By Emma Yasinski
Come this fall, students at Oregon Health & Science University (OHSU) will be the first dental students in the nation to learn how to vaccinate their patients for measles, HPV, chickenpox, mumps, shingles, and other preventable illnesses.
That’s because last month, Oregon passed a law allowing dentists in the Beaver State to administer medical vaccines to their patients, effective January 1, 2020. When the law goes into effect, OHSU wants its students to be prepared.
The new Oregon law, which is likely to be copied by numerous other states, permits dentists to administer every vaccine that physicians provide. The law fulfills the desire of many dentists nationwide to play a greater role in the overall health and well-being of their patients.
Proponents of the Oregon bill believe patients will benefit by having greater access to vaccinations, especially for diseases such as HPV, which can also impact oral health. The theory is, with more providers available to administer vaccines, the cost to patients should come down.
“I would encourage states and dentists in other states to support legislation that allows this kind of activity,” Phillip T. Marucha, D.M.D., Ph.D., dean of the dental school at OHSU told Incisor. “Because who gives more injections than dentists?”
As simple and natural as the concept sounds, it does raise some perplexing questions that may only be answered by real-world experience. For example:
- Will the administering dentists and their team members be prepared should their patients have an adverse reaction to an inoculation?
- What sort of coordination will be required between physicians – who treat patients for medical illnesses – and the dentists who administer vaccines in the hope of preventing those illnesses?
- Will existing dental malpractice insurance policies need to be amended to cover lawsuits stemming from the vaccinations?
“The idea of dentists providing disease-preventative shots to their patients dates back at least five years,” said Dr. Marucha, who helped draft the Oregon law. He previously worked in Illinois, which along with Minnesota, is one of two states that allow dentists to deliver flu vaccines to adults.
A report last year identified Oregon as one of 12 states at high risk of outbreaks of vaccine-preventable diseases due to low vaccination rates. As of May 24, 2019, Oregon has seen 14 cases of measles this year. Nationwide, there have been 1044 reported cases of the disease, up from 372 in 2018 and 63 in 2010.
Dr. Marucha and the Oregon Dental Association first proposed the dental vaccination bill in 2014, but anti-vaccination sentiment prevented it from progressing. This year, he said, they faced very little pushback. “We were supported by the Oregon Medical Association, and nurses, and the university,” he said.
Practicing dentists in Oregon will need about four or five hours of continuing education training before they’ll be allowed to administer the shots. The Oregon Health Authority and CDC currently offer online training for anyone authorized to administer vaccines.
The Tennessee Dental Association’s Anesthesia, Sedation and Scope of Practice Committee discussed and ultimately rejected a similar bill a few years ago.
“On one hand, it is very good as it provides another avenue for access to care, just like when pharmacists began doing them years ago and considering the strong correlation of HPV and oral cancer, it seems prudent,” said Anthony Carroccia, DDS, MAGD, ABGD, a trustee of the Tennessee Dental Association and president of the Tennessee Academy of General Dentistry. “On the other hand, there could be issues on payments as the populace expects the medical insurance to be billed, and many dentists are not on medical insurance plans.”
Dr. Carroccia, a long-time DOCS Education member and forum leader, also mentioned that insurance companies might not sufficiently reimburse providers for the cost of time and storage, an issue that pharmacists, in one survey, said has been problematic since they began giving vaccines in 2009.
“I would encourage any provider considering this adjunct to do their diligent homework with their state boards and analyze its implementation in the practice beforehand,” he added.
Despite these challenges and unknowns, Dr. Marucha is enthusiastic about the bill’s potential impact. While much of medical and dental insurance is still separate, he says he expects the new law to have a substantial effect on the Medicaid population, because a lot of dentists are already Medicaid providers and a quarter of Oregon patients are on Oregon’s Medicaid plan.
Craig Wright, MD, chief medical officer of The Portland Clinic agrees, but offers the caveat that it may make tracking a patient’s medical vaccine records more challenging if they receive vaccines outside of their “medical home.” Still, he said, “Having the dental community offer vaccinations is another opportunity to ensure timely, preventive care” and “increased access to vaccinations is good for the community.”
Most importantly, “dentistry is moving closer to overall health,” Dr. Marucha emphasized. “This is another step in that direction.”
Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at TheAtlantic.com, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.
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