Like so many doctors in this country, Sandra Garbely graduated school with a lot of student debt. Nearly 30 years ago, she joined the National Health Service Corps to help pay back her student loans — a decision that launched her career in public service. After years with a federally qualified health center, she founded her own private practice, but soon realized she missed the sense of community and purpose that came with public health dentistry. That’s when she joined Choptank Community Health System (CCHS), a private nonprofit in Maryland that provides dental services, as well as outreach to schools and communities. Dr. Garbely now serves as Senior VP and Chief Dental Officer, and her team sees around 200 patients a day across Choptank’s five sites, which primarily serve very rural, farming and crabbing communities.

How did you make the decision to return to public health after years in private practice?

The [dental] industry went through a phase in cosmetic dentistry where everyone was doing implants and veneers and it was all about aesthetics — trying to achieve that California smile. And it really threw me for a loop because I was happy getting people out of pain and giving them a better quality of life. I missed taking care of people who really didn’t have an option of going anywhere else. They couldn’t get specialty care either because they were uninsured or because they couldn’t incur the cost of dentistry. So one night I went home and said to my husband, “I’m unhappy. We’re probably going to lose a lot of money, but I have to get back into public health.” He was very supportive, and I haven't looked back since.

How has teledentistry factored into your work at CCHS?

We really wanted to figure out how to reach out to patients and assess their needs — and ultimately provide care — without them having to come into the office. Sometimes it’s difficult to see our population, either because they’re scared or just because of logistics. Teledentistry at first was hard for our providers, because you’re not trained to do that in school, but we knew we had to find a way. 

After our first patient, we all cheered because it was so thoroughly successful. This patient was a truck driver who was on the road and had a front tooth that was very loose and bothering them. They thought they had to lose it, but couldn’t get into the office, so we used their phone camera to look at the tooth and make an assessment. One of our dentists, Dr. Freeman, took a look and said, “No, we probably won’t have to pull your tooth, but I’ll call you in antibiotics because it looks like an active infection. Come into the office when you can.” It took a little while for our staff to build a workflow and for patients to download the app, but now we love it.

How is your field team using teledentistry to improve outcomes outside of the clinic?

When schools open back up, a hygienist from our staff will go to the schools, which are in rural areas around two hours away from me, and use our virtual program to upload photos directly into our system. Then I can take a look at the patient’s mouth if it’s needed. It’s really a neat way to see patients, and you’re able to easily document what you’ve seen that day. It gives our school-based team out in the field that link to us. It also allows us to connect with parents. I’ll call with the teleconference system and explain what we’ve seen and what follow-up care needs to be provided and just getting them on the phone makes a difference. We even work through paperwork with them that way. 

We also utilize the Google Duo video calling app with our team that goes out to migrant camps in Maryland, where access to care is scarce. That way the team can call the dental office if there are issues or concerns. Providers here have teledentistry slots on their schedules dedicated to serving remote patients — and if something is more urgent, we can see a patient virtually between our in-office visits. The goal always is same-day care when it’s needed. The difference for me now is it doesn’t have to be about the revenue — it’s about the long-term effect and keeping these patients coming back.