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GOOD AFTERNOON

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TELEDENTISTRY

CHAITANYA.PIII MDSDept of Public Health Dentistry

Contents• Introduction• Benefits of teledentistry• Highlights of teledentistry• Scope of teledentistry in India• Forms of teledentistry• Teledentistry services• Teledentistry delivery mechanisms• Technology and equipment for designing teledental model• Teledental application Software• Various applications in dentistry• Teledentistry in various countries• Conclusion• Reference

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synonyms

TELEDENTISTRY

TELEHEALTH

TELECONSULTATION

E-HEALTH

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• The initial concept of teledentistry developed as part of the

blueprint for dental informatics, which was drafted at a 1989

conference funded by the Westinghouse Electronics Systems

Group in Baltimore.

• Teledentistry was put into practice in US army in 1994 by doing

dental consultations on person located more than 100 miles

apart. Since then, various institute and organization have

practiced teledentistry with varying degree of success

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Origin

INTRODUCTION

• Dental care is being constantly transformed by the

opportunities which are provided by technology and

telecommunication

• Teledentistry is the use of information technology and

telecommunications for dental care, consultation,

education, and public awareness.

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TELEDENTISTRYCook(1997) defined it as “the practice of using video-conferencing technologies to diagnose and to provide advice about the

treatment over a distance”

TELEMEDICINE“The combined use of

telecommunications and computer technologies to improve the efficiency

and effectiveness of health care services by liberating caregivers from traditional

constraints of space and time and empowering consumers to make

informed choices in a competitive marketplace”

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BENEFITS OF TELEDENTISTRY

Improved access

Cost efficiency

Patient demand

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Dentists and dental hygienist in remote areas can link to specialists in larger communities through teledentistry.

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HIGHLIGHTS OF TELEDENTISTRY

• Improve access to care. • Improve the delivery of health care.• Lower its costs. • Needed resource for dental consulting.• Referral for specialized care• Dental monitoring.• Dentist-laboratory communications.• Continuing education.

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• Prime Minister, Julia Gillard, and Minister for Broadband, Communications

and the Digital Economy, Senator Stephen Conroy, look on Associate Proffesor

Matt Hopcraft conducts a teledentistry trial at Melbourne University.

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SCOPE OF TELEDENTISTRY IN INDIA

India has opened up to telemedicine to address various issues like:

• Inadequate health infrastructure and clinical services,• Paucity of qualified doctors, • Non-availability of specialist care,• The late discovery of the ailment, • The delay in the delivery of the treatment due to the

greater time required for the transport of the patients to urban healthcare facilities and the provision of healthcare by inexperienced primary healthcare service providers.

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• In 1999, the Department of Information Technology, the

Ministry of Communications and Information Technology

(Government of India) launched a pilot project which was

entitled, ‘Development of Telemedicine Technology’, with the

objective of reinforcing the national healthcare delivery

system

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The key specifications of the project include

To identify the appropriate technological tools and services required to

implement telemedicine at the three premier hospitals

• All India Institute of Medical Sciences (AIIMS), New Delhi,

• The Post Graduate Institute of Medical Education and Research at

Chandigarh

• The Sanjay Gandhi Post Graduate Institute of Medical Sciences at

Lucknow (Uttar Pradesh).

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To develop and carry out system integration to enable

telemedicine technology and for establishing telemedicine

services (teleconsultation and telediagnostic services for the

specialties of radiology, cardiology and pathology and

teleeducation) at three tertiary level hospitals.

To train clinicians in the use of telemedicine technology

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Forms of teledentistry

Real time consultation Store and

forward

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Real time consultation

Transfers the information immediately

Dentist and patient at different location can see,

hear and communicate with each other using advanced

telecommunication technology

Store and forward

Allows data to be stored in a local database to be forwarded as needed.

Collecting all the patient information and images, storing that data for review by a dentist specialist at a later time. Later,

the dentist reviews the information make a diagnoses

and a treatment plan.

