Tele-dentistry

Tele-dentistry

In the current crisis, dental practitioners are faced with having to consider limiting the majority of patient interactions to remote consultations. 

ADAWA is currently in discussions with local and national private health insurance (PHI) companies to make  tele-dentistry  rebate a reality. A new item number has been created and the descriptor drafted. Operationalising this at a PHI level will take a few days as it’s not just as simple as adding a number – but so far, signs are positive that this will be in place soon.  

We recommend that you are familiar with the following from the Medical Board, OAIC and ADA

 Setting up tele-dentistry  

  1. Telehealth appointments can take place via a phone call. If you’d like to hide your number from patients, simply type #31# before you dial. 
  2. You could use FaceTime or WhatsApp – however keep in mind that your phone number must be used 
  3. Zoom is an excellent platform for telehealth consultations. Free accounts are available – although limited to 40 minutes per appointment. To understand how to invite a patient to call, click here.

Please refer to Zoom for information on encryption.  

Conducting a tele-dental appointment 

To begin:

  1. Advise the patient how to access the platform you are using
  2. Ensure that you have at least 3 correct patient identifiers such as their name, age, date of birth or address 
  3. Once you have checked that you have the correct patient on the phone, check that you have their contact number to phone them back should the line be cut off 
  4. Please refer to OAIC 
  5. Have a list of phone numbers and addresses handy should you wish to on-refer the patient to an appropriate tertiary service 

 Seek patient consent 

  1.  You should obtain consent before collecting a patient’s health information 
  2. The patient should be aware about the limitations of teledentistry and that dentists are providing the best advice possible in the absence of facetoface consult 
  3. If there are any charges for the phone consult, the patient should be made aware prior to the consult commencing 

Please write down contemporaneously what was discussed with the patient as this forms part of their clinical record. This applies whether or not a consult fee was charged.  

Set up a phone message

Include:

  1. Where they have rung 
  2. If you are open during this time 
  3. If you are available via teled-entistry at this time 
  4. An alternative number for the patient to contact such as the closest dentist who is available for tele-dentistry, or the nearest emergency department 

Example voice message: Thank you for calling Little Giant Dental Centre. We are closed during this time. If this is a dental emergency, please contact the Emergency Department of the Little Giant Village at 987654321 or phone Big Giant Dental Centre should you require a tele-dentistry consult. Their phone number is 123456789. 

 

Example situations in teledentistry: 

The patient is in pain and has a toothache

Determine if it is an acute odontogenic infection

  1. Is this recurrent?  
  2. Have they been on antibiotics for this before? 
  3. Do they have a temperature? 
  4. Is there facial swelling and pain, trismus, neck swelling, difficulty swallowing, difficulty breathing or airway compromise? If the patient has a spreading infection, they should present to the nearest emergency department. If so, dentist should call the closest hospital.  
  5. Medical history: allergies, medications, medical history 

 

Site  Where is the pain? 
Onset  When did it start? 
Character  What is the pain like? Ache? Stabbing? 
Radiation  Does the pain radiate anywhere? 
Associations  Any other signs and symptoms? 

If the patient does not meet admission criteria for hospital, consider if the patient needs pharmaceuticals and/or if their management can be deferred.  

Examples of analgesics and antibiotics include amoxycillin, metronidazole, Penicillin V, paracetamol and ibuprofen.  

Please refer to the Therapeutic Guidelines Oral and Dental V3.  

Broken or loose tooth

  1. Ascertain from the patient how loose the tooth is. If there is no pain and the tooth is not loose enough to be aspirated, management may be deferred.  
  2. If the tooth has broken, the patient should be asked if there is any pain or hot/cold sensitivity. Treatment should be deferred if the tooth is asymptomatic.  
  3. If the tooth is broken or chipped, or causing soft tissue irritation, patients may be directed to file it down themselves with some sandpaper or a nail file.  

Trauma 

Most cases of trauma will require attention, however management of cases of subluxation and concussion may be deferred. 

In cases of dental trauma, determine if management of this may be deferred.  

  1. Which area of the face was there trauma to? 
  2. Is the tooth sore to touch? 
  3. How loose is it? 
  4. Is the tooth broken? 
  5. Is the gum around the tooth bleeding? 
  6. Are there bleeding lips, ears or other tissues?  

Please refer to the International Dental Trauma Guide: https://dentaltraumaguide.org/free-dental-guides/permanent-teeth/ 

Orthodontics 

  1. Ascertain if this is a situation for which the management may be deferred.  
  2. The patient can contact their orthodontist if the archwire has come loose, or the bracket has come loose.  
  3. If there is soft tissue irritation, the patient may be directed to place some orthodontic wax or sponge (from a makeup remover pad) over the sharp area.  

Prosthodontics

Broken dentures/crowns/bridges 

  1. Broken dentures should not be worn if they are an aspiration risk.  
  2. Management of broken crowns and bridges should be deferred. Broken or loose crowns should be kept safely till treatment can recommence.  
  3. Patients should not be encouraged to recement any of these due to an aspiration risk.  

Panetta McGrath Lawyers have compiled an informative blog answering important questions around tele-health and managing medico-legal risks. 

Dental Protection have also provided guidelines and advice around the provision of telehealth. To find out more, click here.