{ from the editor } by Douglas Wyckoff, DDS • Editor

Should Missouri Dentists Be Able to Give Their Best Shot?


n 1796, Edward Jenner inoculated at 13-year-old boy with cow- pox virus to show immunity to smallpox. Two years later the smallpox vaccine was developed, and this was the beginning of immunizing populations in the western part of the world. Over the last two hundred years, several vaccines have been developed to make populations immune or resistant to infectious diseases. In some of those cases, the diseases have become almost nonexistent.

Several states in the U.S. have made it mandatory for children to have certain immunizations prior to entering school. This has not gone without controversy about whether parents should have the right to opt out their children from receiving these immunizations. The debates on the safety of those immunizations continue, but research thus far has not shown any proof of adverse effects.

The purpose of this editorial is not to discuss the controversies associ- ated with vaccines, but to think about who administers them.

In the recent past, administration of vaccinations has been done in a medical setting by physicians and nurses. Pharmacists may now administer vaccines in 46 states plus the District of Columbia and Puerto Rico. As of May 2019, the state of Oregon passed legislation that allows dentists there to administer vaccines, including MMR, HPV and annual flu shots.

According to my research, those dentists are required to take continu- ing education training courses to be educated about vaccine storage and reporting. The Oregon Board of Dentistry, along with other dental entities, developed the training and rules associated with administering immunizations. The hope was to have everything in place by the first of this year, so that, when patients are in the office for routine dental procedures, they will have the opportunity to get immunizations they need. Having the vaccinations available in the dental practice offers another opportunity for them to be immunized, if they so desire.

In 2019, and again in January 2020, the Deans of both Missouri dental schools approached the MDA Board of Trustees about whether the Board would be supportive of trying to seek this opportunity (of dentists administering immunizations) through the Missouri legisla- ture. After presentations by the Deans, and questions and concerns outlined by the by Board, the Board of Trustees voted to oppose the consideration of legislative language the Deans brought before them and determined more information was needed before a position could

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be taken. The Board will be addressing this in future meetings this year and discussing information gathered.

I think the Board took the right move—to gain more information— prior to taking a formal position, because this is not something that should be considered lightly.

Many questions arise when this topic comes up. First and foremost, do our members want this? It would take a legislative move to change rules that do not allow dentists to do this now. In doing that, what will other health providers and coalitions think about dentists being able to give the immunizations? Will they be supportive of it or will they feel dentistry shouldn’t cross that “scope of practice” line? What political capital would have to be spent to try to get such an initia- tive passed? Another point to consider is how would a dentist know for sure that a patient has or has not had the immunization they are about to administer? A plan for open communication between dental offices and other health care facilities would have to be implemented. What liabilities would arise for the provider in being the administer of vaccines in their office?

This issue has several interesting angles that deserve a lot of discus- sion and planning. If there would be a need for millions of persons to be vaccinated for an outbreak, dentists might be able to help if the rules allow. With the Coronavirus pandemic, the topic of who gives those vaccines might become paramount. Regardless of where you may stand on this issue, I think it is one that will occupy some time by leadership in our association and other health care groups, as well. Stay tuned for more information and updates as this issue evolves. f

Your feedback is welcome. Contact Dr. Wyckoff at 816-632-2822 or

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