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Virtual dental homes offer way to get care to the underserved

September 06, 2016

By Michelle Manchir

Stockton, Calif. — Telehealth-connected dental teams can offer a safe and effective alternative for bringing dental care to vulnerable and underserved people, according to an August report from the Pacific Center for Special Care at the Arthur A. Dugoni School of Dentistry.

The center, which spearheaded virtual dental homes in sites throughout California, reported in August positive results after a six-year study that involved evaluation of more than 3,000 patients since 2010.

In the virtual dental home model, registered dental hygienists and dental assistants at schools and long-term care facilities are connected with a local dentist to provide care using telehealth technology. An allied dental health employee collects electronic dental records including X-rays, photographs, charts of dental findings and medical and dental histories and uploads them into a secure website where the collaborating dentist can review it. The dentist uses that information to create a treatment plan for the patient, while the community-based personnel provide preventive procedures (such as prophylaxis and education about brushing, flossing and nutrition.)

Then, patients who require more complex treatment that only a dentist can provide are referred and receive assistance securing a dental appointment in the dental clinic or office.

“Our six-year demonstration project confirms that this is a safe, effective way to bring care to people who need it,” Pacific Center director Dr. Paul Glassman said in a news release from the university. “Basing a virtual dental home in a school, a nursing home or other community setting allows dental hygienists to prevent or treat the majority of oral health problems on site, and also brings prevention information to patients, families and caregivers. Finally, it connects on-site care in the community to dentists in dental offices.”

Virtual dental home systems deliver more prevention and intervention at less cost per patient than the current state dental Medicaid system, according to the report’s findings. The center also reported that, using telehealth, examining dentists determined that approximately two-thirds of children and about half of seniors and people with disabilities in long-term care facilities can have their oral health needs met by dental hygienists in the community.

The Pacific Center for Special Care aims to improve oral health of underserved people and improve access to dental care, and there is a need in California. Children’s access to dental care is limited in 32 of the state’s 58 counties, according to the Pacific Center, citing numbers from the state auditor. In 11 counties, no dentists accepted new Medicaid patients, and 24 percent of all children in the state complete elementary school without ever having seen a dentist.

Project organizers hope the virtual health system will continue to connect more of these kids with the dental care they need.

“Results from the research further demonstrate the benefits of this oral health care delivery system and how this program can reach children and communities that would otherwise likely go without,” said California Assembly member Evan Low, who authored a state bill, which is cosponsored by the California Dental Association, that would provide millions in funding to expand virtual dental homes statewide.

The bill, however, was held in a committee and is unlikely to move forward, according to the California Dental Association, which plans to continue to advocate for this innovative program that has proven to be a successful model of care.

In 2015, the ADA House of Delegates passed a comprehensive statement on teledentistry (Resolution 45H-2015), which lays out the forms teledentistry can take (e.g. live video and remote patient monitoring) and discusses patients’ rights, quality of care, supervision of allied dental personnel, reimbursement and other general considerations related to teledentistry.

For more information about the University of Pacific virtual dental home model, visit http://www.dental.pacific.edu/departments-and-groups/pacific-center-for-special-care/innovations-center/virtual-dental-home-system-of-care. To see the complete six-year findings report, visit http://www.pacific.edu/Documents/marketing/VDH_FullReport.pdf.