Field is open wide for rural teledentistry

The University of Melbourne's Institute for a Broadband-Enabled Society (IBES) has released a report on a field trial of paediatric teledentistry that showed it was popular with children and parents, saved them time and travel costs, and provided a platform for potential expansion into service provision to the elderly and those living in regional and remote areas.

The authors of the study, Paediatric Teledentistry: delivering oral health services to rural and regional children, say that additional economic modelling is required to fully assess the practice and inform the development of sustainable business models, but that the vast majority of parents saw it as a positive experience and a beneficial way to obtain dental services. The kids seemed to like it too.

The study involved three dental practitioners in Rosebud, Shepparton and Geelong who were trained to conduct video consultations with orthodontists and specialists in cleft lip and palate at the Melbourne Dental School and the Royal Children’s Hospital in Melbourne. Google also provided financial support.

It involved both video consultations using Citrix GoToMeeting and store-and-forward for video clips, photos and scans, and a Soprolife intra-oral camera connected to a computer. Intra-oral cameras can provide both real-time video and still images for store-and-forward.

In fact, intra-oral cameras can produce images that are as good as or superior to conventional real-time visual or tactile oral examination, the researchers say. Other studies have shown that their use has improved diagnosis of oral diseases, especially dental caries, and that they are less intrusive and stressful for children than traditional methods.

The main technological hurdle is bandwidth, they say. While store-and-forward offers a way around this, low-speed, high-latency connections like those typically found in rural and remote regions have a negative effect on real-time consultations.

“This project assessed the capabilities of the proposed technical solution in the IBES Lab before deploying the technology in the field,” they write. “The software compressed and encoded the 25 frame-per-second video into an MP4 … video stream of a minimum of 3Mbit/sec data transfer rate – and preferably using 5Mbit/s bandwidth if network conditions allowed.

“These bandwidths gave the clinician sufficient resolution quality to interpret the images received and also removed image blurring due to camera motion. Based on the results of these tests it was ascertained that clinicians had sufficient video quality to interpret the images received based upon the expected bandwidth available at the remote sites.”

The project aimed to connect children who required specialist attention due to cleft lip and palate, dental trauma and orthodontic needs, although trauma was in the end not assessed as no case turned up during the data collection period. One child had Cohen syndrome, a genetic disorder which can involve palate and jaw abnormalities.

In addition to developing a treatment plan by video conference, the specialists were able to provide general advice to the local dentist and to the parents.

Forty-three remote assessments with children between two and 18 were conducted, and the study showed that it was particularly well suited to children and received greater cooperation by younger children and toddlers as no instruments need to be inserted into their mouth. As the researchers write, all children like to see their teeth on screen.

They say there is the potential for more advanced teledentistry implementations involving a larger number of dentists and patients from a wider geographic area, with additional technologies including digital impression, 3D printing to develop dental models, saliva testing and advanced assessment tools.

“Future trials are expected to increase demand for access to local oral health care services, while increasing the level of general oral health in the community,” they say.

“This could be achieved in remote areas with an appropriately equipped and financed mobile unit, which could also service other under-serviced segments of the population, such as the elderly.

“Deployable nodes providing targeted interventions and treatment to address the oral health demand in rural, regional and remote Australia would support the mobile dental unit.”

The researchers include Rodrigo Mariño, David Manton, Matthew Hopcraft and Michael McCullough of the Oral Health Cooperative Research Centre at the Melbourne Dental School, Kerrod Hallett from the Royal Children’s Hospital, Ken Clarke from IBES and Ann Borda of the Victorian eResearch Strategic Initiative (VeRSI).

Posted in Allied Health

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