Teledentistry and its use in dental education

BACKGROUND: Teledentistry is a relatively new field that combines telecommunication technology and dental care. Most dentists and dental educators are unaware that teledentistry can be used not only for increased access to dental care, but also for advanced dental education. TYPE OF STUDIES REVIEWED: The authors describe teledentistry as it is applied worldwide, as well as its uses in education. Teledentistry in education can be divided into two main categories: self-instruction and interactive videoconferencing. Both of these methods have been used in several studies and countries. RESULTS: The type of network connectivity used greatly affects the feasibility of teledentistry education. Furthermore, no optimal type exists, but health care professionals should choose the mode based on budget, geography and technical support available. Of the two main categories of teledentistry in education, the interactive videoconferencing method has had better results because of its ability to provide immediate feedback. CLINICAL IMPLICATIONS: Teledentistry can extend care to underserved patient populations, such as those in rural areas, at a reasonable cost. Teledentistry provides an opportunity to supplement traditional teaching methods in dental education, and will provide new opportunities for dental students and dentists.     

Teledentistry and its applications in paediatric dentistry: A literature review

BackgroundDuring the unfortunate event of the COVID-19 pandemic, restrictions were placed on face-to-face interactions in dentistry to promote social distancing and reduce spread of virus. In order to provide dental services teledentistry was employed.ObjectiveThis article aims to review the literature and information available on the provision and utilization of teledentistry as a method to address oral health needs of paediatric patients.ResultsTeledentistry has been utilised in paediatric population for the purpose of oral health education and promotion, remote diagnosis and monitoring, and behaviour guidance. Studies involving paediatric population for aforementioned applications have shown that this practice strategy is beneficial to provide dental treatment in remote locations with little access to paediatric dental specialists, monitor patients between appointments, conduct remote diagnosis and screening programmes, promote oral health of children through dental education, and in pre-appointment behaviour guidance. This method was particularly useful during the current COVID-19 pandemic where dentists use their mobile phones, computer webcams for patient appointments while maintaining safe distance and avoid exposing themselves as well as patient to the virus.ConclusionTeledentistry can be a supplement to face-to-face methods of paediatric dental care, ultimately leading to better patient management. This technology can make a significant contribution in reducing the supply-demand gap of paediatric dental specialists in places where healthcare facilities are limited and ensure safety during the pandemic whilst providing dental care to paediatric patients. Further research is required for safe, effective and evidence-based use of teledentistry in the field of paediatric dentistry.     

The future of teledentistry

Teledentistry is a rapidly forming subset of telehealth, a field that already has considerable impact on the health care industry. Recent advances have created new opportunities for teledentistry, and changes in diverse technologies have created new tools for the practitioner. Technologies currently available are beginning to change the dynamics of dental care delivery. As teledentistry evolves, it will offer new opportunities to improve the level of patient care and reshape current business models.     

Practicing dentistry in the age of telemedicine

BACKGROUND: This article examines teledentistry and some of its current legal issues. Topics include licensure, malpractice, technology and ethics. General recommendations for the dental practitioner are included. The literature review includes state and federal laws, the Telemedicine Report to Congress and numerous articles (both printed and electronic) associated with the topic. Sources were selected for timeliness and relevance to legal issues and implications of telemedicine/teledentistry for the dental practitioner. CONCLUSIONS: Numerous issues require resolution before telemedicine and teledentistry will truly realize their enormous potential to increase access to health care while decreasing health care costs. These issues include interstate licensure, jurisdiction and malpractice, as well as technological, security and ethical questions. PRACTICE IMPLICATIONS: Telemedicine and teledentistry are relatively new to the dental field. Many of the legal issues reviewed have yet to be resolved by the legislature or the courts. Furthermore, technology has not yet progressed to the point where the practitioner can be certain that no technological failure will occur during a teledental consultation. In spite of these problems, the potential of telemedicine and teledentistry is tremendous. Improvement in accessibility of health care and lowered health care costs are only two of the many advantages that will emerge as telemedicine and teledentistry become integrated with, and fundamentally change, the practice of medicine and dentistry.     

Teledentistry: A Key Component in Access to Care

Teledentistry has the potential to address the oral care needs of those who have limited access to care. More research is needed to establish the evidence base to support teledentistry practice.Background and PurposeEnormous potential exists to improve oral health services throughout the world by using information and communication technologies, such as teledentistry to expand access to primary, secondary and tertiary care. Comparison of teledentistry procedures with standard clinical procedures can demonstrate the relative effectiveness and cost of each approach. However, due to insufficient evidence, it is unclear how these strategies compare for improving and maintaining oral health, quality of life, and reducing health care costs. This review discusses the merits of teledentistry for the delivery of oral care.MethodsThis article summarizes the available literature related to the efficacy and effectiveness of teledentistry and presents possible barriers to its broader adoption.ConclusionsTeledentistry seems to be a promising path for providing oral health services where there is a shortage of oral health care providers.     

