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Teledentistry in Action: Medical-Dental Integration at Greene County Health Care

In eastern North Carolina, Greene County Health Care (GCHC) is embracing teledentistry, one of many innovative steps they are taking to improve patient care and meet the needs of traditionally underserved populations.

“I think the thing that’s most exciting about teledentistry is the integration of medical and dental,” said Dr. Rob Doherty, chief dental officer at GCHC. “I’m looking at the patient and I’m talking to them face-to-face, and I also have that medical provider there in case there are questions.”

Dr. Doherty and Chi Nguyen, a physician assistant at GCHC, recently filmed a joint teledentistry appointment with a patient, which you can watch during Oral Health Day Part 2, a follow up to NCOHC’s annual oral health advocacy event. Learn more, register, and join the virtual event on October 23 from 1-3 p.m.

During a screening with Nguyen, the patient mentioned experiencing pain in his mouth. Rather than schedule a separate appointment with a dental provider, Nguyen was able to loop Doherty into the video call.

Picture of Dr. Rob Doherty talking to a patient via a computer webcam

Doherty consulting with Nguyen and her patient through GCHC’s teledentistry software platform.

“Chi had a patient on the line who she was just checking on. He had made a comment that he had a hard time sleeping because a tooth was bothering him, and it was a little bit swollen,” said Doherty. “So, she just sent me an email and I was able to speak with him face-to-face and really get an idea of what the problem was. I had the schedule right in front of me and I was able to get him an appointment at 2:30 that afternoon.”

Doherty said that the video call helped him get a much better idea of the problem, something he wouldn’t have been able to do had the patient just called in and said he had tooth pain.

“It is awesome, us being able to see a patient and have a three-way appointment,” said Doherty. “We can get so much done, we can be so convenient for that patient, and it’s just plain better care.”

Of the benefits that teledentistry provides, Doherty highlighted just how important time saved can be. Health centers like GCHC see large volumes of patients who otherwise wouldn’t have access to affordable care.

“Every time we open up a new site, we’re swamped,” said Doherty. “We have a long waiting list, and we have to limit the number of patients that we see.”

With technological innovations like teledentistry, providers can increase efficiency, provide care to more patients, and work through those waiting lists.

“I think the horizons are really opening up for us in teledentistry,” said Doherty.

Join NCOHC, Doherty, and the dental directors for Kintegra Health and Piedmont Health on October 23, 2020 to explore the many ways clinics in North Carolina are using teledentistry to improve patient care. At the virtual event, you will also hear from national experts, including the “father of teledentistry,” Dr. Paul Glassman, and more! Register today!

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Teledentistry in Action: Completing a Network of Care

Thousands of young children in the counties west of Charlotte receive annual dental care in their schools’ parking lots. With an active, and growing, mobile dental network, Kintegra Health’s Dental ACCESS Program is improving children’s oral health, and teledentistry is a vital piece of the puzzle.

On board one of Kintegra Health’s mobile buses, complete with three chairs, an x-ray room, and plenty of cartoons to keep children occupied.

“The program has just blossomed,” said Melissa Boughman, director of the ACCESS Program. “We have 60 schools that we work with now, and we saw 5,500 children last year.”

If schools remain open this fall and avoid COVID-19 outbreaks, the ACCESS Program is on track to see between 6,000 and 7,000 students this year, according to Boughman.

Students now receive temperature scans to screen for COVID-19 symptoms at the beginning of their visits to the Dental ACCESS Program.

“Parents working (with limited) access, specifically transportation access, means that parents sometimes can’t get to the dental office, or they can’t get time off of work to come to the dental office,” said Dr. William Donigan, dental director at Kintegra Health. “We need these children to get as much care as we can give them without the parents having to be here.”

“In Title I schools, transportation is such a major issue,” said Boughman. “It’s so wonderful that we’ve been blessed with these mobile dental units that we can drive right up, park, and they bring the children out to us.”

In one day at Battleground Elementary in Lincoln County, the hygienists and assistants on this mobile bus will see around 30 kids.

The ACCESS Program has two mobile dental buses, complete with three dental chairs and an x-ray room, as well as a dental van for follow-ups and dental sealants.

