We live in an era of technologic advancements. Dentistry is no behind in this era. Here is a brief sum up of teledentistry and its applications in the field.

1. TELEDENTISTRY
- A REVIEW
Dr. AASHNA DHINGRA
Postgraduate Student
Dept. Of Public Health Dentistry

2. • Origin & Introduction
• Highlights of
teledentistry
• Types of teledentistry
• Teledentistry Services
• Teledentistry delivery
mechanisms
• Tools in Teledentistry
• Various applications in
dentistry
• Teledentistry in India
• Scope of teledentistry
• Legal issues
• Limitations
• Future
• Summary
• References
CONTENTS

3. ORIGIN
• Initial concept - developed as a part of the blueprint
for dental informatics - drafted in 1989 funded by
Westinghouse Electronics System Group at Baltimore.1
• Put into practice in US army in 1994 by doing dental
consultations on persons located more than 100 miles
apart.2
• Since then, various institutes and organizations have
practiced teledentistry with varying degree of
success.
1. Chen JW, Hobdell MH, Dunn K, Johnson KA, Zhang J. Teledentistry and Its Use in Dental
Education. J Am Dent Assoc. 2003;134:342–6. [PubMed: 12699048]
2. Mittal Sanjeev. Teledentistry: A New Trend in Oral Health. International Journal of Clinical Cases and
Investigations. November 2011. Volume 29 (Issue 6), 49; 56
Greek words:
“Tele” - distance
“mederi” - to heal

4. INTRODUCTION
Dental care is being constantly transformed by the
opportunities which are provided by technology and
telecommunication.
Teledentistry is a combination of telecommunications and
dentistry.
Technologic innovations in the field of dentistry have
been extensive in recent years. Most important advances
have been made in the use of computers,
telecommunication technology, digital diagnostic imaging
services, devices and software for analysis and follow-up.

5. INTRODUCTION
It is a developing area of dentistry that integrates
electronic health records, telecommunications
technology, digital imaging, and the Internet to link
dental providers and their patients.
Through the use of telecommunication and computer
technologies, it is now possible to provide interactive
access to specialist opinions that are not limited by
the constraints of either space or time.

10. Real time consultation
Store and forward

11. ADA GUIDELINES
D9995
D9996
• Synchronous tele dentistry
Real-time counter
Reported in addition to other procedures (e.g., diagnostic)
delivered to the patient on the date of service.
• Asynchronous tele dentistry
Info. stored & forwarded to dentist for
subsequent review.
CDT 1st
Jan. 2018

12. TELEDENTISTRY SERVICES
SPECIALIST REFERRAL
SERVICES
CONSUMER MEDICAL AND
HEALTH INFORMATION
PATIENT CONSULATION
REMOTE PATIENT
MONITORING
PROFESSIONAL EDUCATION

13. TELE DENTISTRY DELIVERY MECHANISMS
• POTS (plain old telephone system)
• Networked programs
• Point-to-point connections
• Primary or speciality care to home
connections
• Home to monitoring center links
• Web-based e-health patient service sites.

14. • Networked programs
Link hospitals and clinics with outlying clinics &
community health centers in rural or suburban
areas by the use of dedicated high-speed lines
or the Internet.
• Point-to-point connections
using private networks, used by hospitals and
clinics that deliver services directly, or contract
out specialty services to independent providers,
at ambulatory care sites

15. • Primary or specialty care to home connections
involves connecting primary care providers,
specialists and home health nurses with patients
using single line phone video systems for
interactive clinical consultations.
• Home to monitoring center links
are used for patient monitoring, home care and
related services that provide care to patients in
the home, using normal phone lines and
internet.

16. • Web-based e-health patient service sites
provide direct consumer outreach and services
over the Internet. Under telemedicine, these
include sites that provide direct patient care.

