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Front Line Innovations – Teledentistry During and After COVID-19

COVID-19 has fundamentally changed the provision of dental care and the way we access oral health services. Virginia Health Catalyst is highlighting topics in oral health that focus on ways to provide care in a post-COVID-19 world through its Front Line Innovations blog series. The second blog in our series is from Dr. Scott Wolpin, the Chief Dental Officer at Eastern Shore Rural Health System.

Serving as the Chief Dental Officer for a safety net provider in one of Virginia’s rural communities I knew we would need to adapt to meet our patient’s needs when the COVID-19 crisis reached our community.  To keep our patients safe at home our health center began offering teledentistry appointments in March. We actually began doing so even before our state’s Medicaid program began reimbursing for teledentistry services. Since then our dental program has provided over 130 telehealth visits.

Broadly speaking teledentistry enables my team to connect with their patients by video to provide guidance, oral health education, and to triage emergent concerns without asking a patient to leave their home.

On Virginia’s Eastern Shore, I have found teledentistry to be a game-changer for the care we provide. Our community is very rural and transportation to dental appointments was challenging even before COVID-19 surged in our area; while people may not always have cars, almost everyone here has a cell phone. I am hopeful for the opportunities of teledentistry, both during COVID-19 and after. The potential is great.

Creating a Successful Teledentistry Program

I believe that the key to our success with teledentistry has been careful planning and realistic expectation setting from the outset. We established a clear purpose for how we could best help our patients during the pandemic and brainstormed how teledentistry might be used to do so. Currently, we are using teledentistry to assist patients with immediate and potentially emergency dental issues, ultimately keeping them out of the emergency room, while continuing to provide some level of a continuum of care for our community.

To do this, we identified a couple of technology platforms that, after some training, the dental team is comfortable with and we established workflow protocols so that all of us on the team understand what to do in a wide variety of scenarios.  We also never forget to remind our patients how important home oral health self-care is and that teledentistry is unable to replace an in-person dental visit. We look forward to welcoming our patients back for preventive and restorative services when it is safe for them to do so understanding that we are now a hot zone in Virginia and that new infection and environmental controls will need to be implemented first.

Like any new service, teledentistry has had a learning curve for ourselves and our patients. For example, we’ve had to learn how to better communicate with patients to help us see the problem they’re experiencing through a camera lens. There are great resources available on lighting and camera angles to get the best look into a patient’s mouth, but nothing will ever replace an in-person visit in that regard.

Never the less, I am surprised at the positive response not just from our team, but from our patients. It has been my experience that patients feel more comfortable and relieved when they can see the provider over a video visit. I fully believe that the planning and training we did, both with our technology platform and visit protocols, was vital to the success we have had. I’d encourage anyone considering implementing teledentistry to start by setting clear goals, creating specific workflows for your team, and finding the platforms that work best for you and your patients. There are already excellent resources to assist here on the National Network for Oral Health Access (NNOHA).

Post COVID-19 Opportunities for Teledentistry

As we move into the dentistry of the future I imagine that teledentistry will play a crucial role. Even before COVID-19 changed how we provide care our team identified virtual and remote supervision programs as an opportunity for us to meet our patient’s needs especially for those we have a difficult time bringing to the office. Teledentistry can help us meet some of the challenges of the social determinants of health that burden our patients and help to assure health equity. Our dental hygienists have been working with community agencies like Head Start on our Traveling Oral Health Prevention Program (TOPs) to integrate oral health into our community. In the months to come our dental team is exploring opportunities to bring TOPs into other settings like the local health department’s WIC and Maternity Clinics, high schools, and perhaps long term care facilities. Here an intraoral camera, portable radiography, and our internet-based EHR (all components of telehealth) will help to create virtual dental homes for these underserved individuals.

I am excited for the future of teledentistry in Virginia and our state certainly has made great strides to make teledentistry a part of the larger health system.  My hope is for these gains to remain after this crisis is over. By putting teledentistry practices into place now, Virginia’s dental providers will be prepared to enter the post-COVID-19 world, and a new phase of dentistry.

For further information on teledentistry please check out these resources: