Possibilities and limitations of teledentistry

Posibilidades y limitaciones de la tele-estomatología

Dmitry E. Suetenkov suetenkov@gmail.com

Saratov State Medical University, Rusia

Olga V. Popkova

Saratov State Medical University, Rusia

Anton R. Kiselev

Saratov State Medical University, Rusia

This work is licensed under Creative Commons Attribution-NonCommercial 4.0 International.

Currently there are areas in the world in which the provision of dental care is difficult due to the lack of medical facilities. Low population density, remoteness from large cities and other factors affect the volume and quality of dental care provided, this is the most important medical-geographical factor in large countries or for remote regions. Presented vision described the organization of dental care based on the application of modern telecommunication technologies.

In those communities it is often difficult to organize specialized care, for example, in orthodontics, maxillofacial surgery, or pediatric dentistry. If the technologies of remote interaction with the patient are not sufficiently developed for the surgical profile, then in the diagnosis of risk factors for dental and maxillofacial anomalies, long-term therapeutic or retention periods of orthodontic correction, the existing methods can be discussed in the development of regional systems for the provision of medical and preventive care to the population. In public institutions, orthodontist dentists have a significant need for assistance, while in private hospitals this creates an opportunity to increase the cost of treatment, increasing the economic burden on households. These and other reasons require the optimization of dental care in sparsely populated areas, or the use of additional methodological approaches.⁽¹⁾

One solution to this problem is to use telemedicine technology. In the early 2000s this term was familiar to a small circle of people, recently we are increasingly using it, and technology is moving forward. A modern smartphone, being a multimedia device, can easily take a photo or record a video, and then send the information to a doctor or a diagnostic center. The development of specialized equipment will greatly increase the effectiveness of theranostics. Telemedicine technologies were first used at the beginning of the XX century to consult seafarers in case of emergency, they were carried out by radio.⁽²⁾ There are scientific works devoted to the use of telemedicine on the international space station.⁽³⁾ More than 20 methods and techniques of telemedicine technologies are described.

In November 2017, the National Agency for Financial Studies (NAFS) conducted a surve y in Russia, posting 61% of respondents are ready to receive medical services remotely, 44% of respondents are ready to receive telemedical services to obtain medical documents and conclusions. Similarly, 39% of respondents would use the services of medical television for emergency medical consultation, 38% of respondents would use telemedicine to obtain a prescription for medication, 22% – for routine medical consultation. Another Russian study was conducted to answer the question: "what is preventing the use of telemedicine now?" More than half (74%) of the respondents primarily focused on the lack of technical facilitations. According to 58% of respondents the reasons was the lack of time to access the Internet for teleconsultation. Another reason is the lack of equipment and level of owning computerised technology.⁽⁴⁾ Almost half of the respondents said that their employees have low knowledge and skills in working with computers.⁽⁵⁾

Teledentistry is one of the specialized areas of telemedicine. Many researchers have repeatedly proven that teledentistry can be used as an alternative to consulting a doctor in areas where there is a shortage of narrowly focused specialists. The application of mobile telemedicine systems for medical examination and broad examinations increases the availability of medical care in remote settlements.⁽⁶⁾ In advanced countries, general dental practitioners are positive about the idea of introducing teledentistry into their practice. Generally, the positive aspects of the introduction of teledentistry are noted by parents and children themselves who are on receiving the treatment.^(7,8)

All mistakes of telemedicine can be subdivide into technical, organizational and substantial. Many authors report that courses of telemedicine need to be introduced into educational programs of higher education institutions, and also to conduct courses for doctors.^(9-11) Telemedicine technologies allow improving skills of medical employees in programs of continuous education of doctors without separation from their jobs.⁽¹²⁾ Modern information support can increase considerably overall performance of doctors, especially concerning diagnostics of rare pathology or in need of participation in various specialists in complex treatment.⁽¹³⁾ One more possibility of using telemedicine is use of so-called "house monitoring". Such devices perform the same functions as standard medical devices, however have an opportunity to save information and are connected by uniform network between several participants of process.⁽¹⁴⁾

Existing specialized journals on the use of telemedicine technologies are an important repository of information for health workers. Among them are: Journal of Telemedicine and Telecare, Healthcare Technology Magazine (UK), Telemedicine Journal and e-Health (USA), Telemedicine today (USA), European Research in Telemedicine (Netherlands), Journal of Telemedicine and e-Health (Russia), Polish Healthcare Journal OSOZ (Poland), Brazilian Journal of Telehealth (Brazil).

For example, in an article published in the Journal of Telemedicine and Telecare in 2008, the possibility of using telemedicine for diagnosing of the mucosa membrane diseases is described, however, attention is focused on the fact that for diagnosis it is not enough to analyze only graphical data.⁽¹⁵⁾ In Finland, video conferencing was successfully used by orthodontists for teleconsultations in research.⁽¹⁶⁾ A 2013 study conducted by Prerna Raje Batham and co-authors showed that, thanks to the orthodontic body, a patient undergoing orthodontic treatment can be observed by a general practitioner.⁽¹⁷⁾

According to another study, general practitioners have positive attitude towards the idea of using telecommunication technologies counseling in orthodontix.⁽¹⁸⁾ However, some doctors are against teleconsultations.⁽¹⁹⁾

Gómez Bravo et al. propose to use social media not only for networking with the purpose of their involvement, but also to facilitate interaction with colleagues and patients.⁽²⁰⁾ There are already standards for the use of telemedicine by nurses.⁽²¹⁾

Teledentistry was as well used successfully in endodontic treatment for finding tooth root canals. According to the research, using teledentistry helps experienced doctors cooperate with young colleagues in everyday practice.⁽²²⁾ Also, teledentistry was as well used successfully for screening schoolers.⁽²³⁾

A simple photo, taken on a smartphone and sent to colleagues, should be enough for making a diagnosis by a general practice dentist.⁽²⁴⁾ Teledentistry technologies can be used for diagnosis in surgical pathologies.⁽²⁵⁾ Therefore, technologies of teledentistry can be used for optimizing dentistry service and making it more affordable.⁽²⁶⁾ Teledentistry is also commonly used in the examination of patients at the stage of anamnesis collection.⁽¹⁷⁾

Analyzing the data of PubMed, we find that there is a trend of increasing published articles by the keywords and tags of telehealth including teledentistry (Fig. 1). Figure 2 shown dynamics of publication numbers in PubMed by keywords: telemedicine, teledentistry, dental telehealth, oral telehealth, and dental telecommunication.

Fig. 1 - Articles in PubMed including keywords and tags: telehealth including teledentistry.

Fig. 2 - Dynamics of publication numbers in PubMed by keywords: telemedicine, teledentistry, dental telehealth, oral telehealth, and dental telecommunication.

Healthcare treatment paradigm is undergoing substantial modifications. Those healthcare tendencies show a conservative yet steady trend of healthcare service scaling. That is proved by such a high technology medical industry as dentistry.