17. COMPONENTS THAT FACTOR INTO
DESIGNING A TELE DENTAL MODEL
Information technology (IT) infrastructure
Networks
Telecommunication services
Data security
Real time video conferencing vs store &
forward communication
Comfort and technology

18. TOOLS FOR EXCHANGE OF INFORMATION
POTS: plain old telephone system.
Low maintenance & technical support costs.
ISDN: Integrated
services digital network.
Higher speed , info. can
travel in both directions
simultaneously.
Expensive
World Wide Web
Easy access of info.
Cost-effective
Privacy & security
concerns - hackers.
Satellite
Live interactive videoconferencing can
be conducted via satellite.

19. APPLICATIONS OF
TELE DENTISTRY

20. TELEDENTISTRY AND DENTAL EDUCATION
• a unique way to deliver long-distance clinical training &
continuing education.
• Videoconferencing - can train dental students & other staff at
remote sites.
• Advantages
improved access to specialists for clinical training.
confirming diagnosis
formulating a treatment plan
reduced cost of oral health maintenance through shared
resources
improved quality of care

21. TELEDENTISTRY AND DENTAL EDUCATION
• Formal online education:
1. Self-instruction
contains information
that has been
developed and stored
before the user
accesses the program.
ADV: user can control
the pace of learning &
can review the material
as many times.
2. Video-conferencing
Interactive VC through
telephone, satellite, ISDN, or
Internet.
includes both live interactive
sessions & supportive info.
that can be sent alongside.
ADV: the user can receive
immediate feedback.

22. TELEDENTISTRY AND DENTAL EDUCATION
DENTAL CHAT ROOMS
available through various organizations
study clubs
individual practitioners
who exchange info. on variety of topics.
MAINTAINING TELEDENTISTRY COURSES
the educational team must continually update the
course material.
A clear, nationwide tele dentistry program is needed,
enabling organizers to control the problems acc. to
standards.

23. TELE CONSULTIONS (E-CONSULTATIONS)
• Patients are becoming more & more knowledgeable and
demanding access to a full range of high quality
treatment options.
• Telecommunication - possible to provide interactive
access to specialist opinions.
• It is the responsibility of referring dentist to obtain
patient’s consent before making online referrals & every
attempt should be made to conceal patient’s identity.

24. TELE CONSULTIONS (E-CONSULTATIONS)
• Referring dentist logs into the secure web server -
patient's details, reasons for consultation, chief complaints,
PD, intraoral images, dental radiographs.
• Specialist is notified immediately of the new referral.
• Specialist subsequently logs into the secure server &
reviews the consult & suggests Diagnosis & T/t plan within
5 working days.
• The Dental-Consults teledentistry system uses secure
sockets layer (SSL) to encrypt the info that flows b/w
web browser and web server - makes it safe to send
sensitive data.

25. TELE ORAL MEDICINE
• Photographic documentation of oral lesions was
considered acceptable by 75% of patients seen for
diagnosis of the lesions.
Leao & Porter (1999)
• The results of radiological interpretation of periapical
lesions when analyzed by conventional methods or tele
dentistry are comparable.
Mistak et al & Baker et al. (1999)
• A 95% correct diagnosis rate found when digital
radiographs were transmitted through email.
Corr et al (2000)

26. TELE ORAL MEDICINE
• Comparison of tele dermatology diagnosis with
histopathological examinations revealed a 79% correct
distant diagnosis.
Lozzi et al
• The majority of papers favor transmission of clinical
and radiographic images by email.
• Direct emails can be used for transmission of
electronic patient history forms, appointment
schedules, referrals, health reports & patient’s
concerns and questions.

27. TELE ORTHODONTICS
• Email image transfer is a reliable form of orthodontic planning
& advice for general dentists in UK.
Stephans et al. (2002)
• Interceptive orthodontics care provided at a rural & inter-city
clinic in Washington state.
Ortho faculty member - real time teledentistry to assist
general dentist on site.
Berndt J et al (2008)
• 71% general dental practitioners (200) agreed that
teledentistry is a good way of positively identifying patients
who should be referred to consultant orthodontist.
Mandall NA et al (2005)

28. TELE ORTHODONTICS
• Use of digital 2D & 3D models.
• Measurements & assessment of relationships are done
using software that processes images.
• orthoCAD
•

29. TELE ENDODONTICS
• Any faults in diagnosis - cause
complications, problems, waste
of time & money.
• With tele dentistry - PA
lesions can be adequately
assessed - help to devise
necessary plan.
• Reducing dental visits &
making urgent help available.

