Teledentistry Provides Orthodontic Treatment to Those Without Access to Care

Richard Gawel
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More than 60% of the 1,972 counties in the United States do not have an orthodontist’s office, according to the Department of Health and Human Services. The American Teledentistry Association (ATDA), however, believes that doctor-directed at-home clear aligner therapy could increase access to orthodontic care. ATDA president Marc Ackerman shared his insights about this treatment and its technology in a recent interview.    

Q: Why do these counties lack orthodontic services? 

A: Many of these areas are rural with smaller population numbers. With orthodontic residents graduating with six-figure debt, there aren’t many who are willing to practice in rural areas and potentially make less money than practicing in a more populated area.  

Q: Are orthodontic services a necessary part of oral healthcare? 

A: By and large, orthodontics is not a medically necessary service. There are a few orthodontic conditions such as cleft lip palate or other congenital anomalies that would qualify as medically necessary orthodontic treatment. However, orthodontic treatment is more of an enhancement of social fitness—that is to say, improving one’s smile has far greater psychosocial benefits that can positively influence a person’s educability, employability, and marriageability.  To characterize malocclusion as a medical condition as many orthodontists have over the past 50 years is a very tenuous position that isn’t easily supported by evidence. 

Q: What are the benefits of teleorthodontics? 

A: Teleorthodontic treatment via doctor-directed at-home aligner therapy costs roughly 40% less than the same treatment rendered in-office and reduces the burden of time away from work/life that would have been used for in-office visits. 

Q: Are there any limitations in teleorthodontics?

A: Teleorthodontic treatment without any office visits is currently viable in only limited orthodontic treatment with clear aligners. Remote monitoring of conventional orthodontic treatment is being practiced. However, adjustments are made in the office.  

Q: What equipment and training is necessary for teleorthodontics? 

A: Teleorthodontics is not a specific serviceIt refers to a broad variety of technologies and tactics to deliver virtual dental services. It can include patient care and education delivery using, but not limited to, the following modalities:

  • Live video (synchronous): Live, two-way interaction between a person (patient, caregiver, or 
    provider) and a provider using interactive audiovisual telecommunications technology. 
  • Store-and-forward (asynchronous): Transmission of recorded health information (for example, radiographs, photographs, video, digital impressions, and photomicrographs of patients) through a secure electronic communications system to a practitioner, who uses the information to evaluate or diagnose a patient’s condition or render a service. 
  • Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support of care. 
  • Mobile health (mHealth): Healthcare and public health practice and education supported by mobile communication devices and software apps, including cell phones, tablet computers, and personal digital assistants.

In its most simple form, teleorthodontic practice requires the clinician and patient to each have a smartphone. There are commercially available HIPAA compliant texting systems, such as Rhinogram, that offer a means of asynchronous communication with patients. 

Q: Could you briefly describe what would happen during the initial teleorthodontic appointment? 

A: It really depends on the teledental methodology that the clinician elects to use. With a synchronous teleorthodontic encounter, the doctor and patient are engaged in a live discussion. With the asynchronous teleorthodontic encounter, the patient has sent photographic images and text for the doctor to review and respond. Both methods create a doctor-patient relationship and clinicians would perform their examination of the patient in the same manner as they would in their office, less physical contact. It should be emphasized that if there is any red flag in the visual examination of the patient, the clinician can always refer the patient to the appropriate bricks and mortar dental or specialty practice for hands-on treatment.

Q: How would teleorthodontics be used to continue treatment, which often can last months or years? 

A: In the case of doctor-directed at-home aligner therapy, the clinician will communicate and examine the patient using either synchronous or asynchronous methods to monitor treatment progress on whatever interval their clinical judgment dictates. If the clinician in a bricks and mortar practice brings back their aligner patients for examination every 90 days, then the teleorthodontist would do the same thing. I would emphasize that the type of limited orthodontic treatment being provided in the teleorthodontic aligner market usually does not exceed 6 to 8 months of duration and is oftentimes less. 

Q: Where can clinicians go to learn more about teleorthodontics?  

A: I would recommend going to our website, americanteledentistry.org, for more information and resources on teledentistry. 

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