|Year : 2020 | Volume
| Issue : 2 | Page : 77-81
Integration of teledentistry in oral health care during COVID-19 pandemic
Neetika Singh1, Amina Sultan2, Akanksha Juneja2, Isha Aggarwal3, Tanzin Palkit3, Tanvi Ohri4
1 Department of Pediatric and Preventive Dentistry, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
2 Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, JMI, New Delhi, India
3 Department of Orthodontics, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
4 Department of Periodontology and Implantology, Bhojia Dental College and Hospital, Baddi, Himachal Pradesh, India
|Date of Submission||23-Aug-2020|
|Date of Decision||18-Sep-2020|
|Date of Acceptance||19-Sep-2020|
|Date of Web Publication||28-Jan-2021|
Dr. Akanksha Juneja
Department of Pediatric and Preventive Dentistry, Faculty of Dentistry, JMI, New Delhi - 110 025
Source of Support: None, Conflict of Interest: None
The COVID-19 pandemic has generated turmoil at all levels. The patients, in particular, are facing a tough time due to the non-availability of physical health care. As everyone is worried about their lives, oral health has taken a back seat. Patients who suffer from dental issues are in a dilemma over available options to address their oral health issues. This is where Teledentistry comes into the picture. Teledentistry is a mode to improve access to oral health services in areas with inadequate availability of general and specialty dental care and is emerging as a practical solution in emergency aid, initial consultation, and expert opinion. In India, several parts of the country lack a sufficient bandwidth or uninterrupted access to the internet facilities, which is also a huge barrier for practicing teledentistry during these pandemic times. Although teledentistry is yet to become an integral part of the oral health-care system in India, nonetheless, COVID times have at least pushed dental practitioners across the country into accepting and using it as an alternative method of dental care. This current pandemic can serve as an opportunity to develop teledentistry on a larger scale, making sure that no individual lacks oral health care, irrespective of the scenarios in the world.
Keywords: COVID-19, coronavirus, oral health care, pandemic, teledentistry, telemedicine
|How to cite this article:|
Singh N, Sultan A, Juneja A, Aggarwal I, Palkit T, Ohri T. Integration of teledentistry in oral health care during COVID-19 pandemic. Saint Int Dent J 2020;4:77-81
|How to cite this URL:|
Singh N, Sultan A, Juneja A, Aggarwal I, Palkit T, Ohri T. Integration of teledentistry in oral health care during COVID-19 pandemic. Saint Int Dent J [serial online] 2020 [cited 2021 Jun 19];4:77-81. Available from: https://www.sidj.org/text.asp?2020/4/2/77/308176
| Introduction|| |
The COVID-19 pandemic has generated turmoil at all levels. The rapid spread of novel severe acute respiratory syndrome (SARS-CoV-2) across China and to the rest of the world forced the government bodies to impose quarantine and lockdown across nations. In India, “Janta Curfew” was imposed on March 21, 2020, and was further extended in three phases, hence limiting any movement. Since then, there has been an increase in agonies of patients' sufferings from different ailments due to the nonavailability of physical health care. As everyone is worried about their lives now, oral health care has taken a backseat as most of the dentists are now handling only the emergency dental procedures and surgeries. Nonetheless, based on the present situation of COVID-19 spread worldwide, it does not seem to appear that this pandemic will end anytime soon. Besides, there is a growing fear that SARS-CoV-2 may never go away, instead may turn into an additional endemic virus in the public domain.
Henceforth, there is a dire need for development and innovations in our dental profession globally to sustain and achieve reduced risk of transmission, if these speculations are not proven otherwise., The impressive growth of telemedicine during the COVID-19 pandemic has led to a lasting impression in medicine worldwide. Hence, the inherently visual nature of dentistry makes it ideal for the practice of telemedicine., Teledentistry is a mode to provide access to oral health care in regions with nonavailability of general and specialized dental services and is coming up as a feasible solution in emergency situations, initial consultation, and expert opinion. Like other health-care professionals, dentists too can use smartphones, laptop webcams at their disposal to provide dental care to the most vulnerable dental patients safely in their home, without exposing themselves and the patient to unnecessary risks and expenses.
