Within 48 hours of the Pfizer/BioNTech COVID-19 vaccine receiving Emergency Use Authorization (EUA) from the U.S. Food and Drug and Administration (FDA) in December 2020, the federal government shipped almost 3 million doses of the vaccine throughout the country.
States were finally getting access to something the world had been eagerly waiting for after witnessing the ravages of a disease that, by that time, had led to more than 300,000 deaths in the United States and almost 1.7 million deaths globally. But the vaccine, the first that would receive an EUA from the FDA (the Moderna vaccine would be the second), needed to be administered quickly and safely, making the massive rollout an “all hands on deck” scenario. To help, some states began to allow dentists to administer the vaccine, and many dentists signed up.
During a Dec. 16 press conference held by Oregon Gov. Kate Brown (D), Ryan Thrower, D.M.D., administered her first COVID vaccine—becoming one of the first dentists in the United States to do so.
“I felt it was a historic and monumental moment to be a part of the vaccination rollout. It was a humbling experience that displayed a bit of light at the end of a dark tunnel,” Dr. Thrower said.
Like many others, the first-year orthodontic dental resident at the Oregon Health & Science University School of Dentistry (OHSU SOD) was personally affected by COVID-19.
“I’ve lost loved ones and seen family and friends fight for their lives,” Dr. Thrower said. “I would not say that it influenced my decision to administer the vaccine, but it did give me a better appreciation for the opportunity.”
Advocating for Participation and Vaccination
At press time, at least eight states had already granted dentists permission to administer the COVID-19 vaccine—Alabama, Arkansas, California, Connecticut, Illinois, Maryland, New York and New Jersey, with Connecticut and New York also granting permission to dental hygienists. Dentists in Oregon are also permitted to give COVID-19 vaccinations under a 2019 law that gave them permission to give vaccines for a variety of conditions.
But the push for dentists to not only administer, but also receive COVID-19 vaccines, has been a challenging one, requiring dental organizations to lobby governors and legislatures in some states. For these organizations, securing vaccines for dentists has been of the utmost importance, especially considering that dentists, dental hygienists and dental assistants are three of the top five professions with the highest risk of infection from COVID-19, according to the World Economic Forum.
“Dentists were initially the fourth priority group in Oregon’s initial COVID-19 vaccine rollout plan, which began with frontline health care workers,” said Brad Hester, D.M.D., President of the Oregon Dental Association. “We advocated successfully to ensure dentists are considered a high priority in the first phase of vaccine distribution in Oregon as well, because dentists are also essential health care workers. Dentists and their teams are now eligible to receive the vaccine in Oregon as supply becomes available.”
In California, dentists are now considered Phase 1a in the vaccination plan, “which is the essential health care workers and people most at-risk,” said Richard J. Nagy, D.D.S., the Director of Postgraduate Periodontics Residency Program and Staff Periodontist at the West Los Angeles Veterans Affairs Healthcare Center as well as Immediate Past-president of the California Dental Association (CDA).
But dentists haven’t always been at the front of the line for COVID-19 vaccinations in the state.
“We were originally placed in tier 3 out of the three tiers in the state of California,” Dr. Nagy said. “And as of this past week, the governor has erased the tiers and just has made the mandate to get off Phase 1a, the top level that people that will be vaccinated, ASAP.”
In addition to getting dentists ranked in higher tiers, Dr. Nagy said the CDA had been pushing the California State Legislature to increase the scope of practice for dentists to be able to give vaccinations. “At the time we were advocating it, it was primarily for the flu and then COVID-19 popped upon us last March,” Dr. Nagy said. “We just felt that we as dentists are experts at giving injections in the mouth, which is much harder to give than intramuscular/in the arm, and we feel strongly that we can be part of the solution.”
Despite the movement forward, the vaccination rollout has still been “all over the board” in the state of California, said Judee Tippett-Whyte, D.D.S., CDA President. “We’re finding people who are able to get better resources to connect to either hospitals or other avenues get vaccines. But with that being said, in California, they left it up to the counties, and there are some counties that just do not have the capability to be able to pull this off. I think we’ll start to see the tide change in the next week or so as things are starting to evolve, and Gov. Newsom begins to change his plan.”
On a national level, dental organizations such as the American Dental Education Association (ADEA) and the American Dental Association (ADA) are pushing for dentists to be placed in the highest tiers to receive the COVID-19 vaccine and to be allowed to administer it.
“Oral health professionals play a vital role in advancing the general health of the population, and this pandemic has only underscored that fact—and highlighted the need to take full advantage of the skills and expertise that these professionals bring to the health care table,” said Karen West, D.M.D., M.P.H., ADEA President and CEO.
The ADEA Council of Deans Administrative Board drafted a resolution showing that ADEA supports and encourages the education of dental students, residents and oral health care providers in the administration of vaccinations. The ADEA House of Delegates will consider the resolution at the 2021 ADEA Annual Session & Exhibition in March. Meanwhile, the ADA passed a resolution at its virtual annual meeting in October 2020, showing support for dentists who choose to administer critical vaccines to help during declared local, state or federal public health emergencies.
