For Dental Professionals and Organizations

For Dental Professionals and Organizations

What is Teledentistry?

In the dictionary sense, teledentistry is the dental form of telemedicine, the use of telecommunications and allied technologies to deliver and coordinate care. In a practical sense, teledentistry means connecting everyone involved in the dental care journey for more seamless and efficient care.

Overlapping definitions of teledentistry

Teledentistry has sometimes in the past been used to describe only the orthodontic /aligner uses of teledentistry but the use cases are much broader.

Teledentistry as a term has also been historically associated with rural use cases and solving access to care disparities. While teledentistry can fulfill those goals, it’s not limited to those use cases either. It’s useful to think about teledentistry as a suite of communication technologies that facilitate both patient-provider and provider-provider communications, as well as facilitating the care-oriented management of clinical data and provider and organization workflows. Teledentistry is more than a video call. 

Read more on What is Teledentistry?

Teledentistry Regulations Vary Across 50 States

Some states have specific legislation on teledentistry. Others merge teledentistry into telemedicine regulation. There’s a great variety of approaches to scope of practice, supervision, reimbursement parity, originating site requirements and even differences in what’s allowed between synchronous and asynchronous teledentistry or telehealth modalities.

How Can You Use Teledentistry in Your Setting

“What states allow teledentistry?” is for the most part the wrong question to ask since teledentistry is not an on or off switch. If you are a dentist or other dental professional, a better question to ask is, “How can I work within my state parameters to use telehealth technology effectively?” Some states incorporate dental telehealth under wider telehealth legislation. State Dental Boards have widely varying policies on scope of practice and expanded functions. Reimbursement for telehealth also varies under private payers or public payers such as Medicaid.

MouthWatch has compiled quick facts on teledentistry across all 50 states (and DC). These are from a variety of state board and state regulation sources. You should look at your state board resources on teledentistry and understand applicable telehealth, telemedicine and teledentistry laws for your particular setting. We also offer a free consultation for dental professionals or dental organizations looking to understand further how teledentistry with MouthWatch TeleDent can be deployed to meet their dental care goals.

Find Quick Facts on Teledentistry in Your State

Find out what level of teledentistry regulations exist in your state, how dental hygienists, dental assistants and expanded function dental professionals (ex. dental therapists) can use teledentistry in your state, if there is public coverage available for telehealth and if payment parity laws are in place. 

Use Cases of Teledentistry

Teledentistry or dental telehealth technologies have applications in the following key settings:

• Private practice
• Group practice or DSO
• Public health programs
• Dental education
• Medical-dental integration
• Crisis response

This means that you could deploy teledentistry from schools to nursing homes, private dental practices to pediatric offices and more.  See our guide to teledentistry use cases. 

During times like the Covid-crisis, teledentistry is a form of crisis response when offices are closed or have reduced access and dental teams maybe working remotely.

What Patient-Facing Services does a Teledentistry Solution Need to Provide?

What specifically do patients want from a dental telehealth or teledentistry solution? Once they’ve reached out to you, what are patients expecting? What must a teledentistry vendor deliver in order for you to meet patients’ needs?

The first question they need to answer is “Do you offer teledentistry?”

If existing or new patients have difficulty discovering you offer teledentistry services that make you and your team accessible now, they can’t take the next step. Make it clear in all your patient communication channels: your website, your outgoing phone message, via email campaigns, Facebook page, etc.

How do patients act on your teledentistry options?

Secondly, it should be really clear how they can act to schedule a teledentistry appointment or reach out to you with an asynchronous interaction (see above). They need to be able to answer easily, “What do I do to start?” If you’ve answered the question on your website and other communication channels about offering teledentistry, next they need to know how to start, what to do next. This can be as simple as a form they fill out on your website, or you can book them over the phone if they are calling. Provide a link wherever you can to the specific starting point. Rather than a general link to your website, link to the form or make it really clear what they need to do next. That include “call us at our office number and we can schedule you right away.”

“Can I schedule an online virtual consultation?”

