Joining the Fight: How Dentists Can Help Screen and Vaccinate for COVID-19
This year saw millions of patients falling ill to COVID-19, a lack of availability and reliability in COVID-19 testing, dental clinic closures, and a spike in stress-related oral health conditions. All of these factors disrupted dental care across the country, while the need for dental care has only continued.1,2 The dental industry saw a loss of 546,000 jobs from February to April, dropping 56% from pre-pandemic levels.3 The numbers somewhat returned, and, by late September, dental offices saw patients at about 80% of the pre-pandemic levels.1
“The COVID-19 pandemic is a financial, medical and regulatory crisis for healthcare providers,” said Joseph A. Battaglia, DMD, FAGD, chair of the AGD Dental Practice Council (DPC). “The pandemic has been politicized, stalemating legislative remedies. In the early stages of the pandemic, especially on the coasts, bipartisan efforts aggressively addressed obtaining the needed resources. Once the initial efforts mitigated the impact of the virus, the climate changed, making it difficult for healthcare providers to obtain the financial resources they’ve needed.”
From testing for COVID-19 to administering what may be an eventual vaccination, many dentists now want to be on the front lines to help fight the virus. (See updated COVID-19 vaccination information, including the Food and Drug Administration’s Emergency Use Authorization process, recent findings and specifics on vaccine manufacturers.)
“As dentists, we know what we do is essential to health and, in many cases, is lifesaving,” said Gigi Meinecke, DMD, FAGD, DPC member. “Humbling and frustrating as it may be, we have to demonstrate in nontraditional ways to those outside our profession how and why we are essential. One of the most potent ways to do this is to offer services that are well understood as essential elements of care by those outside our profession and that, in reality, we’re over-qualified to do.”
From providing injections to checking many general health parameters, Meinecke believes dentists are well equipped to both screen for a multitude of diseases and offer vaccinations. Meinecke got her start in the healthcare industry as a nurse and views herself as a generalist.
“The reality is that the non-clinician administrators in government have an extremely limited knowledge of what dentistry is and what we do,” Meinecke said. By being the only health practitioners who routinely see their patients twice a year, even when patients are healthy, dentists have a unique role in the medical field. “The oral cavity affects general health, and general health affects the oral cavity. It’s all connected.”
Screenings for COVID-19
On April 17, three months after the first COVID-19 case was confirmed in the United States, the American Dental Association (ADA) wrote to the U.S. Department of Health and Human Services (HHS) requesting that dentists be allowed to administer COVID-19 tests. Referring to research finding that 27 million people visit dentists annually while not seeing their physician, the ADA strongly urged the HHS to allow dentists to help screen for COVID-19. “Enabling dentists to test patients prior to dental treatment will help lower the ‘very high exposure risk’ of dental personnel in contracting COVID-19 when treating infected but asymptomatic patients,” wrote ADA President Chad P. Gehani and Executive Director Kathleen T. O’Loughlin. “It would add a layer of safety for both dental personnel and the patients they treat. This is important not only now — when most dentists are performing only urgent and emergency dental procedures — but also as the nation cautiously reopens.”4
A few dentists hired legal counsel and filled out the Centers for Medicare & Medicaid Services’ (CMS’s) Clinical Laboratory Improvement Amendments (CLIA) Application for Certification with Waiver to perform COVID-19 testing.5 Meanwhile, the North American Dental Group announced plans in June that it would begin administering COVID-19 tests at all 230 of its dental practices operating in 15 states.6
The success and efficacy of dentists administering COVID-19 tests has been mixed. In the earliest stages of the pandemic, the types of effective tests that were most widely available were polymerase chain reaction (PCR) viral tests, which required CLIA certifications and specialty equipment not widely available to dental offices and schools, according to the Testing for Tomorrow (T4T) Collaborative, whose membership consists of six different U.S. dental schools. The T4T Collaborative’s goal was to find point-of-care (POC) tests that used sputum, saliva or finger-stick blood samples. The T4T Collaborative wrote, “The initial goal of identifying the best POC test — be it antigen, antibody or viral — was elusive, although each school did identify alternative approaches to evaluate their students, faculty, staff and patients, and developed careful approaches to reopening their clinics.”7
Dental offices wanting to administer tests faced supply hurdles, challenging regulatory measures and some uncooperative state governments.8 “Most of the tests that are available for POC testing are being pretty well controlled by the federal government or the states for distribution to the most serious areas with a high density of COVID patients,” said Battaglia. “They haven’t been readily available for dentists.” He said the most helpful test would be a POC test that is highly accurate and determines whether the patient is negative. “Accurate testing is a force multiplier. It’s another place where the community can be tested, and it provides a mechanism for healthcare providers to make sure that the office is safe for the next patient.”
