Journal of Indian Society of Periodontology
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SHORT COMMUNICATION
Year : 2015  |  Volume : 19  |  Issue : 5  |  Page : 589-592  

Tele-periodontics - Oral health care at a grass root level


Department of Periodontics, Sri Balaji Dental College, Moinabad, Hyderabad, Telangana, India

Date of Web Publication13-Oct-2015

Correspondence Address:
Haritha Avula
Department of Periodontics, Sri Balaji Dental College, Moinabad, Hyderabad, Telangana
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/0972-124X.157875

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   Abstract 


A new concept of tele-periodontics, which merges the innovative technology of telecommunications and the field of periodontics, is proposed. This new field of tele-periodontics will have an infinite potential where access to a specialist will be provided at a grass root level, enhancing effective delivery of therapy and information to the rural and under privileged areas. It would allow the specialist and the patient to interact either by video conferencing (real time) or through supportive information (store and forward) over geographic distances. Different probabilities of tele-periodontics such as tele consultation, tele training, tele education and tele support are also discussed in this paper.

Keywords: Real-time conferencing, teledentistry, tele-periodontics


How to cite this article:
Avula H. Tele-periodontics - Oral health care at a grass root level. J Indian Soc Periodontol 2015;19:589-92

How to cite this URL:
Avula H. Tele-periodontics - Oral health care at a grass root level. J Indian Soc Periodontol [serial online] 2015 [cited 2020 Jun 6];19:589-92. Available from: http://www.jisponline.com/text.asp?2015/19/5/589/157875




   Introduction Top


Technological advances have revolutionized the face of medicine and in pursuit of better health care delivery, the branch of telehealth emerged. Teledentistry, which is a synergy of telecommunications and dentistry, is yet another feather in the cap, and this emerging branch of medicine is a promising avenue in effective delivery of dental care and information at a distance.

Association of American Medical Colleges [1] states that "telemedicine is the use of telecommunications technology to send data, graphics, audio, and video images between participants who are physically separated (i.e. at a distance from one another) for the purpose of clinical care". In absentia care or "care at a distance" is an age old method of health care delivery and due to the technological developments, has blossomed into an emerging branch of modern telemedicine.

During historical times, smoke signals were used by African soldiers to warn people from other villages of the existence of any serious disease. In the early, 1900's people living in remote parts of Australia used two-way radios, powered by a dynamo driven by a set of bicycle pedals to communicate with the Royal flying doctor service of Australia.[2] Teledentistry is a rapidly forming subset of telehealth, a field that already has considerable impact on the health care industry. The term "teledentistry" was used in 1997 by Cook [3] who defined it as "the practice of using video-conferencing technologies to diagnose and to provide advice about the treatment over a distance". 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.[4] Changes within the past few years in the method and speed of data transfer have prompted clinicians and information technology experts to re-evaluate teledentistry as a highly valuable health care tool.[5]

History of teledentistry in periodontics

Teledentistry was first tested at Fort Gordon, Georgia in July 1994 by the US army, where in conjunction with an Intraoral camera a dental image management system was used to capture color images of a patient's mouth.[6] Using a 9600 band modem, these images were then transmitted over a distance of 120 miles from the dental clinic over to Fort Gordon, Georgia. Fifteen periodontal patients were referred to Fort Gordon for surgery after which, each patient reported to Fort McPherson for suture removal and intra-oral imaging after a week. At that point, color still images were obtained of the surgical sites, and these images were transmitted to Fort Gordon for examination by the periodontist who performed the surgery. The results of this study showed that 14 of the 15 patients saved the return trip to Fort Gordon. The patients uniformly felt pleased at the elimination of the long trip to Fort Gordon.

Definition

"Tele-periodontics" is a proposed branch of telehealth (telemedicine, teledentistry) which focuses on the application of telecommunication and internet-based technologies, without demanding specialist presence in the delivery of oral health care related issues (diagnosis, consultation, treatment, public health, education, etc.) across geographic distances.