“Can I schedule an online virtual consultation?” Patients across the board are not only getting used to the idea of telehealth but expecting it as an option. Now more than ever. That may mean in their mind a live video consultation where they can see and talk with a professional face to face.

“Can I message you with concerns and perhaps an image? Can I do it from my phone?”

“Can I message you with concerns and perhaps an image? Can I do it from my phone?” This asynchronous mode of teledentistry is preferred by some patients, and certainly can be more efficient for some dental professionals. If the patient has sent diagnostically useful images and a good description of their complaint, you may have the evaluation already completed by the time of the video consult or can skip that step entirely.

“How to I access my patient and exam data after the video consult?”

“How to I access my patient and exam data after the video consult?” If your teledentistry platform enables a patient portal with clinical data sharing, then you have an easy answer. With TeleDent by MouthWatch the way that works is that patients follow a link in their portal registration email to initially setup their access. From then on it’s like logging into any website. The TeleDent patient portal is where video meetings, patient messaging and file sharing all takes place.

“Will I have treatment plans I can look at and understand at home and share with a partner to discuss?”

“Will I have treatment plans I can look at and understand at home and share with a partner to discuss?” Patients won’t know yet to be asking this! You can surpass their expectations and establish yourself as the dentist they refer to friends and family by giving them visual treatment plans they can look at on any device wherever they are. This is one of the key ways to make use of a patient portal for improving the healthcare journey and your practice’s digital presence.

“How are you keeping my office visit as safe as possible?”

Dental practices are taking significant steps to make their offices some of the safest places in the world for a patient to be. Providing teledentistry communicates to patients that you are adopting technology to mitigate risks while improving patient experience. Retaining in-office visits for those really required and offering better pre-screening of patients, keeps everyone safer, including the dental team. Teledentistry builds patient confidence.

Patient Portals & Teledentistry

Not every product described as a teledentistry solution provides a patient portal. (See questions to ask platform vendors below). A patient portal is your online clinical space. Just like you wouldn’t do clinical dentistry on a crowded street, you don’t want to be using public-facing text messaging for clinical conversations. A patient portal is also a type of virtual dental home: patients know that they have a place online to go that is your digital clinical presence. The online teledentistry space where they can access their PHI securely or visual treatment plans you are sharing or to initiate a conversation or share an image.

Preparing a Space for Teledentistry Video Appointments

There are some simple steps you can take to setup a space either at a remote location or at your office to make an online video consultation be a better experience.

To help prepare a space for a video teledentistry consultation, consider the following bullet points: 

• Don’t have a door behind you. A patient might wonder, “Who’s going to walk through that door?”
• Don’t have windows behind you, even if there’s no light shining through them. Your patient might think, “Well, who’s going to walk by that window? Is the window open?” You want to make sure that they feel comfortable, that their privacy is going to be maintained.
• Try to keep it very simple visually behind you.
• Make sure there’s no light behind you that would back light you in their video view.
• Test the view from your camera. Make sure that before you meet with a patient, you know what the view is going to look like.
• Look directly into the camera. If you’re constantly looking up like that or looking over, you know, the patient may feel that they don’t have you with them. We don’t want to lose our patients trust.
• Have space around you in the camera view so the patient feels the setting is as realistic as possible. We wouldn’t have a conversation with the patient with our face right in their face. Even on a mobile phone, set your camera away from you. We don’t want to make the patient feel that their space is being invaded.

Download a guide on patient assessment via synchronous teledentistry, which includes a checklist. 

Synchronous Teledentistry: Real-time Care

Synchronous teledentistry is the technical term for live 2-way communication; think online video consultations or even a phone call. 

Synchronous teledentistry is often thought of in patient-facing terms: the live video evaluation or consultation. Synchronous teledentistry also has use cases for enriching referrals and for provider-to-provider collaborations.  

Learn more about synchronous teledentistry.

Asynchronous Teledentistry: An Efficient Alternative

One mode of asynchronous teledentistry involves recording patient’s clinical information and transferring the data to another dental professional at a separate location. This is also known as “store and forward.” Typically, store and forward refers to a provider action.

