By Anne Blythe
Michael Riccobene is a dentist on a mission to stress the importance of recognizing that dental care and oral health play a large part in overall well-being.
So when Gov. Roy Cooper added dentists to the list of professions eligible to administer COVID-19 vaccines, Riccobene wanted to play a part in the goal of getting at least 75 to 80 percent of North Carolinians vaccinated.
Now he is.
In March, Riccobene, founder of Riccobene Associates Family Dentistry, began researching the possibility of offering vaccines inside some of the 36 offices that his practice has across the state.
In addition to the hours of training required by the North Carolina State Board of Dental Examiners, Riccobene also had to enter an agreement for the Centers for Disease Control and Prevention to have access to the vaccines.
Then he had to buy freezers to store the Moderna vaccines that he has been administering in Goldsboro and Cary during the past week. That was not a simple task since many of the companies offering them have low supplies.
Riccobene was able to buy seven freezers, at nearly $2,200 each, that he will strategically place across his practice.
The dentist’s original plan was to call on patients on the schedule for routine cleanings or drillings and fillings each week and ask if they wanted a vaccine at their appointments.
There were not enough takers, so he shifted gears at the Goldsboro office where he began the vaccinations.
Riccobene sent out an email blast to all his patients in the Goldsboro area and got the response he was seeking. On Thursday and Friday, the Goldsboro office administered more than 50 Moderna vaccines, about five vials each with between 10 and 11 doses.
“I didn’t want to open a vial and not be able to use all the vaccine,” Riccobene said.
This week, an email blast went out to patients in the Cary office and a robust response came back from people willing to come in and get a shot.
“They’re comfortable coming to us,” Riccobene said.
Riccobene has medical supplies on hand for use in any rare cases of allergic reaction to the vaccine. A medical provider also is on call.
Expanding vaccine scope?
Dentists in other states have been administering vaccines inside their offices, as well.
There has been a push by some organizations and oral health advocates to give dentists authority to inoculate their patients against seasonal flu and HPV, a shift that would require changes to North Carolina’s scope of practice laws.
Many people visit a dentist once or twice a year but might not visit a doctor’s office during that time. The American Dental Association Health Policy Institute estimates that nearly 9 percent of Americans are part of that trend.
“As dental professionals, we are here to do our part and battle this COVID virus,” Riccobene said in a statement when announcing he would be administering vaccines. “We all want to get rid of this virus.”
In Indian Trail, a Union County town about 10 miles from Charlotte, a dentist and pharmacist have teamed up to administer COVID-19 vaccines in the Indian Trail Dental Studio.
Hasmi Patel, owner of the dental studio, is married to Harry Patel, who owns Austin Drugs in nearby Monroe.
Throughout the pandemic, the couple has reached out to the community around them, creating and delivering handmade cloth masks with medicines to homebound seniors.
Because he did not have enough space in his pharmacy to administer COVID-19 vaccines, the Patels sought permission from the state to administer them in the dental office after typical business hours.
They got permission in February.
“We’ve always wanted to give back,” Patel said.
In a telephone interview this week, Patel said that he’s helped organize two vaccine events in a county that has many COVID-19 skeptics and residents unwilling to follow the mask mandate and social distancing restrictions.
Nonetheless, the events he stages inside his wife’s new office building draw people who are anxious to move beyond the pandemic.
“The people that came in just want to get past this,” Patel said. “We’ve got scattered people that want it.”
Even so, Patel had trouble getting all 300 doses that were shipped to him into arms. Because of that, he paired up with pharmacies that were scheduled to administer the Johnson & Johnson vaccine before the pause.
“Rather than these go to waste we reached out to local pharmacies so we could get them to them,” Patel said.
‘Gateway to offering other vaccines’
About 37 percent of the North Carolina population that’s 18 and older were fully vaccinated by 11:59 p.m. April 21, according to the state Department of Health and Human Services vaccine dashboard.
Anybody who is 16 or older is eligible for the Pfizer COVID vaccine. The Moderna vaccine is approved for emergency use for anyone 18 and older.
The single-shot Johnson & Johnson vaccine has been on hold since April 13, when the Centers for Disease Control and Prevention and the Food and Drug Administration recommended a pause. The suspension was suggested after cerebral venous sinus thrombosis, a rare blood clotting condition, was reported in six women, ages 18 to 49, who had received the vaccine six to 13 days before the diagnosis.
The advisory committees that reviewed the data two days after the pause are slated to meet on April 23 to continue the discussion.
Anthony Fauci, director of the National Institute of Allergy and Infectious Diseases and President Joe Biden’s chief medical adviser, has said he does not expect the Johnson & Johnson vaccine to be fully set aside.
On Sunday, Fauci told Chuck Todd of NBC’s “Meet the Press” that though he did not know what the advisory board’s recommendation would be, there might be “some sort of warning or restriction or risk assessment.”
“I don’t think it’s just going to go back and say, ‘Okay, everything’s fine, go right back,’” Fauci said. “I think it’ll likely say, ‘Okay, we’re going to use it. But be careful under these certain circumstances.’”
The pause and any restart of the vaccine could lead to hesitancy among some at a time in North Carolina when the demand for vaccines seems to be waning as more doses are available.
This week, the governor offered an enticement for the hesitant and those who know somebody who has yet to get a shot: If two-thirds of the adult population are vaccinated by June 1, most of the restrictions that have curbed activities throughout the pandemic can be lifted.
Dentists might be able to help get to that goal, Riccobene says, especially if they have supplies on hand and reach out to patients who don’t have a primary care doctor but have built a rapport with their oral health care provider.
Battling false claims
Riccobene has seen hesitancy among his employees. Only 50 percent of his staff are vaccinated against COVID-19, he said.
Many of those who are hesitant are women of childbearing age. Some have bought into claims circulating online that vaccines lead to infertility, assertions that are not supported by the CDC.
Riccobene, who was making plans on Monday to get vaccines to staff in offices near the Cary site, tried to put the issue into context.
“The thing that I don’t understand is are they not afraid of the effects that COVID could have on their bodies,” Riccobene said.
Just this week, a study published in JAMA that followed more than 2,100 pregnant women found that those who contracted COVID were more likely to get sick, be hospitalized, and were much more likely to die than pregnant women who had not contracted the virus. The pregnant women with COVID were also more than twice as likely to have pregnancy complications, including eclampsia preterm birth, than women who had not contracted COVID.
“If you are trying to become pregnant now or want to get pregnant in the future, you may receive a COVID-19 vaccine when one is available to you,” CDC guidance states. “There is currently no evidence that any vaccines, including COVID-19 vaccines, cause fertility problems. CDC does not recommend routine pregnancy testing before COVID-19 vaccination. If you are trying to become pregnant, you do not need to avoid pregnancy after receiving a COVID-19 vaccine. Like all vaccines, scientists are studying COVID-19 vaccines carefully for side effects now and will report findings as they become available.”
Over time, Riccobene and others getting vaccinated in the dental offices hope to change the minds of some of those who are hesitant. He also hopes that vaccinations at dental offices might outlive the pandemic.
“I see this as a gateway to being able to offer other vaccines,” Riccobene said.