CHRISMED Journal of Health and Research

REVIEW ARTICLE
Year
: 2021  |  Volume : 8  |  Issue : 3  |  Page : 139--142

Teledentistry: Role, scope, and future ahead


Malvika Singh1, Manju Jamwal2,  
1 Department of Periodontics, Institute of Dental Sciences Jammu, Jammu and Kashmir, India
2 Department of Law, University of Jammu, Jammu and Kashmir, India

Correspondence Address:
Malvika Singh
Assistant Professor, Department of Periodontics, Institute of Dental Sciences, Jammu, Jammu and Kashmir
India

Abstract

Teledentistry is the use of information technology and telecommunications for dental care, consultation, education, and public awareness and has been ray of hope for patients who need treatment but that have been confined to home due to COVID-19 restrictions. The objective behind writing this article was to assess the relevance of teledentistry during and after COVID-19 pandemic. Internet database Medline/PubMed search for word “teledentistry” resulted in 758 articles. Articles with Medline/PubMed were only considered in writing this review. The result showed that teledentistry became a popular and successful means of tele-treatment during the COVID-19 pandemic. Although not much used earlier, teledentistry is here to stay, it has presented itself as a boon not only during COVID-19 period but holds a strong promise to treat patients in rural inaccessible areas, old age patients, and patients with special needs among others.



How to cite this article:
Singh M, Jamwal M. Teledentistry: Role, scope, and future ahead.CHRISMED J Health Res 2021;8:139-142


How to cite this URL:
Singh M, Jamwal M. Teledentistry: Role, scope, and future ahead. CHRISMED J Health Res [serial online] 2021 [cited 2022 May 20 ];8:139-142
Available from: https://www.cjhr.org/text.asp?2021/8/3/139/339053


Full Text



 Introduction



Coronavirus infection was identified by the Chinese government in China's Wuhan district on January 7, 2020, and declared as a pandemic by the World Health Organization (WHO) on March 11, 2020.[1] In view of this pandemic, the Government of India declared a nationwide lockdown on March 24, 2020, with restrictions on travel and social gatherings. Since hospitals, dental setups or other medical facilities serve as a source of cross infection, it was recommended to avoid visits to the hospitals, dental setups, or other medical facilities unless emergency. The dental setting in particular proved to be a significant source of transmission as most of the dental procedures involve the production of aerosols and droplets contaminated by the microorganisms. This made the dentist prone to get infected from patients and spread the infection to their families and vice versa thereby developing a sense of fear and anxiety in the minds of both the parties. To overcome this, new models of consultation needed to be encouraged to provide minimal contact between dentists and patients as the health-care fraternity believes providing treatment to the patients. Innovative approaches such as teledentistry came into the light which allowed delivery of patient care whilst mitigating the risk of viral transmission. Defined as the remote provision of dental care, advice or treatment through the medium of information technology, rather than direct personal contact with patients, teledentistry was rarely utilized before the pandemic which now not only has become need of the hour but also has proven to be a ray of hope for the patients not only in urban areas, but also for patients residing in rural and inaccessible and remote areas which have immensely benefited by getting specialized dental consultation and care just at the click of their mobile phones. Hence, the aim of this review article is to discuss teledentistry, its need and its importance. Various legal considerations associated with teledentistry have also been discussed in this manuscript. Also special emphasis has been put to to discuss literature relevant in providing specialised dental care to the patients. A total of 758 articles with the word teledentistry were found on Internet. However, internet database Medline/PubMed search for word “teledentistry during pandemic” resulted in 16 articles, “teledentistry and specialized dental care” showed 23 articles, “teledentistry and future” revealed 22 articles. Only highly relevant articles from manual and PubMed search in the English language were considered for the present review article.

