive result through Antigen POCT must:
- Seek an immediate laboratory PCR test (i.e. within 24 hours) to confirm the result, as per Provincial Testing Guidance; and
- Immediately self-isolate until the result of the confirmatory lab-based PCR test is known.
Do I have a duty to report a patient who tests positive using Antigen POCT?
Yes. All preliminary positive results from Antigen POCT must also be reported to the local PHU (Public Health Unit).
A list of local PHUs is available here.
If you are unsure about your public health region, you may access the Public Health Unit Locator online tool.
Where can I purchase POCT equipment and materials?
The College does not endorse or approve any particular brand or company. As with any other equipment or materials, dentists are expected to find and vet appropriate companies who meet the minimum requirements for these products.
Antigen POCT may only be performed using a COVID-19 medical device that has been authorized by the Minister of Health (Canada) for point-of-care use and is available in Ontario.
If you have questions, please contact email@example.com.
Can I advertise that my office now offers POC testing for patients?
Yes. However, the College’s Practice Advisory on advertising applies.
Can I charge a fee for POC testing for patients?
No. Dentists must not charge patients a fee for the performance of an Antigen POCT.
What are the recordkeeping requirements for patients with respect to Antigen POCT?
The College’s Guidelines on Dental Recordkeeping apply.
Specifically, dentists must:
- Obtain and record patient consent or refusal for POC testing in the patient’s chart.
- Record results of the POC test in the patient’s chart.
- Record the instructions that were given to the patient following communication of the POC test results, including referral to their local PHU (Public Health Unit) for follow-up testing if indicated.
What are the IPAC (infection prevention and control) requirements with respect to Antigen POCT?
The College’s Standard of Practice on Infection Prevention and Control in the Dental Office and COVID-19 guidance applies.
Specifically, dentists must:
- Ensure that one time use, disposable items are appropriately discarded following a single use.
- Ensure appropriate PPE (personal protective equipment) is worn by health professionals performing Antigen POCT.
- Ensure that equipment used for Antigen PCOT is appropriately disinfected following each use.