Telemedicine allows healthcare professionals to connect with patients remotely. Advancements in electronic information and telecommunication technologies have fostered the rapid adoption of telemedicine in the past decade. According to Doctor.com’s report on healthcare trends in 2020, telemedicine adoption increased by 33% over the previous year, and telemedicine funding is expected to reach $185.6 billion by 2026.

COVID-19 has been a major catalyst for telemedicine adoption. In response to lockdowns and closures, clinicians adjusted their practices to offer treatment in a pandemic-safe manner, and many implemented telemedicine technology. This resulted in a sizable population of patients becoming familiar with telemedicine. In fact, Medical Economics found that 83% of patients expect to use telemedicine after the pandemic resolves.

However, for dental practices, telemedicine adoption continues to lag behind other medical fields. What is the cause of this?

In this article, we offer an overview of teledentistry, telemedicine for dentists. We discuss the primary benefits of teledentistry, and cover some of the pain points inhibiting its growth.

What is Teledentistry?

Teledentistry is the use of telecommunication technology to allow long-distance dental care, consultation, education, and public awareness. In general, there are two types of teledentistry.

Synchronous teledentistry refers to the real-time interaction between patient and dentist through the use of video conferencing tools (i.e., Evaluating patients through a videoconferencing tool, like Zoom).

Asynchronous teledentistry refers to the non-direct interaction between patient and dentist through the transfer of recorded health information (i.e., Sharing videos and radiographs through a HIPAA-compliant messaging service).

Teledentistry Benefits

Teledentistry offers various benefits for dental practices and patients. Some of the most important benefits are showcased below.

Increased safety

Teledentistry allows dentists to interact with patients in different physical locations. Teledentistry has proven itself to be a valuable tool for evaluating patients prior to in-person care and prescribing medication during post-operative evaluations.

Additional income

Teledentistry appointments are billable! Many insurance companies accept claim submissions for services rendered using telecommunication technology. Typically, CDT codes D9995 and D9996 are primarily used for these types of claims.

Obstacles of Teledentistry

Like we mentioned above, implementation of telemedicine has been slower in dentistry than other medical fields. Below, we cover the biggest obstacles for teledentistry adoption.

In-person care is often necessary

Some medical fields lend themselves better to telemedicine than others. For example, many mental health providers are able to effectively offer care through videoconferencing. Conversely, the most common dental procedures, ranging from teeth whitening to surgeries, rely on in-person care.

Additionally, the ability to implement teledentistry often depends on the type of treatment a dental practice provides. For example, orthodontic evaluations are much easier to do through videoconferencing than periodontal examinations.

Teledentistry implementation can be daunting

Using unfamiliar tech for video conferencing and sharing files can be overwhelming for many dental professionals. Additionally, many dentists are concerned with this teledentistry’s compliance with regulations. HIPAA-compliant telemedicine solutions, like Simplifeye, accelerate the implementation process, and make it easy to conduct remote dental appointments.

Bottom Line

COVID-19 accelerated the implementation of teledentistry in many dental practices nationwide. However, telemedicine adoption in dental practices has not kept up with other medical fields. The likely culprit is dentistry’s reliance on in-person care, which renders teledentistry useless for the common dental procedures.

However, teledentistry can be valuable for specific use cases. Teledentistry is an effective tool for evaluating patients remotely and prescribing medicine. Additionally, teledentistry adds an extra stream of revenue for dental practices. If you decide to implement teledentistry in your dental practice, there are several dental technology solutions, like NexHealth, that can accelerate implementation and management.

Almost half of the nation’s dentists are back to work and open for “business as usual,” according to a recent survey by the American Dental Association. But when it comes to the supply chain for personal protective equipment necessary to provide full-service dentistry, business is anything but usual as the coronavirus pandemic lingers on.

According to the ADA’s ongoing survey, “COVID-19: Economic Impact on Dental Practices,” as of Sept. 7, just 60% of all dentists had a two-week supply of N-95/K-95 masks, which are now required when conducting all aerosol producing procedures, such as ultrasonic scaling, air polishing, and air abrasion.

A quarter of all dentists have a one-week supply of N-95/K-95 masks, and 11% have less than a week’s supply. The ratios are similar for surgical masks, face shields, gowns and disinfecting supplies.

The ADA national survey of 13,000 dentists is further broken down by type of practice: DSO, Non-DSO, Solo Dentists, 2 to 9 Dentists and Group (10+ Dentists).

