Dentist on phone
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By Emma Yasinski

 

At Rochester’s Eastman Institute for Oral Health (EIOH), dentists reach patients throughout the surrounding communities – many of whom are children who have never had the opportunity to see a dentist before – without ever leaving their offices.

A recent issue of Health Affairs dealt exclusively with the promise of various telehealth initiatives, those which improve patient care in rural areas, prevent disease spread, and improve patient communication – and how the technology can be used to deliver dental care.

Dorota Kopycka-Kedzierawski, DDS, MPH, an associate professor at the University of Rochester and lead author on the Health Affairs article, and her team at EIOH have been working for about 15 years to harness teledentistry to provide care for underserved children in Rochester.

But underserved children aren’t the only ones who can benefit from teledentistry. The U.S. Army was the first to explore the use of teledentistry in 1994, and a new company, The TeleDentists, has been working with hospitals, urgent care, and clinics – where patients may appear with tooth pain – to deliver care that physicians are unprepared to provide.

Other providers are working to reach children and adults all over the globe.

In June 2019, the EIOH will co-host the first National Teledentistry Conference with the American TeleDentistry Association (ATDA), which announced its formation in May of 2018.

 

They were able to show that there was no difference in sensitivity or specificity of the identification of caries between a traditional dental appointment and a teledentistry appointment.

 

EIOH teamed with a pediatric telemedicine project in 2004 to test the feasibility of providing teledentistry to rural children, many of whom suffer from dental caries. They were able to show that there was no difference in sensitivity or specificity of the identification of caries between a traditional dental appointment and a teledentistry appointment.

Since then, they’ve studied both synchronous teledentistry, where a dentist is viewing images and communicating with a patient in real time during a visit with a trained health worker, and asynchronous teledentistry, where the health worker stores photos during a visit and forwards them to the dentist to determine the patients’ needs at a later time.

In a follow-up study on caries prevalence, the team found that 50% of preschool-aged children hadn’t ever seen a dentist. Those who had seen a teledentist previously, however, used dental care significantly more than those who had not, demonstrating its ability to reach patients who might not otherwise seek dental care.

In 2010, the group set up a synchronous teledentistry program between EIOH and a rural community health center in western New York State. According to the Health Affairs article, initial startup costs for this type of program are less than $15,000.

A community health center in the Finger Lakes area reached out to EIOH when it became clear that only 15% of children who the center referred to specialized dental care actually completed it. The groups set up a synchronous teledentistry program, where dentists at EIOH could video-chat with patients at the health center. Through the program, they have evaluated 850 patients to date.

Dorota Kopycka-Kedzierawski
Dr. Dorota Kopycka-Kedzierawski

“One of Eastman Institute for Oral Health’s core missions is to provide care for patients who have unmet oral health needs. Sadly, this covers a wide range of people, including those living in poverty, patients with medically complex conditions, geriatric patients, children, and adults with developmental or intellectual disabilities,” said Dr. Kopycka-Kedzierawski “We are encouraged by the fact that the children screened via teledentistry show up for their appointments, initiate oral health care, and have their treatment plans completed.”

A 2014 analysis of the patients who had been referred to specialty care outside the clinic showed care completion rates ranging from 56-100%, depending on the treatment needs.

“Teledentistry has been shown to reduce the costs of and barriers to accessing oral health care, improve oral health outcomes, increase the use of oral health care resources,” the authors of the Health Affairs article wrote.

“ER docs hate dealing with toothache patients,” Dr. Maria Kunstadter said. “The standard was [the patients would] wait for four-to-six hours in busy places, then they'd see the doctor, and the doctor would say, ‘Here's some narcotics. Go see a dentist.’”

As the opioid epidemic was gaining more and more national attention, Maria Kunstadter, DDS, now president of The TeleDentists, was invited to participate in meetings about how to manage patients with chronic pain. Repeatedly, she heard stories from Emergency Room (ER) doctors about patients coming to the ER with toothaches, and that the only thing the doctors could do was prescribe them narcotics and send them on their way. She learned that billions of dollars are spent in ERs for oral complaints alone.

 

“ER docs hate dealing with toothache patients,” she said. “The standard was [the patients would] wait for four-to-six hours in busy places, then they'd see the doctor, and the doctor would say, ‘Here's some narcotics. Go see a dentist.’”

 

But even if the patients did call a dentist’s office to set an appointment, sometimes they’d have to wait weeks to receive an appointment. As Dr. Kunstadter notes, nobody with a severe toothache can wait that long. Twenty-two percent of them wind up back in the ER within two weeks.

Thus, The TeleDentists was born.

The TeleDentists, which the team rolled out nationally in July 2018, are attempting to help both the ER physicians and the patients.

So far, Dr. Kunstadter and her colleagues have partnered with five healthcare providers. When a patient comes to one of these facilities complaining of tooth pain, the patients have a video meeting with a dentist who listens to their complaint. Then, a trained technician uses an intraoral camera to show the dentists the inside of the patient’s mouth. The video feed switches back to the dentist who can explain to the patient the likely causes of pain, prescribe high dose anti-inflammatory drugs (they cannot prescribe narcotics,) and set them up with an in-person dental appointment in the next 24-48 hours to treat the pain’s underlying cause.

“We can't get a dentist into every emergency room, but you certainly could have a virtual dentist in every emergency room,” said Dr. Kunstadter.

 

Federal and state laws can vary, and reimbursement can be a challenge. For example, while Medicare currently covers synchronized teledentistry in New York State, it doesn’t cover the costs of asynchronous care.

 

Other versions of teledentistry are popping up around the country, such as Smiles X-Press, which allows dental hygienists and technicians to provide care in children’s classrooms under the supervision of a virtual dentist in the office; Virtudent, which partners with companies to provide dental care to busy employees; SmileDirectClub, which provides tooth straightening materials via mail without ever meeting a patient in person; and several others.

Dentists are reaching more patients than ever, but there are still challenges.

For example, regulations vary between states, and dentists providing care must be licensed in the states where their offices are located as well as where their patients are meeting them for virtual visits. Federal and state laws can also vary, and reimbursement can be a challenge. For example, while Medicare currently covers synchronized teledentistry in New York State, it doesn’t cover the costs of asynchronous care.

But those who are embracing teledentistry are confident that its use will only grow.

“Our teledentistry initiative has proven 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,” said Dr. Kopycka-Kedzierawski. “I really cannot think of any drawbacks,” she added.

 

Author: Contributing writer Emma Yasinski received her Master of Science (MS) in science and medical journalism from Boston University. Her articles have also appeared at TheAtlantic.com, Kaiser Health News, NPR Shots, and Genetic Engineering and Biotechnology News.

Other Recent Incisor Articles by Emma Yasinski:

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