key: cord-0057343-xs802cbi authors: Wilson, Robert; Jonke, Guenter title: The Ethics of Dentists Receiving the COVID-19 Vaccine date: 2021-03-12 journal: J Am Dent Assoc DOI: 10.1016/j.adaj.2021.02.011 sha: 5db7461232e52cb85539dd779c46c29c38672142 doc_id: 57343 cord_uid: xs802cbi nan Robert Wilson, DDS Guenter Jonke, DMD Q. As primary health care providers, is it ethically justified for dentists and dental staff to be given priority for receiving the COVID 19 vaccine? A. While the monumental task of vaccinating a large enough segment of the population to achieve herd immunity is just beginning, the vaccine supply is insufficient to inoculate everyone. States have developed vaccine allotment schedules that determine when the vaccine will be made available to various groups, many of which are based on recommendations from the Centers for Disease Control (CDC). The CDC guidelines prioritize front line health care workers who deliver essential care, such as dental team members and the most at-risk for serious morbidity and mortality from COVID-19. 1 When formulating the guidance, the Advisory Committee on Immunization Practices considered the vital necessity of protecting the capacity to deliver health care, the risk of exposure to health care providers, and prevention of transmission from healthcare personnel to patients. 1 Keeping dental offices open and able to serve the public is critical. Dental care workers do not have the option to work remotely and remain safely distant from those whom they serve. Dental care is essential. According to the Surgeon General's Report: Oral Health in America, oral diseases and disorders in and of themselves affect health and well-being through life. 2 Research continues to show a connection between poor oral health and underlying medical conditions including heart disease and diabetes. 3 The ADA Principles of Ethics & Code of Professional Conduct (the Code) supports the ethical imperative of prioritizing dentists and dental staff not only for the benefit of the team but for patients and the community as well. The principle of beneficence (do good) calls upon dentists to use their skill and knowledge in the best interests of patients and the community. 4 The ADA's Council on Ethics , Bylaws and Judicial Affairs ethics subcommittee, drafted an Ethical Moment on ethical practice during a pandemic. It highlighted the role of the dental practice in conserving emergency department capacity by treating dental emergencies so patients would not present to local hospitals or community health centers for dental care when the hospitals and community health centers may be overwhelmed with COVID patients. 5 Even with the proper use of PPE, however, the practitioner may still be at heightened risk given the nature of dental practice. If a practitioner is COVD-19 positive, they will not be able to practice until they are no longer infectious. If the entire dental team is vaccinated, however, COVID -19 infection will not diminish the capacity to treat patients with both emergent and preventable conditions. It is vital that dental offices remain open and able to serve not only patients of record but the public more broadly by not putting an additional burden on an already strained healthcare system. Dentists and dental hygienist have some of the highest risk of exposure to COVID-19. 6 When dental treatment procedures are performed patients must remove their masks. Then the dentist operates in close personal contact with the patient and team members while care is delivered. Many procedures generate potentially infectious aerosols, heightening the risk of disease transmission. The Principle of Nonmaleficence stresses dentists' duty "to do no harm." 4 Under this principle, and even before the risks of COVID-19, dental team members were required to don appropriate PPE to prevent transmission of pathogens to one another and to patients. COVID-19 has necessitated enhanced PPE requirements. Dental practices have also incorporated engineering modifications to improve indoor air quality in response to COVID-19. These practices protect both the providers and the patients. The community at large gains some protection by reducing the potential for transmission through these safety mechanisms. Vaccination of the entire dental team further supports the ethical obligation to prevent harm by reducing the risk of transmission from patient to provider and from provider to patient. The Principle of Justice expresses the concept that professionals "have a duty to be fair in their dealings with patients, colleagues and society." 4 Dentists are advised that when treating patients with blood borne pathogens, "decisions regarding the type of dental treatment provided or referrals made or suggested should be made on the same basis as they are with other patients." 4 This applies to patients known to have active COVID-19. Dentists do not always have the option to protect themselves and their staff by remaining isolated from carriers of COVID-19 and therefore vaccinating dentists and dental team members is also necessary under the Principle of Justice. In conclusion, dental care providers and team members are critical front-line workers in an occupation at high risk for exposure to COVID-19. Rather than work from home and stay isolated from exposure, dentists and their team members are exposed to a certain level of risk when delivering care. Exposure to multiple unmasked patients over an extended period of time and the potential need to utilize aerosolizing procedures increases dental workers risk of exposure beyond that of many other health care providers. The dental profession has the ethical obligation to provide care, respond to the pandemic and be prepared for what might lie ahead. All possible measures must be taken to protect patients, staff and dentists so that they can remain in service to patients and our communities. By being inoculated with the COVID-19 vaccine as early as possible, the dental team has increased ability to continue to serve the patient's and public's health. The dental professional is an esteemed member of the community. When patients see that their dental care providers are vaccinated, they may feel more comfortable about getting inoculated themselves. This may be helpful in overcoming some of the reluctance to get vaccinated. Patients may also feel more comfortable with dental visits if they know that their dentist and the dentist's staff have been immunized. Granting dentists priority for receiving the COVD -19 vaccine is ethical and necessary to promote the health of the public. Dr. Wilson practices general dentistry in Gaithersburg, MD and is the Chair of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs. Dr. Jonke practices general dentistry in Stony Brook, NY and is a member of the American Dental Association Council on Ethics, Bylaws and Judicial Affairs. The Importance of COVID-19 Vaccination for Healthcare Personnel Oral health in America: A report of the surgeon general Oral Health: A Window to Your Overall Health at American Dental Association principles of ethics and code of professional conduct, with official advisory opinions revised to 2020 Ethical practice during the COVID-19 pandemic