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 Table of Contents  
REVIEW ARTICLE
Year : 2020  |  Volume : 11  |  Issue : 4  |  Page : 199-203

Telehealth and dental specialties during COVID-19 pandemic


Eastman Institute for Oral Health, University of Rochester Medical Center, United States

Date of Submission26-Aug-2020
Date of Acceptance28-Nov-2020
Date of Web Publication05-Feb-2021

Correspondence Address:
Dr. Shilpa Singh
Eastman Institute for Oral Health, University of Rochester Medical Center, 625 Elmwood Ave., Rochester, New York 14620
United States
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DOI: 10.4103/srmjrds.srmjrds_83_20

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  Abstract 

Dentistry involves very close contact with the patients while providing oral health care. During pandemics like COVID-19, teledentistry has enabled the oral health-care providers to incorporate telecommunication in dentistry to exchange clinical information and allow remote distance virtual consultations. The COVID-19 like pandemics is one of the reasons for inequities in oral health care. The use of technology and telecommunication can be used to bridge these inequities. This article reviews the challenges faced by oral health-care providers and patients, especially with intellectual and developmental disabilities during COVID-19 like pandemic. This article also reviews the utilization of teledentistry by different dental specialties, along with the current evidence that exists in the literature. In response to this crisis, we believe that teledentistry offers a promising uninterrupted oral health care and enhances the quality of care by improving the access, profession education, and patient satisfaction.

Keywords: COVID 19, teledentistry, telehealth


How to cite this article:
Thakkar R, Kakkar M, George R, Singh S. Telehealth and dental specialties during COVID-19 pandemic. SRM J Res Dent Sci 2020;11:199-203

How to cite this URL:
Thakkar R, Kakkar M, George R, Singh S. Telehealth and dental specialties during COVID-19 pandemic. SRM J Res Dent Sci [serial online] 2020 [cited 2021 Mar 2];11:199-203. Available from: https://www.srmjrds.in/text.asp?2020/11/4/199/308790


  Introduction Top


Telehealth is one of the informational technologies that can be used for long-distance exchange of the health-care-related information and health education. This use of electronic information, imaging, and communication technologies like interactive audio/video communication allows to provide immediate health care. This virtual consultation is one of the innovative platforms to provide health-care support, especially to patients with limited health-care access. “Telemedicine” is one of the tools used in medicine that allows health care to be more accessible, economical, and increases patient engagement.

Similarly, teledentistry is emerging among various dental specialties. Teledentistry uses communications technology, electronic records, digital imaging, and the Internet to provide virtual consultation with all health-care professionals including required specialists, which helps in a collaborative approach in delivering health care in remote areas.[1] This potentially reduces the time in diagnosis, avoids patient travels especially in the pandemic time, and optimizes use of resources. The role of teledentistry in different disciplines of the dental field such as oral medicine and diagnosis, oral and maxillofacial surgery, endodontics, orthodontics, prosthodontics, and pediatric and preventive dentistry is described in [Table 1].
Table 1: Role of teledentistry in different dental specialities

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The rapid spread of the coronavirus a disease of 2019, which is reported to be caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared as a public health emergency of international concern by the WHO on January 30, 2020.[1] Since then, this disease has rapidly spread globally, declaring this as pandemic on March 11, 2020, by the WHO.[1] The government organizations, health-care institutions, and agencies have been working unitedly to contain the virus, control the transmission of the disease, and treat the symptomatic COVID-19 patients.[1] Oral health-care providers also joined those organizations in mitigating the transmissions by delaying elective treatment options and observing social distancing.[1] The Centers for Disease Control and Prevention (CDC)/American Dental Association (ADA) also preemptively regulated the rules and regulations for dental procedures during this pandemic.[1],[8],[9],[10] These interim guidelines recommend to postpone elective procedures, surgeries, and nonurgent dental visits and to prescreen before providing emergency procedures.[8],[9],[10]

The rapidly changing guidelines during the COVID-19 global pandemic had a substantial impact on the delivery of oral health care.[8] This also impacted the oral health care for the remote areas with limited accessibility. McLaren et al. conducted a retrospective study to assess the accuracy of predicting dental treatment modalities for children seen initially by means of a live-video teledentistry consultation. According to this study, the live-video teledentistry consultation can be an effective intervention to facilitate the completion of complex treatment plans for children from a rural area that have extensive dental needs.[9]

Teledentistry can provide patient care and education using the following modalities

  • Synchronous (ADA code D9995): Live, two-way communication between patient and a provider using audiovisual telecommunications technology.[1],[10] This allows live-video evaluation and consultation. This also helps augmented referrals and improvised collaboration among providers
  • Asynchronous (ADA code D9996): Transmission of recorded health information of patients (for instance, photographs, digital impressions, video, digital radiographs, and photomicrographs) through a protected electronic telecommunications system to a dental practitioner, who uses the information to assess a patient's ailment
  • Remote patient monitoring: Personal medical data assemblage from an individual in one location through electronic communication technology, which is transmitted to a provider in a different location aimed for use in providing optimum patient care
  • Mobile health: Public health practices, health-care organizations, and educational institutes supported by mobile communication devices such as computers, mobile phones, tablets, and personal digital assistants.


