Guest blog submitted by Leah Smothers, PHRDH, Floss and Gloss Program Manager, Purchase District Health Department, KOHC Steering Committee member.
My journey with teledentistry began in December 2018, when I attended a training session led by Eden Ivey, a teledentistry expert. She showed us how to use Mouthwatch cameras and Teledent software to capture and share intra-oral images of our patients. As the program manager of Floss and Gloss, a K-12 in-school program, I was fascinated by the potential of this technology to improve oral health care for underserved populations. This introduction was part of a grant from Delta Dental of Kentucky aiming to increase the use of teledentistry in our region.
However, I soon realized that there were many challenges and barriers to implementing teledentistry in our program. We had no integration between our software and no reimbursement for services. We decided to use Teledent as a tool to enhance our communication with parents and school staff, as well as to support our cases with the Department for Community Based Services (DCBS). The intra-oral images were very effective in showing the dental needs of our patients and encouraging them to seek treatment.
I did not give up on the dream of fully integrating teledentistry into our program. I continued to educate myself on the latest developments and best practices in telehealth. I participated in various learning opportunities, such as the Telehealth Summit, the Health Resources and Services Administration (HRSA) telehealth learning series, and school-based telehealth webinars. By August 2019, the Floss and Gloss Team was working on a teledentistry pilot program with a local dentist who agreed to provide services without reimbursement. Unfortunately, the COVID-19 pandemic disrupted our plans and forced us to pause the program.
However, the pandemic also created new opportunities for telehealth. As more people turned to online platforms for health care, I learned more about the different models and modalities of telehealth. I also witnessed how telehealth could increase access, quality, and efficiency of care for patients in rural and remote areas.
Our team saw the need to bring teledentistry and Silver Diamine Fluoride (SDF) to our schools. SDF is a liquid that can stop tooth decay and prevent it from getting worse. It can be applied easily and safely by a trained hygienist. I started this project with the support of our public health director and the State dental director, Dr. Julie McKee. I also found a great dentist, Dr. Whitney Deitz, who agreed to be our teledentistry provider. We had to figure out the best way to set up our workflow, follow the laws and regulations, and get paid for our services. A client success manager from Teledent Software helped us with the technical aspects and showed us examples from other programs. We also had to work with the Department for Medicaid Services (DMS) to add new codes to our state’s fee schedule, which took a long time. We chose to use Elevate Oral Care’s SDF product and trained our staff on how to use it properly.
During the 2022-2023 school year, we launched our teledentistry and SDF program for the first time. It was not easy, as we faced some challenges along the way, including staffing. We needed more people and more time to do teledentistry than regular preventive care. Another one was internet access. Sometimes, the internet was slow or down, and we could not use our web-based software. We had to find ways to adapt and overcome these issues.
Despite these difficulties, I am proud of what we have accomplished so far. We have been able to provide more comprehensive preventive care to our patients, especially those who have limited access to dental services. We have also been able to educate them and their parents about oral health and the benefits of SDF. We hope to continue and expand our program, with a goal to include X-rays in our teledentistry services in the future. I am also committed to advocating for more opportunities for Public Health Registered Dental Hygienist (PHRDH) programs to work in different settings, such as nursing homes.
If you are interested in learning more, check out the upcoming Kentucky Rural Telehealth Summit on September 28th in Lexington, KY, featuring Leah Smothers as part of a panel discussion on teledentistry.