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Real time consultation

Store and forward

TELEDENTISRY SERVICES

SPECIALIST REFEREL SERVICES

PROFESSIONAL EDUCATION

PATIENT CONSULTATION

CONSUMER MEDICAL AND

HEALTH INFORMATION

REMOTE PATIENT MONITORING

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• POTS (plain old telephone system)

• Networked programs

• Point-to-point connections

• Primary or specialty care to the home connections

• Home to monitoring center links

• Web-based e-health patient service sites

TELEDENTISTRY DELIVERY MECHANISMS

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• Networked programs link hospitals and clinics with outlying

clinics and community health centers in rural or suburban

areas by the use of dedicated high-speed lines or the

Internet

• Point-to-point connections using private networks , used by

hospitals and clinics that deliver services directly, or contract

out specialty services to independent providers, at

ambulatory care sites

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• Primary or specialty care to the home connections

involves connecting primary care providers, specialists

and home health nurses with patients using single line

phone video systems for interactive clinical consultations

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• Home to monitoring center links are used for patient

monitoring, home care and related services that provide

care to patients in the home, using normal phone lines and

internet

• Web-based e-health patient service sites provide direct

consumer outreach and services over the Internet. Under

telemedicine, these include sites that provide direct patient

care

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Technology and Equipment for Designing a Teledental Model

There is no recommended list of equipment, hardware or

software for designing a teledental model.

Factors determining selection of technology and

equipment for designing a teledental model:

- budget,

- Technology

-infrastructure

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TELEDENTAL EQUIPMENTExtra oral digital camera

Intra oral digital camera

Video conferencing system

Digital radiographic system

Portable dental radiographic system

Laser and Fluorescence Caries Detection Devices

Computer

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COMPONENTS THAT FACTOR INTO DESIGNING A TELEDENTAL MODEL

Information technology (IT) infrastructure,

Networks,

Telecommunication services, Data security,

Real time video conferencing vs.

store and forward communication,

Comfort with technology

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TELEDENTAL APPLICATION SOFTWARE

Dental management

software

Imaging software

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FOUR COMPONENTS TO CONSIDER WHEN CHOOSING MANAGEMENT SOFTWARE

Dental records

Dental billing

Appointment scheduling

Reporting requirements29

• Dental records – allows for the collection of data critical in

the clinical management of patients, including patient

charts and histories.

• Dental billing – may be a factor in choice of software. The

billing and revenue component of management software

allows for the management of patient financial records.

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• Appointment scheduling – management of appointments

and scheduling can be a part of the management

software. The software is designed to track patients from

the moment they are entered into the system and also

tracts missed, rescheduled, and canceled appointments.

• Reporting Requirements – Most dental management

software has built in reports.

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Various application

in Dentistry

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ORAL MEDICINE• High resolution images and a broad spectrum of colors

(32-bit or more), is able to provide high quality

consultation even with the colleagues at a distance of

several hundreds of kilometers (between two or several

experts at a time) lesions are electronically photographed

using a 50 mm macro lens and circular illumination

system, and clinical and anamnestic data are stored in a

textual file with minimal resolution of 600 dpi.

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• The files are renamed according to the patients’

identification numbers in order to avoid confounding and

identity errors.

• Specialist then analyze independently the obtained

images and clinical information. They make the diagnosis

(usually one or two) and electronically return the results

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Through teledentistry consultations and imaging, diagnosis of oral pathology

and oral conditions in remote areas can be improved

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PROSTHODONTICSCAD- CAM

Dentists and dental technicians who are not very skillful , the usual

practice is to request teledentistry help of computerized dentistry

specialists.

The resulting project file is encrypted and sent by e-mail to a

teleconsultant for model analysis, projection of the shape of

restoration, of its height and interjaw relationships using a virtual

articulator

The completed project is then encrypted and returned to the clinic,

usually by e-mail38

PEDIATRICS AND PREVENTIVE DENTISTRY

• Reducing their fear and anxiety in children compared to

clinical examination in real time.

• An intraoral camera - take dental photographs from any

available angle; in addition, sufficiently strong and

focused illumination from the camera itself is required,

as well as optical or software reduction of light reflected

from the smooth surface of the teeth.

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• Together with high resolution, the obtained digital

image is able to demonstrate initial caries stages or

enamel and dentine pigmentations.

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ENDODONTICS• Teledentistry methods based on internet, diagnosis of periapical

lesions can be adequately assessed.

