willingness of new england dental professionals to provide assistance during a bioterrorism event

Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and ScienceVolume 6, Number 3, 2008 © Mary Ann Liebert, Inc.DOI: 10.1089/bsp.2008.0014

WILLINGNESS OF NEW ENGLAND DENTAL PROFESSIONALS

TO PROVIDE ASSISTANCE DURING A BIOTERRORISM EVENT

Thayer E. Scott, Sangeetha Bansal, and Ana Karina Mascarenhas

A bioterrorism attack could overwhelm medical personnel and facilities, suggesting a need for aid from nonmedical per-

sonnel. The American Dental Association suggests that dental professionals should assist in such cases, utilizing their

strong scientific and technical skills. This study describes New England dental professionals’ willingness, potential roles,

motivators, and barriers to providing this aid. This cross-sectional study used a self-administered survey to collect data ad-

dressing the knowledge and opinions of dental professionals concerning acting as responders. The survey was distributed

to 370 attendees of the 2005 Yankee Dental Conference, in Boston, Massachusetts. Most dental professionals expressed

willingness to help during an attack (N � 340, 92%), reporting that dental professionals, in general, should perform a

mean number of 6 roles. Three-quarters of dentists and dental students were personally willing, with proper training, to

give immunizations, and 54% would perform triage. Knowledge was weak, but most dental professionals were interested

in obtaining further education (83%). Since dental professionals are willing to assist during a bioterrorism attack and are

motivated to obtain disaster response training, government officials and local directors and managers of disaster/emer-

gency response agencies should consider incorporating dental professionals into their disaster management plans.

253

FIRST RESPONDERS TO BIOTERRORISM EVENTS are primarilymedical professionals, police officers, firefighters, veteri-

narians, or public health officials. Dentists are rarely per-ceived as operating in an expanded role as first responders.However, some dentists were unknowingly enlisted into theeffort by the public following the 2001 anthrax attacks, whenthey were asked by their patients to prescribe antibiotics foranthrax, even though their patients had not been exposed.The American Dental Association (ADA) was inundatedwith questions from various dental personnel concerning an-thrax recognition, management, and treatment.

In response to the September 11 and anthrax attacks, theADA, in conjunction with the U.S. Public Health Service,convened a series of workshops to determine whether den-tistry should be integrated into the national disaster response

to a bioterrorism event.1,2 Because an attack could massivelyand quickly overwhelm medical personnel and facilities, itwas suggested at these workshops that dentists had a moralduty to make use of their strong scientific backgrounds andtechnical skills to expand their current disaster support rolebeyond their traditional forensic duties of identifying re-mains after a disaster.1,2 In 2007, the ADA House of Dele-gates adopted a resolution that formally said that, based ontheir clinical/medical training, dentists are invaluable assetsin a mass casualty event and should be provided with educa-tional opportunities to become more effective responders,with the ADA providing leadership and training and advo-cating for national emergency preparedness solutions.3

Since dentists are usually perceived as “mouth doctors,”they are often overlooked as potential responders to a

Thayer E. Scott, MPH, is an Instructor; Sangeetha Bansal, BDS, MSD, is a graduate student; and Ana Karina Mascarenhas, BDS, PhD,is Program Director; all are in the Division of Dental Public Health, Department of Health Policy and Health Services Research, BostonUniversity Goldman School of Dental Medicine, Boston, Massachusetts.

bioterrorism event, but the consensus workshops identifiedseveral areas where dental professionals could assist.1,2 Onesuggestion was to provide dental office space to serve as self-contained alternate medical sites for patient treatmentshould the hospital system become besieged. Because dentalpractices are situated throughout the community and alsocontain most of the required equipment and supplies formedical care (eg, sterilization equipment, radiology, nee-dles, etc), they may be better able to provide treatment thansome urban hospitals, which are often located in thedensely populated areas that would be primary targets for amaximum impact bioterrorism attack.

