According to ICMR, dentists will have to take permission from their respective state health authorities to conduct Rapid Antigen Tests (Image: fernando zhiminaicela/Pixabay)
Rapid Antigen Tests are an easy and economical option for dentists to use in their clinics to identify the potential Covid-19 spreaders visiting their dental clinics. However, these tests are not available for dentists. A letter that was sent to health authorities and ICMR on 17 Sept 2020 has finally received a response on 1 Nov 2020. Read the ICMR responses below.
A letter was sent to ICMR and health ministry on 17 Sept 2020 requesting clarification on the use of Rapid Antigen Tests by the dentists. Although the response from PMO office was instant and the letter was promptly forwarded to concerned authorities, it took almost 1.5 months of follow up to get a response from ICMR.
Subsequent to this letter, Dr Rajeev Chitguppi had asked ICMR to provide clarification on certain questions, to which ICMR finally responded on 1st Nov 2020. Read the questions and responses below.
Question 1. What should dentists do to screen their patients with 'Rapid Antigen Tests'?
Question 2. Which private labs conduct these tests where dentists can refer their patients?
Question 3. Can dentists do Rapid Antigen Tests in their clinics if they learn how to take swabs?
Answers to Q 1, 2, 3:
ICMR has authorized all State Govt. to give independent access to suitable Govt./Private institutions to start Rapid Antigen Test (RAT). Letter issued by Secretary-DHR & DG-ICMR in this regard is available on the ICMR website https://www.icmr.gov.in/pdf/covid/labs/District_wise_Rapid_antigen_testing.pdf. Therefore, you are advised to contact the respective State Health authorities to know the name of the sites which are conducting RAT. If you want to start RAT at your clinic, you will need to get permission from the State Govt.
Question No. 4:
Can dentists do saliva-based Rapid Antigen Tests? (Taking samples will be easy)
Question No. 5: If dentists purchase antigen test kits from the vendors and give it to their nearby private labs, will it be legal?
Answer: As indicated above, you will need to obtain the permission of the State Health authorities to conduct RAT.
So these were the answers given by ICMR. Now let's go their advisory. If you read the ICMR advisory dated 4 Sept 2020 on "Strategy for Covid-19 testing in India" (click here to read), it states that ICMR’s advisory is generic in nature and may be modified as per discretion of the state health authorities.
So now it becomes imperative for Dental Council of India and Indian Dental Association state branches to pursue the matter further, contact their respective state health authorities and get approvals for the dentists of their individual states.
Dental Tribune South Asia had earlier published a detailed article on how to make use of Rapid Antigen Tests and separate them from RT PCR tests. Click here to read the 27 Aug 2020 article
What a speedy government actvity it is ? It takes almost one and half months to get a response on an emergency issue. I had also such experience that the issue raised by me on mail was implemented after a month in Gujarat
Good if we are allowed to do RAT.DCI can direct IDA head office to ask local branches to persue the matter from local medical authority and get the permission from them for it.
1.Normally the risk from people who visits dental offices if we assume then most likely will be asymptomatic carriers, so what benefit RAT will hold as for them RT PCR would be the gold std.
2. Ans may be in presence of other viral infections like flu or whatever to exclude covid 19 but anyway everyone will defer elective dental Rx then,
3. Point is to develop a test which has sensitivity and specificity comparable to RT PCR and also is a cost effective, like testing inner side of mask of people (worn for enough amount of time)with their sneeze plus saliva based plus rapid test, and the results of which can be within 20 minutes.
Answers from Dr Rajeev Chitguppi:
1. RT PCR is the gold standard for infection only. It’s not the gold standard for infectivity. Antigen test perfectly identifies those who are infectious.
2. We don’t need a test that is as sensitive as PCR. We just need a test which is highly specific. The high sensitivity of PCR has a problem in that it will identify even those who are not spreaders. This is because of the amplification of scant genetic material of viral RNA. High sensitivity (PCR) is needed to identify who is infected, not to identify who is infectious. So high sensitivity of PCR is a disadvantage for a dental clinic. Antigen tests with low sensitivity and high specificity perfectly fit the requirement.
3. Antigen test is already cost-effective and quick. Addresses all issues.
Please IDA and DCI take this matter to State health authority also we need your support for our enrollment for Covid19 vaccine as MBBS doctors data is collected, form says to cover Dentist but forms are not sent
We had kept our clinic closed for maximum time as at maximum risk then we should be first priority for vaccine please convey this message to health authority
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Confusing answers. No clear cut Yes or No to the questions. Bug pased onto State Health Dept@
What a speedy government actvity it is ? It takes almost one and half months to get a response on an emergency issue. I had also such experience that the issue raised by me on mail was implemented after a month in Gujarat
Good if we are allowed to do RAT.DCI can direct IDA head office to ask local branches to persue the matter from local medical authority and get the permission from them for it.
1.Normally the risk from people who visits dental offices if we assume then most likely will be asymptomatic carriers, so what benefit RAT will hold as for them RT PCR would be the gold std.
2. Ans may be in presence of other viral infections like flu or whatever to exclude covid 19 but anyway everyone will defer elective dental Rx then,
3. Point is to develop a test which has sensitivity and specificity comparable to RT PCR and also is a cost effective, like testing inner side of mask of people (worn for enough amount of time)with their sneeze plus saliva based plus rapid test, and the results of which can be within 20 minutes.
Answers from Dr Rajeev Chitguppi:
1. RT PCR is the gold standard for infection only. It’s not the gold standard for infectivity. Antigen test perfectly identifies those who are infectious.
2. We don’t need a test that is as sensitive as PCR. We just need a test which is highly specific. The high sensitivity of PCR has a problem in that it will identify even those who are not spreaders. This is because of the amplification of scant genetic material of viral RNA. High sensitivity (PCR) is needed to identify who is infected, not to identify who is infectious. So high sensitivity of PCR is a disadvantage for a dental clinic. Antigen tests with low sensitivity and high specificity perfectly fit the requirement.
3. Antigen test is already cost-effective and quick. Addresses all issues.
The link given by ICMR itself is not opening.
Sir can you provide the saliva based RAT list pdf again . This link is not opening
Please IDA and DCI take this matter to State health authority also we need your support for our enrollment for Covid19 vaccine as MBBS doctors data is collected, form says to cover Dentist but forms are not sent
We had kept our clinic closed for maximum time as at maximum risk then we should be first priority for vaccine please convey this message to health authority
Private dental institute already having hemetology Lab can do RAT. Please sugest