April JADA had several upbeat articles about the role of dentists in coping with natural and man-made catastrophic disasters.1–3 There is no question that the manpower required in the health care arena to mount a significant response to an overwhelming event makes the inclusion of dentists essential. Dentists are well-versed in the subject of infection and antibiotic administration, and they are well-trained and deft in injecting medications. Patient management is certainly one of their strong assets.
Sadly, though the U.S. Department of Homeland Security may entertain these grandiose plans for dental participation in an emergency, the reality is quite different.
I recently attended a point-of-distribution training session at which there was a simulated bioterrorist anthrax attack. Much to my surprise and chagrin, dentists were told that only physicians, physician assistants, nurse practitioners and nurses could deal with medical issues and manage the triage tables. Obviously, such weighty issues as asking a patient if he was allergic to ciprofloxacin or doxycycline were beyond the capacity of the dentist, who was relegated to crowd control.
I am delighted that the Illinois legislature has passed a law to modify the scope of dental practice during an emergency, allowing dental participation. Unfortunately, New York remains in the dark ages on this issue. My opinion on this is borne out by remarks from Isaac Weisfuse, MD, MPH, deputy commissioner, Division of Disease Control, Department of Health and Mental Hygiene, the City of New York. In a March 10, 2006, letter to the New York County Dental Society, Dr. Weisfuse stated that "per the New York State Education Department Office of the Professions, only medical doctors can evaluate potential contraindications to antibiotics or vaccines. Other professionals who are licensed to work in collaboration with or under the direct supervision of a medical doctor (nurse practitioners, physician assistants, registered nurses) could also evaluate patients for potential contraindications."
This seems to suggest, outrageous as it seems, that in our practices we are illegally prescribing antibiotics if a physician is not supervising.
Instead of dentists spending time and energy in training for the Medical Reserve Corps at this time, they should devote their efforts to educating their state representatives to the true nature of a dental education, and how dentists can be better utilized in disasters.
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