Dentistry, virtually: teledentistry in Minnesota and beyond

In March 2020, as the United States scrambled to lock down and slow the spread of the COVID-19 outbreak, routine dental work slowed to a halt. Unable to keep up with needed PPE and in response to executive orders preventing non-emergent care, Minnesota dentists couldn’t see their patients. Revenue stopped -- and yet, toothaches and mouth sores and questions of “is this normal?” continued.

How could patients receive the care they needed without wasting time and money in the emergency room?

“It was a perfect storm,” explained Maria Kunstadter, co-founder of The Teledentists and recent Continuing Dental Education presenter. Situations like these were exactly why she’d created her teledentistry organization in 2014: to provide a dentist “in all the wrong places people need care.”

Though teledentistry has existed in many forms since introduced for military use in the 1990s, the COVID-19 pandemic made it a household name. Insurance companies began covering virtual dental visits, HIPAA restrictions temporarily relaxed, and the demand for a video appointment grew exponentially. Suddenly, the world was open to what Kunstadter and others have explored for years.

Teledentistry at the School of Dentistry

While the first occurrence of teledentistry in Minnesota dates back to 2001, when AppleTree Dental established it as a mode of virtual care, the study of its use more broadly began in 2014 at the University of Minnesota with a Delta Dental of Minnesota Foundation grant.

The grant allowed the General Practice Residency clinic to integrate care throughout rural Minnesota with a hub and spoke model for four years, before the project was discontinued due to unforeseen obstacles. But that wasn’t the end of virtual oral health care.

Elise Sarvas, DDS, MSD, MPH, created a teledentistry section for students within their pediatric rotation. Angela Hastings, DMD, an assistant professor in the school’s Outreach division, contracts with teledentistry organizations and has participated in continuing education programs on the concept of dental telehealth.

“Teledentistry is no longer the future. It’s here. The doors that the pandemic opened to virtual specialty consultations and communication with patients won’t be closed any time soon.” - Laurence Gaalaas, DDS, MS

More recently, a 23-member telehealth group convened through the Office of Academic Clinical Affairs included participation from Laurence Gaalaas, DDS, MS, Rachel Uppgaard, DDS, and Jeff Karp, DMD, MS. The three studied and implemented teledental efforts in radiology, oral and maxillofacial surgery, and pediatrics, respectively, in an attempt to determine whether a more robust teledentistry effort could be created at the School of Dentistry.

For Gaalaas, who sees radiology as an ideal place for telemedicine due to the use of digital scans, the pilot was a reminder of the need for significant administrative support in telehealth. IT also reaffirmed his belief that “just because you used to do something a certain way doesn’t mean it’s the best way or even the only way to do it.”

While none of the pilot projects thus far have resulted in a more robust teledentistry program at the school, they have served as guiding experiences in reaching a greater patient population.

Spreading the virtual word

Despite its challenges, School of Dentistry experts believe in the promise of telehealth.

“Teledentistry is no longer the future. It’s here,” explained Gaalaas. “The doors that the pandemic opened to virtual specialty consultations and communication with patients won’t be closed any time soon.”

That’s one reason Continuing Dental Education hosted a webinar on incorporating teledental services into a dentistry practice this semester. It featured the School of Dentistry’s Angela Hastings, Odyssey Management owner Teresa Duncan, and The Teledentists’s Maria Kunstadter. The three presenters shared their experiences embracing teledentistry, as well as some tips and guidelines for dental practices hoping to incorporate synchronous or asynchronous teledentistry efforts into their patient care experiences.

Hastings expressed the cost-saving mechanism that comes with the availability of teledentistry; “Over $1.6 billion is spent each year on dental visits in the emergency room that could be better treated in a regular dental clinic,” she explained. “Teledentistry can help keep patients out of the ER and provide access to those who can’t easily travel to the dentist.”

She provided information on the history, goals, and responsibilities of oral telehealth providers before Teresa Duncan shared her perspective. “It’s about eliminating friction,” Duncan explained. “Friction is what stands between you and what you want.”

Duncan explored how teledentistry removes friction for the patient, extends office hours, and provides for better conversation between the provider and the patient. She even provided scripts of potential conversations each member of the team might have with a patient during synchronous or asynchronous care.

Finally, Maria Kunstadter inspired attendees with her story of creating a teledentistry business and sharing her own perspective. “We write history,” she said. “Teledentistry in your practice is writing history right now.”

She encouraged providers to think of the benefits for themselves and their patients. “This could be the most personal interaction you’re able to have with your patients moving forward.”

Kundstadter shared the benefits of teledentistry, the best ways to prepare, and her recommendations for treating teledentistry as a true patient visit.

“It took a pandemic to make teledentistry a household word, but now it’s going to stay that way.”

High hopes for the future

Through its implementation, heavy lifting, and acceleration brought on by the COVID-19 pandemic, teledentistry experts at the School of Dentistry and beyond know that it’s only going to become more prevalent.

“Teledentistry has become a household word,” Kunstadter explained. “It’s just a new way of using technology for better service.”

Hastings agrees, and says it’s worth the effort.

“Teledentistry will never replace in person dental visits,” she explained. However, “in public health, we need to be concerned about who is not in our chairs as much as who is. Teledentistry visits are economical and can provide a first point of access and education for patients that may not otherwise receive dental care.”