Telehealth involves public health-care services delivered with the aid of information and communication technology to help in the patient consultation, diagnosis, self-care, treatment planning, and scheduling by a health-care worker stationed far-off from the patient. Teledentistry is an alternate division of telehealth that provides dental care at a distance with the help of information and communication technology. It is not a new field but an alternative one for delivering dental services through the transfer of clinical information and pictures for a dental consultation and treatment planning from a distant site. It has the benefit of eliminating the high treatment expenses and also providing dental services to the rural or far-off areas. Its origin dates back to the 1994 military project of the United States Army (U. S. Army's Total Dental Access Project), which aimed to improve dental education, patient care, and implementation of the information transmitted between dental professionals and the laboratories. The term Teledentistry was first defined by Cook in 1997, as, “the practice of using video-conferencing technologies to diagnose and provide advice about treatment over a distance.”
Teleconsult and telescreens have also been recommended in the “Guidelines for Dental Professionals in COVID-19 Pandemic Situation” issued by the Ministry of Health and Family Welfare, Government of India. For the duration of the COVID-19 crisis, teledentistry will aim at “dental triage,” managing pain and infection, giving dental care by remote consultation, planning, and scheduling of definitive dental treatment.
Teledentistry can be an advantageous in situations where the patients are infected with COVID-19 or suspected to be infected. For those not infected with COVID-19, but at higher risk of being affected (e.g., the elderly with pre-existing medical conditions), it provides a safe alternative by avoiding congested hospitals or dental office waiting rooms. However, its effectiveness and sustainability depend on its integration into health services as a routine protocol.,
Largely, teledentistry is used in dental fields involving preventive dental care, orthodontics, endodontics, oral surgery, and periodontal diseases. It helps in the detection of early dental caries, patient education, oral medicine, and diagnosis. Few of the technical approaches in teledentistry include electronic health records, electronic referral systems, digitizing images, teleconsultations, and telediagnosis.
Although the concept of teledentistry is age-old, its use and scope are increasing during these COVID times. It not only provides access to oral health care but also removes discrepancy amongst the rural and urban populations for oral health care. It is not only the cheapest and fastest way of delivering specialized health-care services to patients during the lockdown policy of the government but also aids in avoiding overcrowding and maintaining proper social distancing with the “staggered scheduling” protocols. Medications such as antibiotics and analgesics can be advised to patients with pain. Besides, the patients can also be handled in collaboration with other specialists if that clinician is also using telehealth. Furthermore, as dental institutes and colleges are closed during the nationwide lockdown, teledentistry provides an alternative model to traditional teaching methods permitting students as well as faculty members by selecting the place, time, and manner of teaching. This education can be through on-line video-conferencing, via electronic media, and on-line training programs.
Various methods of teleconsultation are:
- Real-time consultation: It is live communication between dental professionals and their patients at different locations through various audio and video-conferencing platforms
- Store-and-forward method: It is a broadcast of recorded health reports such as the radiographs, photographs, videos, digital impressions of patients through protected electronic transmission
- Remote monitoring method: It involves monitoring of patients from a distance and can either be hospital-centered or individual-centered, mainly recommended for elderly care, chronic disease management, rehabilitation supervision from the comfort of the home and without hospitalization
- A “Near-Real-Time” consultation, which involves low resolution, low frame rate product similar to “jittery television,” i.e., to aid in avoiding delays in data communication and processing.
| Procedure of Teledentistry|| |
There should be a separate phone number or an E-mail address for teleconsultation in a dental institution or hospital. These details and the working hours of the Teledentistry should be with the patients. The patient can initially communicate the problem through WhatsApp messages, short message service, or E-mails, and if required, may appoint an audio-visual consultation date. The patient should be ready with a torch, spoon, and a family member who can assist him in the same. The dentist should take a proper medical history and particulars of present illness to confirm the graveness of the dental concern. COVID-19 status of the patient must be checked by asking him the standard questions of fever, cough, or contact. These are helpful in case the patient will be visiting a dental clinic. Primary care dental triage on the phone should focus on (a). advice, (b) analgesia, (c) antimicrobials. The patients must contact after 48–72 h in case the symptoms do not resolve. Dental conditions not managed on-call, are handled by dentists in clinics following proper precautionary measures.
The National Informatics Centre, Government of India, has developed a mobile app for “Contact tracing, Syndromic mapping, and self-assessment” during this COVID pandemic. It is Arogya Setu's meaning-The bridge for liberation from the disease. It was released for the public on May 26, 2020, amid growing privacy and security concerns and is available in 12 languages such as., Hindi, English, Tamil, Telugu, Kannada, Malayalam, Punjabi, Bengali, Odia, Gujarati, Marathi, and Assamese. The official website is www.aarogyasetu.gov.in and is being used by more than 11 crore users.
