Dental Teledentistry: How Big an Impact Will It Make

By Dr. Quinn Dufurrena 

For more than a decade, those of us in the dental industry have read that teledentistry will soon revolutionize how oral care is accessed, delivered and paid for. Whether we are dentists, producers or insurers, we need to prepare for dramatic changes in the way we do business. Or so we’ve been told.

How widely teledentistry will be used, and how quickly it will replace or supplement in-person office visits, is up for debate. But it clearly presents options for patients and dental professionals that haven’t existed before. And it has the potential to remove some of the barriers that keep people from visiting the dentist as often as we all believe they should.

Teledentistry is a combination of telecommunications and dentistry. It involves the exchange of clinical information and images over remote distances, both for dental consultation and creating a treatment plan.

In this regard, dental care is following on the heels of medical treatment. Advances in digital communications, telecommunications and the Internet have made it possible to provide remote access to medical care. The same potential exists in dentistry.

Teledentistry is not technically a new dental specialty. Rather, it is a new way to deliver existing dental services to people in remote locations.

Several trends have converged to make widespread teledentistry use more possible than it’s been in the past. Dentistry has seen extensive technological advances over the past several years. With advanced information technology and digital imaging capabilities, dentists have the needed tools to evaluate oral health issues remotely.

Their patients have changed as well. Most people carry a smartphone, which is really a supercomputer that does a lot more than make phone calls. Among other features, the smartphone contains a high-quality camera, which makes it easy to share images for others to view and interpret.

Today’s consumers are very comfortable receiving care or advice, making purchases – or doing just about anything — in a public, online setting. An important part of that comfort level is the shedding of hesitation about sharing personal information and images with people in the online community.

In a world of Instagram and Snapchat, the personal often becomes the public. Selfie takers show little reticence about sharing photos of themselves and their friends that almost anyone in the world can see.

This voluntary surrender of privacy may have profound implications. But consumers’ willingness to trust and share online is a development that may clear the way for widespread acceptance of teledentistry.

Improvements in technology – and people’s growing comfort level with accessing dental services remotely – promise to increase the popularity of teledentistry. Expanded availability of broad-band Internet, providing faster, more powerful connections, promise to make teledentistry interactions more reliable and user-friendly.

There are different ways to conduct consultations through teledentistry. One is to consult with a patient in real time, using videoconferencing that enables dentists in one location to view and speak with a patient in another.

Another option is for practitioners to capture static images and clinical information from a patient, and then forward that data to another dental professional for consultation and treatment planning.

Dentists also can share patient information, radiographs, graphical representations of periodontal and hard tissues, therapies applied, lab results, tests, photographs, remarks and other information, all transported by multiple providers if necessary.

This can be very helpful for patients, particularly those who may need additional treatment from a specialist. The ability to instantly share clinical information with providers in multiple locations brings down the geographic barriers that keep many people from seeking oral treatment.

Diagnostically, there is little a dentist can’t do remotely with the same level of precision as in the office. Remote dentists can identify root canal orifices, diagnose impacted or semi-impacted third molars, evaluate periapical bone lesions and screen high-risk preschool children for early childhood caries.

Current growth rates suggest that teledentistry will be available to millions of American patients in the next few years. But while people disagree on how prevalent teledentistry will become, there is widespread agreement in one area. The people who would benefit most from the expansion of teledentistry are those who have to travel long distances to visit a dental office.

Proponents believe teledentistry can ultimately improve access to oral care and lower costs. It may turn out to be the least expensive, and the fastest way to close the access gap between urban and rural communities. Down the road, it may also help reduce the disparities in oral health care that exist between these communities.

According to projections, the United States will continue to face a shortage of dentists, particularly in rural areas. The high cost of dental education could nudge new dental professionals to seek employment in high-population areas offering greater economic potential.

That scenario would produce even more access concerns in less densely populated areas, and could create business opportunities for teledentistry providers.

Technology allows dentists to manage the oral care of patients who may live hundreds of miles from the nearest qualified dentist. Regular preventive screening and maintenance are crucial components of good oral health, and teledentistry can bring remotely located patients into regular contact with dental professionals, establishing an ongoing relationship that will be beneficial to their future health.

And it’s not just their oral health. United Concordia Dental has sponsored research that analyzes the connection between regular oral health care and a person’s overall health. Healthy mouths lead to healthy bodies, and evidence shows the connection between the two.

In particular, our recent research has shown that visiting a dentist twice a year can have a major positive impact, and possibly reduce overall medical costs, for patients with a chronic condition such as diabetes, coronary artery disease or asthma.

As teledentistry becomes more available we’re starting to see companies explore opportunities. For example, there are firms working with insurers to promote teledental options in the individual market or to high-risk members.

Some insurers are reimbursing providers for teledental screenings and consultations in remote locations. As availability evolves, insurers may opt to reimburse for teledentistry services where members request them, but it’s unclear whether they will endorse or recommend it over more traditional office treatment.

But demand drives behavior. Offering plans with a teledental option could provide a competitive advantage. It also could solve access problems for people who often find it inconvenient to visit a dentist’s office. Existing consumer teledental services generally enable consumers to receive a consultation within 24 to 48 hours of requesting one, which could be a major selling point.

But before we assume teledentistry will assume a leading role in the dental business, there are some important questions we must consider.

The patients who would benefit most from teledentistry are people who aren’t currently visiting the dentist on a regular basis. Lack of access is just one of several reasons why people don’t visit the dentist as often as they should.

Will the availability of remote visits be enough to make them change their habits? Probably not. There still is work to be done on raising awareness of the need for regular dental consultations, no matter how they are delivered.

Second, the availability of teledentistry does not necessarily equal inevitability. Among dentists and patients, there likely will be some reluctance to replace in-person services, with all the hands-on value they deliver, with a virtual method that could create complications and quality issues.

Third, security and confidentiality remain central concerns with dental care provided remotely. Transmitting medical and dental information, even over seemingly secure connections, carries the inherent general security risk of sharing data stored in computers.

Teledentistry practitioners will need to be fully transparent with their patients about how their data will be shared and accessed. Patients also will need to be informed of the risk of improper diagnosis and treatment due to the failure of the technology being used.

Teledentistry also raises questions for dental insurers and other payers. How will remotely delivered services be reimbursed? How will it affect the composition of dental provider networks? What changes will be required to contracts to reflect the way care is being delivered, and by whom? These questions will all need to be addressed.

Teledentistry clearly holds significant potential to improve both access and quality of care issues. By exchanging patient information, dental professionals can consult more effectively with their colleagues, no matter where they are located. This should lead to better patient outcomes.

Future family dentists may find themselves standing atop a virtual pyramid of specialists and other dental professionals who collaborate remotely to evaluate and treat patients. With a little imagination, one can envision a future in which dental practitioners are linked to virtual clinics all over the world, revolutionizing the way dentistry is practiced.

It may sound a little far-fetched, but in a few years, the way dental care is delivered could look very different than it does today.

Dr. Quinn Dufurrena is chief dental officer for United Concordia Dental, a leading dental solutions company that provides benefits to more than 8.8 million members.