The New Perspective on Teledentistry in the era of COVID-19

January 2021

Author: Natalie Bradley BDS DCSD MFDS RCSEd

The COVID-19 pandemic has had a huge impact on several aspects of dentistry, and with lockdowns and a reduction in social contacts, the economic viability of many dental practices has been affected.

This is due to several factors, including:

1. An overall revenue decline without opportunities to compensate for it due to the dramatic decrease in patient flow.

2. Patients mid-treatment prior to the pandemic may have had their appointments postponed and been unable to visit the dentist to complete treatment, for example those receiving orthodontic, aesthetic or restorative treatment. Leaving patients in these situations during lockdowns and other restrictions might have had a negative impact on their treatment, which will then need to be rectified.

3. Some people in need of dental treatment or aesthetic procedures might still be avoiding visiting their dentist because of increased risk and fear of contamination, especially if they fall into vulnerable groups.

4. Dentists might desire to eliminate unnecessary in-person visits and to keep only critical ones, especially now, during the second wave of the pandemic.

During the second or further waves of the pandemic, dentists and patients would still like to keep in touch, especially if they need advice about their oral health, follow-up advice if they are mid-treatment or even advice and assessment if they start to experience problems. Moreover, practices still require a revenue income even when face-to-face patient visits are not permitted, in order to help ensure the sustainability of their practice. It will take time for dental offices to recover, and one projection for the US sees 2021 expenditures by patients on dental care still about 20% lower than in 2019.

What is the solution?

One solution might be found by using Telemedicine and as we are discussing dentistry - by using Teledentistry. According to one recent survey, almost a quarter of responding dentists are now using teledentistry while in another survey around 40% reported doing so.

There is a wide range of platforms available with different functionality and levels of sophistication that dentists can use to maintain contact with their patients, which can also help with revenue. Some platforms today are far ahead of just video calls, when a dentist and a patient can see each other and talk online. The American Dental Association recognizes several teledentistry modalities. These are synchronous where the patient and the dentist interact in real time; asynchronous where the information is gathered and a dentist then reviews it at a different time; remote patient monitoring whereby patient information is gathered and then transmitted to another location for review and patient care use; and, mobile health practices supported by mobile communication devices such as a cell phone.

Depending on the system being used, teledentistry can include referrals, viewable treatment plans, recording of remote video visits with patients, virtual scheduling, case presentations and conferencing capabilities.

The more advanced systems use AI (Artificial Intelligence) to help dentists analyze the images received from their patients and to recognize problems based on a massive database of clinical cases and connected images.

There are also other hi-end solutions, more commonly used in telemedicine, such as telebiometric devices but also dental examples like intra-oral scanners, which collect objective patient data for the dentist to interpret. This data, unlike video calls, records a patient's data as well as their history and is then available at any time on demand.

Regardless of which technologies you are considering for use in teledentistry, there are several key considerations. Check the laws in your State (elsewhere, your province/country and location) related to what is permitted, State Board regulations, and what policies and options exist for reimbursement. Make sure that the technology is compliant with healthcare privacy laws in your location - for example, in the United States it would need to be HIPAA-compliant; you may otherwise inadvertently violate HIPAA.

In the era of COVID-19, these platforms can be seen as a great opportunity for both dentists and patients to stay connected; for patients - to make sure their problem is under control, and for dentists - to provide added value to their patients as well as to compensate for decreased revenue brought by the lack of face-to-face patient contacts.

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