The consensus workshops suggested that dentists betrained to recognize the signs and symptoms of bioterror-ism agents, so they can effectively diagnose and report asuspected bioterrorism infection. Because people mayschedule dental visits more frequently than their annualcheckups with their physicians, and because dental profes-sionals may spend more time with their patients than dophysicians,2 they are excellent choices to educate the publicand to augment the disease surveillance system in theircommunities. While an individual would most likely notkeep a dental appointment if he or she were extremely ill,oral manifestations occur for some of these infections, andthe ADA suggests that dental professionals could reportlarge numbers of cancellations or perform salivary or nasalswabbing to help aid in surveillance, diagnosis, or treat-ment.2 Other suggested services that dentists could performwith additional training include assisting medical person-nel, performing CPR and giving first aid, performing vic-tim triage, providing vaccinations and medications undersupervision, performing forensic dentistry, keeping accu-rate dental records, and counseling the public about risksduring a bioterrorism event.1,2

While the ADA perceives the dental professional as animportant protector of the public’s welfare during a bioter-rorism attack, only 1 study has actually asked whether den-tists were willing to provide this assistance: of 133 Hawai-ian dentists surveyed, 74% were willing to help in the eventof an attack.4 This study assessed dentists’ knowledge andwillingness, but it did not identify what roles they shouldplay, nor did it explore the interest levels of other highly ed-ucated and trained dental professionals, including dentalhygienists, in helping to safeguard their community duringan attack. Therefore, the aim of this study is to describe thewillingness of New England dentists and dental hygieniststo be involved in this important national issue, their poten-tial roles, and motivators and barriers to participation.

METHODS

This study used a cross-sectional study design and em-ployed a self-administered survey to collect data addressing

the knowledge, attitudes, and opinions of dental profes-sionals concerning their roles as responders during a poten-tial bioterrorism event. The survey was distributed to atten-dees of the 2005 Yankee Dental Conference held inBoston, Massachusetts. This venue was chosen because itallowed us to survey readily available dental professionalsattending a large regional conference specifically aimed at this profession. After study approval was obtained fromthe Institutional Review Board at Boston University Med-ical Campus, study participants were enrolled in the studywhen they visited the Boston University Alumni andContinuing Education booth and also at 2 continuing edu-cation (CE) courses. This convenience sample targeteddentists and hygienists and included primarily dentalprofessionals practicing in the 5 New England states(Maine, Massachusetts, Vermont, New Hampshire, andConnecticut).

The questionnaire was based on 2 prior studies that sur-veyed the preparedness for bioterrorism of family physi-cians,5 state public health officers, and veterinarians.6 Thequestionnaire also included questions concerning the rolessuggested for dentists in the ADA consensus papers.1,2 Thefinal 18-question survey instrument contained both struc-tured and open-ended questions that measured 4 broadoutcomes regarding bioterrorism: assessing the dental pro-fessional’s opinions, determining both their self-assessedand actual knowledge bases, and ascertaining their need fortraining programs and CE courses. Four survey questionsdescribed the subject’s profession, gender, year of gradua-tion from dental/hygiene school, and the state of practice.The survey was pilot tested by 15 students and facultymembers for good face validity, ease of administration, andreadability prior to administration.

The dental professionals’ opinions regarding bioterrorismwere assessed using a 5-point Likert scale for questions aboutwhether they thought that bioterrorism was a serious na-tional issue, that an attack was possible locally, and that den-tal professionals should be first responders (range: 1 forstrongly disagree to 5 for strongly agree). In addition, a newvariable was created to reflect an overall positive opinion bysumming the scores for these 3 questions. Because there werefew replies at the extremes or “don’t know” answers, re-sponses to individual questions were dichotomized intoagree/strongly agree versus don’t know/disagree/strongly dis-agree. Ten possible roles dental professionals could play dur-ing a bioterrorism event were listed, and respondents wereasked to check all that applied. Self-reported knowledge wasmeasured with a 5-point Likert scale that determined howcapable dental personnel felt in recognizing the signs andsymptoms of an attack, whether they would know how toget information about an attack, whether they could get clin-ical information about an attack, and how capable they feltabout their current knowledge of management of bioterror-ism. A new variable calculating self-assessed knowledge was

WILLINGNESS OF NEW ENGLAND DENTAL PROFESSIONALS TO PROVIDE ASSISTANCE

254 Biosecurity and Bioterrorism: Biodefense Strategy, Practice, and Science

designed by summing the responses to these 5 questions, andindividual questions were assessed after dichotomizing intoagree/strongly agree versus other responses.

