Introduction
Providers have used teledentistry to deliver care to the most vulnerable and underserved patients, both rural and urban for more than a decade.
This initial concept was illustrated with great success in California by the University of Pacific Dental School’s Virtual Dental Home model. In many states, teledentistry was not allowed or is not a reimbursable service, which limited the utilization among providers to implement this model of care.
During the COVID-19 outbreak, many states changed the scope of practice guidelines to allow the reimbursement and utilization of teledentistry, seeing it as an effective way to assess and triage patients while limiting in-office visits except for those in need of urgent or emergency care.
This, combined with many of the early teledentistry platforms such as Mouthwatch’s Teledent and Simlifye’s Connect platforms, made teledentistry for connecting dentists with patients very easy.
Teledentistry offers patients access to a dental provider through a secure platform in the comfort of their own home, removing barriers to care such as long wait times, transportation, and taking time off work. Beyond direct to patient teledentistry, you can find many more possible ways to reach your patients.
This is a two part series that gives some context into ways dentists across the country are utilizing teledentistry as a tool to grow their practices. Let’s start off with the top 4 popular examples.
Example 1 – Limited Evaluation and Triage
Description: A 35-year-old female patient of record was eating and noticed a piece of a dental filling had come out two days prior. The patient was experiencing lingering pain when drinking cold liquids, and it has been keeping her up at night. The dentist is in their office today but does not have availability.
Process: She goes to the practice website and fills out a Teledentistry Consent and Digital Form. The staff reviews the digital form and asks the patient to send a photo of the problem area via a secure messaging platform.
Outcome: The dentist reviews the digital form and image. Additionally, there are existing radiographs on file. The tooth in question is a maxillary molar. Between patients, the dentist creates a referral and gives it to their treatment coordinator.
The dentist recommends that the patient go to the endodontist for root canal therapy and ask the staff to schedule a follow up for a crown following RCT.
| Methodology | Asynchronous |
| Type of Visit | Patient to Dentist |
| Originating Site / Presenter | Patient’s Home / Patient |
| Originating Site Coding | Not applicable |
| Distant Site | Dentist’s office |
| Distant Site Coding | D9996, D0140 |
Example 2 – Hygiene Assessment (limited evaluation)
Description: A 56-year-old male calls for a same-day emergency appointment. The dentist is out of the office at a conference, and it is “hygiene only” day. The patient has some pain and slight swelling on the lower left. The dentist is available remotely to review the diagnostic data while they are traveling.
Process: The patient calls for a same-day appointment. A digital consent and intake form is sent to the patient. The patient comes in for a bitewing, periapical, and intra-oral photo of tooth #21.
Outcome: The dentist reviews the data and image. The tooth in question has a periapical image, and the tooth had a very large restoration that has failed. The hygienist listed in the note that they would prefer to have the tooth removed and is interested in a new mandibular partial.
The dentist reviews the information remotely, develops a treatment plan, calls in an antibiotic, and the team sends consent to the patient to sign prior to coming in for the extraction.
| Methodology | Asynchronous |
| Type of Visit | Hygienist to Dentist |
| Originating Site / Presenter | Dentist’s Office / Hygienist |
| Originating Site Coding | D9996, D0190, D0220, D0270, D0350 |
| Distant Site | Dentists Home |
| Distant Site Coding | D0140 |
Example 3 – Satellite Office Coverage (recall)
Description: A 15-year-old patient of record with low caries risk presents for regular recall and preventive care. The dentist is at the main location and providing general supervision of the dental hygienists at the satellite office.
The patient is having no pain, and the parent is glad that their child can receive care at the office near their middle school instead of traveling across town to the office where the dentist is today. However, the patient’s mother asked the dentist if now was a good time to consult an orthodontist.
Process: The patient was scheduled 6 months ago, and a digital form was sent to update health history and obtain consents. The patient has some crowding on the lower anterior incisors.
The patient sees the hygienist for updated bitewings as well as a full set of extraoral photographs. The hygienist provided prophylaxis, fluoride, and sealants on newly erupted 2nd molars. The dentist is at the main location, and a message is sent to see if they could jump on a webcam discussion with the patient and parent about ortho.
The dentist reviews the new and existing radiographs, as well as the series of photographs. Once the dentist finishes up on a restorative patient, they log into the computer to discuss the findings with the mother.
Outcome: The dentist recommends that between now and the next 6-month recall, the patient has an evaluation by the orthodontist. The referral is given to the parent and a 6-month recall appointment is scheduled. The patient also received sealants without having to have a second visit.
| Methodology | Type of Visit | Originating Site / Presenter | Originating Site Coding | Distant Site | Distant Site Coding |
| Synchronous | Hygienist to Dentist | Satellite Office / Hygienist | D9995, D0191, D0274, D0350, D01351, D1120, D1208 | Dentist’s Office | D0120 |
Example 4 – Follow-up and Patient Consultation
Description: A 64-year-old male patient of record was in the clinic two weeks ago and had a tooth extracted. He is having some issues with food getting stuck in the extraction site and is wanting to know more about his tooth replacement options.
Process: The patient is scheduled for a video consultation with the dentist. A digital patient education video is emailed to him explaining some of the options available for replacing a single missing tooth.
He is also asked to complete an informational form after watching the video so the staff can better prepare a set of treatment options. The office staff has prepared a slide deck for single tooth replacement options ready for the dentist to show the patient.
Outcome: The dentist reviews the patient’s record, as well as the treatment questionnaire. The dentist and the patient discuss how the extraction site may need to be maintained until the site has healed.
The dentist also uses the slide deck to discuss the options with the patient and create a treatment plan for a partial denture to replace that tooth as well as one on the other side of the arch. No PPE or potential exposure was necessary.
| Methodology | Type of Visit | Originating Site / Presenter | Originating Site Coding | Distant Site | Distant Site Coding |
| Synchronous | Dentist to Patient | Patient | Not applicable | Dentist’s Office | D0171 or D9450 |
The examples detailed above are an illustration of potential ways a dental practice can engage with their patients using teledentistry technology. I have found that these are the most common uses that my clients have implemented through my consulting company Access Teledentistry.
Whether using asynchronous teledentistry or synchronous teledentistry, it’s easy to see that there are nuanced ways the technology can be utilized to create what some are calling the “hybrid” schedule of a modern dental practice.
These are all achievable utilizing different digital tools that can be leveraged to make the practice more nimble.
A recent consulting client indicated that these digital tools are “like the blades of a pocket knife.” Healier is one of those tools and we hope you will find its value in organizing and coordinating the communication within the office.
The ability to adapt and grow by using a variety of technologies can help increase the practice’s funnel of new patients while also making chairside time more efficient.