teledentistry

GOOD MORNING

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TELEDENTISTRY

SHIFAYA NASRIN

CRRI2

synonyms

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TELEDENTISTRY

TELEHEALTH

TELECONSULTATION

E-HEALTH

INTRODUCTION

• Dental care is being constantly transformed by the opportunities which are provided by technology and telecommunication

• Teledentistry is a relatively new field that combines telecommunication technology and dental care.

• Due to the enormous growth of technological capabilities, teledentistry possesses the potential to fundamentally change the current practice and the face of the dental care

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TELEDENTISTRY

Cook defined it as “the practice of using video-conferencing technologies

to diagnose and to provide advice about the treatment over a distance”

TELEMEDICINE

“the combined use of telecommunications and computer

technologies to improve the efficiency and effectiveness of health care

services by liberating caregivers from traditional constraints of space and time and empowering consumers to

make informed choices in a competitive marketplace”

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BENEFITS OF TELEDENTISTRY

Improved access

Cost efficiency

Patient demand

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Dentists and dental hygienist in remote areas can link to specialists in larger communities through teledentistry.

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HIGHLIGHTS OF TELEDENTISTRY

• Improve access to care

• Improve the delivery of health care,

• Lower its costs.

• Needed resource for dental consulting,

• Referral for specialized care,

• Dental monitoring,

• Dentist-laboratory communications,

• Continuing education.

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• Prime Minister, Julia Gillard, and Minister for Broadband, Communicationsand the Digital Economy, Senator Stephen Conroy, look on Associate ProffesorMatt Hopcraft conducts a teledentistry trial at Melbourne University.

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SCOPE OF TELEDENTISTRY IN INDIA

India has opened up to telemedicine to address various issues like:

• inadequate health infrastructure and clinical services,

• paucity of qualified doctors,

• non-availability of specialist care,

• the late discovery of the ailment,

• the delay in the delivery of the treatment due to the greater time required for the transport of the patients to urban healthcare facilities and the provision of healthcare by inexperienced primary healthcare service providers. 11

• In 1999, the Department of Information Technology, the Ministry of Communications and Information Technology (Government of India) launched a pilot project which was entitled, ‘Development of Telemedicine Technology’, with the objective of reinforcing the national healthcare delivery system

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The key specifications of the project include

To identify the appropriate technological tools and services required to implement telemedicine at the three premier hospitals

• All India Institute of Medical Sciences (AIIMS), New Delhi,

• the Post Graduate Institute of Medical Education and Research at Chandigarh

• the Sanjay Gandhi Post Graduate Institute of Medical Sciences at Lucknow (Uttar Pradesh). 13

To develop and carry out system integration to enable telemedicine technology and for establishing telemedicine services (teleconsultation and telediagnostic services for the specialties of radiology, cardiology and pathology and teleeducation) at three tertiary level hospitals.

To train clinicians in the use of telemedicine technology

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Forms of teledentistry

Real time consultation Store and

forward

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Real time consultation

transfers the information immediately

dentist and patient at different location can see,

hear and communicate with each other using advanced

telecommunication technology

Store and forward

allows data to be stored in a local database to be

forwarded as needed.

collecting all the patient information and images ,storing that data for review by a dentist specialist at a later time. Later,

the dentist reviews the information make a diagnoses

and a treatment plan.

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Real time consultation

Store and forward

TELEDENTISRY SERVICES

SPECIALIST REFEREL SERVICES

PROFESSIONAL EDUCATION

Patient consultation

CONSUMER MEDICAL AND

HEALTH INFORMATION

REMOTE PATIENT MONITORING

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• POTS (plain old telephone system)

• Networked programs

• Point-to-point connections

• Primary or specialty care to the home connections

• Home to monitoring center links

• Web-based e-health patient service sites

TELEDENTISTRY DELIVERY MECHANISMS

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• Networked programs link hospitals and clinics with outlying clinics and community health centers in rural or suburban areas by the use of dedicated high-speed lines or the Internet

• Point-to-point connections using private networks , used by hospitals and clinics that deliver services directly, or contract out specialty services to independent providers, at ambulatory care sites

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• Primary or specialty care to the home connections involves connecting primary care providers, specialists and home health nurses with patients using single line phone video systems for interactive clinical consultations

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• Home to monitoring center links are used for patient monitoring, home care and related services that provide care to patients in the home, using normal phone lines and internet

• Web-based e-health patient service sites provide direct consumer outreach and services over the Internet. Under telemedicine, these include sites that provide direct patient care

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Technology and Equipment for Designing a Teledental Model

There is not a recommended list of equipment, hardware or software for designing a teledentalmodel.