For dental offices capable of providing COVID-19 testing, the T4T collaborative recommends dental offices first identify who can be tested and if these tests will comply with state law. The dental practice should then identify an FDA Emergency Use Authorization- (EUA-) approved COVID-19 test and find a location to conduct tests that is a safe distance from waiting areas and operatories. Staff can create “online recruitment, prescreening and scheduling tools. Also, they can add systems in the electronic health record to allow medical insurance billing, record essential COVID-19-related patient information, report test results to state and federal health authorities, and track patients for retesting as necessary.” T4T also recommends specific training for specimen collection, safety and data accuracy, along with the creation of checklists, use of training videos and consultation with an infection control officer to ensure personal protective equipment (PPE) is properly acquired, worn and removed.7 The T4T collaborative has since requested that the Office of the Surgeon General allow dentists to acquire tests and be reimbursed for those tests like other medical practitioners. The collaborative is currently performing outreach to corporations and medical professionals and is working on creating guidance for the best tests that dentists can administer.7
Are Dentists Able to Administer Vaccines?
Meinecke is gearing up to begin administering vaccines in her D.C.-area practice. She is purchasing a refrigerator specifically built for storing the flu vaccine. “Given that dentistry has been at the forefront of PPE since the 1980s and has set the bar for patient flow management during the pandemic, I predict dentistry will become a widely accepted ‘port of entry’ for the vaccine-inclined public,” she said. In her state of Maryland, if an accredited dental school teaches a specific practice in any state, she can administer that treatment with proper training. Because she is a registered nurse, she has that training. And, in 2019, one U.S. state came into the fold to offer a certified program for dentists wanting to offer vaccinations.
In May 2019, Oregon became the first state to have a university that trains dentists to administer all types of vaccines. While Illinois and Minnesota allow limited vaccination use by dentists, Oregon has opened the door for the first-ever comprehensive vaccination training program for dentists at the Oregon Health & Science University (OHSU) School of Dentistry.9
“We’re all for expanding care, treatment and prevention,” said Stephen Prisby, executive director of the Oregon Board of Dentistry.
OHSU has seen 280 individuals take part in the training, 222 of which are active students at the school, 30 are faculty, and 28 individuals remain on the waitlist to complete the hands-on portion of the training. The hands-on process has stalled due to the pandemic, but they’re hoping to resume in the fall, according to a spokesperson for OHSU. The online portion of the program covers vaccine administration, vaccine storage, addressing patient concerns and reporting adverse effects, among other topics. The hands-on portion teaches dentists and dental students to physically administer the immunizations.
“Dentists can help expand the public’s access to immunization and bridge immunization gaps,” stated Alexandria Case, MEd, OHSU program director of continuing dental education, and Phillip Marucha, DMD, PhD, OHSU School of Dentistry dean, in an email. The two also helped draft the state bill. “This is especially important as the world is in the grips of the coronavirus pandemic, and officials worry U.S. health institutions could be overwhelmed this fall and winter by the double whammy of the pandemic and the flu season. Providing Oregonians with easier access to any vaccination will be particularly helpful in protecting American health in the coming months and beyond.”
Oregon’s Health Plan and Medicaid program will cover the immunization costs, while other insurance and funding issues are currently being worked out, according to OHSU. Dentists are required both to note their patients’ immunization record in their official dental file and send that information to the state health authority within a week.
Case and Marucha stated, “OHSU has anecdotally heard from Oregon dentists who are eager and excited to begin administering immunizations and to further integrate dentistry with medicine. Other states and dental schools have also contacted the OHSU School of Dentistry to learn more about our process for training dentists and implementing immunizations in our dental clinics.”
Dan Kolen is a freelance writer and media producer based in Chicago. To comment on this article, email impact@agd.org.
References
1. Versaci, Mary Beth. “HPI Poll: Dentists See Increase in Patients’ Stress-Related Oral Health Conditions.” American Dental Association, 28 Sept. 2020, ada.org/en/publications/ada-news/2020-archive/september/hpi-poll-dentists-see-increase-in-patients-stress-related-oral-health-conditions. Accessed 9 Oct. 2020.
