|Year : 2015 | Volume
| Issue : 2 | Page : 77-79
Teledentistry: A must in the era of patient driven dentistry
Nazar Rana, Dhruvakumar Deepa
Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh, India
|Date of Web Publication||22-Dec-2015|
Department of Periodontology, Subharti Dental College and Hospital, Meerut, Uttar Pradesh - 250 005
Source of Support: None, Conflict of Interest: None
Health care has changed dramatically by the scientific blend of computers and telecommunication. The result of which is the telemedicine, an innovative field that involves the exchange of clinical information and images over remote distances for consultation and treatment planning by linking them with the specialists in larger communities. This has increased the patient access to dental care, by improving the quality of care, and the cost effectiveness. It is also very useful in long-distance clinical training, continuing education, screening, and dentist-laboratory communication. In this article, an attempt has been made to review the basics and applications of teledentistry.
Keywords: Advances, dental education, internet, technology, telecommunication, teledentistry
|How to cite this article:|
Rana N, Deepa D. Teledentistry: A must in the era of patient driven dentistry. J Oral Res Rev 2015;7:77-9
| Introduction|| |
In recent years, the field of dentistry has seen extensive technologic innovations. Advances have been made in the use of computers, telecommunication technology, digital diagnostic imaging services, devices and software for analysis, and follow-up.  These digital technologies have not only improved the quality of management of patients but also has made possible their partial or complete management at distances which are away from healthcare centers or qualified dentists.  There are many barriers for the rural population to access specialty dental care, such as geographic remoteness, poor or no public transportation, and poverty, leading to a compromise on quality health care, resulting in complications. 
Internet is the basis of modern systems of teledentistry, being up-to-date and fast, and able to transport large amounts of data. The entire process of networking, sharing digital information, distant consultations, workup, and analysis is dealt with by a segment of the science of telemedicine concerned with dentistry known as "teledentistry." 
Teledentistry is a relatively new field that combines telecommunication technology and dental care. Teledentistry's roots lies in telemedicine, which was first used by NASA in 1970s  and has been defined as "the practice of health care delivery, diagnosis, consultation, treatment, and education using interactive audio, video, or data communications." Cook defined teledentistry in 1997, as "the practice of using video conferencing technologies to diagnose and provide advice about treatment over a distance." 
| Materials and Methods|| |
As patients are becoming more and more knowledgeable and demanding high quality treatment options, teledentistry is the whole new way of providing specialist advice through the use of telecommunication and computer technologies. There are many methods such as "real-time consultation/video conferencing" which allows patients at many sites to communicate with dental professional using an audio-visual system. 
Another method is "store and forward method" which involves the exchange of clinical information such as adequate patient's history, photographs, physical examination, and other information regarding the health status to the consultant or professional for the diagnosis and treatment planning. 
A third method, described is "remote monitoring method," in which patients are monitored at a distance either in a hospital or home-based system. 
Apart from the consultation, diagnosis and treatment planning teledentistry also plays role in educating the patients in rural areas which are distant away by: "Web-based self-instruction educational system," which contains the information that has been developed and stored.  The advantage of this system is that the user can review the stored data as and when he/she wants and could learn accordingly and appropriately.
"Interactive video conferencing" based on satellite, plain old telephone service, Integrated Services for Digital Network, Internet or Intranet system includes a live conferencing using camera setup and supportive information such as patient's history and radiographs that could be sent before or at the same time as the video conference. In addition, teledentistry could also be used as dental chat rooms through various dental organizations and study clubs, as well as through individual practitioners for exchanging the information on various topics. 
| Need of Teledentistry|| |
Dentistry could not seek a long-term exemption from the internet-based world of 21 st century health care system, and the speed and success of its transformation could be affected positively by the right professional leadership which is from organized dentistry.  Changes within the past decade in the speed and method of data transfer have prompted clinicians and information technology experts to re-evaluate teledentistry as a highly valuable healthcare tool.  In rural areas, where there is a shortage of specialists, the lack of comprehensive and sophisticated health care is a problem. Teledentistry could extend care to remote patient population at a reasonable cost, as well as the problem of a shortage of specialized dental consultants and professional isolation in rural areas. It teaches general dentist when to refer a patient and how to treat more complicated cases, which can change the prospective of patients and practice style of a clinician and give them more choices in treating patients.
Global communication with the colleague is instantly available through a single click of the mouse.  With the help of teledentistry, it is possible to make/get data record of the patients from different dental clinics, which will aid in the diagnosis and treatment planning and management of the patient. 
Teledentistry could also be used to increase the awareness regarding oral hygiene, dental, and oral diseases in general population and be very good tool for teaching postgraduate students and providing information to the clinicians/dentist regarding the recent advancements in the field.
An innovative oral health workforce model on teledentistry assisted, affiliated practice for dental hygienists was described by Summerfelt et al.  The 2010 USA Patient Protection and Affordable Care Act called for training programs to develop midlevel dental health care providers to work in areas with underserved populations.
A study was conducted by Duka et al. to investigate practical usability of telemedicine approaches in everyday management of oral surgery patients in terms of reliability of established diagnosis and indications for oral surgery treatment of the third molars. Their study concluded that the diagnostic assessment of the clinical diagnosis of impacted or semi-impacted third molars assisted by the telemedicine approach was equal to the real-time assessment of clinical diagnosis. 
Another interesting comparative effectiveness study assessed dental caries prevalence and dental care utilization in preschool children enrolled in urban childcare centers. Caries prevalence was determined in a cohort of children 12-60 months of age. Eligible children were randomized into two groups: Group one received a traditional visual/tactile oral examination, and group two received a teledentistry examination. The authors concluded that teledentistry was as good as visual/tactile examinations for dental caries screening in young children and offered a potentially efficient means of screening high-risk preschool children for signs of early childhood caries. The results of the study demonstrated that the use of the intraoral camera was a feasible and potentially cost-effective alternative to a visual oral examination for caries screening, especially early childhood caries, in preschool children attending childcare centers. 
| Limitations|| |
There is a considerable variation between countries in terms of accountability, licensure, jurisdiction, liability, privacy, consent, and malpractice. The latter appears to be a major impediment to the use of teledentistry across borders. 
The problems with the internet in general and teledentistry, in particular, are due to a lack of well-defined standards. If a technical problem occurs during data transmission that may cause a misdiagnosis or medical error, if patient data are lost or stolen during the process of transmission, the entire project may need to be discontinued.  A clear, nationwide teledentistry protocol is needed regarding the forms, equipment, efficiency, privacy, and security, which would enable organizers to control the problems caused by different standards and result in a more objective program evaluation. A standardized recording system would make the data-collecting process much easier and decrease the learning curve.
| Training|| |
Instructors of teledentistry education courses need to have both teaching experience and computer knowledge. The educational team must continuously update the course. Educational courses should be guided by instructors who are experienced in leading online communication, able to promote discussion and familiar with the use of computer technology. 
Finally, most of the teledentistry-based education programs are in English. Since the internet is a worldwide tool, future goals should include consideration of more multilingual programs. 
| Conclusion|| |
The explosive growth of the internet and its use in the transfer of data fundamentally alter the way dentistry is practiced. Teledentistry has not yet become an integral part of mainstream oral health care. However in the near future, it will be the another way to access an oral health care, especially encouraging for isolated population who may have difficulty accessing the oral health care system due to distance, or lack of oral health care providers in their area. It would also help in providing new opportunities for dental education providing primary care professionals with an easy access to efficient consultation and by helping in conducting postgraduate education and continuing dental education programs.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
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