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.
The Ministry of Health and Long-Term Care has introduced legislative amendments to the Laboratory and Specimen Collection Centre Licensing Act, 1990 that enable healthcare workers, including dentists, to perform Antigen Point-of-Care Testing (Antigen POCT) for COVID-19.
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 (the Ministry) in the following document: COVID-19: Integrated Testing & Case, Contact and Outbreak Management Interim Guidance: Omicron Surge.
This document sets out guidance for the performance of Antigen POCT by healthcare workers, including requirements for eligibility and reporting. Key elements of the Ministry’s guidance include (but are not limited to):
- Due to the current prevalence of infections, the presence of symptoms and/or a positive Antigen POCT result are strongly indicative that an individual is COVID-19 positive, and absent further confirmatory testing the patient should be treated as if they are positive.
- Antigen POCT is primarily used for screening and cannot conclusively confirm a diagnosis of COVID-19.
- 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.
- The Ministry no longer requires that positive results from Antigen POCT be confirmed with laboratory-based polymerase chain reaction (PCR) testing or be reported to the public health unit.
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
- 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?
In dental practice settings, Antigen POCT is primarily intended as a supplement to the Ministry’s screening checklist, which must be completed by all patients.
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 (see RCDSO’s COVID-19: Managing Infection Risks During In-Person Dental Care and document and COVID-19 FAQ).
What should I do if a patient tests positive using Antigen POCT?
Given the current prevalence of COIVD-19 in the community, a positive Antigen POCT is highly indicative that the individual is COVID-19 positive.
Positive results from Antigen POCT do not need to be confirmed by PCR/rapid molecular testing and do not need to be reported to the public health unit. Following a positive result, the individual and their household members must self-isolate, as per the Ministry of Health’s self-isolation directions.
Patients who test positive on an Antigen POCT will screen positive on the Ministry of Health’s COVID-19 Patient Screening Guidance Document (Q4: Has the person tested positive for COVID-19 in the past 10 days or have they been told they should be isolating?). According to the College’s COVID-19: Managing Infection Risks During In-Person Dental Care guidance document, patients who screen positive for COVID-19 must not be treated in-person except as needed for emergency or urgent care that cannot be delayed.
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 firstname.lastname@example.org.
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.
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.