It’s 6 pm and your toddler walks into the kitchen, opens the cupboard under the sink, grabs a hold of one of the many brightly colored spray bottles of cleaning fluid, and then squirts a healthy amount of it in their mouth. You find him on the floor next to several bottles strewn across the floor. He has just vomited, is having difficulty breathing, is confused, and is exhibiting other strange behavior. It is clear that he has drank poison, so in a panic you reach for the phone and call poison control. Or more recently, poison control offers a web application that you can use, although there is a greater lag time to receive a response.
Have you ever wondered who is on the other end of the line? When you call Poison Control, you will speak to a poison specialist. Poison control staffers sit for a national certifying exam to become CSPIs (Certified Specialists in Poison Information) after a year of training. They have never met your little boy. They don’t even have a visual of what he currently looks like and have to rely on your answers to some questions that you may not have answers to. There is no standard of care for how many questions need to be asked. Here are the 9 common questions:
- Age of the patient.
- Presence of symptoms.
- Weight of the patient.
- Health history.
- The exact name of the product, as read from the label.
- The size of the container.
- The strength of the product.
- When the exposure occurred.
- The amount involved in the exposure, if known.
More than likely, you will be told to give the child some milk and monitor or call the ambulance right away.
So what can this process teach organized dentistry about the safety of teledentistry?
- You don’t need a face-to-face exam to diagnose and make treatment decisions, particularly for low acuity dental conditions, e.g.-crooked teeth
- Dentists go to school for 3-4 years in order to earn their professional degree
- In order to practice, dentists must pass a written exam and a clinical exam on live patients. They also have to pass an ethics and juris prudence exam which tests their moral compass and understanding of the laws of that state governing dentistry
- Many of the warmly held notions regarding standard of care in dentistry are based less on evidence but rather based on the clinician’s “individual judgement”
Teledentistry is upon us. It is a methodology that has been shown to increase access to care, reduce costs of care, and improve convenience for dental patients. So rather than trying to influence State Boards of Dentistry and Federal agencies to legislate against it by mandating draconian rules that are unequal and different to those for bricks and mortar practice, organized dentistry should be working to develop innovative strategies to boost the utilization of teledentistry. Medicine initiated these strategies 26 years ago, it’s about time dentistry joined the 21st Century.