Actual knowledge about bioterrorism was evaluatedbased on the participant’s ability to correctly identify the 2places to report an attack and to list the 4 most importantbioterrorism-related diseases based on the CDC assessmentof Category A and B bioterrorism diseases.7 The need foreducation programs was determined by asking participantsif they needed more education about bioterrorism, if theyknew of any bioterrorism-related CE courses, if they had at-tended a CE course on bioterrorism, if they would attend acourse on bioterrorism, and whether they felt that bioter-rorism preparedness instruction should be provided in thedental/hygiene curriculum.

Data collected by the survey was coded and entered intoa customized database entry form in Epi Info Version3.3.2. and analyzed in SAS v.9.1. Descriptive statistics in-cluded frequencies and means to describe the distributionsof responses between the dental professionals, and multiplelogistic regression analysis was performed to determine thebest predictors of individuals who were willing to assist in abioterrorism event.

RESULTS

Of the 370 study participants, most were dentists (40.8%)and hygienists (39.4%), and the rest were dental students(13.0%) or dental assistants (6.8%). Most participants hadfinished their professional education 12 years ago on aver-age, with the exception of the dental students, who werestill in the process of completing their degrees (Table 1).Gender distributions showed that the dental hygienists andassistants were almost exclusively female, while dentists anddental students showed more equal gender distributions.Almost two-thirds of the study population reported practic-ing in the state of Massachusetts, including dental studentswho were still studying at state institutions and practicingdentists, while at least half of hygienists and assistants prac-ticed in neighboring states.

On average, dental professionals had high opinion scoresconcerning bioterrorism (11.5 out of a maximum score of15). Approximately 9 out of 10 individuals felt bioterror-ism to be a serious national issue, but fewer felt that it waslikely to occur locally. Half of the participants believed thatdental professionals should be members of first responderteams, with dentists most likely to feel they should be mem-

SCOTT ET AL.

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Table 1. Dental Professionals’ Demographics and Opinions about Bioterrorism and Suggested Roles during a Bioterrorism Event

All DDS Students Hygienists AssistantsCharacteristic N � 370 n � 151 n � 48 n � 146 n � 25

DemographicsYears graduated (mean � SD) 12.1 � 11.5 13.7 � 11.5 0 14.5 � 11.2 12.0 � 8.8Male gender 35.2% 65.8% 52.1% 2.9% 0.0%Massachusetts practice 62.3% 69.4% 94.9% 50.0% 40.0%

Opinions concerning bioterrorismScore positive opinions(mean � SD) 11.5 � 2.2 11.4 � 2.5 11.3 � 2.2 11.5 � 2.0 12.0 � 1.9Serious national issue 89.7% 86.7% 85.4% 93.2% 96.0%Attack possible locally 59.9% 61.3% 50.0% 61.0% 64.0%Dental professional first

responder 52.0% 58.0% 53.2% 45.5% 52.0%

Suggested roles for dental professionals during a bioterrorism eventNumber of roles (mean � SD) 5.9 � 2.7 6.2 � 2.8 6.9 � 2.5 5.3 � 2.5 5.6 � 2.8Keep accurate dental records 87.0% 83.4% 80.9% 93.2% 84.0%CPR/first aid 84.8% 82.8% 93.6% 86.3% 72.0%Forensic dentistry 75.9% 75.5% 83.0% 72.6% 84.0%Assist medical personnel 71.3% 78.8% 89.4% 58.9% 64.0%Provide clinic space 54.5% 56.3% 55.3% 50.7% 64.0%Report bioterrorism infection 53.1% 57.0% 61.7% 46.6% 52.0%Administer vaccines/meds

with supervision 46.3% 51.0% 59.6% 37.0% 48.0%Victim triage 40.9% 49.0% 57.5% 28.1% 36.0%Counsel public during attack 40.7% 43.1% 61.7% 32.2% 36.0%Diagnose bioterrorism infection 33.1% 39.7% 44.7% 24.7% 20.0%None of the above roles 1.4% 2.0% 0.0% 0.7% 4.0%

bers (58%) and dental hygienists least likely to think so(45.5%).

