Virtual House Calls: How Teledentistry Can Help You Reach More Patients
Taking care of your patient's teeth with the help of a laptop and an internet connection, rather than the traditional dental chair may sound odd or even impossible to you, but it is actually gaining traction.
The experiences of practicing dentists and hygienists (1), as well as peer-reviewed academic studies (2), attest to the surprising effectiveness of teledentistry – the use of modern communication and information technology to provide clinical services remotely.
In this article we break down what teledentistry is, what are its benefits and drawbacks, and ultimately how it helps you and your patients.
What is teledentistry?
Teledentistry is a form of telehealth or telemedicine, which is the use of modern communication and information technology (like the Internet, video conferencing, and smartphones) to deliver medical consultations, education and care across geographic distances (3).
Its purpose is not to replace in-person medical care, but to make dental care possible in situations where it would otherwise be a struggle (such as travel time and costs, or shortages of specialists).
When done right, telemedicine is not so different from the time-honoured medical practice of making house calls – providing quality healthcare to a community by going to those patients who cannot come to you.
As early as 1994, the US Army's Total Dental Access Project demonstrated that telehealth principles applied to dentistry, and that “teledentistry” could reduce patient care costs, and could extend dental care to isolated areas without compromising the quality of diagnosis or treatment (4).
Because teledentistry can trace its roots back so far demonstrates that it is not a fad dreamed up by tech enthusiasts impressed by the ubiquity of smartphones. Rather, the many innovative technologies available today mean that the promise of teledentistry, recognised by oral health professionals for over two decades, is coming within the grasp of any ordinary practice willing to dip its toes into the digital waters.
How does it work?
Teledentistry can work in two distinct ways. Synchronous (or 'real-time') teledentistry involves engaging with patients in real time, usually through video conferencing – where you might speak to the patient (who is at home, for example) through a laptop or smartphone.
Usually, an assistant or hygienist will be at the patient's location, able to assist with diagnosis and discuss treatment planning under the dentist's guidance (5).
Meanwhile, asynchronous (or 'store-and-forward') teledentistry involves the examination being done separately at the patient's location, usually by a dental hygienist.
The hygienist then saves and sends images, records, and gathers other information so the dentist can review them at a later time (6). Naturally, each country will have their own guidelines regarding teledentistry, and the specific rules and regulations dictated by that region will likely differ.
In the UK
In Europe, the UK appears to follow the US trend, with the UK's National Health Service recently sponsoring general telehealth projects (such as GP At Hand) and setting up resources like the Technology Enabled Care Services (TECS) programme to help medical practitioners, including dentists take advantage of the opportunities telemedicine creates (16).
The role teledentistry can play in triaging patients to the appropriate level of care is another highly valuable factor to consider.
For example, in 2010, a trial in the UK examined 37 patients who had been on waiting lists for clinical examinations by specialists, and teledentistry examinations found eight patients needing urgent biopsies. For the remainder, getting help was less urgent, and 24 patients with common oral lesions were treated entirely under a consultant's supervision via teledentistry.
What tools do you need?
You can get started with either type of teledentistry with easily-available telecom equipment and oral health devices, and interacting with patients can be done for free with computer and smartphone apps like Skype and FaceTime.
To conduct an examination, a hygienist or assistant can bring a lightweight, portable intraoral camera with them to the patient, take the necessary pictures, and send them back to the dentist (7).
The requirements for relaying clear diagnostic images and clinical records, and maintaining a live videoconference if desired, are as straightforward as a laptop on each end of the process, paired with a secure and high-capacity Internet connection.
For dentists who would like to scale up their teledentistry activities, there are also all-in-one programmes available that are designed to integrate teledentistry as a regular part of your practice.
MouthWatch's TeleDent, for example, is a streamlined software that would assist you in performing teledentistry actions better. Ultimately, it is up to the doctor to ensure if these programs are appropriate and useful for those who wish to go a step further and make teledentistry a regular or even routine service.
Who does it help?
Typical cases for teledentistry include seniors living in nursing homes; school children, because they are dependent on their busy parents for transport, or because they are anxious of the dentist's office and are put at ease by being treated in familiar surroundings; and rural communities far removed from the nearest dental practice.
Peer-reviewed case studies for teledentistry are numerous. For example, teledentistry was used to good effect in isolated communities in Australia and Alaska, in some cases bringing dental care to people who had not seen a dentist in 20 or 30 years (9).
In France, teledentistry allowed dentists to bring improved dental care to prison inmates in a 2017 pilot project (10). Meanwhile, a study in Georgia, US, found that teledentistry not only improved access to dental care, but also reduced the number of missed appointments for busy professionals, allowing dentists to schedule them more effectively (11).
What are the pitfalls?
Funding is commonly cited as a barrier for implementation (13). Many of the case studies mentioned above depended on public funding and grants, and large-scale programmes which required participation from a network of clinics, patients, and specialists.
Ethics and confidentiality are another concern that doctors should be aware of. Therefore, be aware and carry out all of the necessary due diligence prior to committing to these kinds of solutions.
When can you start?
The above pitfalls may slow the adoption of teledentistry, but teledentistry is nevertheless likely to gain ground rapidly in the coming years.
The inclusion of teledentistry in the American Dental Association's Code on Dental Procedures and Nomenclature (the CDT) starting this year shows teledentistry is becoming institutionalized as a normal practice in the repertoire of oral health professionals. This is mirrored in the fact that insurers ever more commonly cover teledentistry in the same way they do ordinary in-office consultations (15).
Taking the initiative to reach out to your community with teledentistry could be worthwhile for your practice. Teledentistry offers a way to attract new patients who do not need in-chair surgery time and create visibility within your community. Teledentistry will allow you to deliver healthcare to a wider range of people, many of whom would have difficulty reaching you otherwise.
While no-one is claiming Skype, FaceTime or even TeleDent will replace the brick-and-mortar practice, the 'virtual house calls' teledentistry allows for means that you could reserve your physical chair for those who really need it – without compromising on the care for those who don't.