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Teledentistry can improve access to care for underserved children, researchers say

January 07, 2019

By David Burger

Photo of Dr. Kedzierawski
Dr. Kopycka-Kedzierawski
Rochester, N.Y. — Teledentistry can reduce the costs and barriers to accessing oral health care, improve oral health outcomes and lead to the establishment of a dental home for underserved children, according to research published in the December 2018 issue of health care journal Health Affairs.

The research, titled “Advancement of Teledentistry at the University of Rochester’s Eastman Institute for Oral Health,” was conducted by professors at the Eastman Institute.

The article highlights what the researchers call the “untapped potential to reach underserved populations,” according to Dr. Dorota Kopycka-Kedzierawski, an associate professor of dentistry at the Eastman Institute in the department of community dentistry and oral disease prevention.

The research was based on the institute’s experience with teledentistry for more than a decade.

Dr. Kopycka-Kedzierawski also serves as deputy director of the Northeast region of the National Dental Practice-Based Research Network. She said in an interview with ADA News that she initiated the asynchronous modality of teledentistry at the Eastman Institute and was instrumental in establishing the synchronous modality of teledentistry in collaboration with the Finger Lakes Community Health Clinic in western New York.

Asynchronous teledentistry relates to information stored and forwarded to a dentist for subsequent review, and synchronous teledentistry relates to a real-time encounter delivered to the patient on the date of service.

“As Eastman Institute for Oral Health serves patients from a variety of cultural and socioeconomic backgrounds with different treatment needs, our institution is dedicated to providing care for patients who have unmet oral health needs,” Dr. Kopycka-Kedzierawski said in the ADA News interview. “To that end, our teledentistry initiative has been demonstrated to be an innovative, practical and cost-effective means to improve access and increase oral health care utilization, especially among urban, rural and disadvantaged children who might not otherwise have access to oral health care.”

She has been interested in the subject since 2004, when she teamed up with pediatricians involved in a telemedicine project to initiate a pilot project to assess the feasibility, validity and reliability of teledentistry. “We first envisioned teledentistry as a means to screen large numbers of children for oral disease, mainly dental caries,” she said. Studies followed, detailed in the Health Affairs article, which eventually led to a partnership with community health clinics including the Finger Lakes Community Health Clinic, which cares for Medicaid-eligible children, among other services.

“Teledentistry is effective as an adjunct tool to screen children for oral disease and worthwhile to pursue in the community setting,” Dr. Kopycka-Kedzierawski said. “To date, we have screened and referred more than 500 urban preschoolers to appropriate oral health care. We have screened and treatment planned nearly 900 underserved rural children. We are encouraged by the fact that the children screened via teledentistry show up for their appointments, initiate oral health care and have their treatment plans completed.”

She continued: “Over the years, I have seen the success and positive impact of teledentistry. The potential to reach more people through teledentistry is exciting.”

Dr. Kopycka-Kedzierawski envisions a day when teledentistry becomes more and more utilized.

“In my view, the best-case scenario for teledentistry is that it becomes more prevalent and available for patients, [receives] adequate reimbursement [and] wider adoption of this technology by dentists and dental hygienists and a team approach toward our patients’ needs,” she said.

While every patient can benefit from use of this technology, Dr. Kopycka-Kedzierawski said, “The best-suited patients for this type of dentistry are urban and rural children with limited access to care; older individuals; patients with special needs; and patients who require specialty consultations that are otherwise not available to them.”

Dr. Kopycka-Kedzierawski said that the Eastman Institute will host what she calls the first national teledentistry conference June 7-8, 2019. “We have invited and confirmed outstanding speakers and panelists, including Dr. Paul Glassman, who created a virtual dental home in California,” she said. “Others include lawyers, local insurers, our community partners and technology vendors. Ideally, we aspire to develop and implement a plan to integrate teledentistry with local and national telehealth programs. We hope this initial conference will help to jumpstart that process.”

More information about the conference will be located at the Eastman Institute’s website later this month.

Some impediments to the adoption of teledentistry remain, such as insurance reimbursement issues, initial equipment and operational costs and changing the means of how our profession embraces this technology, she said. “Fortunately, initial equipment costs related to setting up a teledentistry initiative have decreased dramatically over the last decade. In New York state, Medicaid covers synchronous teledentistry consultations when specific guidelines are followed. I hope that more of my colleagues will embrace this technology, as it has been demonstrated to be beneficial to our patients,” Dr. Kopycka-Kedzierawski said.  

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.