Participants thought that dental professionals should playa number of roles during a bioterrorism event, averaging 6out of the 10 possible suggested roles. Dentists and dentalstudents thought more roles should be performed than didhygienists and assistants. The most frequently suggested rolesmentioned were those that fall into the traditional scope ofthe dental practice and training, mainly keeping accuratedental records (87.0%), performing CPR and first aid(84.8%), and performing forensic dentistry (75.9%). Slightlymore than half of the population thought that dental profes-sionals should assist medical personnel, provide clinic space,and report a possible bioterrorism infection. The survey pop-ulation was less likely to agree with dental professionals vacci-nating or administering medications, performing victimtriage and counseling the public, or diagnosing a bioterror-ism infection. Only 5 study participants thought that dentalprofessionals had no disaster support role to play.

Table 2 describes the dental professionals’ willingness,motivators, and barriers to providing care during a bioter-rorism attack. The vast majority (92%) of this study samplewas personally willing to assist during a bioterrorism attackif they were given training, with dentists and dental stu-

dents being slightly more willing than dental hygienists andassistants. If given proper training, almost 3 out of every 4dentists and students were personally willing to give immu-nizations, and more than half of them said they would per-form triage. Dental professionals were least likely to detectand report disease (50.1%).

Primary motivators for providing care included having asense of responsibility (64.9%), feeling that they have theability to provide the care (62.5%), and believing that theyare a part of the public health response (59.2%). Slightlymore than half believed their code of ethics to be a primarymotivator. Approximately 15% of the participants believedthat they would be at low risk when providing assistanceduring a bioterrorism attack.

Barriers to providing care were less prevalent than moti-vators, with 77% reporting no barriers to providing care.Dental students and hygienists reported slightly more barri-ers than did dentists and assistants. The most frequently re-ported barrier was family obligations (10.1%), followed byfear or concern for their own safety (9.3%). Only 8% ofparticipants reported being afraid of contracting a diseaseor checked off potential lawsuits as a barrier. Transporta-tion issues were the least frequently reported barrier.

Table 3 shows that this population’s self-assessed knowl-



Table 2. Dental Professionals’ Willingness, Motivators, and Barriers to Providing Care during a Bioterrorism Attack


Willing to provide care 92.0% 96.0% 100.0% 85.4% 91.3%Number of personal roles

(mean � SD) 1.7 � 1.0 1.9 � 1.0 1.8 � 0.9 1.4 � 1.0 1.7 � 1.2Personally willing to:

Give immunizations 60.8% 73.5% 71.7% 44.4% 58.3%Perform triage 54.3% 62.9% 56.5% 43.1% 62.5%Detect and report disease 50.1% 55.0% 52.2% 45.1% 45.8%Other 1.6% 0.7% 2.2% 2.8% 0.0%

Personal motivations for providing careNumber of motivators

(mean � SD) 2.6 � 1.5 2.7 � 1.5 3.0 � 1.3 2.3 � 1.6 2.4 � 1.5Sense of responsibility 64.9% 65.6% 73.9% 59.7% 75.0%Have ability 62.5% 71.5% 84.8% 48.6% 45.8%Part of public health response 59.2% 63.6% 60.9% 52.8% 66.7%Code of ethics 54.5% 55.0% 67.4% 52.1% 41.7%Risk is low to me 15.6% 16.6% 17.4% 15.3% 8.3%Conflicted about providing care 19.7% 19.9% 37.0% 14.6% 16.7%

Barriers to providing careNumber of barriers (mean � SD) 0.4 � 0.9 0.3 � 0.7 0.6 � 1.0 0.5 � 1.1 0.2 � 0.4

