For those of us who’ve been around the block several times will recall previous flu epidemics … and how we, well us in Bristol, complained when we had to throw out our glossy magazines (changed every month) but the libraries, with their absorbent paper books may many years old, escaped .. “oh Hutch why do you ask such funny questions” was the comment by the Primary Care Trust when I quizzed them on their Cross Infection protocols.
And then, then came Covid…… and Tele-dentisty …
Remote examinations…..Remote monitoring…. The rush to set up software, protocols, even specific areas, or better still rooms to undertake all this tele-dentistry (what books did you have on your background bookshelf?)
And then… then everything went back to normal.
So what’s happened ? Is it just me not looking hard enough … or has everyone simple gone back to the ‘pre-covid’ ways? OK remote monitoring still seems to be pushing forward but what happened to all the the remote consultations etc? Certainly medicine seems to be continuing, even ‘remote wards’ so patients can stay at home.
With technology rapidly advancing (we won’t mention machine learning and quantum computing) is it time to ramp up the signal strength again?
So, what are the advantages of Tele-dentistry?
> Improved access to care: Tele-dentistry allows patients in remote or underserved areas to receive advice without the need to travel long distances. In-addition, theres the convenience and time-saving bonus too. In some areas theres long wining times to be seen so early detection and prevention are possible. Theres even the possibility of regular virtual check-ups and screenings catching certain conditions early whilst still easy to treat.
> Cost-effective: Tele-dentistry can potentially reduce the overall cost of treatment as you don’t need a surgery to examine the patient, just a ‘space’ thereby freeing up the surgery for ‘physical’ treatment. And yes, there are medico legal cases where patents have asked for a discount as they weren’t seeing in surgery every 3 months for their aligners but remotely. The had 4 virtual consultations as opposed to in surgery ones. They want’s a refund…. No joke.
> True ‘informed consent’? There is more time for the patient to ask questions, to us the ‘teach back’ approach and also as the conversation would be reworked, provable that ‘informed consent’ was achieved.
However, its not without its disadvantages
> Obviously there’s limited physical examination, no probing pockets or BPE scores (how many do this prior to undertaking Ortho?…. just poking the box). And, I did find a paper that discusses remote monitoring of ergo patients (https://clinicaltrials.gov/ct2/show/NCT04326413).
> Lack of physical treatment. Obvious really, but then again we hear about people pulling their own teeth with pliers at home in the press…. How long will it be before someone offers ‘DIY Dentistry Mentoring’… Do it at home with a dentist guiding…left a bit…. no I meant my left. However, taking impressions is not one go them with the advances in phone technology.
> Technological limitations: Reliable and high-speed internet access is necessary for effective tele-dentistry. For us in rural areas we still struggle
> Privacy and security concerns: Transmitting health data carries privacy and security risks. Theres always someone watching/listening … to everything we do.
> Poor patient experience. Some patients may prefer face-to-face interactions with their dentists and may find tele-dentistry impersonal. The absence of physical presence may limit the ability to establish rapport and trust between the dentist and patient. It’s also much harder to ‘read’ people … the small ‘tells’ in their body language. Although, AI is again learning to read peoples reactions in video calls.
So why get excited over remote examinations and remote monitoring? Is there more….. well, consider that mobile phones have lidar abilities so technically it is now possible to 3D scan your teeth at home so why go to the surgery for a scan? And computers can ‘see’ and hence can do Orthodontic facial analysis. And it’s only our imagination thats holding us back so goodness knows where it’s all going to end - for some reason I can see rubber dam clamps with micro drills in them...order by post... S/M/L sizes.....(and yes I did have a patient put epoxy resin in his tooth...well it said it was for enamel baths so why not teeth).
The genie is firmly out of the bottle.
And let’s not forget, history has a habit of repeating itself, so may be we should take tele-dentisty off standby and, as was drilled into me as a Boy Scout, be prepared for the next outbreak.
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