This story refers to the aggregate numbers for all dentists unless otherwise noted, but there are some interesting variances between practices, including what appear to be higher shortages of PPE in larger dental organizations.

The current levels of PPE undoubtedly represent an improvement over the early months of the pandemic when 76% of all dentists were open for emergency services only and nearly 20 percent were closed outright. As practices began opening in May, it soon became apparent that the normal PPE supply chain had been severely disrupted by the pandemic.

In an interview in May with Patient Prism, Dr. Scott Drucker, DMD, president and co-founder of Supply Clinic, an online marketplace for medical and dental supplies including PPE, called the supply chain broken, especially in the case of masks.

“N-95s are extremely difficult to source right now,” Dr. Drucker said. “3M is shipping everything to hospitals and to governments, per FEMA’s directive. So, those aren’t on the market. There are some foreign-manufactured N95s that do come in little spurts, and we try to get those on the site (for order) when possible.”

The ADA estimates the demand for PPE is 10 times the supply. As Drucker notes, that demand has driven prices up 400 percent and higher. For example, a box of 50 surgical masks that cost $5 before the pandemic now costs $40 on the Supply Clinic website.

Who pays those inflated prices? Apparently not all third-party insurers are willing to foot the bill, which can be substantial considering the number of people required to wear protective gear, from dentists, to technicians to office staff to patients. The ADA has issued “COVID-19 Coding and Interim Guidance: PPE” to help guide dental health providers through the myriad changes in billing practices.

Just how broken is the PPE supply chain? An alarming article on the Journal of the American Medical Association’s Health Forum website, “Personal Protective Equipment Shortages During COVID-19: Supply Chain–Related Causes and Mitigation Strategies,” pulls no punches:

“The frightening reality is that the routine U.S. PPE supply chain was not designed with the primary objective of protecting health care professionals. Rather, it was designed to fulfill demand while focusing on efficiency and price. While this supply chain can fulfill normal demand, it cannot meet unexpected increases that occur during a public health crisis, such as the current COVID-19 outbreak or the 2009 influenza A outbreak.”

The authors, two MDs, Preeti Mehrotra and Preeti Malani, and an MBA, Prashant Yadav, explain that U.S. PPE production is limited, and 70% of our respiratory protection supplies come from China, which dramatically reduced production during its battle with coronavirus earlier this year. As a result, “Some health care systems currently face estimated delays of 3 to 6 months for requested supplies.”

Suddenly that two-week supply of N-95 masks doesn’t seem like quite enough.

Ideally, we should be able to turn to the Department of Health and Human Services’ Strategic National Stockpile and state stockpiles to complete the PPE supply chain. That’s what they’re supposed to be for — emergencies.

But that hasn’t worked, the authors claim, because the “overall stock in the SNS was much lower than previous estimates of what would be needed to protect health care personnel in the event of a severe influenza pandemic” and the “lack of transparency regarding PPE and other inventory in the SNS as well as the logic behind the allocation of its limited supplies has hampered credibility.”

The authors believe good old American ingenuity will help mitigate some supply chain issues. PPE sourcing initiatives such as ProjectN95.org have provided protective equipment to frontline healthcare workers battling the pandemic across the United States. The growling list of U.S. companies repurposing factories to manufacture PPE includes Ford, General Motors, Lacerta, 3M and others can be found at supplychaindive.com.

The increasing use of telemedicine has helped conserve PPE in the physician’s office, but dentistry ultimately involves treating patients in the seats. So how does the average dentist decide whether he has enough N-95 masks on hand? The Centers for Disease Control and Prevention publication “Strategies for Optimizing the Supply of PPE during Shortages” offers and excellent tool to do just that.

It’s called the PPE Burn Rate Calculator. It’s a simple database program with simple instructions:

“To use the calculator, enter the number of full boxes of each type of PPE in stock (gowns, gloves, surgical masks, respirators, and face shields, for example) and the total number of patients at your facility.”

As mentioned previously, according to the ADA survey, about 60% of all dentists have a two-week supply of N-95/K-95 masks on hand right now. They can use the burn rate calculator to determine whether that’s enough.

Raise your hand if you want to take a break from the heavy stuff and talk about something happy for just a little while.

Right, me too.

New dentists who wish to increase their own happiness, especially while living in the days of attempting to build their dental practice during a world health pandemic, can soon log into an American Dental Association webinar about building more productive habits and working through strategies for taking control of their own happiness.

