Remote Clinical Consultations in Restorative Dentistry A pilot clinical study

Main Article Content

Nicolas Martin David King Sam Hyde Shirin Shahrbaf Bilal El-Dhuwaib Sam Gate Abdulrahman Elmougy

Abstract

Specialist consultations are routine in medical and oral healthcare provision. These take place as an 'in-person' event in the secondary care centres. The primary outcome of the specialist consultation is to provide the dentist and the patient with a specialist assessment, diagnosis, prognosis and a proposed care plan.


  


This in-person procedure remains the gold-standard as it is a considered safe and effective. It presents a number of shortcomings: (1) The referring clinician is not actively involved in the decision-making process. (2) The patient must travel to the secondary care centre for the consultation, creating inequalities of care provision. (3) The patient travel has a carbon footprint. (4) The setting of the referral centre can be unfamiliar and intimidating to the patient.  (5) The outbreak of COVID-19 highlighted the need for alternative system to address this need.


 


This clinical study assessed the feasibility and effectiveness of undertaking remote clinical consultations in restorative dentistry between a patient and dentist co-located in a clinical primary care dental practice and a specialist consultant in a remote secondary care centre.


 


Method: A remote clinical consultation in restorative dentistry was conducted that enabled full engagement between the remote consultant and the patient/General Dental Practitioner (GDP) in the dental surgery.  A comprehensive bespoke high-speed secure internet connected hardware and software platform was used.


 


Each participant completed a semi-structured interview and a validated questionnaire covering four domains: Patient safety, communication between different parties, formulation of a treatment plan, and effectiveness of the technology.


 


Results: Effective and safe clinical consultations were carried out in all the cases, regardless of gender, age and presenting complaint.  Neither the process nor the outcomes were inferior to an in-person consultation.


 


Conclusion: This pilot in-practice clinical effectiveness study identified that Remote Clinical Consultations (RCCs), as conducted in this study, are effective for the delivery of specialist consultations in restorative dentistry. They are not inferior to an in-person consultation.  Secondary outcomes:  Three-way discussion was very positive; high levels of acceptability from the patients and the referring GDPs; an alternative to patient travel, reducing travel inconvenience, cost and the environmental burden from the associated carbon dioxide emissions.

Keywords: Remote Clinical Consultations in Restorative Dentistry, Restorative Dentistry, Clinical Consultations in Restorative Dentistry, Dentistry

Article Details

How to Cite
MARTIN, Nicolas et al. Remote Clinical Consultations in Restorative Dentistry. Medical Research Archives, [S.l.], v. 10, n. 10, oct. 2022. ISSN 2375-1924. Available at: <https://esmed.org/MRA/mra/article/view/3183>. Date accessed: 22 dec. 2024. doi: https://doi.org/10.18103/mra.v10i10.3183.
Section
Research Articles

References

1. Estai M, Kanagasingam Y, Tennant M, Bunt S. A systematic review of the research evidence for the benefits of teledentistry. J Telemed Telecare. 2018 Apr;24(3):147-156. doi: 10.1177/1357633X16689433. Epub 2017 Jan 24. PMID: 28118778.

2. Irving M, Stewart R, Spallek H, Blinkhorn A. Using teledentistry in clinical practice as an enabler to improve access to clinical care: A qualitative systematic review. J Telemed Telecare. 2018 Apr;24(3):129-146. doi: 10.1177/1357633X16686776. Epub 2017 Jan 16. PMID: 28092220.

3. Sharma H, Suprabha BS, Rao A. Teledentistry and its applications in paediatric dentistry: A literature review. Pediatr Dent J. 2021 Dec; 31(3):203-215.
doi: 10.1016/j.pdj.2021.08.003. Epub 2021 Sep 1. PMID: 34848924; PMCID: PMC8613071.

4. Park JH, Kim JH, Rogowski L, Al Shami S, Howell SEI. Implementation of teledentistry for orthodontic practices. J World Fed Orthod. 2021 Mar;10(1):9-13.
doi: 10.1016/j.ejwf.2021.01.002. Epub 2021 Feb 25. PMID: 33642260.

5. American Telemedicine Association.  https://www.americantelemed.org/ (Accessed 17 August 2022).

6. American Teledentistry Association.  https://www.americanteledentistry.org/ (Accessed 17 August 2022).

7. International Telecommunication Union (ITU) https://www.itu.int/hub/publication/d-ind-ict_mdd-2019/ (Accessed 17 August 2022).