Asynchronous teledentistry is also happening if a patient securely messages a dentist an image of a tooth they have questions about and the dentist reviews and replies at a later time. |With asynchronous teledentistry dental providers can safely and securely share patient information, including radiographs, intraoral photos and clinical data with other dental providers for efficient collaboration.

Asynchronous teledentistry is a key capability to streamline treatment planning, efficiently connect with referral networks and increase patient touch points. See more benefits in a blog post on asynchronous teledentistry.

Using D9995 & D9996 CDT Teledentistry Codes

Frequently when using teledentistry, there is more than one provider involved but it’s important to know which provider will submit the code. The dentist that performs the oral evaluation, makes a diagnosis and creates a treatment plan will be the provider that reports the teledentistry CDT code.

The two full Current Dental Terminology (CDT) Code entries are:

D9995 teledentistry: synchronous; real-time encounter. (Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.)

D9996 teledentistry: asynchronous; information stored and forwarded to dentist for subsequent review. (Reported in addition to other procedures (e.g., diagnostic) delivered to the patient on the date of service.)

Teledentistry itself it not a specific service but rather a method of delivering care. When discussing the CDT codes for teledentistry, it’s important to know these codes are used in conjunction with another code, typically an exam.

As an example, a hygienist may offer mobile preventative care while having a collaborative dentist who performs an oral evaluation remotely, while the hygienist performs a prophylaxis and fluoride treatment onsite. In this example the dentist would submit CDT codes D0120 and D9996 for their exam and to report that teledentistry was used in this exam. The hygienist would report CDT codes D1110 and D1206 to report the prophylaxis and fluoride treatment performed on site.

More information and links to resources: CDT teledentistry coding.

4 Example Teledentistry Coding and Billing Scenarios

Here are 3 common scenarios in teledentistry between provider(s) and/or patients with coding guidance based on updates from the ADA:

Teledentistry Scenario 1

Patient contact with dentist who provides the consultation using audio means only

•  D0190 (screening) or D0999

Teledentistry Scenario 2

Patient contact with dentist who provides the problem focused evaluation using audio and visual means

• D0140 or D0170 or D0171

Teledentistry Scenario 3

Patient contact with triage call center who then forwards to dentist who provides the problem focused evaluation using audio and visual means

• CALL CENTER CODING: D0190 (screening) or D0999
• DENTIST CODING: D0140 or D0170 or D0171

Teledentistry Scenario 4

Patient contact with dentist who then forwards to specialist who provides the problem focused evaluation using audio and visual means. The referring dentist can be a GP or a specialist who is referring to another specialists.

• GP DENTIST CODING: D0190 (screening) or D0999
• GP OR SPECIALIST CODING: D0140 or D0170 or D0171

Now add teledentistry codes for the right modality to evaluation codes

Combine each of the above with the appropriate teledentistry CDT code:

• Synchronous teledentistry: D9995 (live, real time)
• Aysnchronous teledentistry: D9996 (store and forward, or patient messaging).

(You need to understand applicable state board policies and state regulations on teledentistry and each modality for your setting.)

Questions to Ask Teledentistry Solution Vendors

1. Was your solution designed from the beginning as a solution for dentists and their teams?

Some teledentistry platforms are really no more than video chat applications with the word “teledentistry” applied, or are from a telemedicine application rebranded for dental use. Find out if the platform has specifically been developed for the needs of dental professionals and their patients.

2. How long has the software been available for teledentistry?

Another quick way to get a sense of the solution is to find out how long has it been developed. That’s not to say that something new can’t have promise. But with the complexities of providing a robust dental telehealth suite for many use cases (not only for now, but for the long term use of your practice) it’s good to get a sense of track record. It’s not just how long a company has been around, but how long they will be around.

3. Is your software built around delivering key benefits to practices such as increased case acceptance rate?

This gets to the heart of the matter. Does the company behind the software solution understand dentists and dentistry. Is their teledentistry product built with a dental practice and its business needs in mind?

