Six Steps to Setting Up a Teledentistry Program

By Caroline McLeod, RDH, MS, and Marybeth Shaffer, DMD

CareQuest Institute has explored the value and potential of teledentistry and observed that virtual encounters can be a flexible and important care delivery methodology that improves access to dental care, increases equity, and reduces costs. Although numerous resources exist (three linked in the previous sentence) on teledentistry, we often hear the question, “Where do I start?” A recent webinar, “Building a Teledentistry Program That Expands Access and Increases Equity,” proposed some answers. Drawing on that webinar, this post, while not a comprehensive guide, will walk you through six steps to consider when starting a teledentistry program.

1. Identify the specific teledentistry need.

First, consider the patient populations you already care for and how they could benefit from teledentistry. Also think about new patient populations you’d like to reach using this modality. Is there a specific population or geographic region in your state that lacks access to oral health care services? You may also want to ask your existing patients or community members their opinions on teledentistry and how they may utilize it if offered the opportunity.

2. Review state teledentistry policy.

States have different policies (or lack thereof) defining teledentistry, who can practice with teledentistry, from where, and which services are permitted and billable using the modality. Medicaid and private insurance, for example, may limit billable services to specific procedure codes, and in some states, teledentistry services may be allowed only in certain areas, such as those deemed Health Professional Shortage Areas (HPSAs). Rules may vary regarding unsupervised (by a dentist) delivery of teledentistry services by auxiliaries (such as dental hygienists), as well as requirements providers must meet before they can deliver care remotely. For example, Ohio requires dentists to obtain a specific permit before providing teledentistry services.

If you need help navigating the existing statutes, call or email your state dental board or dental association.

3. Identify use case and technology needs.

Decide which use case of teledentistry best fits the needs of your patients and community, organization, or office. You can make this determination based on your patients’ needs as well as what’s allowed and reimbursable in your state (i.e., the first two steps above).

For example, if you know your community has high rates of emergency department (ED) visits for dental conditions, you may want to start a teledentistry program that focuses on triaging urgent needs — especially if your state Medicaid reimburses for those triaging services. Or, if you want to provide children in your community with better access to preventive care, you could start a community-based teledentistry program in which a hygienist visits schools or Head Start programs, delivers preventive care, conducts assessments, and sends the dentist the assessment data for an asynchronous teledentistry exam. In this case, you’d need to check whether your state allows hygienists to practice with general supervision, and whether asynchronous services are reimbursed through state Medicaid. You should also consider specific equipment requirements or rules requiring informed consent and documentation in your state.

You don’t have to limit your practice to one use case, but if you’re starting out, it may be best to pick one and try it. Once you have identified how you want to use teledentistry, you’ll need to identify and potentially purchase the technology needed for the use case you will implement (e.g., laptop, cell phone, teledentistry software, intraoral camera, intraoral scanner).

4. Design a workflow.

Identify providers and staff who are willing to implement teledentistry and create a workflow(s) that details which staff will perform which services, when, how, using what technology, etc. Here’s an example workflow for an emergency appointment and another. Below is a hypothetical situation that might arise:

Let’s say a patient calls your office after hours with an emergency. You, the dentist, request and are granted consent to do a teledentistry visit and ask the patient to capture an image of the area in question. You inform the patient that the visit will be confidential and recorded in their chart for reference.

As you would in the office, you should ask SOAP (Subjective, Objective, Assessment, and Plan) questions. After recording the subjective (patient’s initial complaint), record the pain on scale of 1-10. Determine whether there’s any external or internal swelling. (This may require additional pictures — you can coach the patient to use a spoon or two, for example, to retract for intraoral photos.) Then you might ask some questions: Is there any drainage or pus when they push on it? Any difficulty in swallowing? Does swelling feel firm or squishy? You should also ask for the patient’s temperature to assess systemic involvement. Note the duration of the condition and the course — is it getting better or worse? Discuss any comorbidities (diabetes, immune disease, etc.), attempts at home treatments and results, and ask any additional follow-up questions. Then make an assessment and corresponding plan. If care is urgent, send the patient to the ED. Otherwise, offer palliative treatment for pain and schedule an in-person follow-up appointment. Finally, record all the information in the patient’s permanent dental record.

5. Train staff.

It’s critical to train staff on what teledentistry is, how you will be using the modality, and how to use the indicated technology. This will help ensure that staff can deploy the technology appropriately and integrate it into workflows. Create a time and space where staff can learn how to use the technology (e.g., teledentistry software or intraoral camera or scanner), ask questions, and work together to smoothly complete the workflow in a testing environment.

6. Start small.

Test teledentistry workflows with one provider and patient, or a small group of providers and patients. Then, iterate on success, and gradually increase the number of patients and providers involved in the program. Track the type and number of teledentistry services provided and types of patients seen via teledentistry over time so you can evaluate the impact and effectiveness of the program. All of this helps to gain provider/staff and patient buy-in and build program sustainability. Teledentistry is an increasingly popular option with both providers and patients. Once you get started, you’ll be on your way to meeting the needs of your patient population in innovative new ways. In the meantime, we invite you to explore the CareQuest Institute resource library, including papers on dentist perception of teledentistry and a framework for states and territories to expand it.

Editor’s Note: Caroline is the value-based solutions manager at CareQuest Institute and Marybeth is dental director at Community Action Agency of Columbiana County in Ohio.