Teledentistry CONTINUED FROM PAGE 18


however, I will argue that it is not the most reliable or productive. The power of teledentistry and all of telehealth is the abil- ity to do an evaluation asynchronously. The common term for this is store-and-forward. Currently I have patients book video-chat appointments with me; however, they fill out a detailed digital form prior to that visit. It is this digital form and the questions you put in it that make the determination of emergent/ urgent care, as well as the patient’s COVID risk level, more predictable and efficient. In many cases, I can directly message the patient and give them guidance without even having that scheduled video chat. There also is scientific literature1 this claim both before2


and articles to back up and after3


align with OSHA recommendations4


for safe


work environments. With the dentist on site for treatment only, you are reducing half or more of the number of patients and staff in the building at any one time and preserving higher-cost PPE for potential aerosol-produc- ing procedures.


COVID. The


key here is that regardless of what method- ology you use to perform teledentistry, you have one layer of risk mitigation and you then have more control over your precious PPE resources.


Hygienist evaluation and intake of pa- tients: The second application in response to teledentistry is what many doctors are considering as their “new normal” workflow. In many states, prior to dentist interaction, a hygienist under general supervision can collect diagnostic data (radiographs, photo- graphs, periodontal charting, digital scans, impressions, tooth charting, detailed notes, etc.) for both existing and new patients. This ability can help limit dentist movement be- tween patients until necessary for treatment and conserve PPE. In many cases, patients do need to come into the office for further diagnostic evaluation. Using this method can help a dentist with limited PPE more precisely determine a definitive diagnosis. As I said earlier, dentists have been using teledentistry in this way for more than a decade. Using this workflow can help dentists with limited office space to spread out their patient visits and not have to take off PPE after doing certain surgical procedures. Many offices are consid- ering separating their teams into diagnostic or hygiene teams for intake and treatment teams with the dentist. These teams would not work at the same time and also would


20 focus | MAY/JUN 2020 | ISSUE 3


There are other applications of teledentistry that can be applied now, in response to COVID, as well as to the future of dentistry. In my practice I use it to supervise my dental hygiene team so that my patients have unin- terrupted access to their recall appointments. Managing stable, low-risk, recall patients is a very simple use case. For two years I have been doing this asynchronously and review- ing the records that evening or the next day. Asynchronous teledentistry is very predict- able when done with a well-calibrated team. This technology has even more potential in the future as new communication tools are integrated into existing practice management solutions and A.I. diagnostic tools are added to the workflow. Several offices I have worked with also use teledentistry to supervise dental hygiene at a satellite location or for weekend hours. Incorporating teledentistry services with your hygiene team can add value to your staff by allowing them to work at the top of their license and therefore giving you time to do the same. There also is a lot of potential to directly connect a general dental practice to a specialty office and offer either an on-demand consultation with a specialist or provide an asynchronous solution to save the patient time. Another exciting frontier of teledentistry is using connected smart devices to engage and monitor your patients’ dental health. This has some great potential in an uncertain future where regular maintenance and elective treatment may not be sought out by patients.


As well, teledentistry has been tried and tested with great results as a way to extend your practice outside of your four walls. I know many dentists across the country using teledentistry to offer free school screenings in the community, thus bringing families into their practices. Also, I recently helped a prosthodontist design a program to reach new patients in area nursing homes by per- forming high-end treatment consultations. The benefit for outreach programs is that the


cost to scale-up a portable program is less expensive than opening an additional location or expanding your space.


Telehealth services which include teledentistry have been rising5


awareness. Business Insider reports6


in the public’s that


global growth of the telehealth market is set to climb nearly 20 percent in the next five years. That is an increase from $38 billion in 2018 to almost $130 billion by 2025. More than half of that growth is reported to come from the U.S. The April 20 COVID eco- nomic tracking poll7


from the ADA’s Health


Policy Institute indicated that more than 25 percent of dentists are now offering some form of virtual, limited evaluation of patients. Demand among patients is what drives these trends—and with that, acceptance. It likely will be expected for the coming months and years that a dental office will offer some sort of virtual communication tool for announce- ments, payment, reminders and education, as well as patient “visits”. As we move into a new chapter for the dental industry it will be no surprise that in addition to enhanced PPE, teledentistry services will become more com- monplace. f


Nathan Suter, DDS is a private practice owner and the board chair of the Missouri Coalition for Oral Health. He is a clinical advisor for Mouthwatch LLC and serves on the Enable Dental Group board of directors. Most recently he was recognized as a recipient of the 2020


ADA 10 under 10 Award and spends most of his quarantine time as a consultant teaching dentists about teledentistry, through Access Teledentistry, which he formed in 2019. Contact Dr. Suter at nsuter@accessteledent.com.


COMMON SOLUTIONS & COSTS


Following is a list of common solutions and cost ranges that dentists usually consider when adding teledentistry to their prac- tice. Some things are up-front and incurred monthly, while adding teledentistry into your clinical flow can require a more long-term investment.


• Limited Evaluation Checklist Price Range: $150-$500 per month


• Secure Communication/Video Confer- encing Software


• Optional – Digital Consent and Health History


• Optional – Online Scheduling


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