Case study: Teledentistry in Western NSW Local Health District

Dental care generates aerosols and there were concerns about its potential for the transmission of COVID-19. As such, NSW Health dental clinics across the state ceased all routine dental care when stay-at-home restrictions were in place. Services were restricted to urgent and emergency care only. Outreach services to smaller, more remote towns also ceased. To help manage this and to help triage the more urgent dental conditions, Western NSW Local Health District (WNSWLHD) implemented a teledentistry service.

The teledentistry service involved dentists conducting telehealth assessments with patients over the phone to determine which patients could postpone their care without the need for immediate clinical treatment, and who should be prioritised. Systems were also set up to send e-prescriptions or fax print prescriptions to local pharmacies, so clients could be prescribed medication for pain relief.

A phone survey of 128 patients who had received a telephone assessment in the past 12 months found that 80% of clients thought it was better to have a phone assessment rather than a 10 minute in-person assessment appointment.

Teledentistry was reported to have the following benefits:

• clients from across the LHD were able to access the service more easily; they did not have to travel long distances for an in-person assessment that could be just 10 minutes in length
• clients were more comfortable with the assessment as it was not in the clinical environment, making them more receptive to oral health education
• clients were able to provide an accurate report on their current medications
• staff travel between clinics was reduced, freeing up time to support other work.

Limitations and challenges were identified. Effective treatment planning is more difficult over the phone as there is an absence of visual examination and the ability to conduct the usual clinical tests. Engaging intepreters can also be difficult. There were also concerns that delaying physical treatment during COVID-19 stay-at-home restriction periods would result in future spikes in dental emergencies. This is because most dentistry is procedural.

Due to the positive outcomes for patients and staff, phone assessments for some adult patients have continued in WNSWLHD. For patients who have limited mobility or where there are geographic challenges, telehealth models may have application in assessing treatment needs into the future.