8. Capampangan DJ, Wellik KE, Bobrow BJ, Aguilar MI, Ingall TJ, Kiernan TE, Wingerchuk DM, Demaerschalk BM. Telemedicine versus telephone for remote emergency stroke consultations: a critically appraised topic. Neurologist. 2009 May;15(3):163-6.
doi: 10.1097/NRL.0b013e3181a4b79c. PMID: 19430275.
9. Ball CJ, McLaren PM, Summerfield AB, Lipsedge MS, Watson JP. A comparison of communication modes in adult psychiatry. J Telemed Telecare. 1995; 1(1):22-6.
doi: 10.1177/1357633X9500100105. PMID: 9375115.
10. Randhawa RS, Chandan JS, Thomas T, Singh S. An exploration of the attitudes and views of general practitioners on the use of video consultations in a primary healthcare setting: a qualitative pilot study. Prim Health Care Res Dev. 2019 Jan; 20:e5.
doi: 10.1017/S1463423618000361. Epub 2018 Jun 18. PMID: 29909798; PMCID: PMC6476389.

11. Alabdullah JH, Daniel SJ. A Systematic Review on the Validity of Teledentistry. Telemed J E Health. 2018 Aug; 24(8):639-648. doi: 10.1089/tmj.2017.0132. Epub 2018 Jan 5. PMID: 29303678.

12. Fernández CE, Maturana CA, Coloma SI, Carrasco-Labra A, Giacaman RA. Teledentistry and mHealth for Promotion and Prevention of Oral Health: A Systematic Review and Meta-analysis. J Dent Res. 2021 Aug;100(9):914-927.
doi: 10.1177/00220345211003828. Epub 2021 Mar 26. PMID: 33769123.
13. Gleeson HB, Kalsi AS. Remote clinical consultations in restorative dentistry-A survey. J Dent. 2022 Feb;117:103914.
doi: 10.1016/j.jdent.2021.103914. Epub 2021 Dec 3. PMID: 34871634.

14. Martin N, Shahrbaf S, Towers A, Stokes C, Storey C. Remote clinical consultations in restorative dentistry: a clinical service evaluation study. Br Dent J. 2020 Mar; 228(6):441-447. doi: 10.1038/s41415-020-1328-x. PMID: 32221448.

15. OECD (2019), Health for Everyone?: Social Inequalities in Health and Health Systems, OECD Health Policy Studies, OECD Publishing, Paris, 
https://doi.org/10.1787/3c8385d0-en.

16. Jordan H, Roderick P, Martin D. The Index of Multiple Deprivation 2000 and accessibility effects on health. J Epidemiol Community Health. 2004 Mar; 58(3):250-7. doi: 10.1136/jech.2003.013011.
PMID: 14966241; PMCID: PMC1732697.

17. Duane B, Steinbach I, Ramasubbu D, Stancliffe R, Croasdale K, Harford S, Lomax R. Environmental sustainability and travel within the dental practice. Br Dent J. 2019 Apr; 226(7):525-530.
doi: 10.1038/s41415-019-0115-z. PMID: 30980009.

18. NHS Long Term Plan.  www.longtermplan.nhs.uk. (Accessed 17 August 2022)

19. NHS England - Delivering a net zero NHS.  https://www.england.nhs.uk/greenernhs/a-net-zero-nhs/ (Accessed 17 August 2022)

20. NHS England - Elective Care Transformation Programme
https://www.england.nhs.uk/elective-care-transformation/ (Accessed 17 August 2022)

21. Coulthard P, Thomson P, Dave M, Coulthard FP, Seoudi N, Hill M. The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part 1: clinical. Br Dent J. 2020 Dec; 229(11):743-747. doi: 10.1038/s41415-020-2404-y. Epub 2020 Dec 11. PMID: 33311687; PMCID: PMC7729702.

22. Coulthard P, Thomson P, Dave M, Coulthard FP, Seoudi N, Hill M. The COVID-19 pandemic and dentistry: the clinical, legal and economic consequences - part 2: consequences of withholding dental care. Br Dent J. 2020 Dec; 229(12):801-805. doi: 10.1038/s41415-020-2406-9. Epub 2020 Dec 18. PMID: 33339931; PMCID: PMC7747003.

23. Singhal S, Mohapatra S, Quiñonez C. Reviewing Teledentistry Usage in Canada during COVID-19 to Determine Possible Future Opportunities. Int J Environ Res Public Health. 2021 Dec 21; 19(1):31. doi: 10.3390/ijerph19010031. PMID: 35010285; PMCID: PMC8751218.

