If you’ve worked in dentistry over the past few years, it’s likely that you either have firsthand experience with teledentistry or have heard of the concept. In 2023, according to a survey published in the Journal of the American Dental Association, 30% of dentists were using teledentistry in their practices and most had adopted it within the last three years. But if you’re not quite sure what teledentistry is (or isn’t), that’s completely understandable as well – after all, similar to “traditional” dentistry, teledentistry encompasses a diverse range of services and modalities.
Defining Teledentistry
Teledentistry – and the broader term telehealth – refers to the practice of using communication technology to provide patient care. Telehealth services generally fall into one of two categories:
- Synchronous: Sometimes called a remote consultation or “virtual visit,” synchronous teledentistry describes a live, two-way interaction between a person (typically a patient or caregiver) and a dental care provider using audiovisual telecommunications technology. Synchronous teledentistry usually entails videoconferencing, though remote consultations also can be conducted over the phone.
- Asynchronous: Also known as “store-and-forward,” asynchronous teledentistry includes the transmission of recorded health information (charts, photographs, radiographs, videos, digital impressions, etc.) through a secure electronic communications system. For example, a patient may send a photo or X-ray to a provider via an electronic message, who later evaluates this information and offers clinical advice and steps for treatment.
Remote patient monitoring (automated health data collection) and mobile health (mHealth) enabled by electronic devices also are considered forms of teledentistry.
Accessibility & Other Advantages
Like so many other applications of technology in dentistry, teledentistry offers many benefits. As stated in the American Dental Association (ADA) Policy on Teledentistry, “examinations performed using teledentistry can be an effective way to extend the reach of dental professionals, increasing access to care by reducing the effect of distance barriers to care.” For a recent, real-world example, look to the pandemic. In early 2020, when dental offices were required to shutter their doors to slow the spread of the virus, many providers turned to teledentistry as a means of ensuring safety and continuity of care through a time of quarantining and social distancing. Unsurprisingly, the Albany, New York-based Oral Health Workforce Research Center found that by April 2020, teledentistry usage was 60 times greater than pre-pandemic levels.
Even with the restrictions of the pandemic in our rearview, teledentistry still has substantial, everyday utility. Consider, for example, patients who can’t travel to receive care due to limited mobility, lack of transportation or severe weather conditions. Similarly, teledentistry offers an opportunity to provide vital services to patients in remote and underserved areas. Conversely, for busy providers who find themselves at capacity, teledentistry can minimize both the duration and number of in-person visits. Virtual appointments offer a means of screening out individuals who may not require a traditional face-to-face consultation and a way to reduce future, in-person appointment times by completing forms, reviewing patient histories and identifying clinical needs ahead of a trip to the office. It’s worth noting that many patients simply prefer the experience of teledentistry – research shows that virtual consultations may be particularly appealing to members of younger generations and some professionals report that teledentistry has helped them treat patients with dental anxiety.
Challenges & Considerations
Ultimately, all dental patients and providers can enjoy the convenience of teledentistry. Couple this with the expanded patient base that teledentistry enables a practice to serve, and it’s not hard to see how it creates significant opportunities for business growth. But before a practice can reap the benefits of teledentistry, several considerations, and possible challenges, must be addressed.
Integration
When considering any new technology for your practice, a couple of immediate questions probably come to mind, namely, “How long will it take to get up and running?” and “How much will it cost?” The good news is that today’s sophisticated teledentistry solutions minimize costs and complexity of implementation by leveraging hardware you already have (personal computers, smartphones and tablets) and offering simple, seamless integration with existing digital systems (practice management software and electronic health records [EHRs] systems). A patient portal comprises the core component of most teledentistry solutions, which is an online application through which you can communicate asynchronously with patients (messaging), conduct synchronous appointments (phone or video calls), review records, submit referrals and more. To practice teledentistry, you’ll most likely need to invest in a software service you can access via the browser on your computer or mobile device. To ensure quality of care, all staff members who will be using teledentistry technology must receive adequate training. That said, most telehealth apps are designed with interfaces that should feel intuitive and relatively familiar to anyone who regularly uses a smartphone or computer. Working with an experienced dental technology provider like Patterson Dental can make getting started with teledentistry even easier, as a sales representative will gladly assist with selecting a solution that meets the specific needs of your practice and guide your team through the onboarding process.
Costs
In recent years, the ADA has swiftly adapted to the widespread adoption of teledentistry by approving new Current Dental Terminology (CDT) codes that allow dentists to bill for a range of remote services. These include CDT codes representing synchronous and asynchronous patient interactions as well as radiographic and photographic image capture-only procedures. Additionally, many private insurers now include telehealth among their covered services. You also may be interested to learn that, according to a study published by CareQuest Institute for Oral Health, the cost of treating patients via teledentistry totals 11% less annually than dental patients seen in person. In the previously mentioned ADA survey, 31% of responding clinicians reported that teledentistry meant lower costs for their patients. In all, it’s reasonable to conclude that reimbursements and savings can comfortably offset teledentistry implementation and operating expenses.
