The dental hygiene profession has evolved over many years, now allowing more autonomy and the ability to provide increased access to care for the patient population. Whether it be in a rural setting, urban metropolis, care facility, or a large multisite practice, teledentistry can make treating patients with comprehensive care a nearly seamless process.
The evolution of direct access care
The American Dental Hygienists Association (ADHA) defines direct access as “the ability of a dental hygienist to initiate treatment based on their assessment of a patient’s needs without the specific authorization of a dentist, treat the patient without the presence of a dentist, and maintain a provider-patient relationship.”1
According to the ADHA, 42 states allow dental hygienists to provide direct access care in at least some manner.2 Advances in technology and progression in the dental field have enabled hygienists and dentists to provide care in outreach programs serving patients who may not otherwise be able to get to a traditional dental office setting.
Teledentistry is the catalyst
Teledentistry is making many of these outreach programs possible by allowing hygienists to connect and share information with a supervising dentist to ensure that patients receive the follow-up care they need.
Mobile dentistry encompasses a broad spectrum of outreach programs and may be aligned with school programs, public health programs, bringing care to assisted living facilities, community fairs, and even serving homeless populations. In most states, any hygienist providing care must have a supervising dentist, or at least an associated dentist to refer patients to as part of that state’s practice act.1
Supervision is made possible by software platforms such as TeleDent by MouthWatch in conjunction with the use of intraoral cameras to capture images. Data collection and transfer must take place using a HIPAA-compliant, encrypted, and secure platform to share personal health information between providers. Capturing and transferring images via telephone, text message, or unencrypted email leaves the dental provider open to disciplinary action and fines.
During COVID-19, HIPAA regulations in regard to teledentistry have been relaxed temporarily to allow for evaluations to be performed, but this is only a temporary solution and discretion must still be exercised.3 A comprehensive teledentistry software program allows providers to access patient information for the dentist to complete an evaluation remotely, whether it be synchronous (live) or asynchronous (store-and-forward).
The reinvention of team dentistry
The link between dentists and hygienists can be reinforced in a variety of ways. In some states, Colorado for example, a hygienist can practice independently without the supervision of a dentist. However, standard of care requires the hygienist to make a referral if concerns arise and diagnostic evaluation is needed.1
Other states require a hygienist to have a supervising dentist, but don’t require that they be at the same site. Idaho, for example, will allow a hygienist to have an “extended access” endorsement on their hygiene license that allows for treating patients outside the traditional dental setting. However, they must be employed by a dentist who will oversee all treatment provided.1 Teledentistry offers the modality to bridge the distance between the outreach or alternative care hygienist and the dentist who must provide supervision and evaluation.
Expanded access to dental care is ever-evolving, it’s resulting in hygienists moving to the front line in nontraditional settings. This creates a need for enhanced communication between providers to deliver optimal patient care. Teledentistry has rapidly moved to the forefront as necessitated by the coronavirus pandemic, and now the secret is out.
Today and in a postpandemic world, a truly useful teledentistry software platform is not only HIPAA compliant, it also allows for seamless messaging between providers, patients, and specialists. In addition, the program should have the ability to securely share patient information, images and videos, notes, and treatment planning as well as keep the Protected Health Information (PHI) record on a secure site.
Synchronous teledentistry encounters can be initiated from the comfort of the patient’s home to address concerns or even complete a postoperative evaluation. In comparison, asynchronous teledentistry is how most dental hygienists and dentists collaborate for patient care when they aren’t in the same building. The hygienist collects data and assigns a task to the dentist to review at a convenient time; the dentist is then able to diagnose and plan treatment and share findings and recommendations with the patient.
Teledentistry not only provides the ability to practice in various settings, it can also reduce the need for additional personal protective equipment (PPE) when used within dental practices. For example, teledentistry enables the dentist to perform an evaluation from a safe distance, maintaining personal and friendly contact with the patient via videoconference, sans mask or additional PPE. This is a significant benefit, because making a personal connection is an important part of any dental appointment.
Building a better referral system
The teledentistry bridge connects more than just hygienists and dentists, it can also extend to specialists to close the loop of patient referrals. How many times have you handed a patient a paper referral and counted on them to schedule an appointment with a specialist, only to have them return six months later saying they lost the form?
This scenario may happen multiple times before the patient is either prompted by pain or tooth loss is eminent—all when timely care could have halted the problem. Sharing patient information with external providers reduces the likelihood of lost referrals and improves the ability to share information between dental practices. Providers can video chat or hold a videoconference with the patient included, ensuring all parties are on the same page. In TeleDent, the dental practice is also able to add the specialist as a user, restricting access to only their assigned patients versus the entire patient population. The result? No more phone tag and waiting on imaging between practices.
Interdisciplinary collaboration
Teledentistry can also help medical clinicians provide comprehensive patient care by connecting patients seen in a medical office to a dentist to evaluate an area of concern. Pediatricians have the ability to connect children that exhibit early childhood caries to a dentist, or refer an emergency room visit that is best served by a dentist. Assisted care facility nurses can upload images to a dentist for evaluation; for example, an elderly patient may be exhibiting candidiasis, but leaving the care facility is extremely difficult. The doctor can evaluate and prescribe as needed, all from the patient’s bedside.
Where teledentistry may have been an unknown concept to many, it is now a mainstay for many dental practices moving forward. Bridging a gap not only in a nontraditional practice setting between the hygienist and dentist it also moves forward to ensure complete care of the whole health of the patient.
Connecting the medical and dental communities and outreach programs to improve patient care is a key example of how teledentistry best serves communities. Patients are largely surprised by the convenience of teledentistry and have had an overwhelmingly positive response with most coming to see it as a valued service. As dentistry continues to move forward and focus on whole body health and collaboration, teledentistry will be at the forefront to help make it happen.
Editor’s note: This article is sponsored by MouthWatch. Content has been reviewed for editorial integrity per RDH guidelines. For more information on our editorial standards, see rdhmag.com/page/submission-guidelines.
References
1. Direct access states. American Dental Hygienists’ Association. Updated January 2020. https://www.adha.org/resources-docs/7513_Direct_Access_to_Care_from_DH.pdf
2. Direct access 2019: 42 states. American Dental Hygienists’ Association. Updated November 2019. https://www.adha.org/resources-docs/7524_Current_Direct_Access_Map.pdf
3. COVID-19 coding and billing interim guidance: Virtual visits. American Dental Association. May 11, 2020. https://success.ada.org/~/media/CPS/Files/COVID/ADA_COVID_Coding_and_Billing_Guidance.pdf
Jamie Collins, RDH-EA, is an educator, author, and speaker dedicated to advancing the dental profession. She is also a teledentistry specialist at MouthWatch LLC, a leader in innovative teledentistry solutions, digital case presentation tools, and intraoral imaging devices. Collins can be reached at [email protected].