The event is called “What Makes Humans Happy?” In it, the ADA is presenting a free hourlong webinar on May 26 from 2 to 3 p.m. EDT. Webinar panelists will discuss widespread misconceptions about happiness and provide timely insights on the science of well-being.

The webinar kicks off the ADA Accelerator Series, a new online program designed to provide all kinds of information tailored to young (in their career) dentists and addressing their unique financial, business, leadership, growth and work-life balance needs.

Early-career dentists have a lot on their plates, according to Dr. Susan Becker Doroshow, 8th District trustee and member of the ADA Board’s Standing Committee on Diversity and Inclusion. “It must seem impossible to deal with the challenges of clinical practice, juggle their responsibilities at the office and on the home front, maintain their fitness and personal wellness goals, manage their student debt — and have enough energy in reserve to simply enjoy life,” she said.

Enjoying life and happiness is the exact focus of the upcoming webinar. Dentists who log on will hear from a professor of psychology at Yale University, Laurie Santos, who will reveal misconceptions about happiness, common thought processes that lead people to think the way they do and the research that can help individuals better understand themselves and what they need to do to find — and maintain — happiness.

And a dentist’s day does not end after seeing the last patient. The work continues. Whether you have family members to care for, a home to manage, a spouse to consider, your health and wellness and the million other things that make up a life, it all requires balance. Dr. Grace Yum, a pediatric dentist and founder of a Facebook group called Mommy Dentists in Business, will also share some stories and tips during the webinar from her life as a busy dental professional.

The ADA launched the Accelerator Series (which started with 14 women dentists) to help dentists tackle current challenges and achieve their long-term goals. The program is a resource to member dentists for financial, leadership and work-life balance tools.

Dentists can register and learn more about the ADA Accelerator Series at ADA.org/Accelerator.

A recent survey of over 1,000 dental practices conducted by Net32 revealed that dentists across the country were generally very fearful about the prospect of resuming their practices in a COVID-19 world, as state stay-at-home mandates are lifted.

Hundreds of comments were related to safety of themselves, their staff, and their patients. In an effort to answer to some of their concerns, I decided to put together a short list of actions that they could take to increase safety as well as increase their ability to attract new patients.

Safety as a differentiator.

More than ever before, patients are going to be choosing a dental practice based on how safe the practice appears to be. Safety is going to be the new differentiator in dental marketing and dentists should consider new practices and policies to align with this patient need.

Invest early and heavily in personal protective equipment (PPE).

Your team and your patients will not want to enter your practice if you are not employing the highest levels of PPE and infection control protocols. I am concerned about scarcity of PPE impairing dentists’ availability to practice safely.

We have been working diligently to ensure that we can stock as much PPE as possible and maintain reasonable pricing amid global shortages, but it has been a challenge. Products such as N95 masks, face shields, surgical masks, and hand sanitizers are extremely difficult to keep in stock these days.

Upgrade your general air treatment systems.

Consider upgrading your practice’s main air conditioning unit(s) to reduce the chance of contaminants spreading through open areas. At Research Triangle Dental, we recently pulled out the 1” thick standard filters and replaced them with 4” high capacity filters with UV germicidal air treatment, with a cost of about $1,500 per A/C unit. This is a relatively low cost to put your patients’ and employees’ minds at ease.

Consider augmented air purification for your operatories.

If you have enclosed operatories, split mini A/C units with HEPA filtration for each op (or one “high level aerosol op”) would likely provide the best air volume treatment and removal. However, this could be very costly, at about $5,000+ per op, and keep in mind that HEPA filters consume a lot of energy to run.

I have chosen to purchase free-standing iAdaptAir units that claim to filter 99.99% of airborne particles including viruses, using ionization, ultraviolet light, carbon, and true HEPA filtration. These cover 250 enclosed square feet for about $400 per unit and plug into 110-volt outlets.

Hire a concierge.

Busy practices should seriously consider hiring a concierge. Directing incoming patients to use hand sanitizer and providing face masks as necessary, as well as helping patients to fill out pre-appointment screening forms, can be very helpful. Also, frequent disinfection of areas where patients may be touching arm rests, counters, and other surfaces will increase patient comfort and confidence.

…for fast COVID-19 testing with a waiver. This will certify and prepare your practice for fast COVID-19 testing once the FDA provides an Emergency Use Authorization (EUA) with a waiver for a fast test.