2. “United States COVID-19 Cases and Deaths by State.” Centers for Disease Control and Prevention, covid.cdc.gov/covid-data-tracker/index.html#cases_casesinlast7days. Accessed 30 Sept. 2020.
3. Reese, Phillip. “Dental and Doctors’ Offices Still Struggling with COVID Job Loss.” Kaiser Family Foundation, 28 July 2020, khn.org/news/dental-and-doctors-offices-still-struggling-with-covid-job-loss/. Accessed 30 Sept. 2020.
4. Garvin, Jennifer. “ADA Urges HHS to Federally Recognize Licensed Dentists to Administer Point of Service COVID-19 Tests.” American Dental Association, 17 April 2020, ada.org/en/publications/ada-news/2020-archive/april/ada-urges-hhs-to-federally-recognize-licensed-dentists-to-administer-point-of-service-covid-19-test. Accessed 9 Oct. 2020.
5. Cassidy, Pat. “How to Get Approval for Fast COVID-19 Testing in Your Dental Practice.” Dentistry IQ, 28 May 2020, dentistryiq.com/covid-19/article/14176765/how-to-get-approval-for-fast-covid19-testing-in-your-dental-practice. Accessed 9 Oct. 2020.
6. “North American Dental Group Begins Administering COVID-19 Diagnostic and Anti-body Tests to Patients at Affiliated Dental Offices.” North American Dental Group, 23 June 2020, nadentalgroup.com/2020/06/23/north-american-dental-group-begins-administering-covid-19-diagnostic-and-anti-body-tests-to-patients-at-affiliated-dental-offices/. Accessed 9 Oct. 2020.
7. The Testing for Tomorrow (T4T) Collaborative. “Perspectives on Meeting the COVID–19 Testing Challenge: A Dental School Collaborative.” Journal of Dental Education, vol. 84, no. 9, 2020, pp. 950-954.
8. O’Donnell, Carl. “U.S. Dentists Seeking to Conduct Coronavirus Testing Face Regulatory, Supply Hurdles.” Reuters, 22 April 2020, reuters.com/article/us-health-coronavirus-testing-dentists/u-s-dentists-seeking-to-conduct-coronavirus-testing-face-regulatory-supply-hurdles-idUSKCN2242QU. Accessed 9 Oct. 2020.
9. Foden-Vencil, Kristian. “Oregon Becomes 1st State to Allow Dentists to Offer Any Vaccine.” Oregon Public Broadcasting, 8 May 2019, opb.org/news/article/oregon-vaccines-dentists-health/. Accessed 9 Oct. 2020.
“The COVID-19 pandemic is a financial, medical and regulatory crisis for healthcare providers,” said Joseph A. Battaglia, DMD, FAGD, chair of the AGD Dental Practice Council (DPC). “The pandemic has been politicized, stalemating legislative remedies. In the early stages of the pandemic, especially on the coasts, bipartisan efforts aggressively addressed obtaining the needed resources. Once the initial efforts mitigated the impact of the virus, the climate changed, making it difficult for healthcare providers to obtain the financial resources they’ve needed.”
From testing for COVID-19 to administering what may be an eventual vaccination, many dentists now want to be on the front lines to help fight the virus. (See updated COVID-19 vaccination information, including the Food and Drug Administration’s Emergency Use Authorization process, recent findings and specifics on vaccine manufacturers.)
“As dentists, we know what we do is essential to health and, in many cases, is lifesaving,” said Gigi Meinecke, DMD, FAGD, DPC member. “Humbling and frustrating as it may be, we have to demonstrate in nontraditional ways to those outside our profession how and why we are essential. One of the most potent ways to do this is to offer services that are well understood as essential elements of care by those outside our profession and that, in reality, we’re over-qualified to do.”
From providing injections to checking many general health parameters, Meinecke believes dentists are well equipped to both screen for a multitude of diseases and offer vaccinations. Meinecke got her start in the healthcare industry as a nurse and views herself as a generalist.
“The reality is that the non-clinician administrators in government have an extremely limited knowledge of what dentistry is and what we do,” Meinecke said. By being the only health practitioners who routinely see their patients twice a year, even when patients are healthy, dentists have a unique role in the medical field. “The oral cavity affects general health, and general health affects the oral cavity. It’s all connected.”
