This is an excerpt from A Three Domain Framework to Innovating Oral Care, a new white paper from the DentaQuest Partnership for Oral Health Advancement.

Dentistry has long been a profession ripe for disruption. Dental care delivery has disproportionately focused on invasive intervention and a fee-for-service payment model that leaves many people lacking access to quality care. The COVID-19 pandemic has catalyzed an overdue and necessary structural change within dental care delivery.

A more distinct and recharged dental care model is needed for these times.

The DentaQuest Partnership for Oral Health Advancement is proposing an expanded model for primary and secondary prevention using emerging technology and transformative methodology. The Three Domain Framework builds on health promotion and disease prevention while supporting value-based care.

The Framework forms an interdependent care environment that prioritizes prevention but provides oral health providers and the patient an ability to determine the treatment that best meets the patient’s needs. Care teams can tailor the domain approach to the specific needs of the patient while leveraging opportunities for whole-person health. By prioritizing primary care and prevention through Domains One and Two, wholeperson health is deeply integrated into the care delivery process.

Domain One: Tele-Prevention

Domain One’s primary focus is to build an accessible, convenient, evidence-based virtual framework for oral health care centered on disease prevention and whole-person health. The proposed interdependent domains of care delivery rely on increased adoption of teledentistry to accelerate prevention and disease management but cannot completely replace in-person encounters.

Teledentistry bolsters current prevention and healthy behavior strategies used to improve the health of individuals. As a component of telehealth, teledentistry can support integrated, holistic care in conjunction with other health professionals (e.g., medical providers, mental health providers, etc.). Eventual best practices will use telehealth capabilities to enhance risk-based prevention during in-person oral health and dental care delivery.

Before the COVID-19 pandemic, safety net providers were the primary users of telehealth, and most dental providers did not incorporate teledentistry into their practices. Teledentistry has historically struggled with adoption because of reimbursement policies, state and supervision regulations, lack of accessible technology, real and perceived lack of use cases, and an elusive business model.

As COVID-19 drove care teams to reduce direct patient contact, use of teledentistry initially increased to maintain provider-patient connection (although it has subsequently diminished significantly as dental offices reopened). Consequently, several states either created or expanded temporary or permanent teledentistry regulations. The movement toward adoption of teledentistry in the wake of COVID-19 presents opportunities to reengineer the traditional care pathway toward oral health promotion and disease prevention.

The novel modality and variation in regulation (currently only 20 states have specific teledentistry policies) necessitates additional guidance related to teledentistry. Below, we consider three components of telehealth in dentistry: 1) synchronous urgent visit, 2) synchronous prevention visit, and 3) asynchronous prevention visit.

Three Components of Telehealth in Dentistry

1. The synchronous urgent care visit uses telehealth-enabled communication for providers to remotely assess and triage patients with dental emergencies. Urgent or emergent visits can be leveraged as a gateway for patients to establish a dental home and a pathway for prevention opportunities. Providers can determine the appropriate care location, interventions and treatment plan without needing physical contact.

Synchronous consultations can allow providers to prescribe medications and appropriate treatment, which may avert more costly and disruptive visits to hospital emergency departments. Convenient access to a dental provider, coupled with avoiding unnecessary in-person visits (both to a dental office or hospital emergency department), make virtual encounters for urgent care a prime target for expansion.

2. The synchronous prevention visit focuses on evaluating health status for disease prevention using a tele-prevention model. Virtual visits can be a beneficial tool for the provider and community, especially when community health workers are effectively integrated in the process. In populations struggling to access dental care, synchronous teledentistry can provide more consistent connection with the dental provider.

Through tele-prevention, providers can conveniently evaluate and triage dental disease to achieve improved patient management. Patients who cannot access routine diagnostic and preventive dental care risk worsening undetected dental disease, potentially resulting in a dental infection and unnecessary use of emergency departments. This synchronous encounter is proactive and scheduled rather than a reactive urgent telehealth visit. The integration of primary care and inclusion of health coaching creates opportunities for oral health care teams to adopt these procedures for improved population health.

3. Asynchronous preventive visits can expand the reach of providers into communities where their residents do not readily have access to oral health care and provide more convenient and safer services even for those who have, in the past, received regular in-office care.

The visit often includes a patient assessment, radiograph or photographic documentation for referral, oral hygiene instructions, a caries risk assessment, a fluoride application, and a prophylaxis with sealant placement. A dentist electronically evaluates the shared documents and images to develop a treatment plan. Later, the findings and treatment plan are communicated back to the patient for discussion and finalization. Asynchronous visits improve access to care, support those at high risk for disease progression, and facilitate convenient dental care.

Editor’s Note: View the full white paper and executive summary and learn more about this work to transform the oral health care system.