Need for tele-periodontics

Periodontal disease, which is a silent disease of the underlying structures of the teeth remains a global dental problem and is one of the most common reasons for tooth loss in adult populations. Quick detection and diagnosis can prolong the life of the teeth in the oral cavity. People living in rural or underserved areas are among the most in need of oral healthcare in their communities.[7],[8] In circumstances in which a periodontist is not available to provide consultation, general dental practitioners may be called upon to diagnose and treat basic periodontal problems [Figure 1].
Figure 1: A conceptual model of “tele-periodontic”

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Methodology of tele-periodontics

Like in other branches of telehealth, two basic techniques can be used for tele-periodontics. One is the more common, store and forward technique and the other is the real-time videoconferencing technique.

Store-and-forward technology,[9],[10] which is more commonly used in teledentistry, is less expensive, utilizes clinical photos and data that are captured and digitally stored. This can then be transferred to a remote periodontist for review. The dental practitioner collects all the required clinical information and digital intraoral and extra oral images and radiographs (or scanned, originally no digital images) and forwards them to a specialist for consultation and treatment planning via established networks and/or the Internet and treatment is provided in a far timelier, targeted, and cost-effective manner. The dental practitioner can then consult with the periodontist by telephone or E-mail.

Real-time videoconferencing allows people at two or more sites to communicate with each other using a digital screen to display a video image of the person or people at either or both sites.[10] A video camera and speaker phones are used to enhance the visibility and audibility of people at both the ends. Usually, both parties agree upon a meeting time and information that is exchanged in real time is transmitted simultaneously between sites. This allows for a feasibility to verbally clarify points, add comments also allows for a more in-depth discussion and personal contact. Real-time video is more interactive than store-and-forward methods. A general dental practitioner can consult with a periodontist and have a simultaneous evaluation performed. However, the equipment and high-speed network connection required to run the operations can be more expensive.[10] In addition, certain peripheral devices can be attached to the computers or the video conferencing systems, which can aid in an interactive example. For example, tele probes can be developed which can allow a remote periodontist to access the patients' periodontal parameters. Real-time medicine can involve single to multiple points of contact and can be categorized under:[11]



  1. Point to point system - One patient end connect to one specialist doctor within the hospital.
  2. Point to multi-point system - One patient end at a time connect to any of the specialist Doctors' end within the hospital.
  3. Multi-point to point system - Many doctors can connect and interact to one patient end.
  4. Multi-Point to Multi-Point System - Several patients' end simultaneously connects to different doctors' end at different hospitals at different geographical locations.


Technological requirements



  1. Hardware - Laptop, computer, mobile phones, video conferencing equipment, digital camera, X-ray digitalizer, X-ray unit
  2. Software - Image acquisition, storage



    • Audio and video coding and decoding software
    • Transmission




  3. Network connection - Mobile connection



    • Terrestrial connection.




Scope of tele-periodontics

All the applications used in teledentistry aim to bring about efficiency, provide access to the underserved population, improve quality of care, and reduce oral disease burden.[12] From the view point of periodontics the scope of the proposed field of tele-periodontics can be summarized as under:

Tele consultation

The general dentist can send all the pertinent information (radiograph of the area, an intraoral photograph, all charting and health history information) of a patient with a periodontal abscess, via the internet to a periodontist who would then evaluate and suggest the appropriate treatment plan. The general dentist can then prescribe the appropriate antibiotics as suggested by the periodontist and send the patient to the specialist for periodontal surgery (if necessary) after resolution of the lesion. These simple teledentistry consultations not only lessen the patient's travel, but also prepare the area for treatment, as well as relieve him/her of his/her discomfort.

If a medically compromised patient were seen in a tele-periodontics dental practice, the technology would allow for easy interdisciplinary consultations enhancing the concept of holistic health care.

Tele diagnosis

Diagnosis of specific lesions, if not interpreted by the general practitioner can be assisted by a periodontist. This will help in rendering timely treatment of the condition until the patient is required to be seen by the periodontist.

Tele treatment

Various emergency and nonemergency prescriptions can be suggested by the periodontist to the practicing dentist who would appropriately deliver the needful.

Tele monitoring/tele support

Tele monitoring involves monitoring patients who are not at the same location as the health care provider. In general, a patient will have a number of monitoring devices at home, and the results of these devices will be transmitted via telephone to the health care provider. Tele monitoring may stand as a good platform for monitoring the patients after various procedures like periodontal surgeries. Supportive periodontal therapy can be delivered to patients across geographic distances. Periodontal maintenance visits can also be greatly reduced by monitoring them live with the help of tele monitoring. Tele monitoring is a convenient way for patients to avoid travel and to perform some of the most basic work of healthcare for themselves.

