Dentists as a surge workforce resource

COVID-19 is an ongoing example of a disaster—in fact, a catastrophic event—that informs the breadth of potential roles for dentists to assist their communities in addressing surge workforce demands. In localities facing these demands and those approaching their peak COVID-19 caseloads, we have been reminded daily of the shortage of personnel and the extensive shift hours for emergency departments and intensive care units, as well as for units with COVID-19 patients who are ill but not in critical condition. COVID-19 units are demanding environments requiring comfort and diligence with personal protective equipment for protecting staff members, patients, and staff families. Although the personnel surge requirements are particularly in need of ventilator-literate staff members, employees in all positions—whether practitioners, nurses, housekeepers, or orderlies—are under stress in terms of availability, working time, and psychological impact.¹ The United Kingdom’s National Health Service (NHS) has organized a voluntary dental personnel redeployment system (for personnel in excess of those needed for dental emergency coverage) to assist in COVID-19 patient care.² A call for dental volunteers by the chief dental officer of England saw a temporary recruitment pause on April 27, 2020, to process the initial 22,000 applications by dental personnel.³ The United Kingdom’s approach and the profession’s response to this critical surge demand demonstrates both the practicality of using dental personnel and the commitment of the dental profession to contribute to a critical societal necessity, even at personal risk. In fact, the NHS document titled “Redeploying the Clinical Dental Workforce to Support the NHS Clinical Delivery Plan for COVID-19”² represents a thoughtful systematic approach to assessing skills and defining a full range of potential roles. This document is applicable to other local, regional, national, and international disasters, the response to which often entails a surge workforce need component. In the United States, tapping into dental personnel resources could be considered in a surge critical workforce environment during a disaster.

An example of the use of dental personnel resources related to the respiratory challenges of infection in the COVID-19 pandemic is instructive. In a surge workforce situation, when the numbers of trained personnel are inadequate to deal with the care of patients with respiratory illness, the pool of dental residency graduates may contribute to supporting the response. Annually, graduate dental education matriculates more than 1,000 dental residents who have completed an anesthesia clinical rotation as part of their education.⁴ In 2019, there were 433 pediatric dental, 782 general practice, and 25 dental anesthesia residency positions. This totals approximately 1,240 annual graduates of dental residencies with anesthesia clinical rotations and more than 6,000 and 12,000 completing residencies within 5 and 10 years, respectively. The approximately 226 oral and maxillofacial surgery residents enrolled annually represent a further anesthesia-trained workforce resource,⁴ although generally oral and maxillofacial surgery specialists may need to concentrate on emergency care for dental and maxillofacial infections and trauma. Given their familiarity with general anesthesia procedures and equipment, an orientation for these graduates would allow them to monitor patients requiring respiratory assistance and would provide a valuable surge capacity to community hospital emergency departments and intensive care units. The addition of even 1 such staff person may greatly benefit many rural hospitals.

Additional volunteer roles that are more generalizable across disaster scenarios are discernible in the pandemic. A glaring example is the need to support congregate housing sites (for example, nursing homes) with staffing and infection control expertise, a role suitable for dental personnel. The United States Medical Reserve Corps (MRC) is composed of licensed health care practitioners, including dental care professionals, who receive necessary role-specific training for the needs of a particular event before their assignment.^{5 , 6}

A testing, case-finding, and contact-tracing infrastructure—necessary at the start of a pandemic and proposed as a necessity for “opening up the economy”—is generalizable to other microbial threats. More than 155,000 US dentists and another 200,000 dental hygienists^{7 , 8} could represent a large pool of health care professionals available to assist in these critical functions. Their roles may be direct involvement as contact tracers or indirect engagement by replacing public health personnel to free them for case finding, contact tracing, or both.⁹ Dentists in the MRC would be available to provide support in many catastrophic events, including assistance in administering a vaccine or prophylactic medications for mass inoculations or distribution. In fact, these have been planned operational activities since the inception of the MRC.⁶

Dental offices also have an important public health role to play in their communities in disasters such as the COVID-19 pandemic. Fidelity to recommendations by the American Dental Association and the Centers for Disease Control and Prevention to protect staff members and patients is the sine qua non for our professional role. In itself, face mask use and social distancing in office practices model appropriate behavior for these key COVID-19 preventive practices. Dental staff members who practice social distancing and face mask use in their public lives further reinforce these practices for their patients and their wider community. Local dental societies can assess and facilitate office distribution of general and community-specific COVID-19 health promotion and social support materials. In some states, there may be a role for use of dental offices as testing sites for viral or serum surveillance activities. Practices operating at less than full schedules can consider part-time volunteer work that may include their staff team members; this is often personally satisfying and important for society.

The availability of dental personnel may conflict with financial exigencies of their practice. However, rolling epidemics, breakouts, and resurgence, as well as patients’ possible temporary concerns or financial difficulties, might occur as they have in the COVID-19 pandemic, resulting in both part-time and transient local dental personnel availability. Nonmicrobial disasters, whether natural or manufactured, may require only a short-term commitment. Several national programs for emergency response within the MRC are available to dental professionals.¹⁰

conclusions

Some roles would clearly require institutional credentialing, an emergency change to the dental or medical practice acts in some states, or both. However, dentists could support disaster workforce needs in many ways. In monitoring vital signs or transporting patients, assisting and infection control training for staff members in nursing homes, case tracking, delivering vaccine inoculations, or screening for worried well patients (those unexposed but anxious about being sick or injured), dentists will likely be a welcomed and important addition to hard-pressed front-line staff members and local public health agencies. The dental profession is composed of respected members of their communities who are often involved in many social and civic activities; we have a volunteer and community spirit that is a win-win for societies and dentists, personally and professionally. The COVID-19 pandemic, an extrapolatable example of an ongoing disaster, is an opportunity to show the best of the dental profession while making major contributions to our neighborhoods and communities. Our commitment now and thoughtful assessment of roles and practices can be the foundation of dentistry’s broader role in health care and disaster planning.

The COVID-19 pandemic, an extrapolatable example of an ongoing disaster, is an opportunity to show the best of the dental profession while making major contributions to our neighborhoods and communities.

Biographies

Dr. Psoter is an associate professor, University of Rochester School of Medicine and Dentistry, Eastman Institute for Oral Health, Rochester, NY.

Dr. Meyerowitz is professor and director emeritus, University of Rochester School of Medicine and Dentistry, Eastman Institute for Oral Health, Rochester, NY.