Technically Australian dentists are already legally allowed to administer vaccinations, so why aren’t they being called upon to help in the fight against the coronavirus? By Tracey Porter
When the Federal Health Minister Greg Hunt announced that dentists will be included in the first batch of COVID-19 vaccine recipients in Australia, frontline dental workers across the country rejoiced.
Few were more vocal in their delight, however, than the director and head trainer of the Australasian Academy of Dento-Facial Aesthetics (AADFA), Dr Myles Holt. A long-term advocate of dentists having a more prominent general health and prevention role in the boarder healthcare industry, Dr Holt believes that not only should Australian dentists be among the first to benefit from the protection the vaccine provides, they should also be among those allowed to administer it.
Even before a potential vaccine had been developed, Dr Holt made clear his argument that in the face of increasing anti-vaccination movements, Australia would need all hands on deck to ensure its levels of annual vaccines are sustained. “If families can walk into [pharmacies] and receive a vaccine for everything from measles, mumps and rubella, through to whooping cough and meningococcal disease, from someone they don’t know and who may not be as experienced in administering clinical procedures or injections as a dentist, it makes no sense that they can’t receive the same level of care from their family dentist working in a regulated clinical setting with great infection control and with whom they already have a history and long-term rapport.”
And there is precedence to support his argument. The sheer logistical challenge of delivering such a widespread vaccination program in a timely fashion forced the British Government to urge dental professionals there to sign up as part of the national effort to vaccinate against coronavirus after it became the first country in the world to approve a clinically tested COVID-19 vaccine.
Scotland proactively authorised dental practitioners to administer seasonal influenza vaccines last year while Quebec’s Health Ministry has also been proactive in approaching dentists and dental hygienists to train to administer flu and COVID-19 vaccines this season.
The American state of Oregon is a leader in the field because it already allows dentists to administer vaccines without limitations on the type of vaccine or age group. Minnesota and Illinois allow dentists to give vaccines—but only against the flu and only for adults.
Dr Holt says there are numerous reasons why the dental profession should be allowed to administer vaccines of this type. But principally, he says, it is because dentists here already administer a range of medications under their own prescribing rights. They are also are well-versed in reviewing medical histories to identify potential conflicts with medications they may be using and familiar with emergency procedures.
While providing vaccines that can have a direct impact on the oral cavity and respiratory system seems a logical place to start, the technical requirements for a dentist to be able to administer vaccines for other conditions is identical in terms of training and insurance, Dr Holt says.
This means they would require only a small expansion of the definition of dentistry by regulators to reflect the crucial role dental practitioners play in modern general health and prevention service delivery.
Dr Holt says under current healthcare laws, providing they undergo a training program in vaccine delivery and their professional indemnity insurance provides coverage for vaccine administration, Australian dentists could legally already be able to provide vaccines for conditions such as influenza, human papillomavirus and COVID-19.
This is because the definition of dentistry, under the Dental Board of Australia’s guidelines for Scope of Practice, is necessarily broad, stating that ‘dentistry involves assessing, preventing, diagnosing, advising on, and treating any injuries, diseases, deficiencies, deformities or lesions on or of the human teeth, mouth or jaws or associated structures’, he says.
“As vaccine delivery is all about preventing disease and all of these conditions potentially impact the throat and broader respiratory system (structures associated with the mouth), these treatments would already broadly fall within the definition of dentistry and scope of dental practice.
“This is the same approach taken when AADFA assisted in clarifying how dentists are legally able to perform botox injections and drove regulatory acceptance around these services.”
Dr Shiv Pillay, the owner and principal dentist of Queensland’s Serenity Dental says while he agrees that having dentists administer vaccinations makes logical sense, he has some concerns at a practical level. While the actual “popping of a needle” into a patient is something most dentists do almost every day, Dr Pillay says he personally would be unwilling to offer this service unless training was provided to deal with potential side effects.
“Another concern I would have is how we would set it up to pay for it. Most of us operate in private practices so how would we bill it? It would be an awful lot of extra paperwork. I get what [Dr Holt] is saying, that we’d be okay to do it, I think I’d just prefer not to.”
In some countries, notably the US where the virus is rampant, there has been some opposition to the dental industry receiving approval to administer vaccines with concerns raised around whether insurances companies will pay for vaccines administered by dental professionals.
However, Dr Holt says under the Australian healthcare system, patients currently have several options for payment of vaccine delivery ranging from free vaccines under commonwealth and state programs, through to self-paid vaccines—all depending on the condition, their age group, who administers them and the state in which they live. “This is not a money-making exercise for dentists as the financial reward from vaccine delivery is miniscule. The situation of dentists offering vaccines would be no different to pharmacists offering vaccines in terms of payments—some would be free under certain programs, some would attract a fee, however for patients it is all about choice and convenience.”
Dr Holt says unlike pharmacists, dentists already possess their own Medicare provider numbers meaning that with limited effort, changes to government programs could be made such that dentists could offer vaccines in exactly the same way GPs do.
Dental practitioners can play a huge role in general health prevention, beyond the teeth and gums but “for too long health service delivery has been compartmentalised”, he says.
“Dentists are often thought of as just being about teeth and gums but our members routinely speak to their patients about more than the health of their teeth and gums, regularly advising them on everything from daily sunscreen use and skincare, through to screening for skin cancers on a patient’s face and neck region. Most patients pay good money to come and see a dentist and it’s time the profession stepped up and started to utilise our skills to give our patients a higher level of care and service as another trusted voice in general healthcare.”