Tele education

Distance education is another frontier of tele-periodontics, which envisions a better understanding of the subject of Periodontics and scaling new heights in information and science transfer. Formal online education can be divided into two categories: Web-based self-instructions and Interactive videoconferencing. The Web-based self-instruction educational system contains information that has been developed and stored prior to the user access to the program. The advantage of this system is that the user can control the pace of learning and can review the material as many times as he or she wishes. Interactive videoconferencing conducted via plain old telephone system, satellite, Integrated Services Digital Network or internet, includes a live interactive videoconference as well as the provision for exchange of patients' supportive information. The specialist can have a live view of the patients' oral condition, and he can opine regarding the treatment planning for that particular patient. This system can also operate in the absence of the patient where the supporting information of the patient (such as patient's medical history, radiographs) can be exchanged among the dental surgeon and periodontist.

Tele training

Tele-periodontics can be used as a teaching tool, by which experienced periodontists can observe, show and instruct staff in another location, certain diagnostic, surgical and other novel techniques. This can be a doctor-doctor, doctor-student association or group training program.

Tele pharmacy

This would aid in the monitoring and management of acute conditions of the oral cavity or other oral lesions associated with systemic diseases. The primary aim would be to procure and dispense certain newer or rare drugs, which are usually unlikely to be available in a rural setting.

Scope of tele-periodontics in India

Effective dental care in an Indian rural setting has various limitations and barriers which include inadequate health infrastructure and clinical services, paucity of qualified doctors, the nonavailability of specialist care, the late discovery of the ailment, the delay in the delivery of the treatment due to the greater time which is required for the transport of the patients to urban healthcare facilities. Provision of dental care by inexperienced primary healthcare service providers is another setback. Patients also prioritize their primary medical ailments over dental problems and dentists are usually approached only in an emergency (usually severe pain). Periodontal disease being a silent disease is the most neglected oral problem, and patients would usually not reciprocate unless the teeth are exfoliated. Furthermore, due to the abundance of superstitions, baseless nonscientific remedies and myths about dental treatment, it is a common tendency for the patients to self-medicate.

Patients are also not aware of the various preventive regimens, which would otherwise reduce the disease burden.

In the noble context of benefiting the grass root population of India, the Indian Space Research Organization (ISRO)[11] has successfully implemented a number of projects in telemedicine/tele-health, which is of great social relevance to the country for enabling specialty healthcare to the remote, rural and underserved population. ISRO has successfully linked various hospitals and healthcare centers in remote rural areas with specialty hospitals in cities through INSAT satellites. Thus, connectivity between patients at the remote end and the specialist doctors at urban centers has been effectively established.

Various challenges

The biggest challenge for the concept of tele-periodontics/teledentistry or rather any field of telehealth, especially in a country like India is the feeble infrastructure to meet all the technological requirements which include computers with substantial hard drive memory, a significant amount of RAM, and a speedy processor, a digital camera, intraoral camera, a panoramic digital X-ray unit, preferably portable, good connectivity speeds to the Internet, software capable of image acquisition and storage, and transmission of the gathered information. Poverty and illiteracy are other issues, which pose a challenge to this concept. Licensure of teledentistry practice largely depends upon the country definition of teledentistry. The most significant barrier to a nationwide teledentistry practice is the traditional system of state-by-state licensing.[13] Moreover, there exists a possibility that patient information will be intercepted, despite maximum efforts to maintain security there by violating patient confidentiality.[14]

Other potential challenges exist, like-necessity for appropriate training, pressure for an instant response, message-misunderstanding and possibility to overlook/neglect the messages.[15] Certain other limitations also include the cost of the telecommunication equipment and the payments of the consultants who provide the tele consultation services and reimbursement for these services has been a constant issue in the recent years.[15]


