How Teledentistry Powered Dental Hygiene Can Bring Care to Patients in Need

Wednesday, January 16, 2019
How Teledentistry Powered Dental Hygiene Can Bring Care to Patients in Need

Hygienist, Michele Wildes, provides dental hygiene and teledentistry services to a patient in a nursing home.

Most people don’t have any difficulty finding a dentist if they have a broken tooth, something in their mouth that is causing pain or if they simply want a “check-up”.

They find them in their dental office, of course. A simple phone call and an appointment is scheduled. The appointment day and time arrives, they go to the office, sit in the chair, have work done, and leave. It’s a great system, until it isn’t. Seeing a dentist in a dental office is something many take for granted.

I used to be one of those people. Experiences with aging loved ones changed my perspective.

As people age, their physical abilities and cognitive abilities begin to change. Instrumental Activities of Daily Living (IADL’s), that once were completed without any trouble, get more and more difficult.

Typical IADL’s include performing housework, preparing meals, shopping for groceries, using the telephone and other technology, taking medications, managing finances and independently using transportation.

As people become unable to manage these tasks alone, modifications can be made and loved ones and friends often step in to help. In this phase of life, while receiving dental care within a dental office can be achieved, all dental professionals and patient caregivers need to understand that the waning of Activities of Daily Living (ADL’s) will come next.

In this phase, the likelihood of the patient coming to the dental office is slim. People who lose the ability to complete ADL’s (walking, dressing, bathing and personal hygiene, eating, getting in and out of bed, using the toilet) are almost never seen in a traditional dental office.

Those taking care of people in these situations often struggle to find a dentist who will come to where the patient is to deliver care. The good news is deviations from the norm are making services accessible to a wider population.

A few short years ago, most people would not have been able to imagine selecting groceries from a website and having groceries show up at the door. Not having to sit in a classroom to obtain a college degree was not on people’s radar. Obtaining a medical consultation over the internet, in the comfort of the home, was unheard of.

Those things are not only possible now, they are becoming the new normal. Thanks to technology, serving patients’ dental needs is evolving too—especially for the population of people who find it difficult to physically get to a dental office.

Hygiene Heroes

With many states in the United States recognizing the value dental hygienists can bring to immobile patients and changing laws, hygienists are out and about providing much needed dental hygiene services.

In some states, hygienists can practice to their full scope of practice, in certain settings, without having a dentist involved in the process. Other states have opted to create situations where a dentist does have to be involved.

The crazy thing is that even though all licensed hygienists receive the same education, the services they can provide and where they can provide them vary greatly from state to state.

Having so many different regulatory standards can be very confusing, and it is best to consult the state dental hygiene practice acts when determining how hygienists can help with access to care. 

If a dentist needs to be involved or not, it is always great to be able to collaborate with a dentist regarding needs of patients. But, if a hygienist is providing care outside of dental office walls and there is not a dentist who will travel outside of his or her office, how can this partnership happen?

Enter Teledentistry

Dentistry is taking a page out of the medical community’s playbook. For example, telemedicine seeks to improve a patient's health by permitting two-way, real-time interactive communication between the patient and the physician or practitioner at the distant site. This electronic communication requires the use of interactive telecommunications equipment including, at a minimum, audio and video equipment.

Telemedicine has the ability to increase efficiency of care delivery, reduce expenses of caring for patients or eliminate the need to transport to another location, and can even keep patients out of the hospital.1

Teledentistry has some of these same capabilities,2 many of which are included in TeleDent, the all-in-one teledentistry platform from MouthWatch, LLC  that I use to provide oral care to elderly patients who live in nursing homes and assisted living facilities.

Here’s how TeleDent works for me:

With TeleDent, a hygienist working off-site from a dental office can virtually connect with a dentist. The connection can be in real time, which is referred to as a “synchronous” visit. In this scenario, the dentist and patient are talking live via video conference and the dentist can also see a live video of the inside of a patient’s mouth.

If the dentist’s schedule does not allow a live consultation, another option is to upload patient data, such as videos, photos and clinical notes to the cloud for later, on-demand viewing. This is called an “asynchronous” visit.