“At the heart of dentistry is the desire to take care of people and keep them in good health, and when it comes to deploying the COVID vaccine or other immunizations patients might want, dentists are excited to help,” Dr. Hester said. “Dentists are Doctors of Dental Medicine or Doctors of Dental Surgery, so they are already well-educated to administer vaccines.”
He noted that vaccinating these dentists is also important not only for the dentists’ safety, but also to “ensure that dental emergencies do not present at the state’s already overburdened hospital system. Dental care is also associated with better health outcomes for people who have diabetes, heart conditions and other diseases, further reducing the number of patients entering the hospital care system.”
And if states want dentists to help in the vaccination rollout effort, it only makes sense to make them a vaccination priority, Dr. Tippett-Whyte said.
“If dentists are going to give a vaccine, they need to be vaccinated,” she said.
A Kaiser Permanente dentist practices giving a flu shot
during a 2020 training. More than 20 Kaiser Permanente
dentists were the first outside of the Oregon Health &
Science University (OHSU) School of Dentistry to complete
OHSU’s new vaccination training program. Some dentists
trained through the OSHUprogram would later go on to
administer COVID-19 vaccines.
Courtesy of Kaiser Permanente/Permanente Dental Associates
Joining the Rollout
Mark Miller, D.M.D., M.A.G.D., Assistant Professor of Restorative Dentistry at OHSU SOD, has received his COVID-19 vaccine and now he is one of the vaccination instructors at the school of dentistry. Dr. Miller said he had experience giving intramuscular injections, but he took additional training in order to give the COVID-19 vaccine—the same training that Dr. Thrower received while she was still a dental student at OHSU SOD.
“The training is now included in the curriculum for current dental students and is offered as a continuing education course for dentists in Oregon,” Dr. Hester explained. “It requires self-directed training, which is about 10 hours online, including education on how to safely store vaccines and on vaccination record keeping, and hands-on, in-person training, which is about two hours and led by an instructor, including education on how to safely give injections in the arm and practice giving injections on model arms and real humans.”
Since the COVID-19 pandemic, the Oregon Board of Dentistry has directed the OHSU SOD to organize and provide the training required for Oregon dentists to be able to administer vaccines.
“As of the end of December, about 100 Oregon community dentists and 200 OHSU dental faculty and students had completed the training,” said Franny White, Senior Media Relations Specialist at OHSU.
Dr. Thower said she joined the COVID-19 vaccination effort at OHSU not only because she was asked to, but also because “I wanted to do my part as a highly trained health professional.” Also, as an African American, she thought it “was especially beneficial for those disproportionally affected by COVID-19 to see a familiar (masked) face to gain a small piece of trust in a historically untrustworthy system.”
Dr. Nagy knew right away he wanted to join fellow health care professionals who were administering the vaccine as well, and working at a federal facility, he was quickly able to do so.
“Luckily for me, I work at the VA hospital in Los Angeles and I’m the director of the periodontal residency program and since we’re a federal facility, we get a federal source of the COVID vaccine,” Dr. Nagy said. “It doesn’t affect our state’s resource and we follow federal law, not state law, and it gives dentists in our state, at least temporarily, the ability to give the vaccine to help with manpower issues in delivering the vaccine. So, I feel very fortunate to be part of the solution.”
Other dentists who wish to join Dr. Nagy in the vaccination rollout in California first must take three hours-worth of training courses required by the Centers for Disease Control and Prevention, said Dr. Tippett-Whyte. “It’s not a ton of time,” she said.
Initially, the California Department of Consumer Affairs wanted to require 11.5 hours of training “and then we showed the information to say, you know, look into VA hospitals. This is what they’re requiring, and they said, ‘Oh, that works just fine,’” Dr. Tippett-Whyte said.
But those three hours cover a lot of subject matter. Dr. Nagy said the online courses discuss “how to give an intramuscular shot, what are the Pfizer and Moderna COVID vaccines about and how to handle an emergency, such as anaphylactic reaction or an allergy where you need to deliver epinephrine or Benadryl.”
And once California dentists receive their training, they—like many dentists throughout the country—face the challenge of figuring out where to administer these vaccines, Dr. Nagy said
“This vaccine, especially Pfizer, which needs to be at temperature of about -70 Celsius, you cannot do in an office,” Dr. Nagy said. “And the Moderna vaccine is still stored at a cold temperature, but not that cold and with the preparations and paperwork involved, it’s really about being used as a vaccinator in a system at a vaccination center, at a hospital, at a federal qualified health center or a dental school where they need your physical body to put that shot in the arm. And right now, because it’s just a newer transition, it’s about trying to find a protocol to get people plugged in. Right now, this is sort of our setback in moving forward.”
Worth the Fight
But despite those challenges, dentists are still in a unique position to help.
“We are highly trained medical professionals and usually give injections in small, dark spaces. Administering the COVID-19 injection intramuscularly will be a walk in the park,” Dr. Thrower assured. “I’m joking, but in all seriousness, we are indeed very skilled and by working in tandem with our medical colleagues like pharmacists, nurses and medical doctors, we are able to improve outcomes for distribution with more hands on deck. The training is reasonable, and the skillset can be applied immediately.”
Added ADEA’s Dr. West: “Oral health professionals are committed to this fight against the pandemic—and we will win.”
Published on February 10, 2021