Factors determining selection of technology and equipment for designing a teledentalmodel:

- budget,

- Technology

-infrastructure

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COMPONENTS THAT FACTOR INTO DESIGNING A TELEDENTAL MODEL

information technology (IT) infrastructure,

networks,

telecommunication services,

data security,

real time video conferencing vs.

store and forward communication,

comfort with technology

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TELEDENTAL APPLICATION SOFTWARE

Dental management

software

Imaging software

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FOUR COMPONENTS TO CONSIDER WHEN CHOOSING MANAGEMENT

SOFTWARE

Dental records

Dental billing

Appointment scheduling

Reporting requirements27

• Dental records – allows for the collection of data critical in the clinical management of patients, including patient charts and histories.

• Dental billing – may be a factor in choice of software. The billing and revenue component of management software allows for the management of patient financial records.

•

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• Appointment scheduling – management of appointments and scheduling can be a part of the management software. The software is designed to track patients from the moment they are entered into the system and also tracts missed, rescheduled, and canceled appointments.

• Reporting Requirements – Most dental management software has built in reports.

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TELEDENTAL EQUIPMENT

Extra oral digital camera

Intra oral digital camera

Video conferencing system

Digital radiographic system

Portable dental radiographic system

Laser and Fluorescence Caries Detection Devices

Computer

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ORAL MEDICINE

• High resolution images and a broad spectrum of colors (32-bit or more), is able to provide high quality consultation even with the colleagues at a distance of several hundreds of kilometers (between two or several experts at a time) lesions are electronically photographed using a 50 mm macro lens and circular illumination system, and clinical and anamnestic data are stored in a textual file with minimal resolution of 600 dpi.

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• The files are renamed according to the patients’ identification numbers in order to avoid confounding and identity errors.

• Specialist then analyze independently the obtained images and clinical information. They make the diagnosis (usually one or two) and electronically return the results

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Through teledentistry consultations and imaging, diagnosis of oral pathology and oral conditions in remote areas can be improved

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PROSTHODONTICSCAD- CAM Dentists and dental technicians who are not

very skillful , the usual practice is to request teledentistry help of computerized dentistry specialists.

The resulting project file is encrypted and sent by e-mail to a teleconsultant for model analysis, projection of the shape of restoration, of its height and interjaw relationships using a virtual articulator

The completed project is then encrypted and returned to the clinic, usually by e-mail

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PEDIATRICS AND PREVENTIVE DENTISTRY

• reducing their fear and anxiety in children compared to clinical examination in real time.

• An intraoral camera - take dental photographs from any available angle; in addition, sufficiently strong and focused illumination from the camera itself is required, as well as optical or software reduction of light reflected from the smooth surface of the teeth.

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• Together with high resolution, the obtained digital image is able to demonstrate initial caries stages or enamel and dentine pigmentations.

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ENDODONTICS

• Teledentistry methods based on internet, diagnosis of periapical lesions can be adequately assessed.

• Based on that, a necessary plan can be devised for a proper endodontic or oral surgical management of these lesions.

• Teledentistry based on internet as a medium for distant communication enables its use worldwide, wherever the world wide web is present as a wire or wireless connection, reducing the costs of management and increasing the availability of urgent help to all patients

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The method is based on the creation of digital information for each of the teeth of interest

sequence of digital extra oral photographs (frontal and bilateral),

• sequence of digital intraoral photographs (vestibular portion of the alveolar ridge in the area at the level of tooth root, palatal/lingual portion of the alveolar ridge of the target tooth, and dental crown),

• retro alveolar dental digital x-ray,45

• anamnestic information in the format of text.

• Using mobile Internet connection, photographs and text are uploaded to an on-line server.

• Distant consultants, specialist in endodontics, are informed via their mobile phones about the received request,

• after which they download the digital images and accompanying data. They establish the diagnosis and suggest a treatment, then post these information on an on-line server, which informs the consultation-requester dentist about the received response

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ORTHODONTICS• Orthodontic specialists, after taking dental

impressions of the jaws, instead of casting jaw models in plaster, send the impressions by special postal service to specialized companies for 3D digitization of working models;

• then they create digital 3D models using patent-protected systems for 3D scanning and digitization, form a computer file, and return it via Internet to the therapist.

• The therapist share this digital model of the jaws with others via network, effectuating necessary consultations with his colleagues.

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•

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ORAL AND MAXILLOFACIAL SURGERY

• The advances and availability of smartphonetechnology have contributed to the feasibility and availability of telemedicine in oral and maxillofacial surgery.

• Smartphones are able to read and display 3D computer reconstructions of head skeleton, giving instantly the necessary information to distant teleconsultants in oral and maxillofacial surgery.

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• Even on the move, they are able to record the consultation and send an answer.

• It is very useful in emergency conditions requiring immediate interdisciplinary consultation.

