Advances in teledentistry may be key to improving access to care. But as with most things that appear simple, teledentistry is a complex new venture.
Just outside the state’s capital in Polk County, Oregon, the latest in health technology has come to do battle with one of humanity’s oldest foes: tooth decay and periodontal disease.
The Oregon Dental Pilot Project, launched in 2016 by the Oregon Health & Science University (OHSU) School of Dentistry in partnership with Capitol Dental and the University of the Pacific School of Dentistry in San Francisco, was created to evaluate the clinical outcomes of nearly 800 elementary school students receiving school-based preventative dental care using a telehealth system.
The pilot project also gathered important data on the use of teledentistry to keep children healthy. With advances in technology, more states are looking to the potential of teledentistry as an innovative care solution.
OREGON PILOT PROJECT
“It’s heartbreaking to see what these kids are going through,” said Jennifer Lewis-Goff, director of government affairs for the Oregon Dental Association (ODA). The ODA was a key supporter of Senate Bill 738, which in 2011 authorized the state’s pilot project process to test out innovative solutions to deliver oral health care. The legislation allows approved projects to operate outside of current dental practice law. In this case, it expanded the scope of dental hygienists to include Interim Therapeutic Restorations (ITRs) with remote oversight using teledentistry.
Under the pilot project, expanded practice dental hygienists (EPDHs) worked with three elementary schools to provide school-based dental screenings. All told, 779 children ages 5-11 received preventive services and ITRs. Findings were recorded and uploaded to cloud-based dental records, which were reviewed by offsite supervising dentists.
“There is a lot of homelessness and drug use in the area. One of the dentists I spoke with said the health of these kids is equal to those he’d seen in third world countries,” added Lewis-Goff. “It’s very meaningful to see this in person and what’s happening.”
Dr. Eli Schwarz, professor and chair of the OHSU Department of Community Dentistry, oversees the project. Schwarz says the dentists he works with in the pilot project were a little nervous at first about the technology itself and not being physically present with a patient.
“In the beginning they needed to get over that hump of not laying hands on the patients, but the hygienists have been providing good information,” said Schwarz.
“Otherwise, the cameras we have nowadays and equipment in general is of such high quality — it’s almost as if you were there yourself, the photo quality is so good.”
Lewis-Goff said her ODA members have been interested in seeing the data — on both the patients and the return on investment.
“I think that’s going to be the difficult side — it’s expensive to get a lot of the technology in your office,” she said. “That’s the nature of how dentistry evolves.”
‘BRING CARE TO WHERE PEOPLE ARE’
Oregon is not the first — and likely not the last — to explore the possibilities of teledentistry. In California, Dr. Paul Glassman is the founder and director of the Pacific Center for Special Care’s “Virtual Dental Home.” The Pacific Center connects a dentist in the dental office with licensed dental professionals who use ITRs with underserved populations — people who might otherwise receive no care. Glassman’s University of the Pacific is also a partner in the project.
California has paid dentists nearly $130 million in incentives in the last two years in return for treating more low-income children. Funding these prevention efforts helps reduce the amount of oral disease statewide, according to Glassman.
In an interview with DentistryIQ, Glassman explained that “many groups, including the Institute of Medicine, have concluded that to do better we must find ways to ‘bring care to where people are.’ Systems that employ teledentistry and can create telehealth-connected teams and Virtual Dental Homes are a very viable way to do this.”
Dr. Dorota Kopycka-Kedzierawski, an associate professor of dentistry at the Eastman Institute for Oral Health in Rochester, New York, documented her teledentistry findings with Medicaid-eligible children in the Finger Lakes Community Health Clinic in western New York. She has been studying teledentistry since 2004.
In a January interview, Kopycka-Kedzierawski told ADA News, “Our teledentistry initiative has been demonstrated to be an innovative, practical and cost-effective means to improve access and increase oral health care utilization, especially among urban, rural and disadvantaged children who might not otherwise have access to oral health care.”
According to Kopycka-Kedzierawski, teledentistry provides the greatest benefit for urban and rural children with limited access to care; older individuals; patients with special needs; and patients who require specialty consultations that are otherwise not available to them.
In New York state, Kopycka-Kedzierawski added, Medicaid covers synchronous teledentistry consultations when specific guidelines are followed. “I hope that more of my colleagues will embrace this technology, as it has been demonstrated to be beneficial to our patients,” she said.
WHERE IS WASHINGTON?
In 2017, the Dental Quality Assurance Commission (DQAC) published guidelines on the appropriate use of teledentistry. For all intents and purposes, teledentistry is included within the practice of dentistry and is not a separate discipline per the DQAC guidelines.
“It is a tool of dentistry, not a separate form of dentistry,” the commission notes. Licensure requirements and the standard of care expectations remain the same.
“The use of teledentistry is becoming more commonplace with an increasing number of states offering reimbursement,” said Emily Lovell, director of government affairs for the WSDA. “And while teledentistry can be seen as another tool to improve access to care, we want to be sure the role of the dentist remains at the forefront of all treatment and care decisions, whether that dentist is in the office with a patient or through a virtual setting.”
WHAT IS TELEDENTISTRY?
Teledentistry refers to the use of telehealth systems and methodologies in dentistry. It can include patient care and education delivery using, but not limited to:
- Live Video (Synchronous): Live, two-way interaction between a person (patient, caregiver or provider) and a provider using audiovisual telecommunications technology such as a videoconference.
- Store-and-Forward (Asynchronous): Transmission of recorded health information (for example, radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to a practitioner, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live action.
- Remote Patient Monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support of care.
- Mobile Health (mHealth): Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers, and personal digital assistants (PDA).
SOURCE: ADA, “D9995 and D9996 — ADA Guide to Understanding and Documenting Teledentistry Events.”
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