Teledentistry can help dentists’ practice management of staff and patients safely during the COVID-19 coronavirus pandemic

March 13, 2020 FaceWell

Teledentistry gives you, your staff and your patients the option to engage for consults and triage remotely

COVID-19 coronavirus escalation across Australia is causing a number of headaches for dental practices nationwide:

shortage of PPE - especially masks and gloves
staff quarantine for 2 week periods or longer if infected, affecting manpower
risk to staff and patient safety via aerosol spray, especially those who are immunocompromised, requiring postponing non-emergency treatment and reducing clinical workflow

Reduced practice operation is a looming likelihood until the current viral threat passes. Employing a range of solutions to help offset these issues is highly important. Teledentistry safely and conveniently offers capacity building for staff and patients via remote engagement, anywhere.

Teledentistry reduces PPE and consumables usage, allows quarantined but otherwise well practitioners and staff to still work, reduces risk of viral spread via the practice, yet allows patients to have their dental needs serviced to a level of stability for the short-medium term.

What is teledentistry?

Teledentistry is the use of telehealth online video and messaging technology to communicate and consult with patients and other practitioners about dentistry remotely using a smart device. It’s like Skype or FaceTime for dentistry.

Teledentistry technology is now cheaper and easier to install than ever! The upskill time is low for anyone already familiar with using a smart device and making video calls.

Currently this technology operates separately to existing practice management software, but can readily run side-by-side for ease of use by all dental staff.

Teledentistry uses a combination of collated patient data, photographs, video observation and detailed questioning for assessment, indicative diagnosis and problem triaging. This can happen live ie in real time (synchronous) or via review of collected data not involving a video call (asynchronous).

Teledentistry provides a viable alternative to face-to-face dentistry for consults, triage, planning and reviews

Till now a common concern regarding teledentistry is whether the equivalent level of dental assessment and diagnostics can be made virtually compared to in person. Numerous studies have demonstrated clinical assessment quality is equal to a face-to-face consult for:

patient personal contact details, health and dental history updates
oral health assessments not requiring special tests or extended diagnostic services such as radiology or pathology - although referrals for these services can be made and later reviewed
trauma, swelling, bleeding or discolouration to the mouth, jaws, or teeth
caries except incipient lesions - ones that wouldn’t normally need radiographic assessment for definitive diagnosis
teeth breakage, wear, erosion, some visible cracks
endodontic pathology for experienced practitioners, but reduced for inexperienced practitioners
periodontitis presence, but not severity
orthodontic screening, assessment and remote treatment monitoring
non-invasive white light oral medicine screenings
dental sleep medicine screenings and therapy reviews
radiographic reviews
post-operative treatment reviews

By guiding a patient to carefully use a piece of ice from their freezer wrapped in a tissue, a cotton bud, the end of a teaspoon and/or a torchlight, the vast majority of symptomatic dental presentations can be evaluated indicatively well enough to triage successfully.

If recent radiographic assessment is available, advanced treatment planning for many facets of dentistry can be carried out with a high level of confidence, knowing the safety net is an eventual face-to-face investigation prior to any invasive dental treatment being initiated.

View the reference list at the end of the article or enter ‘teledentistry’ as a keyword into PubMed to explore the supportive scientific literature.

Teledentistry doesn’t replace clinical treatment procedures but it greatly assists planning and workflow to minimise risk, wastage and stress

Obviously teledentistry cannot replace an in person visit for actual invasive treatment procedures, yet! Oral deposit and hygiene maintenance, restorations, definitive infection management and reconstructive procedures still require an in person visit.

But with enhanced pre-planning, appointments can be scheduled to reduce the number of visits per patient and therefore the volume of PPE and consumables, as well as staff-patient interactions.

Dedicated item codes for teledentistry are yet to be released by the ADA, but code ‘014’ or similar is suitable for this type of service including ‘teledentistry consult’ in the descriptive and may attract a health fund rebate.

Current good tech options for teledentistry in Australia

Note: Skype, Apple FaceTime, Google Hangouts, Go-To Webinar, Whatsapp and Facebook Messenger are not currently OAIC compliant for healthcare consults.