• Maxillofacial surgeons are thus able to monitor the condition of their patients even after very complex interventions, such as osteotomies, removal of ameloblastic fibromas, and so on

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• Implant placement

• Complicated impaction removal

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TELEDENTISTRY AND ITS USE IN RURAL AREAS

• In rural areas, shortage of specialists, the lack of comprehensive and sophisticated health care is a problem.

• increase the accessibility of the specialists to the rural and underserved communities for their dental needs, decreasing the time and the cost which are associated with the speciality consultations

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TELEDENTISTRY AND ITS APPLICATION IN DENTAL EDUCATION

• The Web-based, self-instruction educational system

• Interactive video-conferencing

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The Web-based, self-instruction educational system

• Web-based dental continuing education or the CE courses

• that lack of face to face communication with their peers and instructors could result in dissatisfaction.

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Interactive video-conferencingIncludes :

a live interactive video-conference with a proper camera set up where the patient’s information can be transmitted

supportive information (such as the patient’s medical history, radiographs, etc) that can be sent before or at the same time (for example, via fax) as the videoconference.

The advantage - the user can receive an immediate feedback

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TELEDENTISTRY AND ITS ROLE IN POSTGRADUATEEDUCATION AND DENTAL PRACTICE

• Good tool for educating postgraduate students and for providing continuing updates for the practicing dentists.

• In interactive video-conferencing, the patient information is evaluated first (with or without the patient’s presence), which allows for the interaction and feedback between the educator and the students.

• The patient cases can be reviewed thoroughly and at the students’ pace. The cases can be discussed at length after all the clinical data have been collected and transmitted, without the patient being present at the scheduled meeting. This enhances the students’ enthusiasm and provides new learning opportunities for the dental students and the practicing dentists.

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TELEDENTISTRY IN VARIOUS COUNTRIES

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Areas adopedteledentistry

Service provided Technology

University of Minnesota School of Dentistry

to increase access to dental specialty care in rural Min

real-time videoconferencing technology

The Melbourne Dental School’s Oral Health Cooperative Research Centre

dental health care amongst aged and remote patients

using the National Broadband Network

Arizona Department of Health Services, Office of Oral Health (OOH)

Increase availability of the oral health workforce and accessibility of oral health services to underserved populations and underserved areas in Arizona

to increase access to dentalcare for underserved and at-risk populations

The Children’s Hospital Los Angeles TeledentistryProject, +University of Southern California’s Mobile Dental Clinic

increases and enhances thequality of oral health care provided to children living in remote rural areas of California,

ISDN

Challenges……

• The teledentistry examination is not a face-to-face. You have to rely on judgment of the other practitioner’s examination.

• Productivity can be another issue as new practitioners become accustomed to the technology.

• Teledentistry initially takes a longer time compared to their regular office visits. When they get used to the system, they get more efficient.

• In India uneducated population, below the poverty line and lack of infrastructure is major challenge.

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Future prespective of teledentistry

Various measures that can be employed for the effective

implementation of teledentistry are:

• The instructors of the teledentistry education courses need to be well versed with computer knowledge and they should have adequate teaching experience

• The practitioners who are engaged in teledentistry must have a license in each state in which they practice

• Dentists who are engaged in teledentistry must make

every effort to ensure the security of their systems, as well as of any data that they may transmit.

For example, data encryption, password protection and user access logs can help in deterring most of the people and in protecting patientconfidentiality 64

conclusionWith all the technological developments taking place in the field of teledentistry, practitioners may eventually link up to virtual dental health clinics and an entirely new era of dentistry can be created. The future might also see distant telemedical control of robotized instruments in situations with long-term unavailability of dental care, e.g., during space flights, on transoceanic ships, and in various rural areas. The results achieved so far are very encouraging, setting the road signs for future investigations. However, a number of things have to be addressed before teledentistry can rise to its peak. Further studies involving greater number of participants will be required to validate the various aspects of teledentalapplications. 65

REFERENCES

• Journal of Clinical and Diagnostic Research. 2011 November (Suppl-2), Vol-5(7): 1486-1488

• International Journal of Clinical Cases and Investigations 2011. Volume 2 (Issue 6), 49:53, 6th November, 2011

• Telemedicine in Dentistry (Teledentistry)

Branko Mihailovic, Milan Miladinovic and Biljana Vujicic

• Teledentistry an art and science of healing: rajan shilorkar , kosha pritesh ruparalia, chandra mani more, pritesh ruparalia

• Telehealth Technologies, Paul Glassman, Michael Helgeson, Jenny Kattlove CDA journal ,volume:40, number: 7

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teledentistry

Education

delivery of health care

use of telemedicine

teledentistry trial

scope of teledentistry

highlights of teledentistry

specialized care

specialty care

india india