Teleconsults have been a boon to dentists during the COVID-19 lockdown, allowing them to assess patients’ need for treatment while minimising the risk of spreading the virus. By Kathy Graham
The coronavirus pandemic is changing the way dental care is provided. When the Federal Government imposed Level 3 restrictions on dental practitioners on 23 March, effectively limiting their treatments to emergencies that didn’t generate an aerosol, it presented dental practitioners with a dilemma: how to assess whether an emergency treatment was warranted without unduly exposing either the patient or dentist to the possibility of virus infection?
Even in normal times, certain patients are deemed suited to a teleconsultation—for example, if their need is outside normal practising hours or they’re unable to attend the clinic due to illness, or isolation. But with dental service restrictions in place—although these have now been dialled back to Level 1—video consults have become the primary communication and triage tool for pre-diagnosis.
Fortunately, advances in videoconferencing technology mean there’s many platforms for practitioners to choose from: Skype, Zoom, GoToMeetings, and FaceTime, to name a few. Although as the Australian Dental Association (ADA) noted in their recently updated Guidelines for Teledentistry, whatever they use, “practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws”.
Dr Geeta Perks is a dentist and the director of Dental Focus Marketing, and—bearing these considerations in mind—recently launched the online consulting platform, Virtuaden, to make it easy for dentists.
“We were looking for a way to help the dental profession and keep us all safe,” Dr Perks says. “Virtuaden is an all-in-one online video consultation system for dental practices. This allows dentists to communicate safely by triaging their patients remotely from home, allowing those with problems to book directly into the diary for the virtual consult. We’re using doxy.me, because it’s one of the most popular platforms among healthcare providers as it’s secure and compliant.”
Dr Lincoln Loi is the principal dentist at Fine Smiles Dental in Footscray, Melbourne. Like many clinics, his has stayed open “but at reduced capacity. So days where we used to have three dentists on, we might have only one dentist to see all the emergencies”. His clinic has been offering complementary 15-minute teledentistry consultations since the restrictions were imposed. “There’s three main elements that I’m trying to balance,” Dr Loi says. “Running a business effectively, ensuring the safety of our staff and patients, and doing our part to minimise the spread of the virus throughout the community.”
When the patient makes an appointment over the phone or via email, they are provided with an internet link. At their designated appointment time, they just need to open the link and Dr Loi or one of his team joins the video call to begin the consultation. Dr Loi uses doxy.me “because doxy was created for medical consultations, as opposed to a normal teleconferencing app.”
Aside from the fact practitioner and patient are in different physical locations, teleconsults are really not much different procedurally to face-to-face consults, in that—as per the ADA guidelines—a patient’s clinical records should be available for reference and a detailed record of the consultation including confirmation of identity, consent to the consultation, and presenting symptoms, should be made. But as this is a teleconsult, the patient should also be made aware of any limitations and that dentists are providing the best advice possible under the circumstances.
Like many dental practices, Fine Smiles has been hit hard financially by the virus crisis. Yet thus far they have not charged for their teleconsults because, as Dr Loi says, “it is an important service to offer the community in these very difficult times. People are losing their jobs or having their hours cut. If we can provide access to dental advice without the financial burden, that’s a good thing.”
That option to charge patients, however, has become more palatable since the ADA issued a new item number on the Australian Schedule of Dental Services and Glossary to allow for telehealth consultations, and called on health insurers to support the introduction of this new item number by paying a rebate for telehealth consultations.
Dr Perks says the decision was overdue. “There’s been a huge push to have item numbers for video consults. Dentists were wondering, ‘Do I charge for it?’ Most weren’t charging because they felt they were just doing a service. But some feel they need to earn something, and whilst doctors are allowed to charge for teleconsults, why not dentists?”
West Australian-based health insurer HIF was the first to announce they’d offer benefits for teledentistry consultations. “These benefits will apply for services delivered until 30 June 2020 and will be reviewed again to see if this temporary period of cover needs to be extended,” HIF managing director Graeme Gibson says. “We’re doing this because it’s important that our members continue to have access to their ancillary providers during this time.”
Videoconsults have been embraced by the profession—Dr Perks confirms the take-up of Virtuaden has been “huge. We’ve had a great response of dental practices come through the system”—and will no doubt be retained as a service by many post pandemic.
But it won’t replace actual dental visits. “Right now, we can assess the patient, but we can’t fully diagnose until we see the patient physically,” says Dr Perks. “Teledentistry is just another line of communication to allow dentists to build patient rapport online and allay patient fears (of going to the dentist and COVID-19) in the comfort of their own homes—and bring more bums on seats into the dental practice.”