Telehealth and dental specialties during COVID-19 pandemic.

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Date: Oct-Dec 2020
Publisher: Medknow Publications and Media Pvt. Ltd.
Document Type: Article
Length: 1,986 words
Lexile Measure: 2610L

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Byline: Radhika. Thakkar, Mayank. Kakkar, Robby. George, Shilpa. Singh

Dentistry involves very close contact with the patients while providing oral health care. During pandemics like COVID-19, teledentistry has enabled the oral health-care providers to incorporate telecommunication in dentistry to exchange clinical information and allow remote distance virtual consultations. The COVID-19 like pandemics is one of the reasons for inequities in oral health care. The use of technology and telecommunication can be used to bridge these inequities. This article reviews the challenges faced by oral health-care providers and patients, especially with intellectual and developmental disabilities during COVID-19 like pandemic. This article also reviews the utilization of teledentistry by different dental specialties, along with the current evidence that exists in the literature. In response to this crisis, we believe that teledentistry offers a promising uninterrupted oral health care and enhances the quality of care by improving the access, profession education, and patient satisfaction.


Telehealth is one of the informational technologies that can be used for long-distance exchange of the health-care-related information and health education. This use of electronic information, imaging, and communication technologies like interactive audio/video communication allows to provide immediate health care. This virtual consultation is one of the innovative platforms to provide health-care support, especially to patients with limited health-care access. 'Telemedicine' is one of the tools used in medicine that allows health care to be more accessible, economical, and increases patient engagement.

Similarly, teledentistry is emerging among various dental specialties. Teledentistry uses communications technology, electronic records, digital imaging, and the Internet to provide virtual consultation with all health-care professionals including required specialists, which helps in a collaborative approach in delivering health care in remote areas.[1] This potentially reduces the time in diagnosis, avoids patient travels especially in the pandemic time, and optimizes use of resources. The role of teledentistry in different disciplines of the dental field such as oral medicine and diagnosis, oral and maxillofacial surgery, endodontics, orthodontics, prosthodontics, and pediatric and preventive dentistry is described in [Table 1].{Table 1}

The rapid spread of the coronavirus a disease of 2019, which is reported to be caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has been declared as a public health emergency of international concern by the WHO on January 30, 2020.[1] Since then, this disease has rapidly spread globally, declaring this as pandemic on March 11, 2020, by the WHO.[1] The government organizations, health-care institutions, and agencies have been working unitedly to contain the virus, control the transmission of the disease, and treat the symptomatic COVID-19 patients.[1] Oral health-care providers also joined those organizations in mitigating the transmissions by delaying elective treatment options and observing social distancing.[1] The Centers for Disease Control and Prevention (CDC)/American Dental Association (ADA) also preemptively regulated the rules and regulations for dental procedures during this pandemic.[1],[8],[9],[10] These interim guidelines recommend to postpone elective procedures, surgeries, and nonurgent dental visits and to prescreen before providing emergency procedures.[8],[9],[10]

The rapidly changing guidelines during the COVID-19 global pandemic had a substantial impact on the delivery of oral health care.[8] This also impacted the oral health care for the remote areas with limited accessibility. McLaren et al . conducted a retrospective study to assess the accuracy of predicting dental treatment modalities for children seen initially by means of a live-video teledentistry consultation. According to this study, the live-video teledentistry consultation can be an effective intervention to facilitate the completion of complex treatment plans for children from a rural area that have extensive dental needs.[9]

Teledentistry can provide patient care and education using the following modalities

*Synchronous (ADA code D9995): Live, two-way communication between patient and a provider using audiovisual telecommunications technology.[1],[10] This allows live-video evaluation and consultation. This also helps augmented referrals and improvised collaboration among providers *Asynchronous (ADA code D9996): Transmission of recorded health information of patients (for instance, photographs, digital impressions, video, digital radiographs, and photomicrographs) through a protected electronic telecommunications system to a dental practitioner, who uses the information to assess a patient's ailment *Remote patient monitoring: Personal medical data assemblage from an individual in one location through electronic communication technology, which is transmitted to a provider in a different location aimed for use in providing optimum patient care *Mobile health: Public health practices, health-care organizations, and educational institutes supported by mobile communication devices such as computers, mobile phones, tablets, and personal digital assistants.