• Based on that, a necessary plan can be devised for a proper

endodontic or oral surgical management of these lesions.

• Teledentistry based on internet as a medium for distant

communication enables its use worldwide, wherever the world

wide web is present as a wire or wireless connection, reducing the

costs of management and increasing the availability of urgent help

to all patients

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The method is based on the creation of digital information for each of the teeth of interest

sequence of digital extra oral photographs (frontal and

bilateral)

• sequence of digital intraoral photographs (vestibular

portion of the alveolar ridge in the area at the level of

tooth root, palatal/lingual portion of the alveolar ridge of

the target tooth, and dental crown)

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• Using mobile Internet connection, photographs and text are

uploaded to an on-line server.

• Distant consultants, specialist in endodontics, are informed via

their mobile phones about the received request,

• After which they download the digital images and accompanying

data. They establish the diagnosis and suggest a treatment, then

post these information on an on-line server, which informs the

consultation-requester dentist about the received response

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ORTHODONTICS• Orthodontic specialists, after taking dental impressions of the

jaws, instead of casting jaw models in plaster, send the

impressions by special postal service to specialized companies

for 3D digitization of working models.

• Then they create digital 3D models using patent-protected

systems for 3D scanning and digitization, form a computer file,

and return it via Internet to the therapist.

• The therapist share this digital model of the jaws with others via

network, effectuating necessary consultations with his

colleagues. 47

•

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ORAL AND MAXILLOFACIAL SURGERY

• The advances and availability of smartphone technology

have contributed to the feasibility and availability of

telemedicine in oral and maxillofacial surgery.

• Smart phones are able to read and display 3D computer

reconstructions of head skeleton, giving instantly the

necessary information to distant teleconsultants in oral

and maxillofacial surgery.

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• Even on the move, they are able to record the consultation

and send an answer.

• It is very useful in emergency conditions requiring

immediate interdisciplinary consultation.

• Maxillofacial surgeons are thus able to monitor the

condition of their patients even after very complex

interventions, such as osteotomies, removal of ameloblastic

fibromas etc.

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• Implant placement• Complicated impaction removal

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TELEDENTISTRY AND ITS USE IN RURAL AREAS

• In rural areas, shortage of specialists, the lack of

comprehensive and sophisticated health care is a

problem.

• Increase the accessibility of the specialists to the rural

and underserved communities for their dental needs,

decreasing the time and the cost which are associated

with the specialty consultations

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TELEDENTISTRY AND ITS APPLICATION IN DENTAL EDUCATION

• The Web-based, self-instruction educational system

• Interactive video-conferencing

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The Web-based, self-instruction educational system

• Web-based dental continuing education or the CE

courses

• That lack of face to face communication with their peers

and instructors could result in dissatisfaction.

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Interactive video-conferencing

Includes :

A live interactive video-conference with a proper camera

set up where the patient’s information can be transmitted

Supportive information (such as the patient’s medical

history, radiographs, etc) that can be sent before or at the

same time (for example, via fax) as the videoconference.

The advantage - the user can receive an immediate feedback

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TELEDENTISTRY AND ITS ROLE IN POSTGRADUATEEDUCATION AND DENTAL PRACTICE

• Good tool for educating postgraduate students and for providing

continuing updates for the practicing dentists.

• In interactive video-conferencing, the patient information is evaluated

first (with or without the patient’s presence), which allows for the

interaction and feedback between the educator and the students.

• The patient cases can be reviewed thoroughly and at the students’

pace. The cases can be discussed at length after all the clinical data

have been collected and transmitted, without the patient being

present at the scheduled meeting. This enhances the students’

enthusiasm and provides new learning opportunities for the dental

students and the practicing dentists. 59

TELEDENTISTRY IN VARIOUS COUNTRIES

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5Areas adopted teledentistry

Service provided Technology

University of Minnesota School of Dentistry

to increase access to dental specialty care in rural

real-time videoconferencing technology

The Melbourne Dental School’s Oral Health Cooperative Research Centre

dental health care amongst aged and remote patients

using the National Broadband Network

Arizona Department of Health Services, Office of Oral Health (OOH)

Increase availability of the oral health workforce and accessibility of oral health services to underserved populations and underserved areas in Arizona

to increase access to dentalcare for underserved and at-risk populations

The Children’s Hospital Los Angeles Teledentistry Project, +University of Southern California’s Mobile Dental Clinic

increases and enhances the quality of oral health care provided to children living in remote rural areas of California,

ISDN (Integrated Services Digital Network)

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Challenges……

• The teledentistry examination is not a face-to-face. You have to rely

on judgment of the other practitioner’s examination.

