How to divert patients from emergency rooms with teledentistry

July 31, 2020
Dr. Katie Hawn

Volume 54, Issue 8

Joining The TeleDentists helped a practitioner contribute to the overall well-being of her patients.

During residency, I received a diagnosis of benign essential tremor, which was a gut punch beyond my ability to process. Although I was able to practice dentistry while taking a beta-blocker, I experienced many unpleasant adverse effects, such as unrelenting dizziness, foggy thinking, and fatigue. I began to question my career longevity in terms of practicing clinical dentistry.

As I researched nontraditional dental careers, teledentistry emerged as a viable option. In 2019, I contacted The TeleDentists and found they were in the process of expanding their business by leaps and bounds. I began training immediately, and within a few weeks, I was a teledentist. Many of my friends did not understand what that meant or how it could be interesting. Initially, even I was afraid it would not meet my expectations for an intellectual and professional outlet. I thought that surely every case would be a toothache, with the same mind-numbing diagnosis, same tedious chart note, same ho-hum patient instructions.

Thankfully, my experience has been anything but humdrum. The TeleDentists launched me into the sphere of public health, for which I’ve always had a burning passion. I want to affect oral health broadly, extending beyond the logistics of patients who could fit in my daily schedule at a local dental practice.

The Health Policy Institute (HPI) of the American Dental Association (ADA) states that patients avoid dental care for many reasons, but topping the list are cost, fear of the dentist, and lack of access to a nearby practice with convenient appointment times.1 The TeleDentists expands access to care for patients with an internet-enabled device throughout the United States, 24 hours a day, 7 days a week, 365 days a year.

In terms of public health, the treatment of toothaches is vital to avoid unnecessary visits to an emergency room (ER). According to the ADA, there are approximately 2 million ER visits for dental pain each year in the United States.2 The cost is estimated at $400 to $1500 per visit, which far exceeds the cost of treatment at a private practice.2 Unfortunately, although patients do receive antibiotics or painkillers at the ER, these visits do not treat the source of infection, which results in 39% of these patients returning to the ER for the same issues.2

With The TeleDentists, the maximum consultation fee is $59 if a patient must pay out of pocket, and even lower if their dental insurance carrier reimburses for the teledental visit. In addition, at The TeleDentists, our primary concern, beyond providing urgent care, is that patients seek definitive care and establish a dental home. This referral is provided at no cost to the patient and lowers the percentage of repeat visits to the ER.

The TeleDentists also helps remove barriers to dental care. According to the ADA, these barriers most often include cost (59%), dental fear (22%), and lack of convenient office locations and times (19%).1 The TeleDentists provides a positive, interpersonal experience with a dental professional sans mask, gloves, and additional infection-control procedures, which also can trigger a fear response.

I began training immediately and within a few weeks, I was a teledentist. My experience working with The TeleDentists has proved personally and professionally rewarding, as well as vital to the health of the public. The TeleDentists launched me into the sphere of public health, for which I’ve always had a burning passion."

A visit with me may be the first positive encounter with dentistry many of my patients have experienced. My role is often that of counselor and motivational interviewer. I can recognize the symptoms of dental anxiety and provide reassurance, empathy, an explanation of why dental care is needed, and a confident, well-executed handoff to a trusted colleague. I also reassure them that regular visits to the dentist are associated with lower overall cost and lower dental anxiety.3 Oftentimes, my patients only visit the dentist for dental emergencies, which can be expensive, traumatic events.

In addition to neglecting routine dental care visits, some patients have been avoiding necessary medical care. One such patient was a young man in his 20s who, during my review of his health history, told me he had a kidney disease inherited from his mother, as well as blood pressure issues. I mentioned “polycystic kidney disease,” which could provide an explanation for his hypertension at such a young age. He said, “Yes! That’s it.” The patient was not being followed by a urologist or general physician for these conditions, and he had not seen a dentist in several years. I discovered that his main pain control strategy involved using ibuprofen, a nonsteroidal anti-inflammatory drug (NSAID) usually contraindicated for patients with polycystic kidney disease. Making this connection was critical to his overall health. He is now taking acetaminophen instead of an NSAID, and I hope he takes my suggestion to follow up with a physician.

Another of my favorite cases involved a young man with maxillary molar pain. His dental history included just one carious lesion, regular 6-month visits to his dentist, full orthodontic treatment, and third molar removal. I categorized him as low caries risk and did not suspect his pain to be odontogenic in origin. He confirmed that he had seasonal allergies and was experiencing symptoms such as morning congestion and headaches. I concluded that his pain was most likely due to maxillary sinusitis, which can direct pain to the roots of the maxillary molars. I recommended he take OTC ibuprofen for the pain, as well as an OTC seasonal allergy medication and xylitol nose spray for 2 weeks. If this young man’s symptoms did not improve or worsened on this regimen, I advised him to seek further medical care from his primary care physician.

These days, temporomandibular joint disorder (TMD) cases are commonplace in my virtual waiting room. This is not surprising because stress is a contributing factor to TMD, and we are living in an intensely stressful time. The symptoms of TMD include trismus, pain in the muscles of mastication, limited range of motion, tinnitus, pain in the ear, and pain in the head and neck region exacerbated by eating or talking.

TMD cases are ideal for The TeleDentists because most can be resolved by educating patients, providing reassurance, and detailing a simple protocol for rehabilitation at home. If this advice does not resolve the issue, I recommend that patients follow up with their dentist for a professionally fabricated night guard and/or physical therapy.

Children are always my favorite patients. These visits provide me the valuable opportunity to make recommendations about diet and oral hygiene practices, which can contribute to a lifetime of good oral health. I also am able to screen for dental decay and to ensure that the patient has a dental home, which many parents are surprised to learn should occur by the time the child is 1 year old.

My experience working with The TeleDentists has proved personally and professionally rewarding, as well as vital to the health of the public. I began taking consultations with The TeleDentists prior to the coronavirus disease 2019 pandemic, and I believe infrastructure enabling telehealth visits needs to be in place before a crisis. The number of consultations has certainly increased since the pandemic started, as have the public’s awareness, need, and respect for teledentistry.

Gratitude fills my heart when I hear the online ding that means I have a patient in my virtual waiting room, followed by my 5-year-old daughter echoing my oft-quoted message to her and her sister: “You need to take that call, Mommy. Someone is hurting.’”

References

1. Oral health and well-being in the United States. American Dental Association. 2016. https://www.ada.org/~/media/ADA/Science and Research/HPI/OralHealthWell-Being-StateFacts/US-Oral-Health-Well-Being.pdf?la=en

2. Reduce health care costs and improve patient care by treating dental disease in the dental practice instead of the ER. American Dental Association. Updated August 2013. http://www.ada.org/~/media/ADA/Public Programs/Files/ER_Utilization_Issues_Flyer.ashx

3. Saatchi M, Abtahi M, Mohammadi G, Mirdamadi M, Binandeh ES. The prevalence of dental anxiety and fear in patients referred to Isfahan Dental School, Iran. Dent Res J (Isfahan). 2015;12(3):248-253.

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