 Historical Background



The initial concept of teledentistry was developed as part of the blueprint for dental informatics, which was drafted in 1989 as a conference funded by the Westinghouse Electronics Systems Group in Baltimore. Later, a teledentistry project was started by US military in 1994 to serve the US troops worldwide which proved to be a great success among US troops.[2] After few years, it was again developed as a confluence of telecommunications and dentistry, involving the exchange of clinical information and images over remote distances for dental consultation and treatment planning.[3]

Types of teledentistry: There are two types:

Synchronous teledentistry: It is also called as real-time consultation and is done by a two-way interaction between the patient at one place and the dental provider or dentist at another place using audio-visual telecommunications technology. This type of teledentistry is being used by International health agencies such as the WHO, national centers for disease control, and various health departments[4],[5]Asynchronous teledentistry: It is also known as store and forward consultation. Here, the transmission of recorded health information (e.g., photomicrographs, digital impressions, video, photographs, and radiographs of patients) is facilitated through a secure electronic communications system to a dentist who uses the information to evaluate a patient's condition or render a service without live video conferencing with the patient.[6]

Application of teledentistry in various specialties of dentistry:

Conservative and endodontics: The patient reports to the endodontist primarily with a chief complain of pain in their teeth. With the use of teledentistry, the endodontist diagnosis periapical lesions and prescribe medications through teleprescriptions (if needed thereby) providing immediate relief to the patient. This has been put by the use by Zivkovic et al. in 2010 and Ather et al. in 2020[7],[8]Oral medicine and radiology: The patient reporting to the specialist of oral medicine and radiology generally reports with the chief complain of oral ulcers, whose images can be clicked using a smartphone and the specialist evaluates and prescribes the same using teleprescription thus, providing immediate relief to the patient. The study on the same grounds was conducted by Torres-Pereira et al. in 2008.[9] Another common complaint by patients reporting to the concerned specialty is that of lesions appearing as oral cancer, temporomandibular joint disorder, and infective orofacial lesions. These lesions require immediate action as if delayed can proved life threatening for the patient. In these cases, teleconsultation and immediate treatment provides a ray of hope for such patients. Studies on similar grounds have done by Bradley et al. in 2008, Aziz and Ziccardi in 2009, and Ata and Ozkan in 2009 who concluded that timely intervention of such cases and prevented progression and treatment of such cases.[10],[11],[12] Digital images when send in the form digital radiography prevent the exposure of radiations to the patient thus preventing them from unnecessary harmful radiationsOral and maxillofacial surgery: In such specialty, the most common complaint of the patient is pain in the third molars. In such cases, their digital radiographs are taken and their treatment plan is planned accordingly as done by Duka et al. in 2009.[13] Furthermore, teledentistry in this specialty provides quick consultation for patients suffering from temporomandibular disorders. However, the hallmark of teledentistry in oral and maxillofacial surgery is placement of dental implants which is done by utilizing digital radiography and is helpful in cases where the specialist sits on the one side of the globe and the practitioner on the other, they exchange digital images and accordingly plan the treatment protocol in the patients thus making world a smaller place as explained by Mihailovic et al. in 2011[14]Orthodontics and dentofacial orthopedics: The chief complain of the patient who reports to orthodontist is that of breakage of brackets and loosening of wire and such complaints can easily be handled by the orthodontist over the telephone and the patient can be instructed how to temporarily fix the problem. Furthermore, consultation to orthodontist using teledentistry helps in the evaluation of the oral cavity and prevention of unnecessary referrals and revisits by the patients. Thus, saving time and energy bot of patient and orthodontist as done by Cook et al. in 2004[15]Pedodontics and preventive dentistry: Children are more apprehensive to pain and acquired infection than adults. Hence, the extravisits of children to the dental clinics can be avoided using teledentistry. One such study in this respect was done by Mihailovic et al. in 2011 who demonstrated that teleconsultation reduce anxiety fear among children.[14] The parents take images of the oral cavity of their child along with the pain history and share the same with the pediatric dentist. The pediatric dentist then evaluates the same and plans treatment plan for the child and subsequently discussed the same with their parents. The parents of such children can the guided by prescribing teleprescription for their child and ensure that they maintain adequate oral hygiene of their child. In cases of dental trauma, the parents can be guided about dealing with the same by applying ice packs, ointments over teleconsultation. In case the child breaks his/her tooth, the parents are guided to store the same in glass of milk so that the same can be re-implanted within some hours in the clinic and all of this happens over smartphones. Furthermore, teledentistry helps in telescreening of children, thereby helping in the early detection of caries and this practice can be widely put in use for preschool and school-going children as done by Kopycka-Kedzierawski et al. in 2008[16]Periodontics and oral implantology: The patients reporting to this specialty have dirty teeth or swollen gums as their chief complain. By using teledentistry, clinical photographs of patients (intraoral and extraoral) along with required radiographs are send to the periodontist for consultation. The periodontist then views them and prescribes the treatment plan of the same. Such type of study was successfully conducted by US Department of Defense dental clinics and the results showed significant improvement of periodontal health of the patientsProsthodontics crown and bridge: The most common chief complaint by patient in this particular branch of dentistry is that of broken or dislodged prosthesis which can be handled by prosthodontist by guiding them how to manage the same and those prosthesis could be temporarily fixed and delivered at the patient's residence by staff of prosthodontists. Fabrication of dental prosthesis by dental technicians can be done using teledentistry. Here, the technician receives image (digital impression) of the oral cavity by the prosthodontist, fabricates the prosthesis and delivers the same at patient's residence. Such practices have already been put to use by Chen et al. in 2003 and Späth and Kordass in 2006.[17],[18]

