Sonoma County dentists prepare to join coronavirus vaccination effort

The state of California is allowing dentists to dole out coronavirus immunizations, and some in Sonoma County are preparing to join the effort.|

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Dr. Anthony Fernandez spent his lunch break running needles from hospital to hospital on Monday. The Pfizer-BioNTech vaccine requires a very specific delivery device — a 23- or 25-gauge 1-inch needle — and when supplies run low, health care workers scramble to fill the gap before the potentially lifesaving material is compromised.

Doctors going the extra mile for patients are nothing new. But Fernandez is a doctor of dentistry. His involvement in the vaccination effort may be surprising to you. It isn’t to him.

“Because we’re health care providers,” Fernandez said. “It’s just a fundamental obligation, to care for the overall health of the community.”

Many of Sonoma County’s licensed dentists — the California Dental Association said there were 395 as of December — are poised to take a more active role in the process, the result of a recent tweak in California’s Business and Professions Code. On Jan. 4, Kimberly Kirchmeyer, director of the state’s Department of Consumer Affairs, approved the elimination of language that excluded dentists from delivering coronavirus vaccinations.

Any licensed dentist in California can currently sign up for online training through the U.S. Centers for Disease Control and Prevention, though many in Sonoma County apparently don’t know it yet.

The program can be another small building block in the region’s attempt to ramp up vaccination, a drive that has started slowly. As of Wednesday, Sonoma County had administered 14,374 doses of vaccine, or approximately one for every 34 county residents.

Much of the effort to involve dentists is being handled by the Sonoma County Medical Association, a nonprofit that supports local physicians. The SCMA was already helping to run a volunteer-staffed vaccination clinic on Chanate Road, with plans to open a larger one soon. The group has been coordinating PPE supplies, patient registration, eligibility notifications and other logistical needs.

When SCMA executive director Wendy Young heard the county was talking to dentists about setting up their own clinic, she offered assistance. Why force them to sort through the same issues the doctors have been tackling?

“They don’t need to re-create the wheel,” Young said. “Look, I created this wheel already. If I can help them get their own clinic up and running, terrific.”

It is yet to be determined where local dentists will be deployed. But it appears clear at this point that dental offices will not be used for vaccination anytime soon. That would create complications (and perhaps liability issues) around the potential for cross-contamination, and require freezers not typically found in dental clinics.

“We certainly don’t want to have any kind of adverse event come back to undermine our enthusiasm for volunteerism,” said Dr. Rick Graham, a Rohnert Park dentist and a member of the state dental association’s Board of Trustees. “But it sounds like our association’s insurance arm has been helpful with that. And it sounds like the state might provide umbrella coverage. Personally, I’m raring to go. But the protocols around vaccinations currently available won’t allow us to work from the office.”

Fernandez believes that could ultimately change if the coronavirus remains prevalent in the community for months or becomes a recurring threat. “It could be so convenient,” he mused. “You come in, get your teeth cleaned, get a COVID vaccination and you’re good to go.”

Graham said the biggest obstacle early on has been the CDC’s online training courses, which he said run about three hours combined. He completed them, but found the process a little glitchy.

One thing most dentists will emphasize, and certainly one of the reasons the state waived the barrier to their participation, is that they can do this work safely. Dentists don’t typically administer immunizations, but as anyone with a phobia can tell you, they give lots and lots of shots.

“As far as the actual delivery of vaccine, giving intra-oral injections with nerve blocks is far more anatomically difficult,” Fernandez said.

The state dental association laid out its arguments when it echoed the state’s announcement two weeks ago, noting that its members receive extensive training in everything from pharmacology to autoimmune response during their dental education, and that they are trained to apply injections “in objectively more complex areas of the mouth that commonly have gag reflexes, major blood vessels, nerves and a moving tongue.”

Fernandez pointed to dentists’ track record over the course of the pandemic. Few classes of workers spend as much time in proximity to unmasked humans.

“We work in an environment of airborne aerosols all day long,” he said. “But because of our training and safety standards, dentists are actually below average for infection rate. That’s a good sign.”

One negotiating point is dentists’ placement in Phase 1A, Tier 3 of the state’s vaccine prioritization system. “Inclusion in Tier 3 is a concern because of dentists’ direct patient contact,” the California Dental Association said. “CDA urges counties to consider dentistry a partner in ongoing vaccination efforts and to elevate dentists and their teams to higher tiers.”

Sonoma County has not placed dental teams higher among the tiers. But county Health Officer Dr. Sundari Mase acknowledged Monday that people staffing dental clinics recently became the first members of Tier 3 to get initial doses. Graham said he and his small staff all were vaccinated Monday at the county-run clinic on Chanate Road.

Not every dentist plans to sign on. Dr. Mirabel Cayco, head of Zen Dental Care in Santa Rosa, said it doesn’t make sense to take on additional duties with her practice already stretched so thin it’s barely able to keep up with medical emergencies.

That jibes with the experience of many California dentists. Early in the pandemic, they were asked to delay a lot of routine care to help conserve PPE. Since the state gave them the green light to resume checkups and cleanings in May, dentists have been wading through the backlog.

Still, Fernandez and Graham believe most of their peers are eager to help out in any way they can.

“The vaccine is here. But only roughly 25% of the available supply (in California) has been used so far,” Fernandez said. “It should be in people already. That’s the biggest fumble. But rather than point fingers, let’s get this going as efficiently as possible and as quickly as possible.”

You can reach Phil Barber at 707-521-5263 or phil.barber@pressdemocrat.com. On Twitter @Skinny_Post.

Track coronavirus cases in Sonoma County, across California, the United States and around the world here.

For more stories about the coronavirus, go here.

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