ADA News: House passes guidelines on teledentistry

December 07, 2015

Washington — It’s similar to visiting a bricks and mortar dental office, only the dentist may be on a computer screen instead of in person.

Or the treating dentist could have securely emailed their patient care instructions to a specialist or dental hygienist at a community dental care event. Dentists could also virtually supervise the oral health care of nursing home patients, residents in rural areas or others who don’t have access to a dentist in their area.
Teledentistry can take many forms and the ADA now has specific guidelines and expectations for dentists interested in delivering their services virtually.

The ADA House of Delegates passed Resolution 45H-2015, Comprehensive ADA Policy Statement on Teledentistry, in November at ADA 2015 – America’s Dental Meeting. The House first issued policy on teledentistry in 2012, but it focused more on the technical aspect of the service, said Dr. Terry O’Toole, vice chair of the ADA Council on Dental Practice, which took the lead on developing the resolution.

“Teledentistry in and of itself is not a service. It’s really a method by which services are delivered,” Dr. O’Toole said. “This latest policy addresses what patients can expect when receiving services via teledentistry, as well as patients’ rights, workforce, licensure and payment issues.”

Teledentistry can take a number of forms, according to the resolution, including:

  • Live video: Two-way interaction between a patient and dentist using audiovisual technology.
  • Store and forward: Recorded health information — such as radiographs, photos, video, digital impressions or photomicrographs — is transmitted through a secure electronic communications system to a practitioner. The practitioner then uses the information to evaluate the patient’s condition or render a service outside of a real-time or live interaction.
  • Remote patient monitoring: Personal health and medical information is collected from an individual in one location then transmitted electronically to a provider in a different location for use in care. This could be used in a nursing home setting or in an educational program.
  • Mobile health: Health care and public health practice and education supported by mobile communication devices such as cell phones, tablet computers or personal digital assistants. This could include apps that monitor patient brushing or other home care.

Having ADA policy is certainly critical for the profession to accept and implement teledentistry because the Association can now support dentists to do it, said Dr. Paul Glassman, a consultant to the ADA Council on Access, Prevention and Interprofessional Relations.

Dr. Glassman looks at teledentistry as an expansion of the traditional dental practice, where patients can have a virtual dental home instead of a physical one. It provides easier access to dental care to patients in nursing homes or those who live in rural areas without a dentist.

Dentists can also develop a plan for patients to receive cleanings, fluoride varnishes, sealants and other treatment at a community site from allied dental personnel, under the dentist’s virtual supervision.

“The policy states that if any allied dental personnel are participating in teledentistry, their supervision should conform to the dental practice act in the state where the patient is receiving services and where the dentist is licensed,” Dr. O’Toole said. “Dentists and allied dental personnel must also be licensed or credentialed in accordance with the laws of the state in which the patient receives care, according to the resolution.

The resolution states that dental benefit plans and other third-party payers — public and private programs — should cover services provided through teledentistry at the same level as if the services were delivered in a traditional in-person encounter.

Dr. Glassman, director of the Pacific Center for Special Care at the Arthur A. Dugoni School of Dentistry at the University of the Pacific, was instrumental in persuading the California state legislature to pass legislation requiring the state’s Medicaid agency to cover teledentistry services.

“I think it’s already sweeping the country. I predict that within a couple of years, every state will have legislation supporting teledentistry,” Dr. Glassman said. “Dentists are realizing it’s a way to expand their practice and not be bound by the four walls of their office.”

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