Technology increasingly shapes all of our lives, and the fourth industrial revolution, also known as Industry 4.0 shows no signs of stopping. The fusion of digital, physical and biological systems to deliver benefits for populations and society will likely accelerate. Healthcare and dentistry are no exception and use of digital communication technologies to assist with remote delivery of dental care is transforming access to oral health services for patients around the world. Whether our patients live in a large city, rural town or deep in the countryside, teledentistry has significant potential to make overall healthcare more accessible, more efficient and more patient specific than ever before.
Teledentistry is the provision of dental services and consultations using telecommunication tools including telephone calls, video calls, online chat functions, ‘scan and send’ digital imaging and mobile device applications. There is scope for remote consultations also known as synchronous communication, but also asynchronous communication using the ‘store and forward’ approach where images or clinical information are sent to the dental team for review, clinical decision making before circling back to the patient with a plan. Teledentistry offers a significant opportunity for patient education and follow-up, and also allows both dentists and specialists to work together and with other members of the healthcare community. Finally remote monitoring and triage are powerful applications of teledentistry.
We all became very familiar with teledentistry tools during the COVID pandemic, and much was written both in the healthcare journals and mainstream media about the uptake of telecommunication tools by the healthcare industry. I was interested at this stage to see the adoption in dentistry, having been part of a large project in the North of Scotland designed to address the challenges of remote geography and the shortage of specialists in the delivery of specific items of oral health care. Through this blog I want to challenge those who were champions during the pandemic but have either reduced or stopped providing these services. Why I ask? Your patients might actually benefit from such services continuing. More of this later.
The benefits of teledentistry are significant. The geographical challenge for the delivery of individualised healthcare around the world is not to be underestimated, and through access to digital technology, teledentistry breaks down such geographical barriers and connect patients with essential dental services. One of many triumphs for teledentistry in one of our services has been to run video appointments from Scotland for patient who have been travelling in New Zealand and for patients and their families in different continents for appointments to discuss their NHS care.
On a more routine basis, one major advantage of this technology is reducing the to-and-fro of patient travel, and helping patients save time where possible, is important. However, sixty-five percent of carbon footprinting for dental appointments is related to travel. Can we really say that we are net zero unless we make a significant reduction in patient travel? Furthermore, teledentistry promotes access to oral health services for populations who would not ordinarily have opportunities to access care. Remote screening, remote consultations and instant information or reassurance are essential in today's world. Using specific applications, the technology can be developed to help with condition-specific identification promoting early referral where required. Are we missing a trick with teledentistry? Schools and public health screening programs, people who are housebound and those with access difficulties should also be added to the list for uses of this technology.
Critics of teledentistry video calls cite regulatory hurdles, technological difficulties, data privacy, and absence of a chaperone as potential barriers or blockers. Whilst licensing laws on use of such technology varies around the world, I am unaware of any regulator which has a complete ban on the use of teledentistry. It is true though that not all patients are digitally literate, however the next generation are digital natives and there are always exception rules to deal with difficulties for any process and system. Taking this further, the exception cases should not overshadow the benefits for the majority. Data privacy is a realistic concern, and we all need to bear witness for secure data transfer and storage to protect the identities of our patients. Again, this should not be used as a reason for non-adoption, but rather clinicians should seek opportunities to deal with such concerns. What about the absence of a chaperone? I routinely undertake a video call clinic in the evenings and do these alone. Whilst patients have no objection to showing me their occlusion on a video call, some other aspects of medical diagnosis would inevitably be more challenging without a witness being present.
The future of teledentistry is secure. The advent of artificial intelligence and machine learning have opened a whole myriad of further opportunities for teledentistry to assess, measure, categorise and indeed provide patients with information, alerts and signposting which would otherwise take up time during the busy clinical day. I am a big fan of one particular system which has allowed my service to become much more efficient, and indeed patients can undertake their imaging at a time when it is convenient for them. I am constantly surprised by how many night-owls we have undergoing treatment at any one time. Other advantages of this system are that we can message all patients at the same time providing service updates when necessary, and I can even review scans and patient data from 40,000 feet in the air. I am not advocating for direct-to-consumer dental care though. Bypassing a rigorous clinical examination and lack of full oversight by a registered dental professional result in inadequate diagnosis, reduced or zero opportunity for course correction when things do not go to plan and formulaic treatment plans rather than person-centred care.
Will I be turning back from teledentistry? You probably know the answer having read this blog, and I would like to see teledentistry continue to grow and support the work we all do within the clinical environment. Whilst the human touch is important in all aspects of oral health care, we have to acknowledge resource limitations and geographical constraints which will both mean that delivering a full package of oral health care for the eight billion population on our planet will continue to be a challenge unless we find alternative methods of not only communication but also delivery of oral health care.
Please feel free to get in touch, digitally of course, at dental@rcsed.ac.uk.