Family obligations 10.1% 6.6% 13.0% 13.9% 4.2%Fear/concern for self-safety 9.3% 5.3% 10.9% 13.2% 8.3%Afraid of contracting disease 8.2% 7.3% 17.4% 6.9% 4.2%Fear of lawsuits 8.2% 8.0% 10.9% 8.3% 4.2%Transportation issues 2.7% 0.7% 4.4% 4.9% 0.0%

edge was poor, with approximately half of the individualsfeeling that they knew where to report a bioterrorism attack,and fewer feeling able to recognize the symptoms of an attackor knowing how to get clinical information about bioterror-ism or any information about an attack. They were leastlikely to agree that their knowledge about management of abioterrorism event was current. Overall, dental students hadthe highest self-reported knowledge and were most likely toagree that they know how to respond to an attack, with anaverage overall score of 17 out of a possible 25 points. Actualknowledge was measured by assessing whether the individu-als accurately knew to report an attack to their state and localpublic health departments. Only 43% of dental professionalscorrectly identified both responses, with two-thirds of dentalprofessionals knowing to contact their state public health de-partment and fewer individuals knowing to contact their lo-cal public health department.

Survey respondents’ actual knowledge also included sup-plying the names of 4 of the CDC’s 6 Category A diseasesor 10 Category B diseases.7 Knowledge about bioterrorism

diseases was weak, with only one-third of individuals ableto record smallpox or anthrax, the most frequently listeddiseases. Dental professionals were no more able to name aCategory B bioterrorism disease. Over half of respondentswere unable to correctly list a single bioterrorism disease.

Almost all participants (90.7%) acknowledged a need formore bioterrorism preparedness education, with dental hy-gienists and assistants reporting a slightly greater need thandid the dentists and dental students (Table 4). On average,approximately 8 out of 10 individuals said that they would beinterested in attending a continuing education (CE) course,with hygienists most likely to attend and dentists showingsomewhat less interest. While respondents were interested inobtaining CE training, only 12% actually knew of any avail-able CE course. Few dental professionals had actively attainedCE training on this topic (5.5%), with most of these individ-uals being dentists or students. Most of the survey respon-dents felt that bioterrorism should be added to the dental/hy-giene curriculum, but the current students were least likely toagree with this compared to graduated professionals.

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Table 3. Descriptions of the Dental Professionals’ Actual and Perceived Knowledge


Self-assessed knowledgeTotal self-knowledge

(mean � SD) 15.2 � 4.2 15.9 � 4.3 17.1 � 4.0 13.9 � 4.0 14.3 � 3.8Know where to report attack 47.3% 51.0% 60.9% 37.9% 54.6%Recognize symptoms of attack 37.5% 47.0% 52.2% 24.3% 27.3%Know how to get clinical info. 36.2% 40.8% 52.2% 26.6% 31.8%Know how to get information 33.6% 39.5% 43.5% 25.9% 22.7%Have good current knowledge 16.8% 20.6% 30.4% 9.4% 9.1%

Would report suspected disease to:State public health dept. 69.9% 67.6% 68.1% 72.6% 72.0%Local public health dept. 55.6% 53.0% 59.6% 56.9% 56.0%

Both correct 43.1% 39.7% 44.7% 44.5% 52.0%CDC 64.8% 59.6% 68.1% 69.9% 60.0%Don’t know 3.5% 4.6% 0.0% 3.4% 4.0%Would not report 1.4% 2.0% 0.0% 1.4% 0.0%

Report of 4 most important bioterrorism related diseasesSmallpox 39.0% 41.7% 37.0% 38.2% 30.4%Anthrax 33.2% 38.4% 41.3% 25.7% 30.4%Viral hemorrhagic fevers 4.7% 7.3% 2.2% 2.8% 4.4%Plague 1.7% 3.3% 0.0% 0.7% 0.0%Botulism 1.7% 2.0% 4.4% 0.7% 0.0%Tularemia 0.3% 0.7% 0.0% 0.0% 0.0%No Category A agent correct 51.4% 45.0% 50.0% 57.6% 56.5%Category A diseases (mean � SD) 0.8 � 0.9 0.9 � 1.0 0.8 � 1.0 0.7 � 0.9 0.7 � 0.9Category A � B diseases (mean � SD) 0.9 � 1.0 1.0 � 1.1 0.9 � 1.0 0.8 � 1.0 0.7 � 0.9

