In a recent edition of the Indian Journal of Dental Research Dr. K Venu Gopal Reddy comments in a guest editorial on the need for Teledentistry in India (IJDR, 22(2):189, 2011).  In his editorial he presents the argument that given the inequalities of delivery of oral health care in India, particularly the problem of specialist distribution throughout the country as it relates to care, Teledentistry might provide a good option for disseminating information and care in underserved areas.  As he states: “Teledentistry is a newly emerging area of dentistry that uses dental health records, telecommunications technology, digital imaging and the Internet to link dental health care providers in rural or remote communities with specialists in larger communities to enhance communication, the exchange of health-related information and access to dental care for underserved patients”.

The Dental Hub applauds the concept he presents and suggests that it might also be applicable to other countries with similar disparities in the distribution of dentists and specialists.  As Dr Reddy notes, the use of Teledentistry could allow ‘real-time’ consultation by way of online video telecommunication between dental health care practitioners or could be provided via, as the author states: ‘store and forward’ methods.  In this scenario a dental health professional, say a hygienist or general dentist, would record a digital video which could then be ‘retrieved’ later by a specialist who would provide an opinion; a  simple concept with profound health care consequences.

The system would require “videoconferencing equipment set up at both the hub site and remote site” which suggests substantial cost, but it should be appreciated that currently even skipe allows for this type of imaging between people using computer cameras.  Thus the expense of setting up such a system may not be overwhelming and should not be a deterrent.

The other potential problem with Teledentistry is the issue of data validity, particularly as it relates to the identification of oral disease.  The digital transfer of DICOM images that include acquisition data reduces the potential problem of digital misrepresentation of bone and tooth pathology but the jpeg or even Tiff images arising from video imaging are subject to color and shape distortions that could make interpretation of mucosal lesions (and subsequent diagnostic sensitivity and specificity) problematic.  Nonetheless, even if there are such problems, the benefits (e.g. detection of precancerous lesions, for example) would seem to far outweigh the potential disadvantages, particularly in underserved areas.  As Dr Reddy notes, the cost savings alone make the system potentially advantageous to patients.

The Dental Hub would like to see Dr Reddy and others who believe that Teledentistry might help to solve some of the inequities in dental health care in the rural areas of their countries apply for research grants that assess the cost savings and health benefit potential of Teledentistry.  There is likely to be Government or private (e.g. The Gates Foundation) support for research that improves oral health using this technology.

Submitted by Dr Jeff Burgess, Editor in Chief