Dentistry is a field that consists of evaluation, diagnosis followed by prevention and treatment of diseases of the oral cavity, not only pertaining to the dentition but also the oral mucosa and other related structures and tissues, principally in the jaw and facial area. Although it is primarily associated with teeth, dentistry also includes other aspects of the craniofacial and maxillofacial complex, including the temporomandibular joint along with other supporting, muscular, lymphatic, nervous, vascular, and anatomical structures.

As we enter a new era in terms of technology, there has been an immense change when it comes to patient care and management too. We are all aware that during and post COVID-19, the approach towards dentistry will totally change. Dental surgeons, dental assistants, and dental receptionists are the people generally working in a dental setup. The risk of contraction of COVID-19 through direct transmission secondary to cough, sneezing, droplet infection, contact transmission, and aerosol production while treating a COVID-19 positive patient is very high. Keeping all this in mind, we need to find a better way of dealing and providing excellent care to patients while ensuring their and our family’s safety as well. 

As Oral Medicine and Radiologist, we are diagnosing and making treatment plans for patients before referring them to a concerned specialty. It has become even more difficult for people, especially those with disabilities and special needs and also the elderly to visit the dentist. Here, Teledentistry will play a major role. Teledentistry is a combination of telecommunications and dentistry involving the interchange of clinical information and digital images over remote distances for dental Consultation and treatment planning. 

In Oral Medicine and Radiology, we come across patients with oral ulcerative lesions or soft tissue ulcers who can get their photographs clicked with smartphones and send them to the dentist. The dentist can analyze these photographs and give suitable advice and medications through tele-prescription after enquiring about patient’s medical allergy history. Digital Intraoral radiographs, Orthopantomogram (OPG), and Cone Beam Computed Tomography (CBCT) reports can be sent to oral and maxillofacial radiologists in cases of cysts or tumors for early and timely diagnosis, following which a due course of treatment can be planned. 

Teledentistry has the ability to improve oral healthcare infrastructure by improving its delivery which can further reduce the cost of oral healthcare. It also has the potential to eliminate the disparities in oral healthcare between rural and urban communities. The Consultation is usually carried out through a live video chat or through the exchange of photographs. If the dentist finds any discrepancy, they advise the patient to visit a local dentist for further evaluation. Various authors have successfully proved the use of Teledentistry in oral medicine in community dental service. They have suggested that telediagnosis is an effective alternative in the diagnosis of oral lesions using the transmission of digital images via email. 

To understand Teledentistry better, we should first try to understand what Teleconsultation is. Teleconsultation is defined as synchronous or asynchronous Consultation using information and communication technology to omit geographical and functional distance.

Teleconsultation through Teledentistry can take place in either of the following ways –

• Real-Time Consultation includes a video conference where dentists and their patients can see, hear, and communicate with each other in different locations.
• The Store and Forward method involves sharing clinical information and static images that are collected and stored by the dentist, who forwards them for advice and planning treatment for the patient who is not present during “office hours.”
• A third method is known asthe “Remote Monitoring Method,” has also been described in which patients are monitored remotely, and this type of method can be performed in the hospital or at home.
• The literature also mentions the “Near Real-Time,” which is a low resolution, low frame rate product that looks like a jittery television.

Although Internet-based Teledentistry takes precedence over other communication channels, there are also potential shortcomings such as: 

• The cost of telecommunications equipment can be a cause for concern.
• There would be a necessity for appropriate training.
• There will be pressure for an instant response.
• There would be a misunderstanding of messages.
• Privacy concerns need to taken care off.
• And finally, the possibility of overlooking or neglecting messages. With the advent of technological developments taking place in the field of Teleconsultation and Teledentistry, dental practitioners will soon be able to set up their own tele-clinics or virtual dental health clinics. This will lead to an establishment of an entirely new era in dentistry.

In the areas and situations where there is an inability of dental staff or treatment to take place, such as space flights, ships, and distant rural areas, there is a possibility of commencement of distant telemedical control of robotized instruments. 

Before Teledentistry can take its peak, a number of things have to be considered, and a lot of work and hard work needs to be put from our side as practitioners. Furthermore, studies involving a greater number of participants will be required to validate the various aspects of teledental applications.

Dr. Komal Sharma, Senior Lecturer, Department of Oral Medicine and Radiology, Faculty of Dental Sciences, SGT University