• Productivity can be another issue as new practitioners become

accustomed to the technology.

• Teledentistry initially takes a longer time compared to their regular

office visits. When they get used to the system, they get more

efficient.

• In India uneducated population, below the poverty line and lack of

infrastructure is major challenge.

Future perspective of teledentistry

Various measures that can be employed for the effectiveimplementation of teledentistry are:• The instructors of the teledentistry education courses need

to be well versed with computer knowledge and they should have adequate teaching experience

• The practitioners who are engaged in teledentistry must have a license in each state in which they practice

• Dentists who are engaged in teledentistry must make every effort to ensure the security of their systems, as well as of any data that they may transmit.

For example, data encryption, password protection and user access logs can help in deterring most of the people and in protecting patient confidentiality

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Limitation• Teledentistry has yet to be accepted as a widely used or

fully accepted adjunct to dentistry. Many constrain are also

there for example, technical, legal, educational and

insurance etc.

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conclusion With all the technological developments taking place in the

field of teledentistry, practitioners may eventually link up to virtual dental health clinics and an entirely new era of dentistry can be created. The future might also see distant telemedical control of robotized instruments in situations with long-term unavailability of dental care, e.g., during space flights, on transoceanic ships, and in various rural areas. The results achieved so far are very encouraging, setting the road signs for future investigations. However, a number of things have to be addressed before teledentistry can rise to its peak. Further studies involving greater number of participants will be required to validate the various aspects of teledental applications.

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REFERENCES

• Jung-wei chen et al: Teledentistry and its use in dental

education. JADA, March 2003 Vol. 134.

• Ajay Bhambal et al: Teledentistry: potentials unexplored!.

J. Int Oral Health, 2010; Volume 2 (Issue 3).

• N.D. Jampani et al: Applications of teledentistry: A

literature review and update. J Int Soc Prev Community

Dent. 2011 Jul-Dec; 1(2): 37–44.

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• Nidhi Chhabra et al: Role of Teledentistry in Dental Education:

Need of the Era. Journal of Clinical and Diagnostic Research.

2011 November (Suppl-2), Vol-5(7): 1486-1488

• Rajan shirolkar et al: Teledentistry : An art and science of

healing. JIndianAcadOralMedRadiol, 2011; 23(2): 108-111

• Mittal Sanjeev, Teledentistry a new trend in oral health.

International Journal of Clinical Cases and Investigations

2011. Volume 2 (Issue 6), 49-53.67

• Paul Glassman et al: Using Telehealth Technologies to

Improve Oral Health for Vulnerable and Underserved

Populations. CDA journal,July 2012: vol 40( 7); 579-588.

• Gaurav Chandra et al: Teledentistry in India: Time to

deliver; Journal of Education and Ethics in Dentistry. July-

December 2012,Vol. 2, Issue 2.

• Ramesh Nagarajappa et al: Teledentistry: Knowledge and

Attitudes among Dentists in Udaipur, India. OHDM 2013,

Vol. 12 (3). 68

• Vikas Singh et al: Teledentistry: it’s all about access to care. TMU

J. Dent 2014, Vol. 1; Issue 2

• Ankita Jain et al : Dental hand for rural population: Teledentistry.

Journal of contemporary dentistry, 2014; 4(1):27-29.

• D.J. Worsley et al: Evaluation of the telephone and clinical NHS

urgent dental service in Sheffield. Community Dental

Health,2016, Vol. 33, 9–14.

• http://www.intechopen.com/books/advances-in-telemedicine ap

plications-in-various-medical-disciplines-and-geographical-region

s/ telemedicine-in-dentistry-

teledentistry- last accessed on 2/7/16 69

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