If a dentist sees a new patient or existing patient throughout COVID-19 quarantine, the treatments provided in the dental office should be billed and coded as per the existing office procedures [Table 2] in addition to those cited above.
Table 2: American Dental Association codes and its description

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Implication of teledentistry for dental professionals

Dental professionals have high possibility for SARS-CoV-2 exposure, as most dental treatments involve aerosol generation by ultrasonic scalers, rotary handpieces and air–water syringes. It is important that supplementary infection control practices are in place to safeguard the health and safety of patients throughout the COVID-19 pandemic. Patients and the staff members who have fever or influenza-like symptoms are advised to stay away and such notices are placed at the entrances of dental offices.[9] To address presymptomatic transmission by patients who may be infected but are asymptomatic, dental offices shall require the use of facemasks or cloth face coverings for everyone entering the dental setting.[11]

The interim recommendation from the ADA and CDC is to perform necessary dental procedures only during the pandemic period.[12],[13] With the help of true emergency questionnaire [Figure 1], dentists can estimate the severity of the condition and make a well-versed judgment to either deliver or reschedule dental care.[14]
Figure 1: Assessment of a true emergency[14]

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According to the CDC, individuals who tested positive with COVID-19 have had a comprehensive variety of symptoms – extending from mild fever to severe illness.[15],[16] Indicators may develop as soon as 2 days after the exposure to the virus or it may take 2 weeks for any symptoms to appear [Table 3].[15],[16],[17] Teledentistry options can be used as substitutions to in-office care for screening and triaging all patients for signs and symptoms consistent with COVID-19. Dental professionals with confirmed COVID-19 positive test and those with potential COVID-19 exposure should contact the local health center for testing and stay quarantined.[18]
Table 3: Signs and symptoms of COVID-19

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  Discussion Top


For majority of dental purposes, asynchronous technology offers exceptional outcomes without unwarranted expenses for additional technology.[19] A standard asynchronous teledentistry (store-and-forward telecommunication) comprises a computer with Internet connection and ample hard drive memory, speedy processor, adequate random-access memory, and an intraoral camera for taking photographs of concerned area in the mouth.[2] Telephones with audiovisual features are also suitable for online assessments.[3]

The Office for Civil Rights will not enforce penalizations for Health Insurance Portability and Accountability Act (HIPAA) noncompliance against oral health providers that oblige patients in good faith through teledentistry during the COVID-19 public health emergency. However, health-care professionals should give a disclaimer before proceeding with virtual consultation to inform patients that third-party applications possibly present may breach in privacy, and all obtainable privacy modes as well as encryption should be allowed while using such technology and applications.[4] These applications are described in [Figure 2].
Figure 2: Examples of public facing technologies, Health Insurance Portability and Accountability Act compliant and noncompliant

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HIPAA does not forbid using communications via text messages or e-mail, but a dentist who implements teledentistry should conduct risk analysis and apply appropriate safeguards.[5] Such safeguards could comprise encouraging the patient move to an equitable distance from people when conversing personal health information and prohibit them from use of loudspeaker function.[5]

Teledentistry can be utilized in several ways with HIPPA compliance, for example, obtaining informed consent, completing COVID-19 screening form, keeping a detailed clinical record of the consultations including patient's protected health information, evaluating medical history, discussing recommended treatment plan, and writing prescriptions. Teledentistry has made it feasible to limit human contacts and therefore reducing the risk of potential transmission of COVID-19.[6]

Acceptability of teledentistry by the patients will upsurge in corresponding with the overall adequacy of telehealth, which is growing day by day. Teledentistry is yet to become an integral part of the dental care delivery system, but it is crucial that dental professionals actively support and endorse the use of teledentistry to complement the existing compromised dental system during the current pandemic.[10]

COVID-19 Coding and billing Interim Guidance by the American Dental Association1

If dentists are delivering care by means of teledentistry for the purpose of triaging potential patients or to offer an assessment to conclude if the condition is urgent, then the following ADA codes [Table 3] can be utilized in the patient's billing and coding record and to an insurance company.