The use of teledentistry in facilitating oral health for older adults: A scoping review

BackgroundTeledentistry is used in many countries to provide oral health care services. However, using teledentistry to provide oral health care services for older adults is not well documented. This knowledge gap needs to be addressed, especially when accessing a dental clinic is not possible and teledentistry might be the only way for many older adults to receive oral health care services.Types of Studies ReviewedNine databases were searched and 3,396 studies were screened using established eligibility criteria. Included studies were original research or review articles in which the intervention of interest was delivered to an older adult population (≥ 60 years) via teledentistry. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review criteria.ResultsNineteen studies were identified that met the criteria for inclusion. Only 1 study was from the United States. Seven studies had results focusing on older adult participants only, with most of those conducted in elder care facilities. The remainder consisted of studies with mixed-age populations reporting distinct results or information for older adults. The included studies used teledentistry, in both synchronous and asynchronous modes, to provide services such as diagnosis, oral hygiene promotion, assessment and referral of oral emergencies, and postintervention follow-up.Conclusions and Practical ImplicationsTeledentistry comprises a variety of promising apps. The authors identified and described uses, promising possibilities, and limitations of teledentistry to improve the oral health of older adults.     

Teledentistry-assisted, affiliated practice for dental hygienists: an innovative oral health workforce model

The 2010 U.S. Patient Protection and Affordable Care Act (PPACA) calls for training programs to develop mid-level dental health care providers to work in areas with underserved populations. In 2004, legislation was passed in Arizona allowing qualified dental hygienists to enter into an affiliated practice relationship with a dentist to provide oral health care services for underserved populations without general or direct supervision in public health settings. In response, the Northern Arizona University (NAU) Dental Hygiene Department developed a teledentistry-assisted, affiliated practice dental hygiene model that places a dental hygienist in the role of the mid-level practitioner as part of a digitally linked oral health care team. Utilizing current technologies, affiliated practice dental hygienists can digitally acquire and transmit diagnostic data to a distant dentist for triage, diagnosis, and patient referral in addition to providing preventive services permitted within the dental hygiene scope of practice. This article provides information about the PPACA and the Arizona affiliated practice dental hygiene model, defines teledentistry, identifies the digital equipment used in NAU's teledentistry model, give an overview of NAU's teledentistry training, describes NAU's first teledentistry clinical experience, presents statistical analyses and evaluation of NAU students' ability to acquire diagnostically efficacious digital data from remote locations, and summarizes details of remote applications of teledentistry-assisted, affiliated practice dental hygiene workforce model successes.     

Teledentistry in the United States: a new horizon of dental care

Teledentistry has been developing since 1994 as a means to allow dental professionals to communicate with one another over long distances. It allows collaboration by multiple practitioners regarding a patient and the necessary treatment for this patient. Teledentistry can be greatly utilized with rural communities or those of underserved populations. It would increase the accessibility of specialists, besides decreasing time and cost associated with specialty consultations. Real-time videoconferencing and store and forward techniques are the mostly commonly used methodologies for teledentistry. Teledentistry will become more widely seen and utilized by the increase in digital media found in dental practices.     

Teledentistry adoption and applications: An American Dental Association Clinical Evaluators Panel survey

BackgroundThe rise of teleworking technologies has affected various industries, including dentistry. Although some dentists have used it for some time, many are discovering the benefits of incorporating this technology to complement their existing patient care capabilities.MethodsTo assess how clinicians are using teledentistry in their practices, an electronic survey was developed and deployed to the American Dental Association Clinical Evaluators (ACE) Panel on February 27, 2023. The survey link remained open for 2 weeks. Nonrespondents received reminders after 1 week.ResultsOf the 244 respondents (24% response rate), 30% use teledentistry in their practices, with more than one-half of those using synchronous (53%) or asynchronous teledentistry (63%). The most common reasons for incorporating teledentistry were increased convenience for patients (53%), COVID-19 (50%), and increased accessibility to providers (39%). Teledentistry can help serve patients of all ages (the lowest represented age group [0-5 years] had 42% of dentists treating them) and distances, with 63% of teledentistry patients fewer than 20 miles away. Most users adopted teledentistry within the past 3 years and use it fewer than 5 hours per month. Benefits cited include a reduced number of in-person patient visits (63%) and increased access and quality of care (57%). Among nonusers, 60% felt there was no need, and 39% had concerns with reimbursement.ConclusionsTeledentistry has gained popularity in since the onset of the COVID-19 pandemic but may be underused, despite its potential to benefit a wider range of patients and applications than many believe.Practical ImplicationsEducation on the capabilities and benefits of teledentistry may help increase adoption and improve patient care.     