4. Does the vendor help practices deliver all 4 key features that  patients are seeking?

This is an important question, because as noted above the word “teledentistry” has wide ranging meanings. There are times when patient-facing teledentistry capabilities are key considerations.

Here are the 4 things patients will hope that the teledentistry company you select will deliver:

1. Message my dental practice with concerns and questions
2. Join simple live video consults without hassle
3. Always know where I can go to access my own data and recommendations from the practice
4. Get visual treatment plans I can really understand and easily look at together with my partner, child, etc.

5. Can dentists and teams  pivot seamlessly between patient messaging, store and forward data sharing, and live video consultations as needed by their own workflow?

Dentistry doesn’t always happen in real-time. In fact “asynchronous” teledentistry can be more efficient. Your patients can schedule a live video consult with you, but in the mean time upload a picture of what concerns them or describe it in the intake form. You may have the evaluation done by the time the video consult happens. Or, you can batch process messages from patients. Your teledentistry platform should allow you and your team to seamlessly transition between messaging and live communication modes with patients and each other.

6. Does the solution create a consolidated record of patient communications (including archiving of video consult recordings) that can be used for documentation and provider-to-provider collaboration?

If your teledentistry solution does not record and document a consolidated record of patient communications, imagine the fragmentation that’s going to take place and the difficulty of tracking where patient communication is at through a case, or providing documentation as needed for insurance or HIPAA compliance.

See 6 more questions in the full blog post on 12 questions to ask teledentistry companies.

Important Teledentistry Features for a Group or Practice to Consider

• Is the system designed for one specific task, such as video conferencing, or does it have the ability to become part of a larger teledentistry workflow?
• Does the system have HIPAA compliance?
• Is the teledentistry system mobile friendly, for both patients and providers?
• Can multiple providers participate simultaneously in a teledentistry consultation or collaboration?
• Is the teledentistry system scalable for broader opportunities?
• Is the teledentistry solution dental focused or is it a more general telemedicine solution?
• Does it offer asynchronous teledentistry, the most common type for dental?
• Can I invite multiple providers to collaborate on a case?
• Can I share images with patients?
• Will it work offline as well, in some important ways?
• Does it support billing, reporting, user management, data/practice siloing for multi-practice/state implementations?
• Does it enable web forms for patient intake?
• Does it include a secure patient portal for clinical interactions with patient, including their secure access to PHI?
• How can it create a documentable record of video chat and messaging and connect to patient record?

Teledentistry Reduces PPE Needs

Teledentistry allows providers to communicate with their patients without being in the same space, eliminating the need during those appointments for PPE.

That communication can be real-time (synchronous) or via messaging (asynchronous). 

Synchronous teledentistry allows for limited exams (commonly billable) to be provided by a dentist while the patient is at home to reduce the number of patients who need to come into the office and require PPE.

Asynchronous teledentistry allows providers to triage patients’ needs and have them fill out paperwork before an appointment, lessening the time they spend in-office. 

Dental hygienists can participate in in-office asynchronous teledentistry by storing all assessment data digitally for the dentist to view and treatment plan in a separate space. With the right teledentistry systems in place, treatment plans could then be sent digitally to a patient for acceptance and questions could be discussed by a synchronous teledentistry appointment.

A flexible teledentistry platform allows dental teams (and patients) to pivot between synchronous and asynchronous modes while retaining a consolidated record or communication and facilitating clinical record keeping. It opens the door to several strategies to both reduce PPE needs and create efficient workflows.