  Conclusion Top


Teledentistry has the aptitude to increase access of dental care as well as lower its expenditures. COVID-19 pandemic has taught us that while communication is necessary during a crisis, traditional conversation methods involving proximity in large groups may become inapplicable. Therefore, unconventional ways have to be established. Dental professionals may consider integrating teledentistry in health-care settings to accommodate patients who have difficulty in transportation because of a distant location. Even though teledentistry has taken precedency over traditional means of communication, conceivable limitations exist, such as – prerequisite for training, possibility to overlook findings, message misunderstanding, and privacy concerns. Future research should put emphasis on strengths, limitations as well as long-term sustainability of virtual consultation and the process of incorporating teledentistry into the existing health-care system.[1]

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Jampani ND, Nutalapati R, Dontula BS, Boyapati R. Applications of teledentistry: A literature review and update. J Int Soci Preven Community Dent 2011;1:37.  Back to cited text no. 1
    
2.
Bhambal A, Saxena S, Balsaraf SV. Teledentistry: Potentials unexplored. J Int Oral Health 2010;2:1-6.  Back to cited text no. 2
    
3.
Folke LE. Teledentistry. An overview. Texas Dent J 2001;118:10.  Back to cited text no. 3
    
4.
Snow MD, Canale E, Quail G. Teledentistry permits distant, cost-effective specialist dental consultations for rural Australians. J Telemed Telecare 2000;6 Suppl 1:216.  Back to cited text no. 4
    
5.
FAQs on Telehealth and HIPAA During the COVID-19 Nationwide Public Health Emergency. Available from: https://www.hhs.gov/sites/default/files/telehealth-faqs-508.pdf. [Last accessed on 2020 Jun 20].  Back to cited text no. 5
    
6.
Kopycka-Kedzierawski DT, Bell CH, Billings RJ. Prevalence of dental caries in Early Head Start children as diagnosed using teledentistry. Pediatr Dentistr 2008 1;30:329-33.  Back to cited text no. 6
    
7.
Salazar-Fernandez CI, Herce J, Garcia-Palma A, Delgado J, Martín JF, Soto T. Telemedicine as an effective tool for the management of temporomandibular joint disorders. J Oral and Maxillofacial Surg 2012;70:295-301.  Back to cited text no. 7
    
8.
Shanafelt T, Ripp J, Trockel M. Understanding and addressing sources of anxiety among health care professionals during the COVID-19 pandemic. Jama 2020;323:2133-4.  Back to cited text no. 8
    
9.
McLaren SW, Kopycka-Kedzierawski DT, Nordfelt J. Accuracy of teledentistry examinations at predicting actual treatment modality in a pediatric dentistry clinic. J Telemed Telecare 2017;23:710-5.  Back to cited text no. 9
    
10.
Sanchez Dils E, Lefebvre C, Abeyta K. Teledentistry in the United States: A new horizon of dental care. Int J Dent Hygiene 2004;2:161-4.  Back to cited text no. 10
    
11.
Giudice A, Barone S, Muraca D, Averta F, Diodati F, Antonelli A, et al. Can teledentistry improve the monitoring of patients during the covid-19 dissemination? a descriptive pilot study. Int J Environ Res Public Health 2020;17:3399.  Back to cited text no. 11
    
12.
Dasgupta A, Deb S. Telemedicine: A new horizon in public health in India. Indian J Community Med 2008;33:3.  Back to cited text no. 12
[PUBMED]  [Full text]  
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14.
Ather A, Patel B, Ruparel NB, Diogenes A, Hargreaves KM. Coronavirus Disease 19 (COVID-19): Implications for Clinical Dental Care. J Endod. 2020 May;46(5):584-595. doi: 10.1016/j.joen.2020.03.008.  Back to cited text no. 14
    
15.
Centers for Disease Control and Prevention. Symptoms of Coronavirus; 2020. Available from: https://www.cdc.gov/coronavirus/2019-ncov/symptoms-testing/symptoms.html. [Last accessed on 2020 Jun 20].  Back to cited text no. 15
    
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Meng L, Hua F, Bian Z. Coronavirus disease 2019 (COVID-19): Emerging and future challenges for dental and oral medicine. J Dent Res 2020;99:481-7.  Back to cited text no. 16
    
17.
Xu G, Yang Y, Du Y, Peng F, Hu P, Wang R, et al. Clinical pathway for early diagnosis of COVID-19: Updates from experience to evidence-based practice. Clin Rev Allergy Immunol 2020 24:1-2.  Back to cited text no. 17
    
18.
Ghai S. Teledentistry during COVID-19 pandemic. Diabetes Metab Syndr. 2020;14(5):933-935. doi:10.1016/j.dsx.2020.06.029.  Back to cited text no. 18
    
19.
Chen JW, Hobdell MH, Dunn K, Johnson KA, Zhang J. Teledentistry and its use in dental education. The J Am Dent Assoc 2003;134:342-6.  Back to cited text no. 19
    


    Figures

  [Figure 1], [Figure 2]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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