When I saw my dentist for a routine teeth cleaning in late February, she discovered two fillings that needed to be redone. So I made a follow-up appointment for late March. But then the coronavirus hit, and my dentist’s office closed up shop and postponed all appointments until further notice. Then, in early April, my dental insurance company emailed me to let me know my plan covers teledentistry. What could dentists really do for patients on video? I knew my fillings would have to wait.
While it’s true that dentistry is an especially hands-on specialty, video consultations can help patients determine if their symptoms require immediate in-person care, can be addressed at a later date or can be managed with over-the-counter solutions. In the past, teledentistry has primarily been used to give residents of urban areas greater access to dental care, but because of COVID-19, more dental offices across the country now offer this option.
Two types of virtual care
There are two main types of teledentistry. In asynchronous or “store and forward” care, a dental hygienist either a) goes to a school, nursing home or another location to meet with patients or b) meets them at the dentist’s office on a day when the dentist isn’t there. The hygienist will document any symptoms, and might also take pictures and X-rays. They then upload all notes and images so the dentist can review everything and perform a remote exam. With this type of teledentistry, dentists have X-rays and professional photos of patients’ mouths, which they can use to make diagnoses. These remote exams appear to be comparable to in-person oral screenings, but more research is necessary.
The synchronous or “live video” modality is what more dentists are using right now, and it saves the patient time and the cost of travel, notes Dorota Kopycka-Kedzierawski, professor of dentistry at the University of Rochester. In this type of real-time appointment, patients report their symptoms and share any photos or videos during a videoconference with the dentist. Images taken by patients aren’t professional, so a dentist can only make limited diagnoses based on them. What they can do, though, is determine if a patient’s need is nonurgent, urgent or emergency.
Nonurgent issues include routine cleanings as well as problems that don’t need to be addressed right away, such as cavities that don’t cause pain. An urgent issue means anything that causes severe pain but can still be managed by a dentist in the office, such as a defective restoration or a broken crown. An emergency issue means a life-threatening concern that requires a trip to the ER, such as a severe infection or uncontrollable bleeding.
Currently, the Centers for Disease Control and Prevention, the American Dental Association and the American Dental Hygienists’ Association all recommend postponing non-emergency care. So for anything that’s not urgent, the dentist will recommend ways to self-manage the symptoms. If the situation is urgent or emergency, however, the dentist will determine if a patient should come into their office, see an oral surgeon or go to the emergency room.
“All we can do is triage. We use the patient’s symptoms and any images to evaluate their pain and what should be done,” says dentist Nathan Suter, owner of Green Leaf Dental Care and Access Teledentistry, a consulting firm that educates providers on teledentistry. “It’s a very limited scope. Unless it’s an emergency, we are just trying to get people comfortable and able to wait out their symptoms a little longer until it’s safer to come into an office.”
Through telehealth visits, dentists can help patients manage tooth pain by prescribing an antibiotic, recommend an over-the-counter mouth guard if they are grinding their teeth, and determine if a broken tooth should be addressed now or if temporary filling material purchased over-the-counter or online can help for the time being. “Ideally we would have the patients come in so we can look at them. But we don’t want to waste personal protective equipment (PPE),” Suter explains. “We need to save PPE for the hospitals and for when it’s necessary to pull a tooth or do a root canal.”
Although the research on this type of teledentistry is limited, studies have found that training teachers and school staff to take photos of children’s mouths is beneficial for oral health, particularly in areas with limited access to care. It also reduces the cost of care and improves oral health in children, according to a 2018 study authored by Kopycka-Kedzierawski.
How to Prepare for Teledentistry
If you decide to try videoconferencing with your dentist, come prepared with detailed information about your symptoms. The dentist may also ask for photos or video of your mouth or problem area. Try to use the best lighting you can. “You may need a flashlight and a family member to help,” Suter suggests. Do the consultation in an area that’s quiet and well-lit, because your dentist will want to be able to see any facial swelling.
Check with your dental insurance company to see if and which types of telehealth your plan covers. In response to COVID-19, most dental insurance plans have loosened telehealth coverage restrictions, says Suter. Many have temporarily made virtual visits free for patients (meaning there’s no copay). Ordinarily, coverage policies vary across different health plans. Some cover limited evaluations, where you show your dentist your mouth during a video conference, while other plans only cover the scenario where you go somewhere to see a hygienist, who sends your X-rays to the dentist so they can perform a remote exam. Once dentists resume regular in-office care, telehealth coverage rules will likely change again.
Teledentistry will never fully replace in-office visits. However, Suter predicts it will have a place in the future. In the near-term, “we will have two to three months of pent-up broken teeth, cleanings and other routine care to address,” he says. “Teledentistry may be used by a dentist to determine who needs to be seen first and safely without wasting PPE, and to protect the patient or care team from risking exposure to the coronavirus.”
Kopycka-Kedzierawski believes screenings, triage, specialty consultations and follow-up care can all be done via teledentistry, particularly for certain populations, “especially for patients who are living in rural or urban areas where specialty dental care is not readily available,” she says. “Also, older adults and patients who live in nursing homes or group homes will benefit from remote dental consultations and screenings.”