Teledentistry is more than simply providing occasional Zoom calls for online consultations. It is a way to provide complete patient communication and treatment, using all the resources available to examine patients within a physical practice, plus off-site visits/ online consults & managing all of the communication channels to facilitate these different visit types.
At a community level, it can involve hygienists providing exams in community settings, such as schools (with intra oral cameras, portable x-ray units and cloud based patient management programmes) , as per Professor Paul Glassman’s model in the Dugoni School of Dental Medicine, San Diego, California , earning the term “The Virtual Dental Home “ . This is bringing care to the patient. This model has been extended to include visits to the workplace by hygienists, with follow up visits to the practice as required.
Each visit to a dental practice creates a carbon footprint. This begins with the journey to the practice, whether this is by private or public transport. It may involve more than the patient receiving the treatment, with parent’s having to accompany children, or dependent parents to the practice. Siblings may also need to attend with family members.
The actual visit then involves the use of disposable items, gloves, masks, aprons etc, plus instruments that require sterilisation, and materials used for the treatment provided on the day .. Most of the disposable items used need to be disposed of as clinical waste, a process which involves even more than normal waste disposal and creates a higher carbon footprint. Sterilisation of reusable instruments will involve more packaging pre sterilisation with autoclaveable pouches and then will involve energy consummation during the autoclave sterilisation process.
What can we do as a profession to reduce patient visits, and ensure any physical visits are maximised to ensure sustainability?
We think of dentistry as a very hands-on profession, but it is also a very visual one. So, we can ask patients to take and submit intra oral images using apps such as Toothpic and Smilo.Ai , which will provide a very good preclinical visit guide for the dentist. There may initially be reluctance from patients to send in photos because of a) shame / fear about judgement –but it can be explained that sending in photos is much easier than attending in person and that without these photos , the dentist cannot offer any meaningful advice b ) fear of the technology –again , everyone , including residents in care homes , can use Facetime etc to communicate with their families and likewise should be able to communicate with a dental provider .
Photos can be submitted for emergency/ pain patients, routine examinations, orthodontic consultations. Whitening consults, cosmetic and tooth replacement/ implant consults.
A video call (recorded and GDPR compliant) can be organised between the patient, treatment co-ordinator or dentist, when the requested photos, medical history and consents have been received by the practice. This allows the patient and dentist to meet and chat, with the patient at home in their own environment, with no barriers and no requirement for PPE use etc. This is what is termed synchronous virtual dental visits. Asynchronous visits are also possible, whereby the dentist views the patient’s submitted photographs/ records and sends a recorded video, with outlined suggestions for treatment, for patient viewing. Again, this removes the need for the first patient visit to the practice.
Synchronous and asynchronous videos can be also used to follow up with patients following surgical procedures or to follow up on hygiene home care.
Historically we have operated on the 2 x 2 principal in dental practices –we saw patients twice a year for an exam and hygiene visit and we advised brushing twice daily. Patients arrived in for their 6 monthly checks, on receipt of a reminder and never thought about their dental health status or their dental professional in the intervening 6 months. Now we have the opportunity for a new standard of care, with our patients actively involved through teledentistry, resulting in fewer actual visits for routine exams, and ultimately fewer treatment visits as online monitoring allows for improved prevention and less demand for treatment. It is “Care beyond the chair “
So, we can see that Teledentistry can be used to submit photos for emergency /dental pain queries / dental exams/ orthodontic and implant queries. These can be followed by recorded synchronous or asynchronous visits to reduce the carbon footprint to
- Travel to a dental practice
- Also eliminate the consumables required for an in-person visit.