Teledentistry helps keep dental patients out of the ER
If you’re like us, it’s hard to keep up with the news about COVID-19. After a conversation with a relative who’s sheltering in place in Brooklyn, New York, we looked at Worldometer, a reference website that has the latest information by individual states about the epidemic. The site explained the vast shortage of hospital beds to accommodate the peak number of patients with the new coronavirus: New York City, for example, would need 140,000 beds but has only 53,000. The problem isn’t specific to New York, either—emergency rooms across the country will be stressed.
Even before the COVID-19 pandemic, emergency rooms were seeing too many dental emergencies that weren’t true medical emergencies. A research paper from the American Dental Association Health Policy Institute1 indicated that in 2007, dental emergencies were the catalyst for more than 2? million emergency room visits, and most of those could easily have been diverted from the ER to the dental office. Now that diversion has become even more critical. Dentists can do their part by using teledentistry to help separate life-threatening emergencies from dental emergencies.
Diverting patients from the ER
Screening patients for symptoms of COVID-19 should be the first step in any teledentistry meeting. Examples of questions to ask:
Do you have fever, cough or shortness of breath?
Have you been tested for COVID-19, or has any family member been tested? Have they been exposed to anyone with symptoms of COVID-19?
Have you recently traveled to another country?
Are you a health care worker or work in a job that may have contact with persons with COVID-19, such as law enforcement, trucking or grocery store?
When performing virtual dental triage, the question needs to be asked: Is there any airway impingement, recent trauma or potential swelling that could affect the airway? An affirmative answer to the question should be a referral to the ER.
For most dental pain, though, teledentistry can be used to prescribe antibiotics and pain medicine to keep patients out of the ER. The Drug Enforcement Administration has relaxed its rules for prescribing for new patients via telehealth; it now requires a videoconference and keeping a record of it, along with a review of health and social history of the patient, before prescribing.
The Prescription Drug Monitoring Program (PDMP) operates in most states to prevent doctors from overprescribing any opioids. When a provider enters the patient’s name in the online system, fields will pop up with the number of providers and the types of prescriptions the patient has had. Not all states participate in the PDMP, however; one possible alternative is calling the patient’s pharmacy, but it is unlikely to be as complete as a PDMP. [Editor's note: The site linked earlier in this paragraph includes a full list of states that participate with the PDMP and, for many states, allows you to register as a dental provider to use this system and check on prescription status.]
Using teledentistry in nursing homes
More than $520 million a year is spent from Medicaid on dental pain in the ER.2 Many residents in skilled nursing facilities receive Medicaid/Medicare, accounting for a large part of that $520 million.
Now, most nursing facilities are in lockdown, with few or no visitors during the COVID-19 epidemic. However, time is important in assessing dental emergencies for older patients. When nursing facility patients have a dental emergency, it frequently means an already frail older adult can’t eat or drink because of dental pain, further compromising their underlying health conditions.
Teledentistry platforms such as MouthWatch TeleDent can help keep these patients, who are more vulnerable to complications of infection, from exposure to COVID-19. Access to oral care via teledentistry helps residents of nursing care facilities remain safe without losing access to dental services. (Teledentistry can also help to improve overall health outcomes for residents, such as diabetes control, aspiration pneumonia and other conditions.3)
Mobile dental companies can use their teledentistry technology to assess dental emergencies, while a providing company or on-site medical staff can provide emergency dental extractions during the COVID-19 epidemic.
For example, a certified nursing assistant can identify and report dental pain from the residents via teledentistry, and may even be able to use an intraoral camera to upload pictures of the resident’s mouth in a secure, cloud-based portal for review by the dentist.
The dentist can identify true dental emergencies, avoiding unnecessary visits to the facility during lockdown but still alleviating a patient’s pain—and avoiding any risks of emergency room visits. Even after the COVID-19 epidemic wanes, we hope that teledentistry will be used more widely in skilled nursing facilities.
When every hospital bed is needed for symptomatic COVID-19 patients, teledentistry in dental practices and nursing homes can help to divert patients in pain from the ER. We can leverage it to help do our part in fighting this terrible virus.
1. Wall, T., Nasseh, K., Vujivic, M. “Majority of Dental-Related Emergency Department Visits Lack Urgency and Can Be Diverted to Dental Offices.” Chicago, 2014. ADA Research Brief, ADA Health Policy Institute.
2. Wald, G. “Teledentistry: Virtual Care for Urgent Oral Health and Dental Problems,” 2018. Dentistry Today.
3. Müller, F. “Oral Hygiene Reduces the Mortality from Aspiration Pneumonia in Frail Elders.” J Dent Res. 2015 Mar; 94(3 Suppl): 14S–16S