Teledentistry: a technological approach to oral health equity
By: Diya Ingle, BHSc Honours Specialization in Health Science, Western University
The World Health Organization has reported an estimate of 2.5 billion individuals globally being affected by dental caries, leading to 380,000 new cases of oral cancers (World Health Organization: WHO, 2022). These statistics are profoundly highlighted within rural and remote communities. Oral care is highly neglected in multiple regions, specifically under-resourced communities, due to low literature exposure and governmental inaction. This disparity underlines the need for innovative approaches like teledentistry, a developing modality focused on mitigating barriers and expanding oral care prevention, specifically in rural communities.
Teledentistry is an approach used by many oral health sectors to enhance efficient care within some urban regions, but it is encouraged to implement this in rural regions. Teledentistry is defined as various technologies that deliver efficient dental care virtually by exchanging clinical information regarding patients (Rathee & Sapra, 2023). These technologies are used for many dental procedures, one of which includes dental caries.
Dental caries are chronic infectious tooth decay, also known as cavities. This is caused by the bacteria in your mouth that break down the sugar and convert it into acid, which impacts the overall tooth enamel, increasing tooth decay or cavities (Rathee & Sapra, 2023).
The prevalence of dental caries is a significant oral health concern, especially within rural communities where accessing dental care in person can be a societal barrier (Al‐Buhaisi et al., 2024). With increasing technology proficiency, teledentistry is an opportunity to reach rural communities through virtual consultations, increasing the speed of treatment plans. This blog advocates for the need for teledentistry in rural communities in place of traditional in-person dental checkups. The outcome focuses on providing easier and earlier access to oral complications, such as cavities and increasing overall preventive care. To further disseminate this discussion, a comprehensive understanding of oral health inequalities is crucial in order to understand the significance of integrating teledentistry.
The burden of oral health inequities in rural communities
Rural communities are facing societal and financial barriers to accessing adequate dental care. One of the major concerns arises from geographic inaccessibility, especially for in-person consultations. Economic constraints play a critical role in rural communities, especially those who lack insurance coverage and experience increased dental complications due to treatment costs (Al‐Buhaisi et al., 2024). Social barriers, such as a lack of education on oral hygiene and care, are major factors that align with cultural perceptions, contributing to a lack of awareness and avoidance of seeking adequate care (Rathee & Sapra, 2023). Alongside inadequate funding for rural dental care and the underrepresentation of minority groups in the dental workforce, this highlights marginalization and deepens oral health disparities (Al‐Buhaisi et al., 2024).
Untreated cavities in populations, can cause more infectious symptoms and increase overall oral complications. When dental caries, such as cavities, remain untreated, especially in rural regions, they can increase bacterial spread, which extends beyond the oral cavity, leading to facial swelling, fever, and further systemic health complications (Al‐Buhaisi et al., 2024). To prevent further consequences, early interventions and consistent oral treatments are crucial. Teledentistry is a proficient way to maintain consistency within oral care to minimize delay through virtual consultations and treatment plans to ensure sufficient care.
Chronic oral health symptoms (e.g., spreading of dental caries, Oral Potentially Malignant Disorders (OPMD), cardiovascular diseases and plaque accumulation) are common resulted symptoms, and require prolonged observation periods, making it more consistent through technology (Ward et al., 2022).
Prior studies have indicated that the escalating risks of reduced dental treatments are linked to inequitable accessibility to treatment centres, overshadowing the incorporation of teledentistry (Ward et al., 2022). However, there are possibilities of additional factors contributing to the heightened rates of dental caries. For example, Ward et al. (2022) suggest that difficulties in accessing traditional in-person dental care stem from geographic barriers and a lack of dental practitioners in rural regions, as most are placed in urban settings. Due to these factors, dental treatments get prolonged, increasing the severity of infectious teeth and leading to broader symptoms such as OPDA, spreading of dental caries, plaque accumulation and potential cardiovascular concerns.
Benefits of Teledentistry in Rural Contexts
Many individuals who live in rural regions require transportation methods in the hope of receiving dental care. Geographic isolation is persistent for individuals in rural communities, due to inadequate transportation services in reaching dental clinics. Through this methodology, teledentistry reduces these burdens by facilitating virtual consultations and decreasing costs of public transportation (Al‐Buhaisi et al., 2024). This approach allows clinicians to examine and diagnose with efficiency while conserving the limited healthcare resources provided along with referring patients for in-person treatments only when needed.