If a dentist sees a new patient or existing patient throughout COVID-19 quarantine, the treatments provided in the dental office should be billed and coded as per the existing office procedures [Table 2] in addition to those cited above.{Table 2}

Implication of teledentistry for dental professionals

Dental professionals have high possibility for SARS-CoV-2 exposure, as most dental treatments involve aerosol generation by ultrasonic scalers, rotary handpieces and air-water syringes. It is important that supplementary infection control practices are in place to safeguard the health and safety of patients throughout the COVID-19 pandemic. Patients and the staff members who have fever or influenza-like symptoms are advised to stay away and such notices are placed at the entrances of dental offices.[9] To address presymptomatic transmission by patients who may be infected but are asymptomatic, dental offices shall require the use of facemasks or cloth face coverings for everyone entering the dental setting.[11]

The interim recommendation from the ADA and CDC is to perform necessary dental procedures only during the pandemic period.[12],[13] With the help of true emergency questionnaire [Figure 1], dentists can estimate the severity of the condition and make a well-versed judgment to either deliver or reschedule dental care.[14]{Figure 1}

According to the CDC, individuals who tested positive with COVID-19 have had a comprehensive variety of symptoms - extending from mild fever to severe illness.[15],[16] Indicators may develop as soon as 2 days after the exposure to the virus or it may take 2 weeks for any symptoms to appear [Table 3].[15],[16],[17] Teledentistry options can be used as substitutions to in-office care for screening and triaging all patients for signs and symptoms consistent with COVID-19. Dental professionals with confirmed COVID-19 positive test and those with potential COVID-19 exposure should contact the local health center for testing and stay quarantined.[18]{Table 3}


For majority of dental purposes, asynchronous technology offers exceptional outcomes without unwarranted expenses for additional technology.[19] A standard asynchronous teledentistry (store-and-forward telecommunication) comprises a computer with Internet connection and ample hard drive memory, speedy processor, adequate random-access memory, and an intraoral camera for taking photographs of concerned area in the mouth.[2] Telephones with audiovisual features are also suitable for online assessments.[3]

The Office for Civil Rights will not enforce penalizations for Health Insurance Portability and Accountability Act (HIPAA) noncompliance against oral health providers that oblige patients in good faith through teledentistry during the COVID-19 public health emergency. However, health-care professionals should give a disclaimer before proceeding with virtual consultation to inform patients that third-party applications possibly present may breach in privacy, and all obtainable privacy modes as well as encryption should be allowed while using such technology and applications.[4] These applications are described in [Figure 2].{Figure 2}

HIPAA does not forbid using communications via text messages or e-mail, but a dentist who implements teledentistry should conduct risk analysis and apply appropriate safeguards.[5] Such safeguards could comprise encouraging the patient move to an equitable distance from people when conversing personal health information and prohibit them from use of loudspeaker function.[5]

Teledentistry can be utilized in several ways with HIPPA compliance, for example, obtaining informed consent, completing COVID-19 screening form, keeping a detailed clinical record of the consultations including patient's protected health information, evaluating medical history, discussing recommended treatment plan, and writing prescriptions. Teledentistry has made it feasible to limit human contacts and therefore reducing the risk of potential transmission of COVID-19.[6]

Acceptability of teledentistry by the patients will upsurge in corresponding with the overall adequacy of telehealth, which is growing day by day. Teledentistry is yet to become an integral part of the dental care delivery system, but it is crucial that dental professionals actively support and endorse the use of teledentistry to complement the existing compromised dental system during the current pandemic.[10]

COVID-19 Coding and billing Interim Guidance by the American Dental Association1

If dentists are delivering care by means of teledentistry for the purpose of triaging potential patients or to offer an assessment to conclude if the condition is urgent, then the following ADA codes [Table 3] can be utilized in the patient's billing and coding record and to an insurance company.


Teledentistry has the aptitude to increase access of dental care as well as lower its expenditures. COVID-19 pandemic has taught us that while communication is necessary during a crisis, traditional conversation methods involving proximity in large groups may become inapplicable. Therefore, unconventional ways have to be established. Dental professionals may consider integrating teledentistry in health-care settings to accommodate patients who have difficulty in transportation because of a distant location. Even though teledentistry has taken precedency over traditional means of communication, conceivable limitations exist, such as - prerequisite for training, possibility to overlook findings, message misunderstanding, and privacy concerns. Future research should put emphasis on strengths, limitations as well as long-term sustainability of virtual consultation and the process of incorporating teledentistry into the existing health-care system.[1]

Financial support and sponsorship


Conflicts of interest

There are no conflicts of interest.


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Gale Document Number: GALE|A651393534