Spotlight on teledentistry

Sir, current teledentistry uses will influence the post-epidemic burden of dental disease. We surveyed applications, clinician experiences and conditions presenting for teledentistry amongst 115 clinicians across the UK between 24 April-15 May 2020, during the lockdown restrictions.

Most were GDPs (60%) with dental core trainees (17%), foundation dentists and orthodontists (each 5%), oral surgeons (4%), OMFS consultants and speciality doctors (each 3%), dental specialist trainees, special care dentists, and oral and maxillofacial surgery (OMFS) registrars (each 1%). Of the respondents, 76% had no prior experience of teledentistry; 63% had no access to video consulting; 39% sometimesrequested photographs of the concerned area; 23% neversent patients further resources; 18% were not confident making diagnoses from telephone consultations alone; 17% couldn't request photographs as systems were unavailable in their workplace; 16% did notfeel confident making diagnoses using telephone consultations alongside clinical images and 11% were unsure if these systems were available. Overall, 52% thought teledentistry would remain following the epidemic whilst 21% did not; 27% were unable to commit to a decision.

The survey highlighted areas necessitating caution in teledentistry use. Remote consultations may reduce waiting lists and financial implications when patients attend in person.¹ Conditions presenting for teledentistry, such as temporomandibular joint disorders (23%) and pericoronitis (63%), may be suitable for self-care measures, thus minimising patient-clinician contact. Yet, concerns have been raised surrounding antibiotic stewardship and the appropriateness of using teledentistry in isolation to manage patients.² Facial swelling (77%) and pulpitis (65%) were frequently reported remote consultations. Such acute conditions traditionally require operative intervention and should continue to do so via Urgent Dental Care centres.³ Remote prescribing in emergencies is warranted but in the long term, could compromise care. Orthodontic problems (17%) or intra-oral swellings (60%) may result in adverse outcomes the longer operative treatment is delayed.

Diagnostic confidence was a highlighted concern. Clinical photographs can improve quality of assessment, however, in the absence of an examination, patients should be 'safety-netted' by providing information specific to the management of their condition should they deteriorate.⁴ This can be readily delivered through various forms of telecommunication.⁵ As we now witness reopening of 'normal' dental services, clinicians should consider developing systems to incorporate digital-consulting and improve patient resources to enhance teledentistry services.