The cost is only $150 to protect you, your family, your team, and your patients, for the period until a vaccine is available. Fast tests typically take three to 10 minutes.

Dental practices across the nation are just one category of small businesses that have suffered, both economically and logistically, due to the near-national shutdown in response to the COVID-19 pandemic. And as lawmakers are working on the next relief package, the American Dental Association, on behalf of its 163,000 members, is urging Congress to include language to assist the dental industry in the process of recovery.

The ADA is making a few key recommendations to legislators:

1. Increase flexibility within the Paycheck Protection Program. ADA representatives are asking that the loan forgiveness guidelines allow individual small businesses to make their own decisions regarding payroll and staffing based on individual plans to reopen.

Dentists would like to see Paycheck Protection Program (PPP) loan funds allowed for purchasing additional personal protective equipment (PPE), making safety improvements to offices, and qualifying for tax credit.

2. Allow nonprofit dental and medical organizations to have access to the Paycheck Protection Program or future small business loan programs.

3. Execute better oversight for the distribution and loan forgiveness process in the Coronavirus Aid, Relief, and Economic Security (CARES) Act for PPP loans to guarantee that only those small businesses that were economically distressed as a result of the pandemic receive the funds and forgiveness.

4. Ramp up the production of PPE with more focused distribution to healthcare workers, including dentists.

5. And a big one:Extend the Department of Health and Human Services’ authority to allow licensed dentists to conduct FDA-authorized COVID-19 diagnostic tests until the end of the year.

This last recommendation is an important one as it would help alleviate the burden of hospital emergency rooms across the country who are coping with the pandemic.

Dentists can visit the Legislative Action Center to contact their legislators today regarding these recommendations. For the latest information on COVID-19, visit ADA.org/virus.

In a month otherwise filled with tough news, Congress passed a $2 trillion stimulus package that is designed to help people, states and businesses all across the country that are devastated by the coronavirus pandemic. The Coronavirus Aid, Relief and Economic Security Act — or CARES Act — passed the Senate on March 25 and the House on March 27.

Following the Senate vote, the American Dental Association reached out to member dentists.

Dental Industry Implications

Following the Senate vote, the American Dental Association (ADA) reached out to member dentists. In the communication brief, ADA President Chad P. Gehani stated, “For the last few weeks, the American Dental Association has advocated on your behalf as federal lawmakers debate the best way to respond to the deepening economic crisis caused by the COVID-19 outbreak. Congress is finalizing legislation that could support dentists during these exceptional circumstances.”

Dr. Gehani shared the provisions in the bipartisan legislation that the ADA believes are the most critical for dentists, dental students and dental practice employees. They are as follows:

Economic injury disaster loans. There are a number of Small Business Administration loans available to dentist owners. One loan, in particular, is the Economic Injury Disaster Loan, which establishes an emergency grant to allow a dental practice that applies for an Economic Injury Disaster Loan to receive an advance on that loan of no more than $10,000, which the Small Business Administration must distribute within three days.

The money may be used to pay for employees’ COVID-19-related sick leave, mortgage or rent, and other overhead expenses. The grants would be awarded on a first-come, first-served basis until the $10 billion fund is exhausted, and applicants would not have to repay the money even if they are denied the loan.

Loan forgiveness for certain small business loans. Employers may be eligible for a portion of their federal small business loans to be forgiven for amounts spent for certain payroll, sick leave, family leave and other overhead expenses between Feb. 15 and June 6.

Additional SBA loan payments. The Small Business Administration will pay the principal, interest and any associated fees that are currently owed on 7(a) loans, 504 loans and microloans. This would be for a six-month period starting on the next payment due date. Loans that are already on deferment would include an additional six months of payment by the Small Business Administration beginning with the next payment.

Retirement account withdrawals. The bill allows for a withdrawal of money from retirement funds of up to $100,000 in 2020 without paying a tax penalty if the dentist, their spouse or dependent are diagnosed with COVID-19, or experience adverse financial consequences as a result of being quarantined, furloughed, laid off or having work hours reduced due to the viruses.

Student loan interest deferral. Federal student loan borrowers would not be required to make a payment through Sept. 30. During this time, no interest would accumulate on those federal loans (payment suspension applies only to loans held by the Department of Education, not private loans).

Income tax break for some employees. Employee borrowers of student loans that receive assistance from their employers in paying off student loans will not have to pay income tax on any payment assistance, up to $5,250, they receive between the enactment of this law and Jan. 1, 2021.