 Legal Considerations in Teledentistry



We all live in digital era where sending an E-mail or a text message to a colleague as teledentistry referral might become a matter of legal scrutiny and can have immense ramifications for the dentists. Any practitioner offering an opinion over the internet, either to a colleague or a layperson, through E-mail or formal consultation should ensure that they write a disclaimer mentioning that all of the consultation is done over teledentistry and should also ensure that they take a digital written and duly signed informed consent from the patient to prevent themselves from being sued for malpractice by courts. There are also issues about the confidentiality of medical and dental information. Therefore, an informed consent should be taken from the patient and the patient should be made aware about the inherent risk of improper diagnosis or treatment due to the failure of technology.

Furthermore, since the dentist does not treat the patient physically, the patients might (or claim to) suffer from a teledentistry referral and such consultant may be liable under negligent supervision thus, it is imperative for them to obtain a digital written and duly signed informed consent from the patient to prevent themselves from getting trapped for under malfunction. The Office for Civil Rights will not enforce penalizations for Health Insurance Portability and Accountability Act noncompliance against oral health providers that oblige patients in good faith through teledentistry during the COVID-19 public health emergency. However, health-care professionals should give a disclaimer before proceeding with virtual consultation to inform patients that third-party applications possibly present may breach in privacy, and all obtainable privacy modes as well as encryption should be allowed while using such technology and applications.[19]

Advantages of teledentistry

Teledentistry provides better discussion of patient's problems with other peer dentists of concerned specialty within minutes, therefore leading to better treatment planning. It also decreases time and labor that is required to store the data. The distance diagnosis of oral diseases is possible. It also provides efficient and immediate formation of a treatment plan for the patient by saving their time. Follow-up visits of the patients are avoided saving time for patients. There is less patient exposure due to digitalization of techniques and equipment. Furthermore, there is no wastage of papers and files for patient records. The chairside time management becomes. The preventive services can be provided to the patient services. It also enables to provide oral health-care services to patients who are medically compromised, children, and geriatric populations. Teledentistry also serves as an efficient medium for having a specialist consultation without the need to visit a dentist during the lockdown. The dentist after performing emergency procedures such as extractions or emergency access opening in cases of swelling can obtain a proper follow-up for the patients with the help of photographs clicked by the patient of the site of infection and the dentist can manage primary emergencies by prescribing suitable antibiotic therapy and prescribing home care measures to the patient.

Disadvantages of teledentistry

Teledentistry has various pitfalls such as the fact that many dental practitioners and patients find it difficult to opt this new method. There is lack of face-to-face communication at times which leads to apprehension of patients of inadequacy of proper communication of their problems to their dentists. This is practice is particularly common in rural and among less literate patients. Many practitioners face problems of poor internet access, hardware problems, etc., It does not match with the accuracy of the diagnosis of the patient performed clinically. Legal issues such as confidentiality of the patient's information raise a concern. Initial investment of digital setup at the dentist's end is high. It is extremely time-consuming during signal issues and technique sensitive and technical problems occurring during the data transmission may cause a misdiagnosis or medical error.

