Tele-dentistry could (video-) feed mouths in need
If you think it’s difficult trying to get a home visit from a GP, imagine how hard it is to have a mobile dental surgery come to your house.
The small number and reach of these services has led to recent trials into tele-dentistry by the University of Melbourne’s Institute for a Broadband-Enabled Society (IBES).
Aged care residents are one group of the population vulnerable to inadequate dental care. As oral hygiene has improved in the general population, the number of people entering aged care who still have some or all of their teeth has grown, increasing the requirements on age care providers to arrange for dental care.
At a typical facility, half the residents might still have their teeth and all of those will probably need a regular scale and clean. Half of them might need fillings or extractions, and some of the residents will suffer from serious tooth and gum disease.
According to Melbourne Dental School Associate Professor Matt Hopcraft, however, getting dentists to visit these residents is a real challenge.
Dr Hopcraft said the nature of the problem was two-fold: dentists don’t want to go into aged care facilities because the environment is not set up for their needs, and aged care administrators and nurses have difficulty getting sometimes immobile or frail patients into dental surgeries.
Trying to get more dentists into aged care facilities “is never going to happen”, he said, so the use of tele-dentistry will be a very useful mechanism to address the problem.
“We're trying to test the concept of it – can we make it work?” Dr Hopcraft said. “But the big challenge is then going to be how we can change our healthcare delivery systems to make it work.
“For example, will there be dentists and specialists who make themselves available at specific times so that other people know they can call in and get a consultation over the internet? We don’t really think about the delivery of these services.
“In a few years’ time, when everyone is connected at these very high speeds, how do we then re-orient the healthcare system to take full advantage of that?”
In the IBES trial, an intra-oral camera approximately the same size as a toothbrush was operated by an aged care nurse who had received training in its use. The footage was collected with Vidyo's video conferencing software that the dentist and operator download onto their devices. Individual care plans were then developed by the dentist.
Dr Hopcraft said there are two ways to use the technology – real-time monitoring by a dentist who can direct the operator, or “store and forward”, in which a video recording is sent to the dentist, who can block out time to assess several of these videos at leisure.
The trial sessions showed there was a high degree of correspondence between the dentist-directed and nurse-controlled methods, putting to rest researchers’ initial concerns that adequate footage might not be collected by operators.
That is an important finding, because much of the demand for the final system will be in store-and-forward videos, he believes.
IBES senior research fellow Ken Clarke said it's very hard to schedule a dentist exactly when aged care residents are free.
“It’s not about the technology, which works very well,” Mr Clarke said. “It’s about the human factor of just scheduling people to show up at the right time, and for the dentist to be available at that time.”
The training required for nurses’ is not onerous – a four-hour block delivered over a morning or afternoon.
However, Dr Hopcraft said that over-work and under-resourcing in the sector – as well as high staff turnover and the lower prioritisation of oral health – has been problematic for delivering training and implementing follow-up care.
Further trials are scheduled for aged care facilities in North Melbourne and Stawell, although a final timeline for reporting has not been established as the next phase of the project is currently awaiting approval from the University of Melbourne’s ethics committee.
Posted in Aged Care