Sum of correct disease reports and Category A agentsOverall knowledge (mean � SD) 2.0 � 1.3 2.1 � 1.3 2.1 � 1.3 2.0 � 1.2 1.9 � 1.5

Multiple logistic regression modeling was performed tobetter describe individuals who reported being willing to as-sist during a bioterrorism event (Table 5). These individualswere more likely to be dentists or students and to be recentgraduates, to have more positive attitudes, and to think den-tal professionals should perform more roles during an event,but they had poorer actual knowledge. State of practice,gender, and self-assessed knowledge concerning correct re-porting and identification of bioterrorism were not statisti-cally significant and thus were not considered to be predic-tors. Because few dental professionals had attended abioterrorism preparedness CE course, it was impossible toassess in a multivariate model whether bioterrorism pre-paredness CE affected the willingness of individuals to assist.

DISCUSSION

Dental professionals are very willing to assist in emergencyresponse during a bioterrorism event, with 92% of dentalprofessionals being willing—this is in contrast to the 80%of physicians in a nationwide study who reported willing-ness to assist in a bioterrorist event.8 Multivariate modelingshowed that willing practitioners were more likely to bedentists or dental students than dental hygienists or assis-tants, were more recent school graduates, felt that bioter-rorism is a serious threat, and thought that dental profes-sionals should play more roles in a bioterrorism event.

Surprisingly, individuals with more bioterrorism knowl-edge were less willing to become involved; these results aresimilar to those reported in a survey of Hawaiian dentists.4

Dental practitioners believe their profession should pro-vide aid during a bioterrorism event, performing a meannumber of 6 roles. The most frequently mentioned rolesthat dental professionals should perform include keepingaccurate dental records, providing CPR and first aid, per-forming forensic dentistry, assisting medical personnel,providing clinical space, and reporting a possible bioterror-ism infection. Approximately 40% of respondents thoughtthat dental professionals should help vaccinate or providemedications under medical supervision, perform victimtriage, or counsel the public during an attack. Dentists anddental students thought that dental professionals in generalshould perform more roles, and they also were slightly moreinterested in active roles for themselves than were hygienistsand dental assistants.

While motivation to help was evident, the ability to carrythis motivation out was not as robust, since both self-as-sessed knowledge and actual knowledge were low. The vastmajority of respondents understood this deficiency, withover 90% acknowledging their need for further educationand 82% interested in obtaining training. While respon-dents reported an interest in CE, only 12% actually knewof any available CE course—a surprising finding since acourse on bioterrorism preparedness was being presented atthis very meeting.



Table 5. Multivariate Model Describing Dental Professionals’ Willingness to Assist during a Bioterrorism Event

95% ConfidenceCharacteristic Odds ratio Interval p-value

Dentist/dental student 7.4 (1.03-54) 0.047Male sex 0.9 (0.1-6.9) 0.9Time since graudation (years) 0.95 (0.91-0.99) 0.03Massachusetts practice 0.5 (0.2-1.5) 0.2Number of positive opinions 1.3 (1.06-1.7) 0.01Number of suggested roles 1.8 (1.4-2.5) �0.0001Perceived knowledge (number) 1.07 (0.95-1.2) 0.3Measured knowledge (number) 0.7 (0.4-1.007) 0.054

Table 4. Dental Professionals’ Perceptions Regarding Bioterrorism Education


Participant needs further education 90.7% 88.1% 84.8% 94.4% 95.7%Participant would attend CE course 82.9% 78.8% 81.4% 87.8% 81.8%Participant knows of CE course 12.1% 13.9% 13.0% 10.4% 8.7%Participant attended a CE course 5.5% 8.0% 6.5% 3.5% 0.0%Add course to curriculum 70.0% 68.2% 63.0% 71.9% 85.7%

