Telehealth is rising as one of the most creative and useful applications of information technology in medicine and health. It can be defined as the use of telecommunications to support healthcare when there is geographical distance between patient and care providers. Among the multitude of applications that have been developed in the last 30 years in this field, telediagnosis, teleconsultation, teleradiology and telemonitoring are the most promising, both from the point of view of commercial success and clinical usefulness.
Dentistry and oral medicine, however, have been lagging behind in relation to other areas of medicine, in respect to telehealth applications. This is a pity, because there is ample demonstration of its potential as a tool to improve quality of care and safety for patients as a whole. To prove this in a more concrete way, I will give a personal example. Starting in 1995, I became involved in a telehealth project which involved setting up a service for transtelephonic heart monitoring in dentistry. A private company named Telecardio, which is based in the city of São Paulo, used technology provided by an Israeli company, Aerotel, to provide to dentists the possibility of carrying out an electrocardiogram of their patients before anaesthetic and surgical procedures. Readers may well note that it is an exceedingly rare event that a dentist or oral surgeon performs an EKG in an ambulatory or dental office setting. However, it has been widely demonstrated that this simple procedure would decrease significantly the risks of adverse cardiac or circulatory events during a surgical procedure, due to the fact that many heart ailments, such as atrial fibrillation, are sensitive to circulating levels of even local anesthetics used by dentists on a routine basis.
Telecardio’s project consisted in renting to the dentist a small portable device which is able to collect in real time ca. 20 seconds of dual derivation EKG. The signal can subsequently be transmitted via a normal telephone line (POTS, or Plain Old Telephone System) to a remote monitoring station, where the EKG is displayed in a computer’s screen. A resident trained electrocardiologists examines the tracing, and using the same telephone line, advises the dentist about the results and what to do in case an abnormality is detected. The EKG tracing is also sent via a fax machine to the dentist’s office, in order to document the diagnosis.
Trying to establish the scientific evidence for the continued use of this resource by dentists, we analysed about 2,500 records of EKG monitoring coming from dentist offices. What we found was startling. About 25% of patients showed some degree of heart rhythm disturbances which required a closer inspection. About 64 surgeries were suspended, due to an unacceptably high risk for the patient. And, in two cases, the patient was suffering an ischaemic myocardial event! The service had to call an ambulance to remove the patient to a proper acute coronary unit (this is part of the service contract with the dentist). Nowadays, Telecardio has put more than 3,000 devices in dentists offices and has a permanent staff of 16 cardiologists in its monitoring centers. This is a clear demonstration of the usefulness of telecardiology in dental care; and we could easily evaluate its impact not only on the wellbeing of patients, but also on the marketing image of the dentist vis-a-vis the preoccupation with the safety of his/her patients.
Other areas of teledentistry address the interpretation of x-ray images and of oral pathology biopsies, second opinion and even the dialogue between prosthetic and dental cosmetology services and the referring dentist; not to mention the usefulness of the Web and of videoconferencing in continuing education in dentistry and oral medicine (please see our previous editorial on this subject).
I am sure that we will soon witness an expansion in the number of dental offices which will have wideband connections to the Internet in order to have access to videoconferencing, distance education and high-speed access to the Web. Teledentistry can be translated as “distance collaboration”, either between care providers or between patients and care providers. There are a number of computerized tools to allow this, and it is imperative that dentists learn how to use them. Without any doubt, is a future we cannot avoid. And a good place to start is the Telemedicine Information Exchange site, where a great number of links and information resources on telehealth can be found.
Renato M.E. Sabbatini holds a doctorate in biomedical sciences by the University of São Paulo, Brazil. He was founder and director of the Center for Biomedical Informatics of the State University of Campinas, Brazil, and is currently an associate professor of medicine and chair of Medical Informatics at the Medical School in the same university. A pioneer in distance education in Latin America, Dr. Sabbatini also developed programs in telemedicine and electronic publishing in the health sciences.
Email: renato@sabbatini.com
Home page: http://renato.sabbatini.com