Front-line ready
The federal government’s 2021 expansion of individuals qualified to deliver COVID-19 vaccines led Texas A&M University College of Dentistry to equip dental students to join the fight against the pandemic.
“The idea started in January when dentists were still not authorized to give vaccines,” says Dr. Penelope Drayer, clinical assistant professor in comprehensive dentistry. “But the federal government amended the Public Readiness and Emergency Preparedness Act March 11, 2021, allowing dentists and dental students, among other health care professionals, to administer the COVID vaccine.”
According to the PREP Act, this authorization extends to students in multiple fields: dentistry, medicine, nursing, pharmacy, pharmacy intern, midwife, paramedic, advanced or intermediate EMT, physician assistant, respiratory therapy, podiatry, optometry and veterinary medicine. However, those students must have appropriate training in administering vaccines as determined by their schools or training programs. They also must have supervision by a currently practicing health care professional experienced in administering intramuscular injections who administers COVID-19 vaccines.
After Governor Greg Abbott approved Texas dentists and dental students to administer the COVID-19 vaccine on March 22, 2021, the idea that began in January became the impetus for a summer selective course at the College of Dentistry.
“When Dr. Asim Abu-Baker, associate dean for clinical and professional affairs, and Dr. Andrea Mora, clinical associate professor of pharmacy practice at the Texas A&M University College of Pharmacy, came here in February to administer the COVID vaccines to our faculty, staff and students, I got to know them because I volunteered, so I had that connection,” Drayer says. “When they said that dentists could give the COVID injection, that’s when I called Dr. Abu-Baker and Dr. Mora and said, ‘Could you offer a training for us, and can you come back to Dallas?’”
Drayer says the College of Pharmacy faculty members were excited to work with the dental school on the selective course.
Drayer began assembling the course curriculum with help from College of Dentistry faculty members including Elain Benton, Dr. Brent Hutson, Dr. Matthew Kesterke, Dr. Shirley Lewis-Miranda, Dr. Amal Noureldin, Dr. Stephen Griffin, Dr. Simmi Patel, Dr. Kishore V. Shetty, Dr. Lawrence Wolinsky and Dr. Lynne Opperman.
After it was approved, the selective curriculum was offered to fourth-year dental students. Many third-year dental students expressed interest in the course as well, Drayer says, but because they have different selective course hours, it was not possible to get them scheduled for this session. Drayer is hopeful the college will be able to offer the course again.
“I had to decide who should go first, and the D4s won’t have the opportunity next year, so I thought the D3s could have that opportunity next year if we’re still allowed by the state of Texas to do that,” she says. If booster doses become recommended, that could open a door, she adds.
Participants in the selective studied the biochemistry of the COVID-19 vaccines, overcoming vaccine hesitancy and motivational interviewing. Although the dental students have completed courses in anatomy, those in the summer selective undertook an abbreviated refresher anatomy course focused on the anatomy of the arm before moving to the hands-on portion of the selective.
The course culminated with an injection lab that was facilitated by College of Pharmacy faculty. The students and faculty injected oranges, then injected one another with sterile saline. Upon completion of the selective course and the required Centers for Disease Control and Prevention’s COVID-19 vaccine training modules for certification, the students rotated to a community clinic where they administered hundreds of vaccines under the administrative oversight of the community clinic’s medical personnel.
Marcus Hurt, community practice manager for UT Southwestern Medical Center, assisted Drayer in coordinating the student’s vaccination rotation schedule at the North Dallas Shared Ministries clinic.
“The students are already familiar with the environment because they go there for their dental rotations, but this time they were working on the medical side,” she says.
Drayer sees potential long-term benefits for patients.
“If we are allowed to give intramuscular injections, besides COVID, can you imagine the impact we could have on increasing the immunization rates in our communities? We often see patients every six months for a dental cleaning, so we see them more routinely than their physicians.
“If we could incorporate vaccines into our practices and ask patients, ‘Have you gotten your flu shot?’ or ‘Have you gotten your COVID vaccination’ then we could take care of that while they were at the dental office and they wouldn’t have to make an additional trip to get vaccinated,” she says.
Because dentists routinely give intraoral injections and some have specialized training to administer intravenous injections, Drayer said when she submitted the selective course for review, some college administrators who are not dentists were surprised that dentists could not administer the COVID vaccine.
According to the American Dental Association, the Commission on Dental Accreditation—which develops the accreditation standards for U.S. dental schools—currently does not have outlined dental education standards regarding the training for administering vaccines. Should that change, perhaps the college’s summer selective could become a prototype curriculum.
Dr. Brent Hutson, clinical associate professor in comprehensive dentistry, witnessed the College of Dentistry’s program from start to finish and praises Drayer’s work.
“I was very impressed with the course; it was excellent,” Hutson says. “Dr. Drayer is a rising star in our clinical program.”
Drayer sees the PREP Act as a stepping stone and is hopeful that there will be future legislation that will increase the scope of practice for dentists to allow them to provide immunizations.
“We are part of the medical profession just as any pharmacist, nurse or paramedic who is allowed to give the vaccines,” Drayer says. “It is a privilege for us to be part of the effort for reducing COVID.”