Underserved communities frequently encounter prolonged wait times due to limited accessible dental clinics (Al‐Buhaisi et al., 2024). Teledentistry reduces wait times through technological incorporation, while accelerating treatments through early diagnostic evaluations (Al‐Buhaisi et al., 2024). This includes interventions such as expedited prescription of antibiotics, which can help mitigate emergency visits and reduce barriers to dental care facilities.
Beyond acute care, many rural regions are deficit in oral health literacy given the minimal educational resources (Rathee & Sapra, 2023). Teledentristy platforms can be a source for clinical care but also to deliver proficient dental health education, highlighting hygiene practices and long-term behavioural change on routine check-ups. Teledentistry addresses economic, geographic, and informational barriers through a transformative approach to enhancing oral care delivery.
Limitations and Implementation Challenges of Teledentistry
Throughout the dissemination of all studies, limitations were found and highlighted within teledentistry. These limitations are crucial to study and interpret when discussing future policies and solutions. For instance, the first limitation was adolescents not being exposed to educational resources on oral hygiene, leading to low prioritization of teledentistry and oral hygiene practices (Rathee & Sapra, 2023). Research has shown that dental caries is an accumulation of many poor oral practice initiatives, which need hygiene attention (Rathee & Sapra, 2023). Additionally, adapting to technology during pivotal times can be challenging in these communities. Implementing modules for patients to learn and follow can ease the transition to virtual care. Surgical procedures and treatments require in-person appointments, revealing a key limitation of teledentistry. Despite its benefits, there is still a persisting gap in dental care accessibility, such as transportation costs, and if needed, further in-person procedures such as surgery. (Al‐Buhaisi et al., 2024). Nevertheless, technological advancements have accelerated treatments while reducing oral complications and alleviating some economic burdens (Al‐Buhaisi et al., 2024). Referral processes have been enhanced with the help of teledentistry, enabling timely access to specialized care and addressing the systemic barrier in healthcare for rural communities (Al‐Buhaisi et al., 2024).
Recommendation For Policy or Practice
Policymaking plays a critical role in the futuristic approach of increasing the use of teledentistry within rural communities. Both provincial and federal levels must address poor oral health as a growing concern among these regions, leading to high OPMD and cardiovascular diseases. Providing adequate educational resources and dental hygiene kits can help reduce severe rates of cavities, highlighting the need for future research initiatives. Alongside, collaborations between community centers and dental associations can strengthen this initiative.
Finally, for early detection, teledentistry screenings among schools should become mandatory to detect malignancy, cavities, and bacterial buildup, before they progress into complex health concerns. By implementing digital platforms within educational systems, students from underserved communities can receive access to adequate oral health evaluations. This approach offers an opportunity to educate children on hygiene practices, reducing future dental complications.
Conclusion
Through the incorporation of teledentistry, enacting legislation for dental practitioners to deliver efficient care under remote supervision is a preventive measure against delayed treatment. The incorporation of technology can help mitigate the persistent gap between patients and the required treatment. By investing in teledentistry infrastructure, securing governmental funding, and enhancing oral health education, policymakers can work towards establishing an equitable oral healthcare framework.
Citations
Al‐Buhaisi, Diana, et al. “The Role of Teledentistry in Improving Oral Health Outcomes and Access to Dental Care: An Umbrella Review.” Journal of Oral Rehabilitation, 13 Aug. 2024, https://doi.org/10.1111/joor.13836.
Rathee, Manu, and Amit Sapra. “Dental Caries.” PubMed, StatPearls Publishing, 21 June 2023, www.ncbi.nlm.nih.gov/books/NBK551699/.
Ward, M. M., Bhagianadh, D., Ullrich, F., Merchant, K. A. S., Meyer, C. L., Wovcha, S., & Reyelt, E. (2022). Two teledentistry models for the provision of essential oral health care services in rural school settings. Journal of dental hygiene : JDH. https://pubmed.ncbi.nlm.nih.gov/36539288/
World Health Organization: WHO. (2022, November 18). WHO highlights oral health neglect affecting nearly half of the world’s population. WHO Highlights Oral Health Neglect Affecting Nearly Half of the World’s Population. https://www.who.int/news/item/18-11-2022-who-highlights-oral-health-neglect-affecting-nearly-half-of-the-world-s-population
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