Arogya Setu has many salient features:
- It is user friendly and easy to operate
- Scans nearby arogya setu user using Bluetooth LE scanner
- Updates user about the nearby activity using location service
- Secures information transfer with SSL pinning
- Encrypts any sensitive information
- Provides nationwide COVID-19 Statistics
- Self-assessment as per MoHFW and ICMR guidelines
- Emergency helpline contact
- List of ICMR approved labs with COVID-19 testing facilities
- Provision of e-Pass.
The app has been highly successful in identifying people with a high risk of COVID-19 infection and has also played a significant role in detecting potential COVID-19 hotspots. Persons with red status on Arogya Setu App are not allowed to travel/fly as per the norms. The app has also aided the international community in COVID-19 combat.
| Ethical and Legal Issues in Teledentistry|| |
Teledentistry should be a confidentiality practice and not compromise with the patients' record by any unauthorized entities. Informed consent by the patients should be taken and should include all the standard points. Currently, there are no methods to ensure quality and safety, due to ill-defined standards, leading to medico-legal and copyright issues.
| Potential Barriers in Practicing Teledentistry in India|| |
So far, only those medical professionals have tested positive for COVID-19 who had exposure in the long-duration care facilities in the hospitals such as intensive care units. There are reports that the virus remains stable and virulent in aerosols and on open surfaces for a significant period. Thereby, there is a strong possibility that 2019-CoV can be transmitted during a dental procedure, or from patients to dental staff or other patients at the clinic. As there is a lack of clarity about the actual spread of coronavirus, it would still be a wise decision to avoid direct contact with the patients and to minimize the aerosol generation procedures, thereby using teledentistry as an alternative.
Though teledentistry is very helpful during these COVID times, it still comes with some potential shortcomings. The pressure to answer instantly, misinterpretation of the message by a dentist or patient, or neglect in responding are a few issues that are faced. Hence, dentist practicing teledentistry must educate themselves about the recent technology. Since there is no face-to-face consultation during teledentistry, a lot of apprehensions develop in the patient as he might feel his chief complaint has not reached the dentist. In India, most of the areas lack a sufficient bandwidth or uninterrupted access to internet facilities, which is also a huge barrier for practicing Teledentistry during these pandemic times. Furthermore, there have been unresolved issues relating to the telecommunication equipment costs and reimbursement for teleconsultation.
| Implications of Teledentistry|| |
At present, the technological advancements taking place will provide an opportunity to change the dynamics of patient care system. As teledentistry progress ahead, it will provide novel and favorable circumstances to improve the level of dental care and reshape dental working practices. It is an exciting field that has endless potential and has the potential to revolutionize the delivery of dental care. Unfortunately, people who are located in remote areas or patients who have disabilities, or old patients, lack routine access to regular dental services, and many of have dental issues that need immediate care. In most rural areas in this country, there are many barriers to dental health care, including geographic remoteness, unfavorable weather and road conditions, poor or no public transportation, poverty and a low number of dentists relative to the total population, and a scarcity of specialized dentists. Teledentistry is a suitable medium in such scenarios. It helps in linking the dental personals in rural or remote areas through electronic health records, telecommunications technology, digital imaging, and the internet and thus enhance communication, the exchange of health information, and access to care for less privileged dental patients. Inclusion of teledentistry in dental teaching curriculum will also provide a hope to supplement traditional teaching methods in the dental education system and new opportunities for dental students and dentists. The countrywide lockdown of educational institutions has disturbed the teaching and examinations schedule to a large extent. In the current pandemic, most of the teaching for students of the medical and dental colleges is possible only through online lectures. These online learning cannot fully replace the traditional teaching of dental science, at least teledentistry will aid in complementing the existing compromised situation with the successful sharing the images of clinical procedures by the dental teachers with their students. Internet-dependent teledentistry teaching provides students with the freedom to decide a suitable and convenient place, time, and mode of learning.
Through various internet linked apps such as WhatsApp, e-mails, discussion groups, and chats, videoconferencing, we can share pictures related to clinical situations among our students for facilitating the discussions related to the diagnosis, treatment planning, and supportive dental care.
In the remote areas and the absence of face-to-face teaching, web-based distance learning courses with practical modules can be an innovative type of educational modality. Corrêa et al. found out satisfactory results with this kind of web-based course, in a multimedia lab in teaching the oral surgery basics for the undergraduate students.
