“Teledentistry can be defined as the remote provision of dental care, advice, or treatment through the medium of information technology, rather than through direct personal contact with any patient(s) involved. Within dental practice, teledentistry is used extensively in disciplines like preventive dentistry, orthodontics, endodontics, oral surgery, periodontal conditions, detection of early dental caries, patient education, oral medicine, and diagnosis. Some of the key modes and methods used in teledentistry are electronic health records, electronic referral systems, digitizing images, teleconsultations, and telediagnosis. All the applications used in teledentistry aim to bring about efficiency, provide access to underserved population, improve quality of care, and reduce oral disease burden.
Teledentistry is an exciting new area of dentistry that fuses electronic health records, telecommunications technology, digital imaging, and the Internet to link health providers in rural or remote communities. For the patient located in underserved or remote areas, teledentistry improves ready access to preventive dental care and teleconsultation with specialists. It allows the dentist in the nearby community to provide easier access to preventive care to a patient who, otherwise, probably will not seek care. It enables the specialist located many miles away to make a diagnosis and recommend treatment options and/or referral.
****When provider organizations were using teledentistry for consults with general dentists, the main functions of the service was to diagnose disease, to develop treatment plans, determine the primary and preventive oral health services that could be provided to patients in their home communities, and to expedite referral and follow-up for dental treatment when necessary. One of the teledentistry programs in the case studies used real-time teleconferencing between dental hygienists, patients, and general dentists to determine a diagnosis and to complete treatment planning. The dentist would then direct the dental hygienist to provide the necessary preventive services after completion of the teledentistry consultation. Other programs used store-and-forward teledentistry to enable diagnosis and treatment planning by the general dentist. The dental hygienist in these programs acquired images and x-rays, completed an oral health assessment, and provided education and preventive services during the initial patient visit. The records and images acquired during the visit were then forwarded for timely review by a consulting dentist, usually within hours or a day. Once diagnosis and treatment planning were complete, the dental hygienist managed patient notifi cation and referral for any necessary follow-up treatment services.****
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.
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.
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 is an emerging modality for delivering oral health services to populations with signifi cant diffi culty fi nding services because of geography or other factors that limit the accessibility or availability of dental care. Case study participants commented on the effi cacy of teledentistry for patients, especially on the advantages for triaging patients to the most appropriate level of care. A percentage of patients who were assessed through teledentistry consults were able to remain in their local communities for basic oral health services and for care management. As a result, scarce dental resources in communities were appropriately reserved for patients in need of more extensive treatment or surgical services or for those assessed at high risk for disease. In addition, informants to the case studies remarked that patients and providers expressed satisfaction with the quality of services and the outcomes from teledentistry consultations. Patients experienced shorter wait times to obtain consultation services, and providers found the modality effi cient, timely, and cost eff ective.
Populations living in rural areas experience diverse challenges to obtaining oral health services, including higher rates of chronic disease, higher percentages of elderly people, limited availability of health and oral health workforce and provider organizations, higher rates of unemployment, underemployment and poverty, lower rates of dental insurance, and greater dependence on public insurance coverage than those in more densely populated areas.1-3 Lower levels of community water fl uoridation and greater dependence on private water supplies in rural areas aff ect oral health outcomes over the long term. Personal barriers include a lack of public transportation or reliable private transportation to access distant oral health services. As a result of these and other barriers, rural populations exhibit higher rates of oral disease, lower rates of oral health services utilization, higher rates of inappropriate emergency department usage for dental complaints, and poorer oral health outcomes generally than other population groups. Strategies to increase access to and utilization of oral health services must be tailored to these special characteristics of rurality.1 Although dental services are now increasingly provided in public health settings in rural areas, including federally qualifi ed health centers (FQHCs), access to services in the safety net is constrained by limited resources and capacity, including a limited supply of clinical providers. The use of teledentistry as a means to improve access to oral health services in areas with inadequate availability of general and specialty dental care is emerging as a practical solution, especially for treatment planning and specialty consultations. A review of the scientifi c literature on teledentistry found it to be a promising and eff ective strategy for increasing access to services in both rural and urban areas.
Wireless technology, cloud computing, standardized protocols for digital imaging and communication in medicine (DICOM), capable picture archiving and communication systems (PACs), and portable medical and dental equipment, including small intraoral cameras and lightweight portable imaging devices, reduce the complexity of obtaining and transmitting health and oral health information and diagnostic x-rays across distances. High-capacity broadband networks relay clear diagnostic images and patients’ clinical records, providing an opportunity for patients and providers to interface in real time by video technology. Secure health information is now more easily and safely transmitted across local, regional, and statewide information exchanges, allowing for improved communication between providers and patients.
Telehealth has been described as a “disruptive” innovation in health care because it has the potential to impact service delivery design in many areas, particularly in specialty care.5 Delivering services through telehealth modalities appears to expand both system and workforce capacity for increased convenience for patients and improved effi ciency for providers. Use of telehealth modalities promotes risk assessment, early diagnosis and intervention, and the opportunity for continuous monitoring of patients in their home communities.
Common motivating factors for providing teledentistry services were the multiple barriers for underserved patient populations to access oral health providers. These included geographic and socioeconomic factors that prevented patients from seeing general dentists or specialists to address oral disease. Using capable technology to provide access was described as a logical strategy to link patients to necessary services.Hourly employment is especially common in rural areas where there are few large industrial employers. Obtaining leave time from hourly jobs to obtain oral health services during the work week, especially when lengthy travel is required to access those services, was described as economically burdensome. Patients without leave time benefi ts forgo pay when not present at work. In addition, in many of the catchment areas served by case study organizations, there were few private dental practices and most were inaccessible to patients insured by state Medicaid programs.Teledentistry services were described as convenient, safe, of high quality, and cost eff ective for patients and particularly useful under these circumstances.
Implementing a teledentistry program requires adequate communication infrastructure, portable dental equipment, a source of sustainable funding, and a capable workforce trained to effectively use the equipment. Necessary infrastructure may include: High-speed broadband networks/cables Wireless modems Dedicated bandwidth Interconnectivity between information systems, including network interfaces and bridges.Required equipment may include: Desktop or laptop computers Computer software, including imaging storage and retrieval programs, electronic dental records, and administrative and billing modules.Encryption and security software Intraoral cameras .Portable x-ray equipment and sensors .Fixed, mobile, or portable dental chairs and other dental equipment, including water supplies, sterilizing equipment, etc. Video conferencing technology, including monitors Voice-over-IP for telephones