Presentation by Fred Summerfelt, RDH, MEd, Associate Professor of Dental Hygiene, Northern Arizona University

1. MATRC
Telehealth Summit
Teledentistry-Assisted
Affiliated Practice
Dental Teams
Fred Summerfelt RDH, AP, M.Ed
March 18, 2013
1
2
AZ’s Affiliated Practice
Dental Hygiene Model
The AZ Affiliated Practice
Dental Hygiene Model
• 2004 §32-1289 signed into law
• Allows an affiliated agreement, with standing orders,
between a dental hygienist and a dentist
• APDHs may see patients of any age who are:
Allows APDHs to see patients
without general supervision!
•
•
enrolled in the National School Meal Program – or
•
3
enrolled in a federal, state, or local health
program – or
from a family with a household income of less
than 200% of the federal poverty guidelines
4

2. AZ’s Affiliated Practice
Dental Hygiene Model
• 2009 SB 1400 added to §32-1289
• Affiliated practice dental hygiene patients
must be seen by a dentist within
12 months of initial treatment by the
dental hygienist otherwise further dental
hygiene services are prohibited
APDH Services
• Specific language concerning elderly and
medically-compromised patients
5
Affiliated Practice
Dental Hygiene Services
6
Affiliated Practice
Dental Hygiene Services
• Assessment
• Preventive
• Blood pressure & medical history
• All procedures for a complete
prophylaxis
• Screen and photograph oral cavity and
surrounding structures
• Apply sealants according to ADA and
CDC guidelines
• Chart dental restorations and clinical findings
• Administer topical fluoride gels and
varnish as indicated according to ADA
and CDC guidelines
• Expose and process x-rays
• Conduct a caries risk analysis
7
8

3. Affiliated Practice
Dental Hygiene Services
Teledentistry
• Patient Education
Dental Hygienist
• Discuss patient’s home care procedures
General Dentist
Allied Health
Professionals
• Provide appropriate home care
instruction
• Provide tobacco cessation intervention
and a referral when appropriate
Dental Specialists
A Digitally-Linked
Oral Healthcare
Team
Pedodontist
9
Telehealth & Telemedicine
10
Teledentistry
• Presents as:
• In use since the 1950s
• An emerging Web-based
intervention system
• Prevalent in rural communities
• Effectively use telecommunications technology
• A distance-learning framework
• Transmitted Electronic Data
• Graphics, audio, and video images shared
between physically separated professionals
• Diagnosis, consultation, and treatment planning
11
• A vehicle to decrease the
phenomenon of professional
isolation common to rural and
underserved areas
12

4. Teledentistry
NAU’s Teledentistry
Equipment
• Utilizing current technologies, it is
possible to acquire and digitally
transmit all necessary subjective and
objective diagnostic data to a distant
dentist for:
Are there digital technologies that allow us to see better
than the eye can see in face-to-face examinations?
• Triage
• Dental treatment planning
• Referral
13
Nomad Pro X-ray Unit
14
Nomad Pro X-ray Unit
• Certified by all 50 states
• Allows the operator to be in the
room when the x-ray is exposed
• Easy to use
• Long battery life
• Protective carrying case
• Ideal for remote locations
15
16

5. Nomad Pro X-ray Unit
Nomad Pro X-ray Unit
Lead and Glass Shield
Area of Protection
Primary
Protective
Shielding
17
Scan-X Duo Processor
18
Scan-X Duo Processor
• Sturdy piece of equipment
• Carrying case
• Easy to maintain - periodic cleaning
strip
• Processes phosphor plates quickly
• Scans and erases phosphor plates,
ready for reuse
19
20

6. Scan-X Duo Processor
Acclaim Intraoral Camera
30,000 images per x-ray film!
21
Acclaim Intraoral Camera
22
Acclaim Intraoral Camera
• Has proven to be very valuable in the
public health environment
• Barrier sheaths prevent the need for
sterilizing mirrors
• Projected images allow for excellent
viewing of the intraoral environment
• Photographs are easy to take
23
24

7. 25
26
27
28

8. VELscope
VELscope
29
VELscope
30
Spectra
31
32

9. Spectra
2.4
1.7
2.8
2.5
Green
Sound
Enamel
Blue
Red
Orange
Yellow
Incipient Advanced Incipient Advanced
Enamel
Enamel
Root
Root
Caries
Caries
Caries
Caries
33 2.4
34
35
36

10. Rather than take the patient
to the typical dental home . . .
37
. . . take many services
to the patient!
38
Linking the Team Members
• Store and forward the diagnostic data
• On the laptop computer
• On a DVD, CD, or by e-mail
• On a thumb drive or other hard drive
• Direct real-time link to the team members
• Satellite link
• Hard wired into an Internet connection
39
40

11. Link via Cloud Computing!
Linking the Team Members
• Patient Privacy and HIPAA compliance
• Current technology exists - medical data
• Data encrypted to insure privacy
• Encrypt store-and-forward data
• Encrypt real-time data
• Encrypt live-action video
• Multiple group members can participate
41
42
43
44
Student Training
• Approximately six hours
• Nomad training manual
• Nomad certification exam
• Phosphor plate management
• Scan-X Duo competency
• DXXTR x-ray exposure experience
• Acclaim intraoral photos on peers

12. 45
46
47
48

13. Kaibab Band of the Paiutes
450 Mile Round Trip
49
50
51
52

14. Kaibab Band of the Paiutes
• Screened and referred 23 kids for care
• Five had immediate needs - acquired their digital
diagnostic data
• Forwarded diagnostic data to my affiliated dentist who
confirmed the need for immediate care
• Forwarded the data to the pedodontist at Polacca
• The kids’ parents were told to call to be put right on the
the pedodontist’s schedule - no further exam required
• An opportunity to save each patients' family a 450-mile
round trip for an exam and treatment planning!
53
54
Havasupai
55
56

15. 57
Teledentistry Curriculum
58
Teledentistry Curriculum
• The APDH
• Courses complete with methods and materials
• Interested Parties
• Teledentistry
• Community leaders
• HIPAA & Teledentistry
• Funding agencies
• Nomad Training
• Continuing Education
• Teledentistry Equipment Set Up
• Dental professionals
• Hands-on Training
• Comprehensive Training
• Future Trends in Teledentistry
• To form enhanced dental teams
59
60

16. Verde Health Initiative
• NAU has partnered with VHI to provide
teledentistry services to Verde Valley area
schools
Questions?
• Beaver Creek School in Rimrock, AZ
• Approximately 350 student patients
• Diagnostic and preventive services
• Hopefully expanding to other schools
next year
61
62
Thank You!
Fred Summerfelt, RDH, AP, M.Ed.
Associate Professor
Northern Arizona University
(928) 523-0953
fred.summerfelt@nau.edu
63
64

17. References
McKinnon, M., Luke, G., Bresch, J., Moss, M., & Valachovic, R. (2007). Emerging allied dental
workforce models: Considerations for academic dental institutions. Journal of Dental
Education, 71(11), 1476-1491.
Patient Protection and Affordable Care Act, U.S.C. H. R. 3950 (2010).
Senate Bill 1400 Amending Section 32-189, A. R. S. § 32-1289 (2009).
Title 32 Professions and Occupations, A. R. S. § 32-1289 (2004).
U.S. Department of Health and Human Services. (2001). Oral health in America: A report of the
surgeon general. U.S. Department of Health and Human Services, National Institute of
Dental and Craniofacial Research: Rockville, MD.
65