By Anne Blythe

As more North Carolinians become eligible for a COVID-19 vaccine, they could be rolling up their sleeves at a dentist’s office for that jab.

The North Carolina State Board of Dental Examiners issued rules on March 3 for dentists who want to help administer vaccines.

In early February, Gov. Roy Cooper issued an executive order that opened the door for more types of health care providers to help get people vaccinated in North Carolina, including licensed dentists.

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At a board meeting in February, the state dental board discussed how that might play out across North Carolina, with members debating whether dentists would want to vaccinate people in their offices or volunteer their time at larger vaccination clinics.

Bobby White, chief executive officer of the state dental board, explained to members in February that Cooper had delegated authority to Mandy Cohen, secretary of the state Department of Health and Human Services, to set up requirements with the North Carolina Medical Board and dental board so dentists would not have to administer vaccines under the direct supervision of a physician.

“We’re not completely driving the bus here, some people think that we are,” White told dental board members in February. “We’ve gotten a lot of emails about ‘Why aren’t we doing this already?’”

Since then, dental board representatives have had discussions with DHHS and medical board representatives and outlined a process that dentists should follow.

Prior to administering any COVID-19 vaccines, dentists must successfully complete COVID-19 training programs including eight segments, according to the March 3 order signed by Millard “Buddy” Wester III, president of the dental board.

Dentists giving shots elsewhere

Other states have welcomed dentists on vaccination teams.

If dentists want to do vaccinations in their offices in North Carolina, they have to enter into an agreement with the Centers for Disease Control and Prevention, as other providers do, according to state board instructions.

For some, that could mean a large investment in the cold storage equipment necessary for the Pfizer and Moderna vaccines. Both those vaccines require freezers, but the Pfizer vaccine needs to be stored in ultra-cold freezers that keep the precious vials at temperatures below -80 degrees.

The Johnson & Johnson vaccine does not require the challenges of cold storage that come with the Pfizer and Moderna vaccines. Additionally, the Johnson & Johnson vaccine requires only one dose, where the others currently authorized for emergency use in the United States are two-dose vaccines.

“I don’t see a lot of dentists signing up to do this in their office,” White said in February. “Maybe there will be some.”

In addition to any outlay on new equipment, dentists cannot charge patients for COVID-19 vaccines. Some insurance providers will cover administration costs, but the vaccine program was set up so all Americans could receive a shot regardless of ability to pay.

In addition, practices that vaccinate patients must collect all the data required by the state. During a legislative hearing on Wednesday, Forsyth County health director Joshua Smith told lawmakers that he has 12 National Guard members helping out with his county’s vaccine efforts. Four of them give the actual shots, while the other eight input data into the state’s data collection system daily.

‘We deal with emergencies’

Michael Riccobene, a dentist with 36 offices across the state through his practice Riccobene Associates Family Dentistry, is weighing the costs as he goes through the CDC application process.

To get in the mix, Riccobene would have to assure the CDC that his practice could administer 100 doses each week, something he said that could happen in some of his offices between Charlotte and Wilmington.

Though Riccobene hasn’t finished his research on any new equipment purchases that he would have to make or tallied the costs of adding vaccine administration to the workload of some of the dentists in his practice, the dentist sees benefits beyond the economic aspects.

“I believe that if a majority of the population is vaccinated, I believe it’s best for society,” Riccobene said. “We take oaths to take care of people’s health. I don’t see it as an economic boon.”

Riccobene, an advocate for reopening dental offices quickly after the shutdown in April 2020 for any procedures other than emergencies, says dentists are naturals for administering COVID-19 vaccines.

Through the federal COVID-19 programs, Riccobene says his business has been in a V-shaped recovery, dipping from where he was pre-pandemic to a low last spring with his office booking more and more appointments and getting more done with each patient visit.

If he and other dentists play a part in vaccine administration, whether it’s inside their private practices or at larger vaccine events, the light at the end of the pandemic tunnel could shine more brightly even sooner.

North Carolina has vaccinated more than one million people, more than 10 percent of the eight million adults in the state.

“If you think about it nationally, we’re used to booking appointments, we deal with emergencies,” Riccobene said. “I’ve been told that half the population goes to the dentist regularly. If we could help lessen the lines, it would be good for everyone.”

Why not make dentists regular vaccinators?

Zachary Brian, director of the North Carolina Oral Health Collaborative, has been an early advocate of getting dentists and oral health care providers more involved in COVID-19 vaccinations.

In August, Brian published a piece on the collaborative’s website about how dentists could play a role in inoculating their patients against HPV and seasonal flu, as well, with some changes to North Carolina’s scope of practice laws.

Dentists in Massachusetts and New York were allowed to administer vaccines during the 2009 H1N1 pandemic.

In 2019, Oregon joined Illinois and Minnesota as states that allow their dentists to do vaccinations in their offices throughout the year.

Though that’s not the case in North Carolina, Brian suggests that it would be beneficial for the state’s public health to expand scope of practice so a visit to your dentist might include more than a routine cleaning.

“You might be surprised to learn that dentists administer injections far more often than their medical counterparts,” Brian wrote.

Each year, he said, millions of people visit a dentist but don’t go to a doctor or other medical provider.

Research published by the American Dental Association Health Policy Institute estimated that nearly 9 percent of Americans see a dentist annually but not a physician.

“Because dentists are skilled at administering injections, and they routinely engage with patients who do not frequently visit medical providers, dental visits are a prime opportunity for vaccination,” Brian wrote.

Riccobene agreed with such a notion as he explored the potential to add a COVID-19 vaccination to the menu of choices for his patients.

Dentists have tried in recent years to highlight the connection between oral health and systemic health. A trip to the dentist might expose gum disease or mouth sores linked to diabetes or hypertension, heart disease, cancers and more.

“Dentists, those of us who not only focus on dental health, but see the mouth as the gateway to the body, often detect diseases before others,” Riccobene said.

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Anne Blythe, a reporter in North Carolina for more than three decades, writes about oral health care, children's health and other topics for North Carolina Health News.