Teledentistry Shows Potential to Assist Rural Communities

December 24, 2008

For most low-income parents in rural America, the news that one of their children needs to visit an orthodontist to straighten misaligned, or maloccluded, teeth can send their minds racing.  Many families live paycheck to paycheck, and parents must scrimp and budget carefully to pay for each visit to the orthodontist.  Making matters worse, many families must embark on long drives out of town to find an orthodontist and usually miss a day at work and school to keep the appointment.  Given the barriers of cost and access to care, too many rural, low-income children go without and enter adulthood with “bad teeth” that can impair their quality of life. 

In the November issue of the American Journal of Orthodontics and Dentofacial Orthopedics, NIDCR grantees and colleagues offer a possible solution to the access issue in rural communities using teledentistry to treat malocclusion.  Broadly defined, teledentistry harnesses the real-time capability of modern telecommunications to allow off-site dentists of any specialty to assist their colleagues in providing care.  In the study, interceptive orthodontic care was provided at a rural and an inner-city clinic in the state of Washington.  The treatment expands the jaw and reshapes the mouth to reduce or eliminate the malocclusion.  Each clinic followed comparable selection criteria, treatment protocols, and outcome measures.  The key difference was the method of supervision.  At the rural clinic, an orthodontic faculty member from the University of Washington offered real time teledentistry to assist a general dentist as he provided inceptive orthodontic care to 30 low-income children (ages 8-11).  The dentist, though experienced, had only modest training in orthodontics.  At the inner-city clinic, first- and second-year orthodontic residents were supervised on site by orthodontic faculty members only while providing inceptive orthodontic care to 96 low-income children in the same age group.

Using the peer assessment rating (PAR) index to score the outcomes of the procedure, the authors found that the general dentist faired nearly as well with the aid of teledentistry as the residents did under direct supervision.  The general dentist improved his PAR score by 35 percent, while the residents under direct supervision boosted their performance by 44 percent.  “Our study demonstrates for the first time that a trained general dental practitioner, with real-time access to orthodontic expertise through teledentistry, can also provide interceptive orthodontic treatment to significantly reduce the severity of malocclusions and produce results that are comparable to those obtained by orthodontic residents supervised on-site by orthodontic specialists.”  Although further research and technological refinements are needed, this initial investigation suggests teledentistry might one day serve as a valuable tool to treat disadvantaged children when a referral to a specialist is not feasible.