To increase childhood vaccine uptake, researchers look to dental visits

In the early months of the COVID-19 pandemic, federal data showed declining rates of childhood vaccinations as more and more people were avoiding non-emergency contact with the health care system. So, to help reverse this trend, the Health Resources and Services Administration (HRSA) put out a call for solutions with the Promoting Pediatric Primary Prevention (P4) Challenge.

Among the respondents was Jessica Jack, MD, an assistant professor of pediatrics at the University of Colorado School of Medicine and clinician at Denver Health. Jack and a team of health care providers also working at Denver Health hypothesized that medical-dental integration could be a helpful tactic in getting vaccines to more children.

After all, the researchers note, children over the age of nine tend to visit the dentist more often than the medical providers who usually administer those routine vaccinations.

“A few months prior to learning about the competition, Scott Hamilton, a dentist at Denver Health, had this idea of vaccinating kids during dental visits,” Jack says. “When I saw the competition announcement, I thought, “This could be really interesting. Maybe we should work together on something.'”

Uniting for a common cause

From the HRSA competition, a pilot project was born. The goal was to increase adolescent vaccination and well-child checkups through medical-dental integration.

In the end, the researchers hypothesized correctly. Because the dental offices were located within Denver Health family health centers, patients could receive dental care and vaccines all in one place.

One-hundred-twenty-two patients received a vaccination due to the medical-dental integration, which represented a 5% increase from the 2,438 vaccines given in 2020 vaccinations when compared with the 2,560 vaccines given in 2021.

The team also won the competition and the prize money, which went back into building the program at Denver Health. Now, Jack, Hamilton, and fellow researchers are honing their research. New findings by the team, published in Pediatrics in March, show that their medical-dental integration model has been especially successful at increasing the rate of human papillomavirus (HPV) vaccinations. During the study period—June 1, 2021, to May 31, 2023—the overall vaccination rate at eligible visits increased from 5.3% to 13.9%.

There are more than 100 varieties of the sexually transmitted disease HPV, some of which can cause oropharyngeal cancer in the throat. Dentists often screen for signs of these cancers during routine check-ups, making HPV vaccine offerings a natural fit for many dentists.

“Sometimes we run into challenges with hesitations of the HPV vaccine because there’s a sexual nature to it, but we’ve found that shifting the lens to oropharyngeal cancer gets people to think about the bigger picture. It’s not as taboo to talk about preventing cancer as it is to talk about sexually transmitted diseases,” Jack says.

As for patients, Jack and her colleagues have found that patients tend to like a one-stop shop.

“Nobody loves having to come back to the doctor, so if you can get a vaccine when you’re not due for a physical, it’s great convenience,” Jack says.

A model that works

Denver Health has six community-based dental clinics, all of which are co-located within family health centers. Jack says this makes getting vaccines to patients relatively simple for the patients and the providers.

“The reason this model works here is because the dentists can interface with Epic, the electronic health record system Denver Health uses. The dentist pulls a report that tells them if the patient is up to date on their vaccines,” Jack says. “When the patient decides that they want a vaccine, the medical assistant from the co-located clinic comes over and gives the vaccine right there in the dental chair.”

Researchers have found bringing the vaccine to the patient is often the most effective strategy. Even sending the patient to a clinic in the same building can sometimes result in the patient leaving and forfeiting the vaccination.

Expanding the reach of medical-dental integration

In some states, including Oregon, Minnesota, and Illinois, health regulations allow dentists and hygienists to administer vaccines, but that’s not yet the case in Colorado. However, in 2021, an emergency executive order signed by the governor in the wake of the pandemic did allow dentists to provide some vaccines, including the COVID-19 vaccine, to patients if the dentist had the knowledge and skill to perform the service.

For a large safety-net health care system like Denver Health, it’s not a huge undertaking to provide dental patients with HPV vaccines because the system is looped into federally-funded programs that supply vaccines, especially to children who are uninsured or on Medicaid. For small private practices, it’s often a different story, Jack says. Vaccines can be expensive for medical professionals to obtain. The HPV vaccine, for example, can cost up to $200 per dose.

“A private practice setting would also have to invest money in a fridge to properly store the vaccines. Plus, there are a lot of regulations that go along with participating in these programs to get federally-funded vaccines for children,” Jack says.

“There are many hoops to jump through, but it could be a great way to increase access to vaccines, so I think that’s part of what we’re going to be exploring in this next phase of medical-dental integration: Can we get standalone dental practices to get this up and running?”