The Rise of Teledentistry

Teledentistry has become increasingly popular for patients and dental providers since the COVID-19 pandemic accelerated its use. At that point, the American Dental Association (ADA) updated its teledentistry policy to require that teledentistry “must be based on the same level of information that would be available in an in-person environment,” and it stressed that “it is the legal responsibility of the dentist to ensure that all records collected are sufficient for the dentist to make a diagnosis and treatment plan.”¹

Definition

Teledentistry is the use of health information and communications technology to deliver oral care, consultations, and education. It includes the remote provision of dental treatment (screening, diagnosis, consultation, and treatment planning) or advice using encrypted patient electronic data via the use of electronic health records, videoconferencing, and/or intraoral photographs and radiographic images.² Virtual dental visits allow for adaptability as they can occur in real-time using synchronous communication methods or they can be asynchronous, “meaning there is no real-time interaction between the provider and patient so information is stored and forwarded.”³ Additionally, rapidly developing information and communication technologies for teledentistry have increasingly shown improvements in cost effectiveness, accuracy, and efficiency.⁴ Other modes of delivering oral healthcare services or oral health education from a distance include remote patient monitoring, where a provider can access data for monitoring conditions, and mobile health (mHealth), which provides education over mobile communication devices.⁵ Not only does teledentistry allow for continuity of care and access to patients in need, but also it continues to play a role in increasing access to dental care for patients who live in remote locations or who may have mobility issues or disability, as well as for dentists who want to expand their practice.⁶

Benefits and Risks

Increasing access to care, providing safeguards to mitigate risk, demonstrating an innovative ability to deliver care, and creating convenience for patients are some of the benefits of teledentistry. However, dentists may risk professional liability claims and licensing board actions when using teledentistry. To manage these potential risks, dentists should comply with state laws and regulations related to teledentistry and always provide a standard of care that aligns with their state’s standards of practice.

Security Requirements

In addition to benefits and risks associated with teledentistry, dentists also have the responsibility to ensure the confidentiality and integrity of information obtained and exchanged. Consulting security experts when setting up these systems to exchange information may be very helpful.

Dentists also should be aware that systems and processes being used to transmit images and data need to meet security requirements under the Health Information Technology for Economic and Clinical Health (HITECH) Act of 2009 as well as any state-specific requirements as a general rule.

Using Teledentistry in Practice

When using teledentistry in their practices, dentists are responsible for:

• Understanding professional guidelines and legal requirements.
• Maintaining the necessary liability and licensure protection.
• Developing criteria to conduct teledentistry.
• Creating and having teledentistry policies and procedures in place.
• Evaluating patients’ ability to participate in teledentistry.
• Obtaining patients’ informed consent to participate in teledentistry.
• Ensuring HIPAA requirements are met while conducting teledentistry; i.e., maintaining the privacy and security of patient information.
• Documenting all teledentistry services in the patient’s dental record. (If images are being sent for a second opinion, the referring dentist should note that in the record. The returned opinion also should be documented in the record as well as how it factored into any treatment decision.)
• Educating staff on how to use related technologies and transmit files securely. All staff education and training should be documented in employee files.
• Properly documenting images to ensure they are linked to the correct patient. Documentation includes patient name, identification numbers, date and time of the examination, name of facility, type of examination, anatomic orientation, and amount and method of data compression. See ADA Technical Report No. 10601 The Security Exchange and Utilization of Digital Images – E-BOOK.
• Retaining images to meet state or local requirements.
• Maintaining patients’ rights by actively involving them in treatment decisions and services that are provided in accordance with applicable laws and regulations related to the privacy and security of protected health information (PHI).⁷

Tips for Starting a Teledentistry Program

For any dentists interested in starting teledentistry in their practices, here is some helpful advice:

• Familiarize yourself with teledentistry. Read your state’s dental practice act to determine what is permitted in terms of teledentistry. If unclear, contact the state dental board office or dental association office.
• Check with your professional liability carrier to determine whether you are covered for any teledentistry or telehealth practice.
• Identify use case and technology needs, and choose your software wisely. Find a HIPAA-compliant solution for either a store-and-forward method, synchronous method, or both methods.
• Design a workflow for implementation, establish billing procedures, and educate office staff on all of them.
• Inform current patients of the availability of teledentistry in your practice, and educate them about when teledentistry is appropriate and when in-person care is required.⁸

In Summary

To successfully implement and maintain teledentistry, dentists should understand professional guidelines and state and federal governmental regulations, confirm that they have the necessary liability and licensure protection, adhere to the state’s standard of care, and ensure the secure exchange of information from their systems.

As with regular dental care, staying focused on safe and best practices will help to minimize the occurrence of adverse events when using teledentistry in the dental practice.

For additional information, see the Proposed ADA’s Technical Report No. 1112 Teledentistry.

¹ Burger, D. (2023, June 12). Teledentistry poised for vivid future. ADA News. Retrieved from https://adanews.ada.org/ada-news/2023/june/teledentistry-poised-for-vivid-future/

² National Society of Dental Practitioners, Inc. (2020). Teledentistry: Risk management considerations for dentists. Risk Management Newsletter, 35(1). Retrieved from www.aawd.org/wp-content/uploads/2020/08/ TeledentistryManagementforDentists.pdf

³ Ibid.

⁴ Irving, M., Stewart, R., Spallek, H., & Blinkhorn, A. (2018). Using teledentistry in clinical practice as an enabler to improve access to clinical care: A qualitative, systematic review. Journal of Telemedicine and Telecare, 24(3), 129146. doi: 10.1177/1357633X16686776. Retrieved from https://pubmed.ncbi.nlm.nih.gov/28092220/

⁵ Detrick, L. (2020, June). Implementing teledentistry: The why and the how. Michigan Dental Association Journal. Retrieved from www.michigandental.org/Portals/pro/ProDocuments/Membership/Coronavirus/ June%202020%20MDA%20Journal%20Teledentistry%20Article.pdf

⁶ Burger, Teledentistry poised for vivid future.

⁷ National Society of Dental Practitioners, Inc., Teledentistry: Risk management considerations for dentists.

⁸ McLeod, C., & Shaffer, M. (2022, July 11). Six steps to setting up a teledentistry program. Care Quest Institute for Oral Health. Retrieved from www.carequest.org/about/blog-post/six-steps-setting-teledentistry-program; Simpson, J. (2021, January 18). 10 essential steps to a successful teledentistry launch. Practice-Web. Retrieved from https://blog.practice-web.com/10-essential-steps-successful-teledentistry-launch/