Background

With many states in the United States permitting dentists to administer the COVID-19 vaccine, there is much discussion about their scope of practice in relation to delivering other vaccines.

Methods

Survey questions were developed to assess dentists' awareness about their vaccine administration scope of practice and attitudes and barriers if choosing to incorporate vaccine delivery into their practice scope. The survey was deployed electronically to members of the American Dental Association Clinical Evaluators (ACE) Panel (N = 989) on September 2, 2021, and remained open for 2 weeks. Data were summarized descriptively in Qualtrics and SAS Version 9.4.

Results

Of the 330 ACE Panel members who responded to the survey, 42% were not aware of which vaccines their state permits them to deliver. More than one-half (55%) would be willing to administer influenza or COVID-19 vaccines in their practice setting, but at present only 2% of respondents administer vaccines. To overcome vaccine administration barriers, the top 3 resources respondents want access to are the following: training or education, financial support, and access to protocols. Of all the respondents, 91% indicated the dental hygienist should be involved in certain capacities.

Conclusions

Few dentists are administering vaccines, possibly owing to a number of challenges. Dental hygienists may play an integral role in the administration of vaccines in the dental clinic, but few dentists are educating their patients about vaccines.

Practical implications

Although dentists wishing to administer vaccines in their practice may encounter barriers, support at the state, federal, and organizational levels could help them overcome these challenges.

Background

Oral squamous cell carcinoma is the most common manifestation of malignancy in the oral cavity. Adjuncts are available for clinicians to evaluate lesions that seem potentially malignant. In this systematic review, the authors summarized the available evidence on patient-important outcomes, diagnostic test accuracy (DTA), and patients' values and preferences (PVPs) when using adjuncts for the evaluation of clinically evident lesions in the oral cavity.

Types of studies reviewed

The authors searched for preexisting systematic reviews and assessed their quality using the Assessing the Methodological Quality of Systematic Reviews tool. The authors updated the selected reviews and searched MEDLINE, Embase, and the Cochrane Central Register of Controlled Trials to identify randomized controlled trials and DTA and PVPs studies. Pairs of reviewers independently conducted study selection, data extraction, and assessment of the certainty in the evidence by using the Grading of Recommendations Assessment, Development and Evaluation approach.

Results

The authors identified 4 existing reviews. DTA reviews included 37 studies. The authors retrieved 7,534 records, of which 9 DTA and 10 PVPs studies were eligible. Pooled sensitivity and specificity of adjuncts ranged from 0.39 to 0.96 for the evaluation of innocuous lesions and from 0.31 to 0.95 for the evaluation of suspicious lesions. Cytologic testing used in suspicious lesions appears to have the highest accuracy among adjuncts (sensitivity, 0.92; 95% confidence interval, 0.86 to 0.98; specificity, 0.94; 95% confidence interval, 0.88 to 0.99; low-quality evidence).

Conclusions and practical implications

Cytologic testing appears to be the most accurate adjunct among those included in this review. The main concerns are the high rate of false-positive results and serious issues of risk of bias and indirectness of the evidence. Clinicians should remain skeptical about the potential benefit of any adjunct in clinical practice.