California Dentists Wait Their Turn For COVID-19 Vaccine, Fight To Be Able To Distribute It

As California receives more doses of both the Pfizer and Moderna vaccines, health care workers as well as congregate care facility workers and residents are beginning to get their shots. 

But workers in dental offices say they should be higher up on the recipient list in the state’s first phase of vaccine distribution.

The state’s current guidance for Phase 1A details the order of distribution to health care workers based on what setting they work in:

Tier 1

• Acute care, psychiatric and correctional facility hospitals
• Skilled nursing facilities, assisted living facilities, and similar settings for older or medically vulnerable individuals (includes residents)
• Paramedics, EMTs and others providing emergency medical services
• Dialysis centers

Tier 2

• Intermediate care facilities for persons who need non-continuous nursing supervision and supportive care
• Home health care and in-home supportive services
• Community health workers, including promotoras
• Public health field staff
• Primary Care clinics, including Federally Qualified Health Centers, Rural Health Centers, correctional facility clinics, and urgent care clinics 

Tier 3

Other settings and health care workers, including

• Specialty clinics
• Laboratory workers
• Dental and other oral health clinics
• Pharmacy staff not working in settings at higher tiers

In November, the California Dental Association sent a letter to the state emphasizing the risk of providing oral care to patients who may be breathing out viral particles.

The association was concerned that the initial lack of clarity around which health care workers would be in the first phase would lead to cities and counties overlooking dental providers.

“In order to continue providing safe and essential oral health care for Californians, dental team members should be explicitly included in the plans for distribution and administration of the state’s vaccine plan,” the letter read.

When the state released new guidelines this month detailing which workers would be in Phase 1A and which tiers they would be in, the association said it was “an important recognition of dental teams’ priority in providing care to their patients.”

But despite new safety measures in dental offices, some dentists say they’re still worried about contracting the virus from patients. 

Dr. Matt Hall, owner of Hall Family Dental in Sacramento, said he was disappointed to see dental workers in the third tier of the first phase.

“Just like all the folks out there in the hospitals and all the different health care workers that are at risk of contracting COVID and spreading COVID, it’s been top of mind,” he said. “When I found out dentists were so far down on the list to actually receive the vaccine, it was really troubling to me.”

The U.S. Department of Labor’s Office of Safety and Health lists some of the procedures that dentists perform in the “high” and “very high” risk categories and provides detailed recommendations for screening patients for symptoms and equipping staff with protective gear.

Hall says he and some of his workers are wearing medical hoods similar to what’s being used in hospitals during certain procedures, and that he has one negative pressure dental suite to ensure any viral particles released there don’t spread to the rest of the building. He’s also been contacting state and local agencies to raise the alarm about the need for more safety measures in the dental field. 

“There’s a big disconnect between the medical and dental communities,” he said. “That truth has been really emphasized during this pandemic.”

The American Dental Association has acknowledged that health care workers explicitly treating COVID-19 positive patients should get the vaccine ahead of dental workers, who are doing their best to avoid treating anyone with symptoms.

The California Department of Public Health says the Phase 1 tiers were established based on federal guidelines, and were determined by a drafting guidelines workgroup with input from the Community Vaccine Advisory Committee. The department did not specify why dentists were placed in the third tier.

There’s also a conversation underway about whether California dental workers should be involved in distributing the vaccine once more doses are available for the general public. Dentists say they are more than capable of providing shots, whether it’s immunization against COVID-19 or influenza. In Oregon, dentists already have authority to give the flu shot to adults.

The federal Centers for Medicare and Medicaid Services has recommended that states expand their definitions for who can provide immunizations. California recently issued an order giving pharmacists the ability to administer COVID-19 shots.