Similarly, Ignatius et al. suggested that videoconferencing can be an excellent and economical tool in specialist training and does not require the students to travel to the university for specialized learning every time. Moreover, the interactive videoconferencing mode has a better impact because of its ability to provide a prompt assessment.
Thus, with all the technological advancements taking place in the field of teledentistry, it can be used not only for increased access to dental services but also for advanced dental education.
| Conclusion|| |
In these testing times, telehealth has been able to monitor the patients and got (their) complete information by just giving a phone call on the extension number. In this way, we have been able to minimize the spread of COVID-19 to health-care workers and have also significantly reduced the use of PPEs. The same is being done in dentistry to restrict the unnecessary exposure of patients and dentist during these COVID times.
Although teledentistry is yet to become an integral part of the oral health-care system in India, still in COVID times have at least pushed dental practitioners across the country into accepting and using it as an alternative method of dental care. This current pandemic can serve as an opportunity to develop teledentistry on a larger scale, making sure that no individual lacks oral health-care irrespective of the scenarios in the world.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Rose S. Medical student education in the time of COVID-19. JAMA 2020;323:2131-2.
Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Huang B, Kruger E, et al
. A proof-of-concept evaluation of a cloud-based store-and-forward telemedicine app for screening for oral diseases. J Telemed Telecare 2016;22:319-25.
Brown N. A brief history of telemedicine. Telemed Inform Exch 1995;105:833-5.
American Telemedicine Association. Defining telemedicine. American Telemedicine Association. Available from: https://www.americantelemed.org/
. [Last accessed on 2020 Mar 29].
Yoshinaga L. The use of teledentistry for remote learning applications. Pract Proced Aesthet Dent 2001;13:327-8.
Fricton J, Chen H. Using teledentistry to improve access to dental care for the underserved. Dent Clin North Am 2009;53:537-48.
Chopra SS, Sahoo NK. Protocol for teledentistry during COVID-19 in Armed Forces dental establishments. Med J Armed Forces India 2020;76:356-9.
Smith AC, Thomas E, Snoswell CL, Haydon H, Mehrotra A, Clemensen J, et al
. Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19). J Telemed Telecare 2020;26:309-13.
Damanpour S, Srivastava D, Nijhawan RI. Selfacquired patient images: The promises and the pitfalls. In Seminars in cutaneous medicine and surgery. Front Med Communicat 2016:35;13-7.
Khan SA, Omar H. Teledentistry in practice: Literature review. Telemed J E Health 2013;19:565-7.
Reddy KV. Using teledentistry for providing the specialist access to rural Indians. Indian J Dent Res 2011;22:189.
] [Full text]
Bagchi S. Telemedicine in rural India. PLoS Med 2006;3:297-9.
Kirshner M. The role of information technology and informatics research in the dentist-patient relationship. Adv Dent Res 2003;17:77-81.
Mihailovic B, Miladinovic M, Vujicic B. Telemedicine in dentistry (Teledentistry). Advances in telemedicine: Applications in various medical disciplines and geographical areas. In Tech 2011;22:215-30.
Reynolds P, Mason R. On-line video media for continuing professional development in dentistry. Comput Educ 2002;39:65-98.
Chang SW, Plotkin DR, Mulligan R, Polido JC, Mah JK, Meara JG. Teledentistry in rural California: A USC initiative. J Calif Dent Assoc 2003;31:601-8.
Zhao F, Li M, Tsien JZ. Technology platform for remote of vital signs in new era of telemedicine. Expert Rev Med Devices 2015;12:411-29.
Birnbach JM. The future of teledentistry. J Calif Dent Assoc 2000;28:141-3.
Sultan A, Singh N, Juneja A. Dentistry and risk management – A challenging balance in an era of COVID-19. J Int Clin Dent Res Organ 2020;12:94-101. [Full text]
Bauer JC, Brown WT. The digital transformation of oral health care. Teledentistry and electronic commerce. J Am Dent Assoc 2001;132:204-9.
Kopycka-Kedzierawski DT, McLaren SW, Billings RJ. Advancement of Teledentistry at the university of Rochester's eastman institute for oral health. Health Aff (Millwood) 2018;37:1960-6.
Corrêa L, de Campos AC, Souza SC, Novelli MD. Teaching oral surgery to undergraduate students: A pilot study using a Web-based practical course. Eur J Dent Educ 2003;7:111-5.
Ignatius E, Makela K, Happonen RP, Perala S. Teledentistry in dental specialist education in Finland. J Telemed Telecare 2006;12 Suppl 3:46-9.