30. TELE ENDODONTICS
• Brullmann D et al. (2011) reported that remote
dentists can identify root canal orifices based on
images of endodontically accessed teeth.
• Baker WP 3rd et al. (2000) showed that no
statistical difference existed between the ability
of evaluators to identify periapical bone lesions
using conventional radiographs on a viewbox and
their ability to interpret the same images
transmitted on a monitor screen by a video
teleconferencing system.

31. TELE PEDIATRIC & PREVENTIVE DENTISTRY
• High quality alternative for children
afraid of dentists.
• Reducing their fear & anxiety
compared to clinical examination in
real time.
• Intraoral cameras - take dental
photographs from all angles, with
focused illumination.
• Helps in connecting children and their
families to needed health & social
services.

32. TELE PEDIATRIC & PREVENTIVE DENTISTRY
• Billings RJ (2011) showed that teledentistry is as good
as visual/tactile examinations for dental caries
screening in young children.
• Kopycka Kedzierawski DT et al. (2007) suggested
that teledentistry offers a potentially efficient means
of screening high risk preschool children for signs of
early childhood caries.

33. TELE DENTAL PROSTHETICS
• CAD/CAM systems.
• dental crowns, dental inlays, onlays.
• Highest level of computerized support in dental
implants placement.

34. TELE ORAL&MAXILLOFACIAL SURGERY
• Duka M et al. (2009) showed that diagnostic
assessment of the clinical diagnosis of impacted
third molars assisted by the telemedicine approach
was equal to the realtime assessment of clinical
diagnosis.
• Aziz SR and Ziccardi VB (2009) stated that
Smartphones provide fast and clear access to
electronically mailed digital images and allows the
oral/maxillofacial surgeon free mobility.
- allows for improved efficiency of the specialty
consultation and improved triaging, ultimately
providing improved care to the maxillofacial patient.

35. ROLE IN COMMUNITY DENTISTRY
• Bradley M et al. (2010) successfully proved the
use of teledentistry in a community dental service
in Belfast, N. Ireland, using a prototype
teledentistry system.
• Summerfelt FF (2011) reported a teledentistry
assisted, affiliated practice dental hygiene model
developed by the Northern Arizona University
Dental Hygiene Department,
that allowed dental hygienists to provide oral
healthcare to underserved populations by digitally
linking up with a distant oral health team.

36. TELE DENTISTRY IN INDIA

37. TELE DENTISTRY IN INDIA
• KEY SPECIFICATIONS OF THE PROJECT
INCLUDE:
• To identify the appropriate technological tools
& services required to implement telemedicine
at 3 premier hospitals.
AIIMS, New Delhi
PGIMER, Chandigarh
SGPGI, Lucknow

38. TELE DENTISTRY IN INDIA
• KEY SPECIFICATIONS OF THE PROJECT
INCLUDE:
• To develop and carry out system integration to
enable telemedicine technology & for establishing
telemedicine services (teleconsultation &
telediognostic services or the specialities of
radiology, cardiology & pathology & teleeducation)
at 3 tertiary level hospitals.
• To train clinicians in the use of telemedicine
technology.

39. TELE DENTISTRY IN INDIA
Mathur P, Srivastava S, Lalchandani A, Mehta JL (2017) Evolving Role of
Telemedicine in Health Care Delivery in India. Prim Health Care 7:260.

