In the 1990s the concept of ‘teledentistry’ was introduced. Cook, in 1997, defined this as “the practice of using video-conferencing technologies to diagnose and provide advice about treatment over a distance” (Cook J. ISDN video conferencing in postgraduate dental education and orthodontic diagnosis. Learning Technology in Medical Education Conference, 1997 (CTI Medicine:111-116). A review of teledentistry and its current status is recently reported by authors A Bhambal, S Saxena, and S Balsaraf of the People’s College of Dental Sciences and Research Centre, Bhopal, India, in the Journal of International Oral Health (J Int Oral Health, Oct, vol 2(3): 1-6).
In their review they discuss the meaning of teledentistry, the forms of teledentistry, how it is currently used in terms of education and in the specialties, its benefits, and the legal issues. As they note in the article, there are two forms of teledentistry: real time consultation, and “store and forward”. With the use of videoconferencing dentists and their patients can consult in real time at different locations with advanced telecommunication technologies and ultra-high-bandwidth network connections. For example, general dentists can consult with Oral Medicine specialists or Orthodontists regarding diagnosis or treatment strategies. In the second type of teledentistry information can be gathered and stored and then forwarded to consulting clinicians after all the required data is collected. This data packet may include the patient’s history, digital photographs, and digital x-ray images.
They point out that the US Army introduced teledentistry at Fort Gordon, Georgia, in July of 1994. In what seems like an antiquated system now, they used an intra-oral camera to transmit color images of a patient’s mouth using a 9600 band modem from one clinic to another 120 miles away. This procedure was performed on 15 pre-surgical periodontal patients. Post surgery, images were taken and transmitted to Fort Gordon for evaluation by the Periodontist who performed the surgery. This resulted in only one of the 15 having to return to Fort Gordon for follow-up intervention.
In the late 1990s and early 2000 numerous articles were published regarding teleradiology and Dentistry. To mention just a few, G Clark discussed its status and future considerations in the J of California Dental Association(J Calif Dent Assoc. 2000; 28(2):121-7). Golder and Brennan published a piece: Practicing dentistry in the age of telemedicine in the Journal of the American Dental Association as well (J Am Dent Assoc 1000; 131(6):734-44). Rocca et al published an article: The Evolution of a Teledentistry System within the Department of Defence. (Proc AMIA Symp 1999: 921-924). Stephens and Cook described the attitudes of UK consultants to teledentistry as a means of providing orthodontic advice to dental practitioners and their patients in the Journal of Orthodontics 2002 (j Ortho 2002;29(2):137-142). And Cook, et al, published their piece: Dentists’ opinions of an online orthodontic advice service (J Telemed Telecare 2001;7(6):334-337).
As the authors of this review article point out, the benefits of Teledentistry include:
- reduced cost of service and improved quality of care
- Reduction in peer isolation and increased specialist support as well as education.
- Improvement in diagnostic services
- Improved integration of Dentistry into the larger health care delivery system.
- Improvement in communication with the Insurance industry with respect to requirements.
- Improvement in communication with dental laboratories.
However, at the present time there remain significant legal and compliance considerations for all areas of telemedicine, including teledentistry. For example, there is considerable variation between countries in terms of accountability, licensure, jurisdiction, liability, privacy, consent, and malpractice. The latter appears to be a major impediment to the use of teledentistry across borders. The authors also point out that “patients will need to be advised of the inherent risks of improper diagnosis and/or treatment due to failure of the technology involved”. Nonetheless, the authors conclude that teledentistry is ‘a potential source of healthcare’.
Submitted by Jeff Burgess DDS MSD - Editor in chief
Editor’s note: In the coming months incedental.com will present the latest research on teledentistry. Stay tuned.