Screenings for COVID-19
On April 17, three months after the first COVID-19 case was confirmed in the United States, the American Dental Association (ADA) wrote to the U.S. Department of Health and Human Services (HHS) requesting that dentists be allowed to administer COVID-19 tests. Referring to research finding that 27 million people visit dentists annually while not seeing their physician, the ADA strongly urged the HHS to allow dentists to help screen for COVID-19. “Enabling dentists to test patients prior to dental treatment will help lower the ‘very high exposure risk’ of dental personnel in contracting COVID-19 when treating infected but asymptomatic patients,” wrote ADA President Chad P. Gehani and Executive Director Kathleen T. O’Loughlin. “It would add a layer of safety for both dental personnel and the patients they treat. This is important not only now — when most dentists are performing only urgent and emergency dental procedures — but also as the nation cautiously reopens.”4
A few dentists hired legal counsel and filled out the Centers for Medicare & Medicaid Services’ (CMS’s) Clinical Laboratory Improvement Amendments (CLIA) Application for Certification with Waiver to perform COVID-19 testing.5 Meanwhile, the North American Dental Group announced plans in June that it would begin administering COVID-19 tests at all 230 of its dental practices operating in 15 states.6
The success and efficacy of dentists administering COVID-19 tests has been mixed. In the earliest stages of the pandemic, the types of effective tests that were most widely available were polymerase chain reaction (PCR) viral tests, which required CLIA certifications and specialty equipment not widely available to dental offices and schools, according to the Testing for Tomorrow (T4T) Collaborative, whose membership consists of six different U.S. dental schools. The T4T Collaborative’s goal was to find point-of-care (POC) tests that used sputum, saliva or finger-stick blood samples. The T4T Collaborative wrote, “The initial goal of identifying the best POC test — be it antigen, antibody or viral — was elusive, although each school did identify alternative approaches to evaluate their students, faculty, staff and patients, and developed careful approaches to reopening their clinics.”7
Dental offices wanting to administer tests faced supply hurdles, challenging regulatory measures and some uncooperative state governments.8 “Most of the tests that are available for POC testing are being pretty well controlled by the federal government or the states for distribution to the most serious areas with a high density of COVID patients,” said Battaglia. “They haven’t been readily available for dentists.” He said the most helpful test would be a POC test that is highly accurate and determines whether the patient is negative. “Accurate testing is a force multiplier. It’s another place where the community can be tested, and it provides a mechanism for healthcare providers to make sure that the office is safe for the next patient.”
For dental offices capable of providing COVID-19 testing, the T4T collaborative recommends dental offices first identify who can be tested and if these tests will comply with state law. The dental practice should then identify an FDA Emergency Use Authorization- (EUA-) approved COVID-19 test and find a location to conduct tests that is a safe distance from waiting areas and operatories. Staff can create “online recruitment, prescreening and scheduling tools. Also, they can add systems in the electronic health record to allow medical insurance billing, record essential COVID-19-related patient information, report test results to state and federal health authorities, and track patients for retesting as necessary.” T4T also recommends specific training for specimen collection, safety and data accuracy, along with the creation of checklists, use of training videos and consultation with an infection control officer to ensure personal protective equipment (PPE) is properly acquired, worn and removed.7 The T4T collaborative has since requested that the Office of the Surgeon General allow dentists to acquire tests and be reimbursed for those tests like other medical practitioners. The collaborative is currently performing outreach to corporations and medical professionals and is working on creating guidance for the best tests that dentists can administer.7
Are Dentists Able to Administer Vaccines?
Meinecke is gearing up to begin administering vaccines in her D.C.-area practice. She is purchasing a refrigerator specifically built for storing the flu vaccine. “Given that dentistry has been at the forefront of PPE since the 1980s and has set the bar for patient flow management during the pandemic, I predict dentistry will become a widely accepted ‘port of entry’ for the vaccine-inclined public,” she said. In her state of Maryland, if an accredited dental school teaches a specific practice in any state, she can administer that treatment with proper training. Because she is a registered nurse, she has that training. And, in 2019, one U.S. state came into the fold to offer a certified program for dentists wanting to offer vaccinations.
In May 2019, Oregon became the first state to have a university that trains dentists to administer all types of vaccines. While Illinois and Minnesota allow limited vaccination use by dentists, Oregon has opened the door for the first-ever comprehensive vaccination training program for dentists at the Oregon Health & Science University (OHSU) School of Dentistry.9
“We’re all for expanding care, treatment and prevention,” said Stephen Prisby, executive director of the Oregon Board of Dentistry.