Marketing Your Teledentistry Services

Patients and your community need to hear about the services you offer. Here are some quick bullet points that you can use as a checklist for getting the word out:

• Update your practice’s outgoing phone message to mention your teledentistry services and how to schedule 
• Add a clear announcement on your homepage about teledentistry services
• Make sure there’s a way for people to take action: a button, a navigation item, a link, a phone number that brings them into your scheduling workflow.
• Include a mention of teledentistry on your Facebook business page, including a link to where patients can request a teledentistry appointment
  
• Post about new teledentistry options on our social channels.
• Update or create your Google My Business listing to include telehealth services with links to where to book your teledentistry appointments.
• Sent a press release to local papers, tv outlets, business chamber, and relevant local organizations (nursing homes, community support, schools) about how you are serving the community by leading with the adoption of teledentistry. 
• Email your patient list with an announcement of teledentistry services and invitation to register for your patient portal. 
• Started running local targeted ads for people searching for dental problems that highlight your telehealth or teledentistry availability. 

(TeleDent subscribers have access to templates and step-by-step how-to resources for all of the above and additional marketing objectives to help get the word out on their new teledentistry services.)

Tellies Awards: Innovation in Teledentistry

MouthWatch launched the Teledentistry Innovation Award to shine a light on innovators and pioneers across the spectrum of connected dental care who have lead the way and shown by example how teledentistry technology can enhance dentistry.

See the 2020 Tellies Recipient Interviews

Further past teledentistry innovation award winners have included:

Teledentistry Pioneer Paul Glassman, DDS, MA, MBA

Dr. Glassman is the first recipient in the newly created “Teledentistry Pioneer” category. He is the founder of the Virtual Dental Home Program, whereby he and his team at the University of the Pacific developed a more efficient way to connect patients to dental care through the combination of technology and innovation. This care-delivery model, combined with his efforts in education, in supporting legislative changes that support teledentistry and improve access to care have helped create a landscape where more and more programs and providers are interested in teledentistry and the opportunities it creates.

Paul Labbe, DDS

Dr. Labbe is a pediatric dentist with 5 office locations. He uses teledentistry to provide care to underserved children in his community. Teledentistry enables him and his team to conduct  dental screenings at local schools and then in turn, provide the parents and guardians with diagnosis and treatment plans with the option to bring their children to one of his offices for restorative treatment.

MiQuel McRae, RDH, CDHC

Miquel founded ToothBUDDS, a non-profit that employs a team of dental hygienists to provide
oral care to underserved children in her area – Many of which have some form or oral disease. Miquel and her team provide education, screenings, cleanings and fluoride treatments in local school settings. Thanks to teledentistry, they can connect children with urgent dental needs to a local dentist, so they don’t fall through the cracks.

Angie Stone, RDH

Angie and her team of oral care specialists provide onsite hygiene services to elderly patients who live in nursing homes, assisted living facilities and private homes. They use teledentistry to document each patient visit with intraoral photos and videos and to communicate with family members and participating dentists to ensure that their clients receive restorative care when needed.

Brittany Kinol, DMD

With two offices in the Pittsburgh area, Miracle Dental reaches children in a range of settings that are most convenient for them and their families. By coordinating care delivery with Head Start programs, schools, and public insurance carriers, Miracle Dental’s mobile hygienists use teledentistry to deliver preventive care to students in the most convenient way possible.

Liz Best – NYU Dental College

Liz is a grants administrator at the New York University (NYU) College of Dentistry, who obtained a Human Resources & Services Administration grant to fund the implementation of teledentistry technology into the school’s curriculum. Working with TeleDent, NYU has incorporated teledentistry technology into second year coursework.

Staci Stout, RDH, BSDH

Smart Smiles, a school-based oral health program based in Utah that focuses on prevention. Its mobile hygiene program provides care to children at school to ensure they have access to oral healthcare. A team of hygienists equipped with portable preventive care equipment and teledentistry technology see children at more than 30 schools in the Salt Lake City area.

Learn more about the Tellies Award and submit a candidate.

Explore Further: Recent Blog Posts on Teledentistry

About TeleDent™ by MouthWatch

A robust teledentistry platform that’s been built from the ground up for dental care, dental teams and dental organizations of all sizes. Use cases include patient-facing remote consultations as well as provider-to-provider collaboration and intraoffice use to mitigate infection control and make efficient use of chair time and other resources.  Learn more.