Deferred Social Security tax. Employers and self-employed individuals would be allowed to defer payment of their employer share of the Social Security tax until Dec. 31.

Federal tax rebates. The bill provides for a one-time federal income tax rebate for eligible dentists and their employees in 2020. The rebate amount would be $1,200 for individual tax filers, $2,400 for those filing a joint return and $500 for each child. (The amount of the rebate will be reduced for single filers making more than $75,000 and joint filers earning in excess of $150,000.)

Increased unemployment benefits. Emergency unemployment compensation benefits will be dramatically increased should dental office employees be laid off. This is a supplement for state-funded unemployment insurance, with the federal enhancement being funded for four months.

Dr. Gehani concluded by urging all dentists to get in touch with their accountants to determine how they might benefit from taking advantage of them. And that once the bill has been signed into law, the ADA will provide a detailed account of all the provisions that affect dentistry.

“These are challenging times, but the ADA will continue to be a resource on important issues for you, your practice, and the profession,” Dr. Gehani said. “This is uncharted territory for the entire dental community, but we will get through this together.”

Visit ADA.org/virus for the latest ADA information on the coronavirus pandemic.

Coronavirus, now named COVID-19, is making headlines around the world. From statistics about the rapidly spreading illness to tips for travelers, this hot issue is at the top of most news reports. The American Dental Association has now released an informational handout for dentists.

The informational handout, which can be downloaded here, covers strategies for helping prevent the transmission of suspected respiratory disease in the dental healthcare setting and also answers frequently asked questions related to the virus, based on guidelines from the Centers for Disease Control and Prevention.

Coronavirus Basics

Coronaviruses are a large family of viruses that are common in animals and people, causing the common cold, and sometimes, more severe illnesses, such as SARS and MERS.

To date, the coronavirus has led to tens of thousands of cases of respiratory illness in China, and infections have been reported in many other countries as well, although the vast majority of them have been associated with travel from Wuhan, China, where the virus was first detected.

Due to the growing number of cases and reach of the disease, the International Health Regulations Emergency Committee of the World Health Organization declared the outbreak a “public health emergency of international concern” on Jan. 30. The next day, the U.S. Department of Health and Human Services secretary classified it as a U.S. public health emergency.

But it is important to note that the immediate health risk from the coronavirus to the general American public is considered low at this time, according to the CDC.

What Dentists Need to Know

The precautions are not so different than flu season preventative measures. To help prevent the transmission of any kind of respiratory infection, dental practices should adhere to standard respiratory hygiene/cough etiquette infection control measures, such as adhering to excellent hand hygiene, providing tissues and no-touch receptacles to throw away used tissues and offering face masks to patients who are coughing. Practices also should follow routine cleaning and disinfection strategies used during flu season.

If any member of your clinical team is assessing a patient with a flu-like or other respiratory illness, they should wear a disposable surgical face mask, nonsterile gloves, gown and eye protection to prevent possible exposure.

Note: Because recommendations for COVID-19 could change as more information becomes available about the disease, the ADA suggests checking for updates on the CDC’s coronavirus infection control page for health care professionals.

Are you a recently graduated dental professional looking for the perfect place to start your career? Or an experienced dentist looking to make a move to another practice? Your job search may have just gotten a whole lot easier.

Dental professionals looking for the right job could always turn to the American Dental Association’s CareerCenter, the ADA’s official online job board. But on July 17, the ADA CareerCenter debuted its upgraded website, which now offers even more tools to improve the user experience and personalization of job searches.

The online job board features a new personalization dashboard, which provides a more user-friendly experience for job seekers in the dental profession and generates more relevant responses for employers and dental professionals seeking team members, according to ADA CareerCenter.

New features include:

• employer custom content
• company profiles and branding with the ability to use video and images
• searchable tags
• employer resume access
• premium job postings
• job of the week
• employer profile page
• targeting job campaigns
• social push (which makes it easier to share a job via social media)

In addition to the new dashboard, the job alerts feature can be customized in several ways: by keyword, location, specialty, career level, salary, hours, contract type, and recruiter type. Dentists and other dental professionals can also choose how often they receive the alert (daily or weekly).

For employers looking for dentists and other dental professionals, they have access to a unique page that allows them to share details about their practice and explain why a dental professional should choose them over somewhere else. Employers can add pictures, videos and links to educate jobseekers.

For more information on the ADA CareerCenter, visit careercenter.ada.org.