OHSU has seen 280 individuals take part in the training, 222 of which are active students at the school, 30 are faculty, and 28 individuals remain on the waitlist to complete the hands-on portion of the training. The hands-on process has stalled due to the pandemic, but they’re hoping to resume in the fall, according to a spokesperson for OHSU. The online portion of the program covers vaccine administration, vaccine storage, addressing patient concerns and reporting adverse effects, among other topics. The hands-on portion teaches dentists and dental students to physically administer the immunizations.
“Dentists can help expand the public’s access to immunization and bridge immunization gaps,” stated Alexandria Case, MEd, OHSU program director of continuing dental education, and Phillip Marucha, DMD, PhD, OHSU School of Dentistry dean, in an email. The two also helped draft the state bill. “This is especially important as the world is in the grips of the coronavirus pandemic, and officials worry U.S. health institutions could be overwhelmed this fall and winter by the double whammy of the pandemic and the flu season. Providing Oregonians with easier access to any vaccination will be particularly helpful in protecting American health in the coming months and beyond.”
Oregon’s Health Plan and Medicaid program will cover the immunization costs, while other insurance and funding issues are currently being worked out, according to OHSU. Dentists are required both to note their patients’ immunization record in their official dental file and send that information to the state health authority within a week.
Case and Marucha stated, “OHSU has anecdotally heard from Oregon dentists who are eager and excited to begin administering immunizations and to further integrate dentistry with medicine. Other states and dental schools have also contacted the OHSU School of Dentistry to learn more about our process for training dentists and implementing immunizations in our dental clinics.”
Dan Kolen is a freelance writer and media producer based in Chicago. To comment on this article, email impact@agd.org.
References
1. Versaci, Mary Beth. “HPI Poll: Dentists See Increase in Patients’ Stress-Related Oral Health Conditions.” American Dental Association, 28 Sept. 2020, ada.org/en/publications/ada-news/2020-archive/september/hpi-poll-dentists-see-increase-in-patients-stress-related-oral-health-conditions. Accessed 9 Oct. 2020.
2. “United States COVID-19 Cases and Deaths by State.” Centers for Disease Control and Prevention, covid.cdc.gov/covid-data-tracker/index.html#cases_casesinlast7days. Accessed 30 Sept. 2020.
3. Reese, Phillip. “Dental and Doctors’ Offices Still Struggling with COVID Job Loss.” Kaiser Family Foundation, 28 July 2020, khn.org/news/dental-and-doctors-offices-still-struggling-with-covid-job-loss/. Accessed 30 Sept. 2020.
4. Garvin, Jennifer. “ADA Urges HHS to Federally Recognize Licensed Dentists to Administer Point of Service COVID-19 Tests.” American Dental Association, 17 April 2020, ada.org/en/publications/ada-news/2020-archive/april/ada-urges-hhs-to-federally-recognize-licensed-dentists-to-administer-point-of-service-covid-19-test. Accessed 9 Oct. 2020.
5. Cassidy, Pat. “How to Get Approval for Fast COVID-19 Testing in Your Dental Practice.” Dentistry IQ, 28 May 2020, dentistryiq.com/covid-19/article/14176765/how-to-get-approval-for-fast-covid19-testing-in-your-dental-practice. Accessed 9 Oct. 2020.
6. “North American Dental Group Begins Administering COVID-19 Diagnostic and Anti-body Tests to Patients at Affiliated Dental Offices.” North American Dental Group, 23 June 2020, nadentalgroup.com/2020/06/23/north-american-dental-group-begins-administering-covid-19-diagnostic-and-anti-body-tests-to-patients-at-affiliated-dental-offices/. Accessed 9 Oct. 2020.
7. The Testing for Tomorrow (T4T) Collaborative. “Perspectives on Meeting the COVID–19 Testing Challenge: A Dental School Collaborative.” Journal of Dental Education, vol. 84, no. 9, 2020, pp. 950-954.
8. O’Donnell, Carl. “U.S. Dentists Seeking to Conduct Coronavirus Testing Face Regulatory, Supply Hurdles.” Reuters, 22 April 2020, reuters.com/article/us-health-coronavirus-testing-dentists/u-s-dentists-seeking-to-conduct-coronavirus-testing-face-regulatory-supply-hurdles-idUSKCN2242QU. Accessed 9 Oct. 2020.
9. Foden-Vencil, Kristian. “Oregon Becomes 1st State to Allow Dentists to Offer Any Vaccine.” Oregon Public Broadcasting, 8 May 2019, opb.org/news/article/oregon-vaccines-dentists-health/. Accessed 9 Oct. 2020.