Teledentistry - a review

Teledentistry - a review

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  TELEDENTISTRY - A REVIEW Dr.AASHNA DHINGRA Postgraduate Student Dept. Of Public Health Dentistry
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  • 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
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  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
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  INTRODUCTION Dental care isbeing 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.
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  INTRODUCTION It is adeveloping 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.
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  Real time consultation Storeand forward
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  ADA GUIDELINES D9995 D9996 • Synchronoustele 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
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  TELEDENTISTRY SERVICES SPECIALIST REFERRAL SERVICES CONSUMERMEDICAL AND HEALTH INFORMATION PATIENT CONSULATION REMOTE PATIENT MONITORING PROFESSIONAL EDUCATION
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  TELE DENTISTRY DELIVERYMECHANISMS • 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.
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  • Networked programs Linkhospitals 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
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  • Primary orspecialty 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.
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  • Web-based e-healthpatient service sites provide direct consumer outreach and services over the Internet. Under telemedicine, these include sites that provide direct patient care.
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  COMPONENTS THAT FACTORINTO 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
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  TOOLS FOR EXCHANGEOF 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.
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  APPLICATIONS OF TELE DENTISTRY
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  TELEDENTISTRY AND DENTALEDUCATION • 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
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  TELEDENTISTRY AND DENTALEDUCATION • 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.
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  TELEDENTISTRY AND DENTALEDUCATION 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.
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  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.
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  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.
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  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)
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  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.
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  TELE ORTHODONTICS • Emailimage 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)
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  TELE ORTHODONTICS • Useof digital 2D & 3D models. • Measurements & assessment of relationships are done using software that processes images. • orthoCAD •
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  TELE ENDODONTICS • Anyfaults 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.
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  TELE ENDODONTICS • BrullmannD 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.
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  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.
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  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.
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  TELE DENTAL PROSTHETICS •CAD/CAM systems. • dental crowns, dental inlays, onlays. • Highest level of computerized support in dental implants placement.
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  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.
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  ROLE IN COMMUNITYDENTISTRY • 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.
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  TELE DENTISTRY ININDIA
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  TELE DENTISTRY ININDIA • 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
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  TELE DENTISTRY ININDIA • 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.
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  TELE DENTISTRY ININDIA Mathur P, Srivastava S, Lalchandani A, Mehta JL (2017) Evolving Role of Telemedicine in Health Care Delivery in India. Prim Health Care 7:260.
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  TELE DENTISTRY ACROSSTHE WORLD
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  SCOPE OF TELEDENTISTRY 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.
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  SCOPE OF TELEDENTISTRY 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.
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  SCOPE OF TELEDENTISTRY 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.
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  HEALTH INSURANCE PORTABILITYAND 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.
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  LEGAL ISSUES • Inteledentistry 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
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  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.
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  FUTURE OF TELEDENTISTRY • 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.
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  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.
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  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).