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Teledentistry: A Path Toward Oral Health Equity

Oral health equity will be achieved when all patients can get the dental care that they need when they need it. In 2018, we are a long way from oral health equity in America. Oral health disparities exist for many racial and ethnic groups, by socioeconomic status, gender, age and geographic location. Tremendous gains have been made in improving oral health in America over the past several decades with such initiatives as community water fluoridation, school sealant programs, and an expansion of the Medicaid/Children’s Health Insurance Program (CHIP). However, a major barrier to making sustainable gains in oral health equity has been a burgeoning dental workforce that is hampered by tremendous educational debt and by a lack of economic incentives to treat America’s most vulnerable populations. [1] Let’s face it, traditional stand-alone bricks and mortar dental practices are not being built and staffed in underserved areas because the vast majority of dentists either can’t afford to go there and/or frankly don’t want to go there. Increases in access to dental care have been far and few between and have mainly come via alternative dental care delivery models sponsored by federally qualified healthcenters (FQHC’s), dental service organizations (DSO’s), district health centers, mobile dental clinics, and other non-traditional practices. [2] The common thread in those access to care success stories is the use of teledentistry.

Teledentistry describes a set of tools to link patients with providers who are not otherwise accessible. The American Teledentistry Association (ATDA) defines teledentistry as “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, where the originating site of care is the location at which the oral health professional is licensed.” [3] Essentially, any modality that can bring the patient and the provider together without them being physically located in the same place would qualify as a viable teledental technology. Smartphones are ubiquitous and affordable. There is probably a better chance that a young person in an underserved area is using a smartphone than the chance that they are drinking fluoridated water. At present, there are several health insurance portability and accountability act (HIPAA) compliant iPhone applications available to clinicians for incorporating teledentistry into their practice. The ease with which we can engage a patient in improving their oral health is remarkable. So why are we not making greater gains in increasing access to dental care?

Dentistry has traditionally been defined as a procedure-oriented profession with emphasis on mechanical expertise. [4] Although our profession’s mindset has been very slow to adopt new approaches there has been a sea change in the past decade with many oral health professionals embracing the concept that dental disease, e.g. early childhood caries, is a chronic infectious disease and as such should be regarded as a public health problem [5] Teledentistry bolsters risk assessment, early diagnosis and intervention, and provides the opportunity for continuous monitoring of patients in their home communities. Although teledentistry has great promise for expanding access to care, there are some serious regulatory and reimbursement barriers that need to be addressed so that providers can implement it. We have a tremendous opportunity right now to work with State legislators and insurers to develop teledentistry policy that will expand access to care. In the process, we might just reimagine clinical practice altogether. [6]

References

1. Wall Street Journal. Available at: https://www.wsj.com/articles/mike-meru-has-1-
million-in-student-loans-how-did-that-happen-1527252975 (Accessed August 9, 2018)

2. Langelier M, Rodat C, Moore J. Case Studies of 6 Teledentistry Programs: Strategies to Increase Access to General and Specialty Dental Services. Rensselaer, NY: Oral Health
Workforce Research Center, Center for Health Workforce Studies, School of Public Health, SUNY Albany; December 2016.

3. American Teledentistry Association. Available at:
https://www.americanteledentistry.org/facts-about-teledentistry/ (Accessed August 9, 2018)

4. Institute of Medicine (US) Committee on the Future of Dental Education; Field MJ, editor. Dental Education at the Crossroads: Challenges and Change. Washington (DC): National Academies Press (US); 1995.

5. American Academy of Pediatric Dentistry Policy on Early Childhood Caries (ECC): Unique Challenges and Treatment Options. Available at:
http://www.aapd.org/media/Policies_Guidelines/P_ECCUniqueChallenges.pdf (Accessed August 9, 2018)

6. Ackerman MB. Reimagining clinical practice: Teleorthodontic technology and its impact on workflow, workforce and access to care. J Am Coll Dent. 2018;85(2):26-29.

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