November 2020 Volume LV Number 6


Resident's Corner

July 2020 Volume LV Number 4

Teledentistry in the Time of COVID-19
Jessica Baron, D.M.D., and Sarah Khan, D.D.S., M.P.H.
With the onset of COVID-19, the dental community was plunged into an un- charted territory overnight: we were faced with mandatory closure of our of- fices to prevent the spread of the highly contagious virus. Practitioners had to provide care for only "true" emergencies, keeping in mind the ever changing infec- tion control and social distancing guide- lines. This was especially important in the beginning of the pandemic since many offices were ill-equipped with PPE (this has drastically improved) and there were many unknowns about the transmission of the virus. Luckily, the existing tele- health infrastructure paved the road for teledentistry, which allowed providers in this unique time to care for patients remotely and triage emergencies.
According to the American Dental Association’s Policy on Teledentistry, telehealth is not a "specific service, but a collection of means to enhance care and education delivery." This delivery can include live video, store-and-forward (sending secure information), remote patient monitoring and mobile health. In terms of coverage, the policy states that both public and private dental ben- efit plans and other third-party payers should provide the same coverage for teledentistry. In 2018, the ADA estab- lished two codes to use for teledentistry: D9995 (synchronous, real-time encoun- ter) and D9996 (asynchronous, infor- mation stored and transmitted). These codes are important for the dentist to include while billing the proper CPT code for the rendered services.
Isabel Driggers, D.M.D., is a pediatric dentist practicing in Charleston, SC. She is the founder of a multi-office pediatric dental practice called Coastal Kids Dental and Braces. When the outbreak of the pandemic occurred, Dr. Diggers, along with several other dentists, advocated to the state board the importance of allowing teledentistry to treat and tri- age patients. At that time, the state did not permit teledentistry. Luckily, the state eventually allowed teledentistry and state Medicaid began to reimburse for services. This is important for two main reasons: 1) the dental community realized the importance and place of teledentistry in their diagnostic arma- mentarium, and 2) the powerful impact of advocacy.
Dr. Driggers quickly established a pro- tocol within her multi-location offices. The scheduler typically took the call and gathered "details, including a photo of the area of concern if possible, and then a dentist (in the practice) would call the patient/parent back." If more informa- tion was needed, the dentist would Face- Time the patient/parent. In rare cases, if a diagnosis was unable to be obtained, the patient was scheduled to be "seen at the office during the emergency care hours." According to the ADA, the federal government will waive penalties for HIPAA violations allowing providers to utilize everyday applications like Zoom, FaceTime or Skype for teledentistry visits.
Erinne Kennedy, D.M.D., M.P.H., is a board certified dental public health specialist who practices clinical dentistry at the Alliance Dental Center LLC in Quincy, MA; her office implemented teledentistry within the second week that dental offic- es were closed for elective care. Beyond the pandemic, Dr. Kennedy believes that teledentistry will have a lasting public health impact by "help(ing) to reach patients who have a physical barrier that limits their ability to receive care at a dental office. This barrier could be lack of transportation, physical challenges, lack of childcare, or inability to get off work." In addition to removing these accesses to care barriers, teledentistry increases the efficiency of triaging emergencies and allows for patient follow up and disease management/education during the pandemic. Similar to any new technology or workflow in health care, Dr. Kennedy feels that "the major barrier that prevents more dentists from using teledentistry is to develop the (appropri- ate) systems to develop teledentistry well."
Dentistry, especially pediatric dentistry, is increasingly becoming a prevention centered approach to disease manage- ment. As dental offices throughout the country begin to open for routine dental care, teledentistry is here to stay. We hope that as pediatric dentists we can continue to innovate and find unique ways to champion the oral health and wellness of children, as well as address- ing access to care.
Jessica M. Baron, D.M.D., is a second-year pediatric dental resident at Montefiore Medical Center in the Bronx, N.Y. She is from Charleston, S.C., and attended dental school at the Medical University of South Carolina.
Sarah Khan D.D.S. M.P.H., is a second-year chief pediatric dental resident at Maimonides Medical Center in Brooklyn, N.Y. She is from Long Island, N.Y., and attended dental school at Stony Brook School of Dental Medicine.

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