TELEDENTISTRY FOR A NEW AGE

Teledentistry is not a new concept. In fact, teledentistry has been around since 1994 when it was first introduced by the Department of Defense as the Total Dental Access Program or TDA. The goal of TDA was to increase every Army soldier's access to dental care, allow dental officers at different duty stations to participate in continuing education courses, enhance communication between dental officers and laboratory personnel as well as improve the care of soldiers through the collaboration of dental specialties. But, what exactly is Teledentistry? And what are some of the benefits as well as short comings in diagnosing dental health and disease when utilizing Teledentistry? These are some of the topics that this article will discuss.

What is Teledentistry? According to the American TeleDentistry Association, "Teledentistry is the use of electronic information, imaging and communication technologies, including interactive audio, video, data communications as well as store and forward technologies, to provide and support dental care delivery, diagnosis, consultation, treatment, transfer of dental information and education". In 2015, the American Dental Association established a policy on Teledentistry that included general considerations, patient's rights, quality of care, supervision of Allied Dental Personnel, licensure, reimbursement and technical considerations(Resolution 45H-2015 www.ada.org)

Early uses of Teledentistry included video conferencing, phone calls, email and fax. Communication and transfer of information was unreliable, of low quality and slow in speed due to dependency on POTS, the plain old telephone system. Such limitations did not make it feasible for large scale use in private practices. But, with technological advancements, high quality imaging and real time transfer of information via the internet have made remote consultations and treatment planning a viable solution for addressing both the immediate and long term needs in the field of dentistry.

Benefits of Teledentistry

In recent history, the supply and location of dentists in the United States, could not meet the increasing demand for dental care in under served populations. This made it difficult to almost impossible for children, the elderly and individuals residing in rural areas to obtain treatment or consultation from a licensed dentist. In providing access to dentistry to both under-serviced and rural populations, Teledentistry was hailed as an untapped resource. However, despite the potential need and benefits of teledentistry, wide spread use of remote communication and transfer of information never really took a foot hold, up until recently. Enter, a pandemic named COVID19. With increased concerns of exposure and cross contamination as it relates to COVID19, Teledentistry has taken on a new life. With the continued emphasis on 'social distancing', TeleDentistry provides an opportunity for providers to continue one aspect of dental care in a safer, more efficient manner. Some benefits of Teledentistry include:

- Triage and diagnosis of dental emergencies

- A continuation in providing new patient and recall exams

- Maintain patient flow while decreasing patient in office wait time

- Decrease PPE requirement

- Create patient centric protocol for consultation and patient education

- Maximize provider in office time if cancellations to the schedule occur

- Improve access to new patients, contributing to the growth of the practice

- Decrease employee time away from the office due to emergency, new patient or recall exam

- Improve access for under served and rural populations

In addition to the benefits in improved access, Teledentistry also has benefits in diagnosing oral health and disease. Providers are now able to evaluate digital radiographs remotely and make accurate diagnosis of active caries, periodontal disease, infections, hard tissue pathologies and defective restorations prior to consulting with a patient. Diagnostic radiographs can also be used as an educational tool when discussing the health of teeth and supporting bone as well as the need for additional treatment such as restorations, crowns, root canals, extractions and periodontal treatment.

Disadvantages of Teledentistry

Despite all the advantages Teledentistry offers in the way of patient access and diagnosis, there are some disadvantages that may take time to resolve. To gain a better understanding of some of the barriers faced when implementing Teledentistry as a means to diagnose oral health and disease, a large consideration must be given to a clinicians tactile ability. Tactile acuity is a clinical skill that dentists develop over the life time of their career. It is an indispensable skill that when accompanied with site and sometimes sound allows a dentist to diagnose dental issues that may not be apparent on radiographs or even sometimes clinically. If Teledentistry is to be rooted in the everyday use in the practice of dentistry , the lack of a dentist utilizing her/his hands to pull all of the diagnostic information together to fabricate a comprehensive or limited treatment plan is a hurdle that must eventually be overcome.

Some disadvantages of Teledentistry include:

- In ability to do diagnostic testing such as percussion, cold, palpation and probing to properly determine any issues with the dentition, soft tissue or surrounding periodontium.

- In ability to do Oral Cancer screenings via palpation.

- Without and intraoral camera and diagnostic photos, unable to determine some clinical issues that do not show up on radiographs, such as occlusal caries, gingival recession, abfractions, clinical fractures, soft tissue pathology etc.

- Inconsistency in collecting diagnostic information such as intra-oral photographs and 3D imaging.

- Other disadvantages of Teledentistry exist around its application such as Ethics, Licensure, Malpractice and Security.

Advances in technology like the internet, face time video conferencing, 3D imaging and smart devices are creating a solid platform from which Teledentistry can establish its value in the practice of dentistry. COVID19 is providing a backdrop against which innovative uses can be highlighted.This positions Teledentistry to be a technological tool that is leading the paradigm shift back into a patient centric system. Health care providers are again making house calls but this time with a slight twist.

That which was once old is now new again. Teledentistry is an older technology that has been given a new life and a new purpose for a new age.