24. Hung M, Lipsky M, Phuatrakoon T, Nguyen M, Licari F, Unni E.  Teledentistry implementation during the COVID-19 pandemic: Scoping Review. Interact J Med Res 2022;11(2):e39955. URL: https://www.i-jmr.org/2022/2/e39955. DOI: 10.2196/39955

25. Cope AL, Chestnutt IG, Wood F, Francis NA. Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study. Br J Gen Pract. 2016 May; 66(646):e329-36.
doi: 10.3399/bjgp16X684757. Epub 2016 Mar 29. PMID: 27025554; PMCID: PMC4838445.

26. Ibraheim A, Sanalla A, Eyeson J. The role of teledentistry in oral surgery during the COVID-19 pandemic, Advances in Oral and Maxillofacial Surgery, 2021; 1:100005.
doi.org/10.1016/j.adoms.2020.100005.

27. Health inequalities further exposed. Care Quality Commission, England. Page last updated: 12 May 2022.
https://www.cqc.org.uk/publications/major-reports/soc202021_01b_inequalities-exposed (Accessed 01 September 2022)

28. Bavaresco CS, Hauser L, Haddad AE, Harzheim E. Impact of teleconsultations on the conduct of oral health teams in the Telehealth Brazil Networks Programme. Brazilian Oral Research 2020; 34:e011. doi.org/10.1590/1807-3107bor-2020.vol34.0011.

29. Aboalshamat KT, Althagafi TK, Alsaeedi SA, Alhumaidi SN, Alemam AA.  Accuracy and perceptions of teledentistry in KSA during the COVID-19 pandemic: A single-centre randomised controlled trial. Journal of Taibah University Medical Sciences, 2022; 17:506-515. doi.org/10.1016/j.jtumed.2021.11.015.

30. León S, Giacaman RA. Proposal for a Conceptual Framework for the Development of Geriatric Dentistry. J Dent Res. 2022 Mar;101(3):247-252.
doi: 10.1177/00220345211042268. Epub 2021 Sep 28. PMID: 34581227.

31. Romano DM, Longson TD, Martin N. Minimal Data Set for Remote Clinical Consultations in Restorative Dentistry - An Exploratory Case Study. Eur J Prosthodont Restor Dent. 2020 Aug 31;28(3):142-150. doi: 10.1922/EJPRD_1972Romano09. PMID: 32347670.

32. Aboalshamat KT, Althagafi TK, Alsaeedi SA, Alhumaidi SN, Alemam AA. Accuracy and perceptions of teledentistry in KSA during the COVID-19 pandemic: A single-centre randomised controlled trial. J Taibah Univ Med Sci. 2022 Jun; 17(3): 506-515. doi: 10.1016/j.jtumed.2021.11.015. Epub 2022 Jan 21. PMID: 35079243; PMCID: PMC8778484.

33. Steinmeier S, Wiedemeier D, Hämmerle CHF, Mühlemann S. Accuracy of remote diagnoses using intraoral scans captured in approximate true color: a pilot and validation study in teledentistry. BMC Oral Health. 2020 Sep 25; 20(1):266. doi: 10.1186/s12903-020-01255-8. PMID: 32977794; PMCID: PMC7517740.

34. Braun V, Clarke V. What can "thematic analysis" offer health and wellbeing researchers? Int J Qual Stud Health Well-being. 2014 Oct 16;9:26152. doi: 10.3402/qhw.v9.26152. PMID: 25326092; PMCID: PMC4201665.

35. Governance and Management, Information Security Policy:  Confidentiality and Integrity. University of Sheffield. https://www.sheffield.ac.uk/govern. (Accessed August 2022).

36. IT Code of Practice regulations. University of Sheffield. https://www.sheffield.ac.uk/it-services/code-practice/regulations. (Accessed August 2022).

37. Charles-Ozuzu. Long Term Plan will be a game changer. National Elective Care Transformation Programme.  NHS England 03 May 2019.
(https://www.england.nhs.uk/blog/long-term-plan-will-be-a-game-changer/) (Accessed August 2022).

38. Rahman N, Nathwani S, Kandiah T. Teledentistry from a patient perspective during the coronavirus pandemic. Br Dent J. 2020 Aug 14:1–4. doi: 10.1038/s41415-020-1919-6. Epub ahead of print. PMID: 32801323; PMCID: PMC7427495.