Teleoral medicine towards accessible healthcare

i must admit

my favorite types of movies used to be

about apocalypses and pandemics

worldwide contagion outbreak

i don’t quite look at them the same way

anymore if there was a movie that i

thought i would be living out in real

life

this was not it it is incredible how

something so small and infinitesimal

has changed life as we know it however

things are looking up

on the bright side every day that goes

past we are learning on how to better

manage this

and on the bright side and this must be

everyone’s favorite thing to do

you can now visit the dentist yay

now at the peak of the outbreak in perth

one of the things that i was thinking

was

gee i hope i don’t have to see the

dentist during this time

well i’ve never had a toothache before

and nobody ever really wants a toothache

however i knew that it would be very

difficult to get in with my dentist

during this time

now you may not be aware but the dental

service industry in australia during

that time was under service restrictions

and the reason for this was multi-fold

first off the elderly immunocompromised

and the recently overseas needed to stay

home

some dental procedures like using a high

speed drill

can produce aerosols which is where

where particles in the saliva

are suspended in the air and this

actually puts the dentist and their team

most at risk

there was also the concern that we would

run out of personal protective equipment

like masks and gloves and we needed to

save those for frontline medical workers

now i’m a dentist myself and i know that

the dental practice is one of the

cleanest places that you could be in

because it is always being scrubbed and

sterilized

i also knew that if i were to really

have a toothache there would be multiple

private and public practices still open

to address urgent dental patients

but still i tapped my teeth together

nervously and prayed that it wouldn’t

happen

my husband is an engineer my

sister-in-law is a school teacher

my best friends are a lawyer an i.t

specialist and a fashion designer

now can you guess what was the one thing

that they all had in common during this

time

they were all able to work from home now

i’m not taking away from the challenges

of working from home

i know that there were issues with

accommodating to the change in working

space and pace

but they had the luxury to do something

that i and many other dentists were not

able to do

they could work from home now you might

be thinking

can a dentist can’t work from home can

they well that was one of the questions

that myself and the team at the

australian dental association of western

australia

set up to try to solve the concept of

tele-dentistry

or providing patients health information

without the need for a face-to-face

consult is not new

and we didn’t invent it however the

covet 19 pandemic gave us the impetus

and drive

to make this feasible accessible and

practical

and quickly to boot so how do you start

tackling a problem like this

where do we start well first of all

is this something that patients would

even want is there demand for

it you already know that i’m a dentist

i’m also a dental specialist an oral

medicine specialist

or what you might be thinking that’s

okay you’re not alone

there are only 33 oral medicine

specialists in australia so not

everybody knows what we do

in a nutshell we see a wide range of

oral facial conditions

now some of the more urgent things that

someone may want to see us for include

oral cancer

and oral facial pain during this time i

consulted with several patients

mr x who was from geraldton was

suffering acute jaw pain and was not

able to open his mouth

mrs y had a suspicious ulcer involving

her tongue that had been

that had been present for a long time

mrs z had oral burning and needed to

renew her script

and the list goes on and i know that my

experience was not unique

so there definitely is a need for oral

medicine and

dentistry services to continue during

this time do patients and dentists

have the technology and equipment to

make this work and if they have the

equipment

do they do they know what to do with it

well the good thing is that the

equipment and technology required for

tele dentistry is actually fairly

minimal

ideally what you would have is three

things an internet connection audio and

a camera

however even if you don’t have that a

phone line is sufficient to do a phone

consultation with the patient

so while teledentistry as a concept is

not new

many dentists had never done this before

so we needed to look closely at the

potential pitfalls

that may be facing the clinicians or

patients and these were numerous

they include patient security and

privacy record keeping

and medical legal considerations let’s

summarize the latter

the inability to perform a physical

examination may increase the risk of

misdiagnosis

there may be fragmentation of care where

the clinician that you’re consulting

with remotely is not your usual

clinician

many times a tele-dentistry concept will

need to be supplemented by a

face-to-face consultation

afterwards and of course anyone who has

been online knows that security and

privacy

is something that is important and

difficult to maintain

so while i looked into these and wrote a

guide to teledentistry

my friends at the australian dental

association of western australia

started lobbying health funds to make

this service accessible to patients

doctors sean archibald and david hallett

did a fantastic job

and the dental association soon unveiled

a new item number

to be able to provide this service and

the health insurance fund of australia

came on board i started to share my

experience with other medical

professionals and allied health

professionals

in that space to try and build the

networks and groundwork necessary

to bring this into the future now you

might be thinking why do we need to

bring this into the future can’t you

already see a dentist face to face

would you like to see your dentist via

computer screen

now it is clear that tele-dentistry is

not a substitute for dentistry

you will not be able to have a filling a

root canal treatment or have your tooth

extracted

via talent dentistry you will need a

face-to-face consult

however there exists a need for this

service in the armamentarium of a health

professional in today’s world

for starters it reduces their barriers

to care and improves access

particularly for patients in the remote

and regional areas

australia is a vast country sparsely

populated

with many remote and regional

communities that do not have the same

access to healthcare

you know that there are 33 oral medicine

specialists in australia

there is one per seven hundred thousand

australians to give you an idea of the

scale that is one specialist

for the population of england and

scotland combined and this statistic

only comes into play

if the population of australia was

homogenously scattered but we know that

that is not the case

let me paint a better picture for you

there is one oral medicine specialist

for a land mass three and a half times

the size of tasmania

if you are lucky or you may have access

to several specialists

if you live in a capital city so i know

that this is a

experience that is not limited to oral

medicine there are many other medical

specialties and allied health that have

the same experience

so tele-dentistry could be the answer to

help solving this disparity

it is still too soon for me to watch

pandemic movies brad pitt or not

however if there is a silver lining to

the coefficient 19 pandemic

it gave us the ignition to try and

address one of the biggest problems

facing health care

dentistry and oral medicine which is

reducing the barriers to access

now i know tally dentistry is not the

magic answer and there are many

limitations

however it feels like we are further

along the path today than we were

yesterday

have a clear plan moving forward and

have helped patients along the way

and i really could not ask for more so

today i would like to challenge you

to think about one of the problems

that’s facing your industry or your

community

what can you do to change it

you