COVID19 pandemic shines light on telehealth services

Anytime, anywhere: Dr. Brooke Fukuoka looks at patient photos and videos taken by her hygienist while she is away in Boston at the 2020 Yankee Dental Congress.

When the COVID-19 pandemic struck, Dr. Brooke Fukuoka and her team were no longer able to go into long-term care facilities to see their patients.

For Dr. Fukuoka’s practice, which specializes in providing dental care to adults who have disabilities and seniors who have limited mobility, teledentistry became key.

“During COVID-19, teledentistry has been a godsend,” said Dr. Fukuoka, owner of Your Special Smiles in Jerome, Idaho.

According to polling from the American Dental Association’s Health Policy Institute for the week of April 20, 24.8% of responding dentists reported they were conducting remote problem-focused evaluations through virtual technology/telecommunications. By the week of July 13, that percentage dropped to 12.2%, but teledentistry consultant Dr. Nathan Suter believes the use of that technology will become more mainstream.

“There are a variety of teledentistry applications being applied in response to COVID-19,” said Dr. Suter, owner of Green Leaf Dental Care in House Springs, Missouri, and Access Teledentistry, a company that provides teledentistry consulting services for dentists, community health centers and state health departments. “As we move into a new chapter of care delivery, it is apparent that enhanced personal protective equipment and telehealth services will become more commonplace.”

New dentists, in particular, may play a role in that trend, he said.

“New dentists are the most likely early adopters since they tend to be willing to adopt new technology and tools,” Dr. Suter said. “New dentists also had experience in dental school with coursework that closely resembled a teledentistry examination.”

Dr. Suter, who graduated from the University of Missouri-Kansas City School of Dentistry in 2013, uses teledentistry to increase patients’ access to hygiene services. If he is traveling or has a conflict, hygiene appointments are not dependent on his schedule because he can perform exams at a later time using hygienists’ photographs and detailed assessments, as well as normal preventive and diagnostic imaging. He also can connect with the hygienist and patient via video during an appointment if there is an urgent question.

Dr. Suter

Especially during the pandemic, teledentistry has helped his practice with limited evaluation and triage, hygiene assessment, satellite office coverage, patient consultations and specialist consultations, and he also hopes to expand community outreach, which has been limited because of COVID-19.

“These applications allow our practice to extend past the physical walls of our building and the hours that I am physically present, in order to bring patients into a dental home from multiple different points of care,” Dr. Suter said.

Prior to the pandemic, Dr. Fukuoka’s practice established a mobile clinic to care for patients who were unable to be seen in a clinical setting but too medically complex to be treated under general anesthesia in an operating room. The idea was that the familiar, nonmedical setting would make the patients more comfortable and cooperative, she said.

Space was limited in most facilities, making it difficult for both Dr. Fukuoka and a hygienist to treat residents the same day. After Dr. Fukuoka reviewed a patient’s medical history, her hygienists would offer mobile hygiene services and collect photographs, videos and X-rays for her to evaluate to see if she needed to go to the facilities to provide care. A dental hygiene student also helped residents in one of the facilities with preventative oral hygiene procedures, such as brushing and flossing their teeth.

“Our unique system combines safe spaces, teledentistry and minimally invasive dentistry to revolutionize the delivery of care for adults who have special needs and seniors in group living facilities,” said Dr. Fukuoka, who graduated from the University of Louisville School of Dentistry in 2012.

Dr. Fukuoka

Since the start of the pandemic, Dr. Fukuoka and her staff have used teledentistry to monitor patients’ oral health and guide caregivers as they provide preventative oral hygiene services. Your Special Smiles also received approval from the Idaho State Board of Dentistry to prescribe silver diamine fluoride and allow certified nursing assistants to apply it under Dr. Fukuoka’s license.

“During the COVID-19 outbreak, many states changed the scope of practice guidelines to allow the reimbursement and utilization of teledentistry, seeing it as an effective way to increase the practice hours and availability while limiting the amount of people in the office at any one time,” Dr. Suter said.

For new dentists looking to incorporate teledentistry into their practices, Dr. Suter recommends they start with a small pilot using only part of their day or some of their staff to test both the technology and their workflow.

Dr. Fukuoka also suggests they determine what works best for their particular team.

“Teledentistry is not as complicated as it sounds, and it has many uses,” she said. “Find the use that fits your and your patients’ needs.”