Odds are, you’ve had a telemedicine visit since the start of the COVID-19 pandemic. But have you scheduled a teledentistry visit, either as a provider or patient?
As the pandemic continues to affect all of us and our lifestyles, the usage of teledentistry (TD) has increased. Compared to the beginning of the pandemic, when many dentists in private practice closed offices out of necessity, now more practitioners are offering the service as an adjunct to in-office visits. The American Dental Association describes TD as not a specific service, rather a means to enhance care and education. When the pandemic began in 2020, its usage was more obviously a solution for triaging patients with emergency needs while preventing infection transmission in the office. Since then, the tool has changed and evolved.
Many have welcomed TD for providing a means to reach those who may not geographically have access to dental care. Furthermore, companies such as MouthWatch, an intraoral camera company, are making strides by erecting remote patient sites. In this business model, patients use the high-quality camera themselves via phone with the dentist. As an individual who grew up in rural North Carolina, I can relate to the need for accessibility of care when it may be needed most.
When I first learned about TD, I questioned how care could be provided without diagnostic radiographs. This is still a concern, and exactly why TD will not totally replace the need for a patient to attend an in-office appointment for a full evaluation. Nevertheless, there is use for TD as an adjunct for dental care. Some skeptics cite an incorrect diagnosis, technological challenges, software integration, high cost of set up, HIPAA compliance and financial reimbursement as reasons for not using TD.
Although implementing TD may not be feasible for some dentists and it certainly presents new challenges to dentists, I believe we, as a generation in which technology is a defining aspect of our daily lives, are responsible for implementing it ethically into our own practices. Trying to treat and triage emergency services, an integral aspect of dentistry, falls under the ADA Code of Ethics principle of justice. Further integration of TD also includes respecting patient’s autonomy by safeguarding patients’ records, which is transmitted and stored online in all cases of TD.
Furthermore, the ADA is currently seeking volunteers for a working group on establishing new standards for its ethical usage. Of greatest concern is a dentist’s license in the state in which the patient is receiving TD care, a patient’s ability to access that licensure, and ensuring that patients who are seen via TD are not abandoned. Ultimately, it is the dentist’s responsibility to implement and follow the principle of beneficence by continuing treatment after a TD consult. Many practitioners currently provide the public with the opportunity to access their board certifications and licensure by stating their license number on their website.
TD consults should be documented accordingly in patient’s appointment notes, and proper billing codes should be submitted. Some common codes dentists are using include a limited evaluation, problem-focused; teledentistry – synchronous, real-time encounter; teledentistry – information stored and forwarded.
Teledentistry has become an increasingly important adjunct to providing dental care, and its increased usage will only drive more systemic changes in delivery models that benefit both our patients and us as oral health care providers.
~Amelia Wilson, Boston ‘23