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Smart Coding

In 2018, the ADA introduced two new teledentistry codes. Download the ADA Guide to Understanding and Documenting Teledentistry Events.

Whether synchronous or asynchronous, either type of teledentistry visit enables the patient to obtain the opinion of a dentist regarding his or her dental needs without needing to physically visit the office. If the hygienist identifies areas of concern while providing services, he or she can make notes that are attached to photos of that specific area. The dentist then can decide if he or she believe care is needed and/or instruct the hygienist on what can be done to assist.

The Impact of Remote Care

Serving patients who are unable to get to a dental office with dental hygiene powered by teledentistry can go a long way toward satisfying progressive state dental hygiene regulations. Also, dental needs get documented and reported.

Teledentistry creates collaborations between dental hygienists, dentists, patients and caregivers. The silver lining is when necessary dental work can be coordinated with a local dentist for those patients who can accept treatment.

In this situation, the hygienist interfaces with the care team and/or the patients loved ones. They assist with determining if the patient can be transported to a dental office, can sit to have treatment completed, and if they can pay for services. The hygienist also interfaces with the dental office, making sure they know who the point of contact is for the patient so necessary dental office forms can be sent, completed and returned to the office.

Payment arrangements also can be made prior to the appointment. The dentist has a basic idea of what treatment the patient needs before they arrive. With continued dental hygiene visits at the patient’s location, their dental health needs are being taken care of.

Teledentistry at Work

Here are some real-life examples of dental hygiene powered by teledentistry: 

Patient 1: Woman in a skilled nursing facility: Cannot ambulate. Completely coherent. Very cooperative and pleasant. No reports of dental discomfort. Reports she has only roots left in a couple areas and maybe a cavity.

  • Treatment Completed: Extraction of 2 root tips, and five areas of decay restored.

Patient 2: Woman in a skilled nursing facility: Cannot ambulate.  Completely coherent. Very cooperative and pleasant. Reports she cannot wear her partial because it doesn’t clasp to the tooth. Clasp tooth fractured at the gingival margin.

  • Treatment Completed: Extraction of one root tip, repair of partial clasps and a reline, two areas of decay restored.   

Patient 3: Man in a skilled nursing facility. Completely mobile. Moderate cognitive impairment.  Very cooperative and jovial. No reports of any discomfort. Rampant tooth decay.

  • Treatment Completed: One extraction and approximately 10 areas of decay restored and more to be completed.

Patient 4: Woman in a skilled nursing facility. Cannot ambulate. Brain tumor that isn’t affecting her cognitive abilities.  Very cooperative and pleasant. She has no discomfort. #4 had endo completed at endodontic office through a crown. Then patient got sick. Never had permeant restoration placed.

  • Permeant restoration placed #4.

Patient 5: Man in a memory care community. Cannot ambulate. Moderate cognitive decline. Semi verbal. Very cooperative. Cannot report if he has any pain.

  • Core build up and restoration of four areas of decay   

Patient 6: Man in an assisted living community because his wife had Alzheimer’s.   Mobile. Very cooperative and pleasant. No reports of any discomfort. Five-unit bridge # 27-31. Bridge loose #31 due to decay.

  • Removal of decay and recementation of bridge

Patient 7: Woman in a memory care community. Mobile. Moderate cognitive impairment.  Semi cooperative. No reports of any discomfort. Class III mobility of # 7 with draining fistula.

  • Removal of #7 after antibiotic regimen

Patient 8: Woman in a skilled nursing facility. Cannot ambulate. Mobile. Moderate cognitive impairment.  Semi cooperative. No reports of any discomfort. Draining fistula #20

  • Removal of #20 after antibiotic regimen

So where are the dentists in these examples? Still in their offices and collaborating with a dental hygienist who is utilizing teledentistry. If a dental hygienist had not been in these care communities providing services and utilizing teledentistry, at some point, all these patients, loved ones, care teams and likely emergency room physicians, would have been faced with a dental emergency that was completely preventable. This is proof this system works, even with the dentist still in the office.

  1. https://www.medicaid.gov/medicaid/benefits/telemed/index.html Retrieved 11.20.18
  2. https://doxy.me/advantages-of-telemedicine Retrieved 11.20.18
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