   Conclusion Top


Teledentistry though it has its limitations and legal issues such as licensure, jurisdiction, and malpractice, as well as technological and security related issues, it still holds a lot of promise and potential in patient management over geographic boundaries.[16] Tele-periodontics can be used as a valuable tool for providing dental care in rural areas, where there is a paucity of specialists and a lack of comprehensive and sophisticated health care. It also provides new opportunities for dental education by providing the primary care professionals with an easy access to efficient consultation and by helping in conducting postgraduate education and continuing dental education programs. This new technology-based approach although might encounter a few initial teething problems, it is bound to see newer frontiers of health care delivery, which is pivotal in an Indian scenario. Not only bringing a smile on the lips of the rural millions, the concept may throw light on manifold issues transcending geographic boundaries including distance education, international collaborations and live interactions widening the frontiers of periodontal health care. The infinite potential of this field needs to be explored with a goal of delivering periodontal care, barring all geographic boundaries and distances.


   Acknowledgement Top


I would like to acknowledge the help rendered by Dr. Sumayya Farha, Post graduate, Department of Periodontics, SSCDS, Vikarabad, in helping me with the figure.

 
   References Top

1.
Association of American Medical Colleges. Medical School Objectives Project: Medical Informatics Objectives. Washington: Association of American Medical Colleges Publications; 1998. p. 3-15s.  Back to cited text no. 1
    
2.
Nakajima I, Sastrokusumo U, Mishra SK, Komiya R, Malik AZ, Tanuma T. The Asia Pacific Telecommunity's Telemedicine Activities. IEEE Xplore.com website; 2006. p. 280-2.  Back to cited text no. 2
    
3.
Cook J. ISDN Video Conferencing in Postgraduate Dental Education and Orthodontic Diagnosis. Learning Technology in Medical Education Conference 1997 (CTI Medicine); 1997. p. 111-6.  Back to cited text no. 3
    
4.
Kopycka-Kedzierawski DT, Billings RJ. Teledentistry in inner-city child-care centres. J Telemed Telecare 2006;12:176-81.  Back to cited text no. 4
    
5.
Chen JW, Hobdell MH, Dunn K, Johnson KA, Zhang J. Teledentistry and its use in dental education. J Am Dent Assoc 2003;134:342-6.  Back to cited text no. 5
    
6.
Rocca MA, Kudryk VL, Pajak JC, Morris T. The evolution of a teledentistry system within the Department of Defense. Proc AMIA Symp 1999;1:921-4.  Back to cited text no. 6
    
7.
Allukian M Jr. The neglected epidemic and the surgeon general's report: A call to action for better oral health. Am J Public Health 2000;90:843-5.  Back to cited text no. 7
    
8.
Beetstra S, Derksen D, Ro M, Powell W, Fry DE, Kaufman A. A "health commons" approach to oral health for low-income populations in a rural state. Am J Public Health 2002;92:12-3.  Back to cited text no. 8
    
9.
Reddy KV. Using teledentistry for providing the specialist access to rural Indians. Indian J Dent Res 2011;22:189.  Back to cited text no. 9
[PUBMED]  Medknow Journal  
10.
Sanchez Dils E, Lefebvre C, Abeyta K. Teledentistry in the United States: A new horizon of dental care. Int J Dent Hyg 2004;2:161-4.  Back to cited text no. 10
    
11.
Available from: http://www.isro.org/publications/pdf/Telemedicine.pdf. [Downloaded on 2012 Mar].  Back to cited text no. 11
    
12.
Khan SA, Omar H. Teledentistry in practice: Literature review. Telemed J E Health 2013;19:565-7.  Back to cited text no. 12
    
13.
Sfikas PM. Teledentistry: Legal and regulatory issues explored. J Am Dent Assoc 1997;128:1716-8.  Back to cited text no. 13
    
14.
Mittal S, Garg S. Teledentistry a new trend in oral health. Int J Clin Cases Invest 2011;2:49-53.  Back to cited text no. 14
    
15.
Jampani ND, Nutalapati R, Dontula BS, Boyapati R. Applications of teledentistry: A literature review and update. J Int Soc Prev Community Dent 2011;1:37-44.  Back to cited text no. 15
    
16.
Golder DT, Brennan KA. Practicing dentistry in the age of telemedicine. J Am Dent Assoc 2000;131:734-44.  Back to cited text no. 16
    


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