Zoom video conferencing app - the easiest, cheapest solution that meets healthcare privacy and security standards in Australia and overseas. It is purely a video conferencing tool. While you can use the free version, it’s worth paying $21 per month for a Pro package for one primary user account in the practice.
Simply download the app on all devices, set up and account, watch a few tutorials and you’re away. Patients simply need to download the free app on a mobile device (not necessary on desktop) to open the meeting link you share with them when booking a time to chat. It’s an app they’ll likely use for other video conferencing purposes in their daily lives.
It gives you whiteboard options, document sharing, screen sharing, chat boxes, multiple video participants (up to 100 people) and more.
Integrates with many other online applications, eg Dropbox, Gsuite, many CRM’s and more - except dental practice management software and health fund copayment gateways.
It’s platform agnostic, meaning it works on any device.
Coviu Global - an Australian developed telehealth platform, backed by Telstra, it provides a turnkey scheduling and video app with prices starting at $20 per month per user for basic features, rising to $60 per month for more advanced features like multiple people on a video call and customisable forms - although these have limited capacity for dental needs.
Definitely a decent solution for a single practice but doesn’t integrate with many other apps and quickly gets expensive for practices with multiple users.
It requires its own app download by end users they are unlikely to use for anything else.
ViDe Virtual Dental - a marketplace platform developed by a dentist, specifically for the dental industry in Australia, it’s priced between $80-99 per month per practice for up to 2 users, with additional users $35 per month each.
Currently powered by Zoom for Business video (although an upgrade to an even smoother video (webRTC) platform is on the horizon).
ViDe provides your practice with online scheduling, online payments, predesigned secure digital forms for patient history, diagnostic assessments, reports and referrals typically used by many practitioners in daily practice.
Practitioners get a profile on the marketplace to engage with other practitioners or patients for clinical consults or professional mentoring.
Plus for those practitioners with at least 7 years Australian clinical practice experience, gain access to patients who present in pharmacies and aged care homes (coming soon) all over Australia for additional consult and income options.
A dedicated practice online portal for branded and customised forms and links for use with the ViDe platform can be added for a one-off fee of $350 + $100 for each additionally created digital form required to meet your specific needs.
New to the market we are now scaling!

What you need in place to be a teledentistry practitioner

Registered with AHPRA as a dental practitioner - technician, hygienist, dental or oral health therapist, dentist or specialist.
Current opportunities are limited for OHPs (oral health practitioners) to provide teledentistry services, although there are huge opportunities to be the ground person coordinating teledentistry consults with dentists or specialists for remote patients in your care, allowing you to work more independently and fully to your scope than you’ve ever thought possible!
Current professional indemnity - with a clearance to provide teledentistry services - talk to your insurance representative prior to starting consults.
Provider number - for dentists and specialists to provide prescriptions and diagnostic referrals - your main practice number is suitable.
If you don’t have a main practice then apply for a mobile provider number (contact ViDe to find out more about this option).
Smart device less than 2 years old - with the most up-to-date operating systems and fastest wifi available (minimum system requirements can be found here).
While consults can be done on a mobile device, it’s easier to view photos and write reports on a laptop/desktop with a tablet or similar set up as a secondary screen.
Chrome or Firefox internet browser - video applications work best on these, Safari and Outlook are particularly troublesome but getting better.
Charisma - ability to engage in a friendly way with others via video. Trust building body language cues are limited online, so your verbal manner and facial expressions are often amplified, make them good!

Want more tailored info for your specific teledentistry needs?

ViDe founder and principal dentist Dr Christine May has given numerous lectures to the industry on teledentistry and is happy to have a video meeting with you for up to 30 minutes to confidentially discuss your needs and answer your queries for $50+GST. If you sign up to the ViDe platform this fee will be deducted from your subscription. Click here to schedule a time.

Alternatively, register your interest in teledentistry and keep in the loop with future ViDe updates here.

Teledentistry will help you provide expert dental care during the current crisis and may transform your practice!

In short, teledentistry is an excellent cost-effective alternative for many non-invasive dental consults, procedures, administrative tasks and communications between staff, practitioners and patients when face-to-face consults are too challenging.

Dental practitioners have a professional obligation to take measures to maintain access to expert dental care for those who need it, safely and conveniently.

Best wishes for navigating the COVID-19 coronavirus in good health.

Written by Dr Christine May, ViDe Principal Dentist and Founder. All information is of a general nature only and does not replace the information provided by your selected digital applications for your specific use. Christine and ViDe receive no incentives for mentioning products or services in this article.