Teledentistry for screening new patient orthodontic referrals. Part 1: A randomised controlled trial

OBJECTIVE: The primary aim was to evaluate the validity of a teledentistry system for screening new patient orthodontic referrals. The secondary aims were to evaluate whether the teledentistry system affected i) referral rates ii) inappropriate referral rates iii) number of failed appointments. STUDY DESIGN: Randomised controlled trial. SAMPLE: Fifteen dental practices in Greater Manchester, UK, were randomly allocated to either a teledentistry test group (n = 8) or a control group (n = 7). They referred 327 patients over a 15 month period. METHOD: Practitioners in the test group referred patients to one of two consultant orthodontists via a 'store and forward' teledentistry system consisting of photographs sent as email attachments. The decision to accept or not accept a referral on this basis was compared with the same decision choice when the same patient was subsequently seen on a new patient clinic. This measured the validity of the system with the clinic's decision used as the gold standard. Patients in the control group were referred using the usual letter system. Referral rates, inappropriate referrals and number of failed appointments were then compared between the teledentistry and control groups. RESULTS: The sensitivity (true positive value) of the teledentistry system was high at 0.80 with a positive predictive value of 0.92. The specificity (true negative value) was slightly lower at 0.73 with a negative predictive value of 0.50. The inappropriate referral rate for the teledentistry group was 8.2% and for the controls 26.2% (p = 0.037). There was no statistically significant difference in clinic attendance between teledentistry and control groups (p = 0.36). CONCLUSIONS: Teledentistry is a valid system for positively identifying appropriate new patient orthodontic referrals. However, there is a risk that a patient is not accepted on the teledentistry system who would benefit from a full clinical examination. Teledentistry could be a significant factor in reducing the inappropriate referral rate. Patient participation in a teledentistry system does not appear to mean they are any more likely to attend their hospital appointment.     

Changes in dental care use patterns due to COVID-19 among insured patients in the United States

BackgroundDemand for dental services has been known to be linked closely to dental insurance and disposable income. Widespread economic uncertainty and health systems changes due to COVID-19 thus may have a significant impact on dental care use.MethodsUsing deidentified dental practice management data from 2019 and 2020, the authors observed variations in dental care use among insured patients since the COVID-19 outbreak (during the period of practice closure and after the reopening) by patient age, procedure type, insurance type, practice size, geographic area, and reopening status. The authors examined whether the rebound in procedure volumes at dental practices can be explained by county-level characteristics using hierarchical regression models.ResultsAlthough dental care use among privately insured patients fully rebounded by August 2020, use still remained lower than the prepandemic level by 7.54% among the publicly insured population. Demand for teledentistry increased 60-fold during practice closure. Geographic characteristics—such as median household income, percentages of rural or Black populations, and dental care professional shortage designations—were associated significantly with the number of procedures performed at dental practices.ConclusionsAs a result of COVID-19, dental practices experienced substantial decreases in procedure volume, particularly among patients covered by public insurance or residing in underserved areas.Practical ImplicationsDuring economic downturns, state health officials should be encouraged to adopt policies to expand access to oral health care for vulnerable populations via oral health promotion strategies and increasing the supply of dentists or midlevel dental care providers in underserved areas.     

Teledentistry: what is it now, and what will it be tomorrow?

A few years ago, teledentistry involved calling an expert on the telephone for advice. Now it involves consulting experts using the Internet. This article explains the basic ideas underlying teledentistry. It involves the local dentist digitizing and electronically transmitting drawings, diagrams, photographs, and X-rays to a specialist. Along with these data, the dentist will most likely need to fill out a standard consult form from the specialist's Web site. In return, the specialist will develop and return a confidential consultation report to the dentist or physician requesting help. For this service, a time-based fee will be paid to the expert. Unfortunately, it is likely that some doctors will use the Internet to set up and seek direct patient contact, thus becoming "cyberdentists." In most cases, cyberdentistry will not be in the best interests of the public. However, teledentistry should not only be a practice builder for the local dentist, but also has the potential for helping dentists better serve their patients while increasing their own knowledge.     