Security & Privacy
Because it involves protected health information (PHI), before practicing teledentistry, it’s critical to consider all relevant privacy, security and civil rights regulations. This includes federal laws – those issued under the 1996 Health Insurance Portability and Accountability Act (HIPAA) and the Health Information Technology for Economic and Clinical Health (HITECH) Act – as well as any applicable state laws. With regard to the former, at minimum, practices should select a teledentistry solution that claims HIPAA compliance and enter into what’s known as a business associate agreement (BAA) with the service provider (a telehealth application designed specifically for use in dental or healthcare settings is likely to meet these criteria). As for state-specific teledentistry regulations, these are varied and ever-evolving. Some states, for instance, restrict providers from seeing new or out-of-state patients via virtual appointment.
Overall, it may be worthwhile to partner with an expert who can help you develop sound protocols for compliant teledentistry and ensure that you don’t unknowingly leave your practice open to fines or other penalties. Once again, staff training is key to verifying that all team members who will be using telehealth technology understand and follow the necessary steps to maintain patient privacy and regulatory compliance. For more detailed coverage of this topic with healthcare risk management and compliance expert Linda Harvey, RDH, MS, go to page 62 in this issue of Advantage.
Teledentistry & the Patient-Provider Relationship
As the ADA writes, “The dental profession holds a special position of trust within society.” But it can be a challenge to uphold this trust from a distance – some patients may be wary of the quality of care they’ll receive in a remote consultation and voice concerns about the thoroughness of the examination or preservation of personal privacy. However, you can put these insecurities to rest and earn patients’ trust by treating the teledentistry appointment as you would a traditional, in-person visit. In other words, maintain equally high standards of conduct. This includes remaining attentive throughout the consultation, minimizing distractions and “meeting” with patients in a quiet, private area. It also means thoroughly familiarizing yourself with your telehealth technology so you can use it to pull up EHRs, refer to patient photos and manage electronic prescriptions or referrals during the appointment without hesitation.
Most patients who’ve received virtual dental services embrace this type of care. The 2020 CareQuest Institute survey showed that 86% of patients reported satisfaction with their teledentistry experiences and the 2023 ADA survey of dentists found that 31% reported that teledentistry made patients more receptive to care. Another survey of younger patients (Gen Z, millennials and Gen X) by the American Hospital Association revealed that 70% of respondents preferred telehealth because of its convenience and 44% would even switch providers if they don’t offer remote care options in the future. Remember that teledentistry solutions open novel channels of communication for patients, giving them unprecedented access to practice services outside of normal operating hours. Subsequently, it’s easy to see, as staff from New York University College of Dentistry concluded in the article by Torosyan and colleagues, how teledentistry can “become a resource for building and maintaining patient loyalty in private practice” and, by extension, an opportunity to strengthen the patient-provider relationship.
A Powerful Tool for Practice Building
Teledentistry presents a host of questions and challenges, all of which are vital to address given that so much is on the line, including patients’ health and privacy, as well as your professional reputation.
After navigating these obstacles, however, most dentists and their teams will discover that teledentistry serves as a powerful tool that off ers many opportunities and rewards – from breaking down barriers between patient and provider to elevating care experiences and building your practice.
References
- American Dental Association. ADA policy on teledentistry. 2020. ada.org/en/about/governance/ current-policies/ada-policy-on-teledentistry
- American Dental Association. The ADA principles of ethics and code of conduct. 2023. ada.org/about/principles/code-of-ethics
- American Hospital Association.There may be a generation gap in telehealth’s future. 2021. aha.org/aha-center-health-innovation-market-scan/2021-06-29-there-may-be-generation-gap-telehealths-future
- Burger D. Teledentistry poised for vivid future. ADA News. June 12, 2023. adanews.ada.org/adanews/2023/june/teledentistry-poised-for-vivid-future/
- CareQuest Institute for Oral Health. Teledentistry is an effective tool to triage patients & save
money. December 10, 2020. carequest.org/resource-library/teledentistry-effectivetool-triage-patients-save-money - Fernando T, Surdu S, Langelier M, O’Malley E. Use of teledentistry to increase access to oral health services during the COVID-19 pandemic. Oral Health Workforce Research Center. 2022. chwsny. org/wp-content/uploads/2022/06/OHWRC_2022-Teledentistry-Poster_Theekshana.pdf
- Howell SEI, Kumar P, da Costa J, et al. Teledentistry adoption and applications: An American Dental Association Clinical Evaluators Panel survey. JAm Dent Assoc. 2023;154(9):856-7. jada.ada.org/article/S0002-8177(23)00342-2/fulltext
- Torosyan S, Moursi AM, Glickman RS. The challenges and rewards of teledentistry. Compend Cont Educ Dent. 2021;42(6). aegisdentalnetwork.com/cced/2021/06/thechallenges-and-rewards-of-teledentistry
