Domains in Action: Successes and Challenges of Using Teledentistry

In September, the DentaQuest Partnership for Oral Health Advancement announced a Three Domain Framework that creates a new model in dentistry that is cost-effective, efficient and more equitable. The Framework, which includes contributions and support from more than 110 oral health leaders, builds on health promotion and disease prevention while supporting value-based care. It’s a roadmap for the future, a new paradigm of oral health care that focuses on overall health as an outcome.

How can we get to that future?

To start, we need to understand what works in practice. What barriers exist today? What opportunities aren’t being realized? What changes in the system do we need to accelerate? Tele-prevention, the first of the Three Domains, is a good place to begin answering those questions. And the ongoing work within the Community Oral Health Transformation Initiative (COrHT), a learning community for dental professionals using the Three Domain Framework, will help highlight next steps.

Domain One: Tele-Prevention

Domain One’s primary focus is to build an accessible, convenient, evidence-based virtual framework for oral health care centered on disease prevention and whole-person health. The proposed interdependent domains of care delivery rely on increased adoption of teledentistry to accelerate prevention and disease management but cannot completely replace in-person encounters.

Teledentistry bolsters current prevention and healthy behavior strategies used to improve the health of individuals. As a component of telehealth, teledentistry can support integrated, holistic care in conjunction with other health professionals (e.g., medical providers, mental health providers, etc.). Eventual best practices will use telehealth capabilities to enhance risk-based prevention during in-person oral health and dental care delivery.

Before the COVID-19 pandemic, safety net providers were the primary users of telehealth, and most dental providers did not incorporate teledentistry into their practices. But that has changed — a lot. Teledentistry has been in the spotlight more this year as a tool to provide remote access during the pandemic, and it has a broader, more important role to play in the future of oral health.

Learnings from Massachusetts

During the last several months, a community of providers in Massachusetts has engaged in shared learning opportunities with peers and expert faculty to discuss strategies for testing and adopting various components of the Three Domain Framework. Known as the COVID-19 Oral Health Recovery and Transformation Learning Community, this group will help inform the work of the COrHT learning community. The Massachusetts providers recently gathered virtually to share and collaborate around the successes and challenges of implementing teledentistry technologies into their own practices.

Members of the group offered tangible tips and takeaways on how they are using the tools and how others can benefit from their own successes and challenges going forward. Some noteworthy successes, challenges, learnings and ideas:

  • Samantha Jordan, a provider in Lowell, MA, detailed her practice’s workflow when using teledentistry and how they’re looking to make it more efficient and accessible to all their patients. “We mostly use the phone and have patients email us a photo of their teeth/mouth, as we found that video quality isn't as good as the picture they can email to us,” she said. “It's usually easier to see what’s happening based on photos patients take.”
  • Jordan also shared that getting video technology to work reliably for patients can also be a challenge. “Our patients are open to video visits but they can’t always get it to work,” she added. Her team is exploring the possibility of support staff working with patients before the appointments to ensure videos work.
  • Others on the call applauded the ideas of a pre-teledental visit to ensure technology and utilization of the platform with patients and a teledentistry care coordinator to ensure no patients fall through the cracks.
  • Others noted several challenges, including understanding patient limitations with technology (including data plans), finding ways to coordinate interprofessional care and ensuring privacy while there are other providers around. Potential solutions on the latter item included staggered schedules and restructuring the workday, if possible, to maximize the time providers see patients virtually and in-person.
  • In an effort to help answer questions about workflow and triage, the Holyoke Health Center shared its Adult Telehealth Triage Workflow to give other providers a guide for how to approach their teledentistry appointments and how to smoothly transition to using more teledentistry in practice.

A Tool to Expand Access

As providers discussed these concerns, several also noted that teledentistry is a viable long-term solution in certain situations. Instead of walk-ins for emergency care, for example, some providers had started to see patients virtually first. So far, this has proven to be a more efficient process.

Carolyn Brown, a senior strategic advisor within the DentaQuest Partnership for Oral Health Advancement, reminded providers that teledentistry is meant as a tool for expanding access, and to be cautious of adding processes that could create a barrier.

“In some cases, requiring patients to fill out a form or send a photo before an appointment could be a barrier, when telehealth is supposed to alleviate those barriers to access,” Brown said. “Asking for things ahead of time doesn't always lead to compliance or showing up.”

She added that there will likely need to be some on-the-ground alterations at each practice.

“Investigate what your platforms allow you to do,” Brown says, “and work with your patients and teams.”

Editor’s note: learn more about the Three Domain Framework and the upcoming learning communities.