Compared to the Hawaiian dentists, our sample of NewEngland dental professionals were more willing to act asfirst responders; perhaps they had been sensitized to the is-sue because the planes embarked from the Boston airporton September 11. New England dental professionals hadgreater self-reported knowledge than their Hawaiian coun-terparts, being 3 times more likely to recognize the signsand symptoms of an attack,4 but they were less likely toagree that they could obtain information about an attackthan New York City–based physicians.5 Dental profession-als had less knowledge than physicians about the CDC Cat-egory A bioterrorism diseases based on their greater diffi-culty in listing anthrax and smallpox, perhaps because morephysicians had obtained bioterrorism training than haddentists (5.5% versus 18%). On the other hand, bothphysicians and dental professionals had similarly poorknowledge bases surrounding the remaining Category Aagents (viral hemorrhagic fevers, plague, botulism, and tu-laremia7).

A limitation of this study is a potential lack of generaliz-ability, because the study population was a conveniencesample of volunteer subjects who became study participantswhen they visited an exhibition booth at the Yankee DentalConference. This venue was chosen to try to boost the lowrate of survey return that is frequently seen for mailed sur-veys to dentists; however, individuals motivated to attend aregional conference may inherently be more motivated toobtain further education and training and thus may nottruly reflect the attitudes and knowledge of all New En-gland practitioners. While this conference attracts a largenumber of dental professionals regionwide, this diversitymay be diluted by the number of individuals who actuallychose to visit this specific dental school alumni booth. Inaddition, volunteers may be more motivated to answer thesurvey because of their interest in bioterrorism than wouldbe those who refuse. While motivated respondents mightoverestimate the knowledge level of the New England den-tal professional, our study results still highlight the strongneed for further CE opportunities for this population. Fu-ture areas of study could determine if other geographic ar-eas show similar interest in all-hazards response volun-teerism and training, as well as assessing actual followthrough on obtaining this training and its effects on dentalprofessionals registering with local disaster managementprograms. Additional information on disaster planners’perceptions of dental professionals’ capabilities and useful-ness as responders would also be of interest.

Our study results signal the dental profession’s desire toprovide aid during a bioterrorism attack; however, while theADA actively encourages dental professionals to become moreinvolved, disaster planners appear to be unsure whether andhow to integrate dental professionals into their response plan-ning.9 Reports exist of dentists who volunteered at mock an-thrax attacks being informed that they were unqualified to

deal with medical issues, and of New York City dentists beingrelegated to crowd control.10 This approach by disaster plan-ners may be shortsighted, since a complex disaster will requirea surge capacity of available, trained healthcare providers.

In addition, the assumption that all medical providerswill report for duty may be faulty. One survey of medicalpersonnel estimated that absenteeism rates would be 27%for physicians and 56% for nurses during an avian flu out-break and that even an offer of triple pay would be no in-ducement to improve attendance.11 Another study deter-mined that while 80% of physicians would treat patientsinfected with an unknown but potentially deadly bioterror-ism disease, when the disease was known to be deadly only40% were willing to provide patient care.8 These scenariossuggest a greatly reduced workforce may require supple-mentation by trained individuals from outside the medicalprofession to help the community survive an outbreak.Dental professionals may be key to helping to fill this void.

Are dental professionals ready to provide this aid? Not yet,since they require additional disaster response training to betterassist in the effort. However, their knowledge base is similar tothat of many physicians, and studies show that they learn as ef-fectively as physicians in the same classes.12,13 State legislaturesmay need to modify dental professionals’ scope of practice to al-low them to perform more duties during an emergency.14 Withfurther education, dental professionals are motivated to helpthe disaster response. Government officials, local officials, andmanagers of disaster and emergency response agencies need tounderstand and appreciate that dental professionals have theability and the desire to provide more care to their communitiesthan tooth whitening and cavity drilling.

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concerns regarding bioterrorism. J Occup Environ Med 2004;46:77-83.

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Manuscript received February 21, 2008;accepted for publication June 26, 2008.

Address reprint requests to:Thayer E. Scott, MPH

Boston UniversityGoldman School of Dental Medicine

Health Policy & Health Services Research715 Albany St., 3rd floor

Boston, MA 02118

Email: [email protected]



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