40. TELE DENTISTRY ACROSS THE WORLD

41. SCOPE OF TELE DENTISTRY
TD has the ability to improve access to oral health care
improve the delivery of oral healthcare & lower its costs.
potential to eliminate disparities in oral healthcare
between rural & urban communities.
Inter-professional communications will improve
dentistry’s integration into the larger healthcare delivery
system.
Provide aspects of decision support & facilitate a sharing
of contextual knowledge of the patient among dentists.

42. SCOPE OF TELE DENTISTRY IN INDIA
In India, where a majority of population lives in rural areas
& where healthcare facilities are insufficient, tele dentistry
can have a significant contribution in bridging the gap
between the demand & the supply.
Improve access to underserved population & reduce oral
disease burden.
enhance patient satisfaction.
Live video tele consultations - increase treatment
adherence in complex adult and pediatric dental cases.

43. SCOPE OF TELE DENTISTRY IN INDIA
Primary health center and community health center
can be equipped with modern telehealth and
teledentistry to facilitate the education and better
services in the society.
Students and teachers from schools and college at
various levels and even social workers from gram
panchayat can be educated and trained towards the
importance and functioning of telehealth with
connectivity to higher center and experts.

44. HEALTH INSURANCE PORTABILITY AND
ACCOUNTABILITY ACT
• Effective on April 14th, 2o03.
• The privacy, confidentiality, security & secure
back-up of data must meet Health Insurance
Portability & Accountability Act requirements.
• Digital Certificates - pt identification,
cryptographic info., digital signature.
• Certificates - prevent hackers from entering the
network.
Verify that participants are authentic.

45. LEGAL ISSUES
• In teledentistry practice, medicolegal and copyright
issues also have to be considered.
Wallace G. 2001
• These problems arise primarily due to a lack of well
defined standards.
Golder DT, Brennan KA. 2000
• Many of the legal issues, such as licensure, jurisdiction,
and malpractice, have not yet been definitively decided
by legislative or judicial branches of various
governments.
Sander JH, Bashshur RL. -Telemed J

46. LIMITATIONS
• Legal issues - licensure, malpractice, privacy, security &
ethics.
• Technical problems during data transmission -
misdiagnosis or medical error.
• Undetectable alteration of patient’s records has been a
longstanding problem.
• Currently no insurance company has a reimbursement
system for tele dentistry.
• Most teledentistry programs are in English. Future goals
should include considerations for multilingual programs.

47. FUTURE OF TELE DENTISTRY
• Potential to replace costly, traditional, dental
consultations in remote areas.
• Invention of devices capable of capturing &
transmitting images & other data in digital form.
• Digital x-rays sensors, laser scanners, intraoral
cameras.
• Primary Health Care centers : a desktop computer,
teleconsulting software, Internet connection, digital
camera, radiograph/text scanner.

48. TO SUMMARIZE . . . .
“Teledentistry” is a synergistic combination of
telecommunications technology, internet and dental
practice.
Care providers will be able to take advantage of remote
resources & define new business models for patient care.
In dental education it can provide primary care
professionals with easy access to efficient consultation &
case-based continuing education opportunities.
Some barriers still exists for TD practice, including legal,
educational & insurance issues.
With thorough planning, tele dentistry has a bright future.

50. REFERENCES…
• Bhambal A, Saxena S, Balsaraf SV. Teledentistry: Potentials
unexplored. J Int Oral Health 2010;2:1-6.
• Jampani ND, Nutalapati R, Dontula BS, Boyapati R.
Applications of teledentistry: A literature review and update.
Journal of International Society of Preventive & Community
Dentistry. 2011 Jul;1(2):37.
• Monika, Bhaskar DJ, R Agali C, Gupta V, Jain A, Garg Y, Jain R.
Teledentistry: An Overview. J Adv Med Dent Scie Res
2015;3(2):88-91.
• Jain A, Bhaskar DJ, Gupta D, Agali C, Gupta V, Karim B. J Adv
Med Dent Scie 2013;1(2):112-115.
• D9995 and D9996 ADA Guide – Version 1 – July 17, 2017 –
Page 1-10 ©2017 American Dental Association (ADA).