Technology is a Critical Game Changer to the Practice of Dental Hygiene

Dental hygienists will need to embrace 21st century technology to adapt to workplace settings.Background and PurposeTo stay relevant in the workforce, dental hygienists need mastery of new skills and technologies. The purpose of this paper is to elucidate the vast array of technological advances impacting dental practice and the consequent implications for oral health care providers.Critical AnalysisNew technologies have provided unparalleled opportunities for degree and career advancement for dental hygienists. Advances in science and technology are providing patients with better quality and more convenient oral health care. Dental hygienists need technological skills that enable them to fully utilize technology as a strategy for consultation with dentists and other health care professionals and for other purposes. Continuing education and life-long learning factor into preparing dental hygienists for 21st century technologies.ConclusionWith technological advances, less adaptive professionals could potentially see a decrease in demand for their services. Possessing a high level of knowledge of dentistry and dental hygiene does not ensure a position in the workforce. Knowledge of technologies and associated skills are required for quality patient care and career and personal growth.     

Financing oral health services for people with special needs: projecting national expenditures

Low-income people with disabilities or who are elderly have more dental disease, more missing teeth, and more difficulty obtaining dental care than other members of the general population. These realities lead to untreated infection, increased medical costs and needless suffering for the most vulnerable members of our society. It is critical we provide adequate reimbursement for oral health services in order to avoid the tragic and costly consequences of oral neglect. This article focuses on the financial implications of delivering oral health services to low-income individuals who are "aged, blind, and disabled" in the United States. The experience of providing oral health services in California for these populations is extrapolated to predict the cost implications of a national reimbursement system for ABD adults under Medicaid and reform Medicaid oral health programs for vulnerable children. The new federal dollars required to implement this legislation would be more than offset by a conservatively estimated 0.5 percent reduction in costly emergency room and hospital charges for the treatment of serious dental problems, as well as a reduction in the prevalence and severity of several general health conditions. Treating and/or preventing oral infection and disease for the ABD populations in our country will significantly reduce overall health care costs, improve quality of life, and end needless suffering for America's most vulnerable citizens. Treating and/or preventing oral infection and disease for this population simply is the right thing to do.     

Ethics and the electronic health record in dental school clinics

Electronic health records (EHRs) are a major development in the practice of dentistry, and dental schools and dental curricula have benefitted from this technology. Patient data entry, storage, retrieval, transmission, and archiving have been streamlined, and the potential for teledentistry and improvement in epidemiological research is beginning to be realized. However, maintaining patient health information in an electronic form has also changed the environment in dental education, setting up potential ethical dilemmas for students and faculty members. The purpose of this article is to explore some of the ethical issues related to EHRs, the advantages and concerns related to the use of computers in the dental operatory, the impact of the EHR on the doctor-patient relationship, the introduction of web-based EHRs, the link between technology and ethics, and potential solutions for the management of ethical concerns related to EHRs in dental schools.     

Dental public health in California: a mixed picture

Californians face significant dental public health problems. To address these problems, state government, professional organizations, and philanthropic entities in some areas have joined forces. Major issues such as fluoridation, access to care, and the role of the Dental Board of California are examined in terms of the varying roles these critical segments play in affecting the oral health of Californians. This issue of the Journal is dedicated to an examination of public health dentistry in California. While often thought of as innovative and at the "cutting-edge," the state presents a mixed picture of publicly funded oral health programs. Public health concerns sometimes take a lower priority or are overlooked by state government in an era of cutbacks. California lags behind other states in many public goods crucial to the overall quality of life of its residents. This dichotomy is evident in dental public health as it is in education, general health, and air quality. This paper assesses selected dental public health programs, identifying those where innovations have occurred and other program areas where the state has inadequately addressed the dental public health needs of its population.     

Teledentistry applications for mitigating risk and balancing the clinical schedule

The upheaval of providers and their patients has led to many changes in the way people live and work. In addition to the changes in Personal Protective Equipment (PPE) guidelines, there has been evidence of rapid adoption of telehealth services. In April of 2020, the American Dental Association’s Health Policy Institute released a report stating that 1 in 4 dentists nationally were utilizing teledentistry to perform limited evaluations. Many of these dentists are new to teledentistry, and unfortunately, direct-to-patient consultations yield limited clinical outcomes. The more traditional methods of using teledentistry have been extending the reach of dental care for over a decade, using an allied team member such as a dental hygienist or expanded-function dental assistant. As dentistry adapts to this new environment, it is important that there be adequate awareness of the diverse uses of teledentistry to meet the needs of the population. This brief, outlines one dental clinic’s attempt at providing a broad use of teledentistry.