 Conclusion and Future Ahead



Teledentistry has had its existence since 1980s, but its importance was realized during COIVD-19 pandemic and with the pandemic not seeming to disappear completely from the world anytime soon, teledentistry is here to stay for long. Teledentistry has proven to be a boon for patients who were confined home due to the lockdown as they receive dental consultation and treatment just by the click of a phone. Patients who are aged, physically challenged and the ones who are in prisons for various reasons also get benefitted due to revival of teledentistry. Patients living in rural and inaccessible areas for whom the time to travel to and fro to dental clinic was a major setback, for such patients world has literally shrunken into their smartphones, teledentistry is a ray of hope. Considering its wide use and so many disadvantages both for patients and dental professionals, it will only be put to use more and more in coming times and age. The only change or addition in this field appears to be the addition of quality of software that are cheap and easy to maneuver both for patients and clinicians. However, having discussed its merits teledentistry in no means can be considered a replacement for dental treatment and can only be considered as an adjunct to dentistry. However, it will definitely be right to say that this confluence of dentistry with telecommunications is here to stay, will be moving ahead in a positive direction and is the future of dentistry.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

1World Health Organization. Report of the WHO-China Joint Singh: Preparing Periodontal Clinic for Management of COVID-19 Patients. Available from: https://www.who.int/docs/default-source/coronavirus/who-china-jointmission-on-covid-1-final-report.pdf. [Last accessed on 2021 Jul 05].
2Rocca MA, Kudryk VL, Pajak JC, Morris T. The evolution of a teledentistry system within the Department of Defence. Proc AMIA Symp 1999;1:921-4.
3Yoshinaga L. The use of teledentistry for remote learning applications. Pract Proced Aesthet Dent 2001;13:327-8.
4World Health Organization. Critical Preparedness, Readiness and Response Actions for COVID 19. Available from: https://www.who.int/publications/i/item/critical-preparedness-readiness-and-response-actions-for-covid-19. [Last accessed on 2021 Jul 01].
5Control C for D, Prevention. Coronavirus Disease 2019 (COVID 19) Situation Summary. Available from: https://www.cdc.gov/coronavirus/2019-ncov/index.html. [Last accessed on 2021 Jul 01].
6Snow MD, Canale E, Quail G. Teledentistry permits distant, costeffective specialist dental consultations for rural Australians. J Telemed Telecare 2000;6 Suppl 1:216.
7Zivkovic D, Tosic G, Mihailovic B, Miladinovic M, Vujicic B. Diagnosis of periapical lesions of the front teeth using the internet. PONS Med J 2010;7:138-43.
8Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus disease 19 (COVID-19): Implications for clinical dental care. J Endodon 2020;46:584-95.
9Torres-Pereira C, Possebon RS, Simões A, Bortoluzzi MC, Leão JC, Giovanini AF, et al. Email for distance diagnosis of oral diseases: A preliminary study of teledentistry. J Telemed Telecare 2008;14:435-8.
10Bradley M, Black P, Noble S, Thompson R, Lamey PJ. Application of teledentistry in oral medicine in a community dental service, N. Ireland. Br Dent J 2010;209:399-404.
11Aziz SR, Ziccardi VB. Telemedicine using smartphones for oral and maxillofacial surgery consultation, communication, and treatment planning. J Oral Maxillofac Surg 2009;67:2505-9.
12Ata SO, Ozkan S. Information technology in oral health care: attitudes of dental professionals on the use of teledentistry in turkey. European and Mediterranean Conference on Information Systems. 2009. p. 13-4, 1-8.
13Duka M, Mihailović B, Miladinović M, Janković A, Vujicić B. Evaluation of telemedicine systems for impacted third molars diagnosis. Vojnosanit Pregl 2009;66:985-91.
14Mihailovic B, Miladinovic M, Vujicic B. Telemedicine in dentistry (Teledentistry). In: Graschew G, editor. Advances in Telemedicine: Applications in Various Medical Disciplines and Geographical Regions. Rijeka (Croatia): InTech; 2011. p. 215-30.
15Cook J, Edwards J, Mullings C, Stephens C. Dentists' opinions of an online orthodontic advice service. J Telemed Telecare 2001;7:334-7.
16Kopycka-Kedzierawski DT, Bell CH, Billings RJ. Prevalence of dental caries in Early Head Start children as diagnosed using teledentistry. Pediatr Dent 2008;30:329-33.
17Chen JW, Hobdell MH, Dunn K, Johnson KA, Zhang J. Teledentistry and its use in dental education. J Am Dent Assoc 2003;134:342-6.
18Späth C, Kordass B. Optimization of the static occlusion by “occlusal surface settling” in the Cerec 3D software. Int J Comput Dent 2006;9:121-6.
19FAQ's on Telehealth and HIPAA During the COVID-19 Nationwide Public Health Emergency. Accessed from: https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf. [Last accessed on 2021 Jul 05].