Dental programs in Florida and Nebraska could be models for care in areas that don’t have a dentist.
The University of Florida created a study to determine if dental hygienists or assistants could remotely assess patients, sending information back to dentists and pathologists at the university’s School of Dentistry.
The results of the 18-month study are promising, said Dr. Teresa Dolan, the dental school’s dean.
“This country is faced with a great challenge,” she said. “There are a lot of dental needs in children and adults but not enough dentists to provide care for those individuals. We’re always exploring ways to extend our reach, particularly to low-income children and adults.”
The study, funded by a $1.5 million grant from the Office for the Advancement of Telehealth at the Health Resources and Services Administration, helped the university understand that the model of remotely supervising and assessing dental patients would work.
Dentists use audio-visual equipment to talk to the patient and technician, understanding the patient’s history and symptoms. They also use images captured by digital video and still cameras to look inside a patient’s mouth.
“The dentists can’t touch the person, but they can visualize what’s there, or train the person on the other end of the camera to describe what they’re feeling,” Dolin said.
The high-resolution cameras and computers used by the Florida team worked very well, Dolin said, but noted that others could do similar work with a lower-resolution still camera and an e-mail account.
“There are lower-tech alternatives, too,” she said. “The initial investment and experimentation will allow us to figure out how to make this work in real life in a way that’s not expensive or inconvenient.”
One area of particular success was with dental pathologists, Dolin said: two full-time pathologists on the dental school’s staff could provide services for remote communities that couldn’t support the position.
The university works with “partner clinics” across the state, some of which are up to five hours away. Teledental services could eliminate the need for many patients to drive to Gainesville for a consultation, she said.
Future plans include sending hygienists to rural communities with Head Start programs or nursing homes for routine consultations, Dolin said.
“We’re trying to reach a low-income population in a way that doesn’t jeopardize the quality of care, but does it in a cost-effective way,” she said. “We’re working to develop different delivery models that use dentists in the most effective ways to come up with a better model, one that publically-supported programs could afford.”
Nebraska also leading; Kansas lagging
Kathy Weno, director of the Kansas Department of Health and Environment’s Office of Oral Health, said officials from the state and the dental professional associations have attempted to pull in federal funding for teledentistry programs in Kansas, but those efforts have not been successful.
The University of Nebraska Medical Center College of Dentistry has an interest in expanding teledental services to rural areas in their neighboring states, said Dr. John Reinhardt, the dental college’s dean.
The school started its own teledentistry program with a remote location in Nebraska used to train dental hygienists in a rural setting. A federal grant also provided start-up funds and they were able to build the necessary infrastructure to transmit courses from Lincoln to a small classroom where four students could interact with their instructors on the other side of the state.
They now have five sets of equipment – including inter-oral cameras and a device that allows them to transmit with clarity photos and video from a patient’s chair to the consulting dentist in Omaha or Lincoln. Reinhardt said the equipment is portable and can quickly be moved to the office of rural dentists affiliated with the program.
Some of those affiliated offices, Reinhardt said, could someday be located in Kansas.
“There are legal matters associated with doing consultations across state lines,” he said. “But we’re very interested. We’re hoping to do what we can to establish affiliate sites and send students back to their home state, and do the same thing there that we’re doing here.”
Dental students must complete an “externship” in a clinic to graduate, Reinhardt said. Kansas this year changed a law that had prohibited dental students from gaining hands-on experience in dental clinics.
Students from Kansas interested in returning home to practice in rural areas, he said, were going to other places to get that experience.
“Now that that has improved, we’d like to develop more affiliate sites so students from Kansas could experience rural dentistry,” he said. “This could open doors.”
-Sarah Green is a staff writer for KHI News Service, which specializes in coverage of health issues facing Kansans. She can be reached at sgreen@khi.org or at 785-233-5443, ext. 118.