Guidelines for Teledentistry

Last updated: 14 April 2020

In an exceptional circumstance where a patient is seeking urgent care from a dentist but is unable to attend a dental clinic in person, it may be necessary to conduct a consultation by audio or through a videoconferencing platform such as Skype, Zoom, GoToMeetings or Face time. Videoconference services are the preferred approach for substituting a face-to-face consultation. Regardless of the application used, practitioners must ensure that their chosen telecommunications solution meets their clinical requirements and satisfies privacy laws.

It should be noted that a service may only be provided by teledentistry where it is safe and clinically appropriate to do so. This item number is not intended to be used for offering routine assessments, advice or oral health instructions.  It is a patient-led service.

Ideally teledentistry services should only be offered to existing patients or those referred by another practice.

The appropriate item number to use from the Australian Schedule of Dental Services and Glossary is:
919 Teleconsultation

The remote provision of a consultation to a patient in exceptional circumstances which prevent face to face consultation. It may include the provision of oral health or treatment information and referral.

The item number may be used with other relevant item numbers, e.g. 019 Letter of referral


What steps should I take in conducting a teleconsultation appointment? 

Patient consent for the consultation must be attained and the identity of the patient should be confirmed using at least three patient identifiers such as name, age/date of birth and address.

The patient should be made aware of the limitations of teledentistry and that dentists are providing the best advice possible in the absence of face–to–face consultation.

The patient’s current clinical records should be available for reference.

A detailed record of the consultation including confirmation of identity, consent to consultation, updates to medical and medication history, presenting symptoms, recommended treatment should be added to the clinical record. This applies whether a consult fee was charged.


Do I need to conduct the teleconsultation from my normal clinic?

No, you do not need to be in the dental practice to provide telehealth services, but you should ensure you have access to patient’s clinical records.
You may use your provider number for your primary location and must provide safe services in accordance with normal professional standards.


Can I delegate responsibility for conducting a teleconsultation to another staff member?

Only if the person who conducts the consultation is the holder of a provider number.


Which patients are most suited to a teleconsultation?

Any patient who has recently undergone a dental procedure and requires follow up or has concerns with their recovery after the procedure or is presenting with an acute dental problem:
  • outside of normal practising hours,
  • who is unable to attend the clinic due to illness, isolation or quarantine,
  • Vulnerable patients during pandemics including those who are:
    • aged 70 years or older
    • identify as being of Aboriginal or Torres Strait Islander descent
    • pregnant; or
    • the parent of a child aged under 12 months; or   
    • being treated for a chronic health condition; or
    • immune-compromised; or
    • meet the current national triage protocol criteria for suspected COVID-19 infection.


When would a teleconsultation be appropriate?

Outlined below is a series of examples where it would be appropriate to conduct a consultation remotely.

Toothache
The following suggested questions may help you to determine if it is an acute odontogenic infection
  • Is this new or recurrent?  
  • Has the patient recently undergone a dental procedure?
  • Have they been prescribed antibiotics for this problem before? 
  • Do they have an elevated temperature? 
  • Do they have facial swelling and pain, trismus, neck swelling, difficulty swallowing, difficulty breathing or a compromised airway? If the patient has a spreading infection/cellulitis, they should present to the nearest emergency department and the dentist should call the hospital and provide details of the referral. 
  • If an existing patient, do they have any changes to their medical history, including allergies, medications.  If new patient, detail full medical history.
  • Determine the site of the pain
  • Determine how long the patient has the pain
  • Determine the nature of the pain. E.g. Stabbing throbbing etc
  • Determine if the pain radiates
  • Any other signs and symptoms.  
If the patient does not meet admission criteria for hospital, consider if the patient needs pharmaceuticals and/or if their management can be deferred.  
Please refer to the Therapeutic Guidelines Oral and Dental V3 for the appropriate prescription of analgesia and/or antibiotics.  

Broken or loose tooth
Ascertain from the patient the degree of mobility of their tooth or teeth. If there is no pain and the tooth is not mobile enough to be aspirated, management may be deferred. 
If the tooth has broken, the patient should be asked if there is any pain or hot/cold sensitivity. Treatment should be deferred if the tooth is asymptomatic. 
If the tooth is broken or chipped, or causing soft tissue irritation, patients may be directed to file it down themselves with some sandpaper or a nail file. Orthodontic wax might also be suggested.

Trauma 
In cases of dental trauma, determine if the management of this may be deferred or if urgent visual inspection is required.  You may wish to ask some or all of the following questions to help in determining the extent of the injuries.
  • Which area of the face was there trauma to? 
  • Is the tooth sore to touch? 
  • How loose is it? 
  • Is the tooth broken? 
  • Is the gum around the tooth bleeding? 
  • Is there bleeding from the lips, gums or other tissues?  
Please refer to the International Dental Trauma Guide: https://dentaltraumaguide.org/free-dental-guides/permanent-teeth/ 
 
Orthodontics 
Ascertain if this is a situation for which the management may be deferred.  
The patient can contact their orthodontist if their archwire has come loose, or the bracket has come loose for advice.  
If there is soft tissue irritation, the patient may be directed to place some orthodontic wax or sponge (from a makeup remover pad) over the sharp area.  

Broken dentures/crowns/bridges 
Broken dentures should not be worn if they are an aspiration risk.  
Management of broken crowns and bridges should be deferred. Broken or loose crowns should be kept safely until treatment can be provided in the clinic. 
Patients should not be encouraged to recement any of these due to an aspiration risk.  
 
 
 

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