Once a child is on the bus, Kintegra’s dental team takes a series of nine photographs of the child’s teeth as well as x-rays, if necessary. While the dental hygienists and assistants can only provide preventive care on the mobile buses, the care doesn’t stop once a child goes back to class. Thanks to the Kintegra’s teledentistry software, those photos and x-rays are automatically uploaded, made immediately available to dentists and staff at one of their brick-and-mortar sites.

The computers on Kintegra Health’s mobile buses transmit data in real time to staff at clinic sites.

“Literally immediately, we can view all of that information at one of our sites,” said Donigan. “So, our Dental ACCESS Program navigators can then talk to the dentist and direct the parents to get the patient in for the care that they need.”

Dental navigators are another vital piece of the puzzle. Kintegra employs navigators to help parents and patients efficiently get the care that they need. For parents experiencing any of a slew of social determinants of health that make accessing care more difficult, having someone there to guide the process along can have a big impact on the care a child receives.

For more on dental navigators and how they increase access to care, check out a blog by one of our summer interns on community care coordination.

With a complete network, connecting the staff on Kintegra’s dental buses to the dentists at their clinic locations, children who may have not received care otherwise now have the opportunity to receive regular care.

“We see the difference in the children we have seen for many years versus the newcomers like the kindergarteners, and in some schools pre-k,” said Boughman. “When we see them yearly, we see a big difference. We also do education because we all know that education is the most important part of all of this. Once we clean their teeth (plaque and tartar) will come back quickly, but if we teach them how to take care of their teeth, they can have a lifetime of great (oral health).”

Want to see teledentistry in action?

Join NCOHC for Oral Health Day Part 2 to see how clinics like Kintegra Health use teledentistry to improve access to patient care. We just announced a change of plans. Instead of in-person tours, we will bring tours of clinics, including Kintegra Health, to you virtually on [DATE], along with a star-studded panel of teledentistry experts from across the country!

Learn more and register here.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!

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Racism, Food, and Your Mouth: Parallels Between Food and Oral Health Equity

“Historic and systemic structural racism are inherent parts of the United States,” said Jen Zuckerman, director of strategic initiatives at the Duke World Food Policy Center. “This means every single system that exists within the United States is rooted, designed, and based in racism, and has been built on the system of oppression. Nobody alive today is to blame for the unfairness of our history, but we each hold a responsibility to create a better future.”

Continuing NCOHC’s series on the social determinants of health and how they impact equity in oral health, we spoke with Zuckerman to discuss how the Duke World Food Policy Center approaches inequities in food systems and the policy work that can make a lasting impact.

 

Click here for more on equity in oral health.

 

Access to food is an important social determinant of health, and healthy food options can significantly impact oral health. Unlike other posts in this series that directly break down relationships between the social determinants and oral health, this post will focus on food systems, underscoring how Zuckerman and the Duke World Food Policy Center are addressing inequities, while drawing parallels to oral health systems.

 

Oral Health Takeaway

Lack of access to affordable, healthy food options means consumption of less healthy food, often high in sugar and carbohydrates. This is an important concern, as these kinds of foods increase risk of tooth decay, gum disease, and other oral health issues.

 

The Center for Assessment and Policy Development defines racial equity as “the condition that would be achieved if one’s racial identity no longer predicted, in a statistical sense, how one fares.”

Racial inequity plagues food production, distribution, financing, ownership, and access in the U.S., so much so that Zuckerman said there is no true working example of an equitable food system. To understand the fundamental role that racism plays in creating systems of inequity, the World Food Policy Center looks toward ownership structures.

“An equitable food community is one where there is an equitable distribution of ownership as it relates to the ability to grow food, distribute food, and provide retail,” Zukerman said. “An equitable food community would also have equitable access to capital.”

 

Food Deserts vs. Food Apartheid

The Duke World Food Policy Center uses the term “Food Apartheid” to refer to areas with limited access to healthy food options. Food Apartheid broadens the conversation to include various factors and root causes of inequities in the food system such as historic disinvestment from communities of color.

 

The term “food desert” insinuates that the phenomenon is naturally occurring. Zuckerman pointed out that to truly understand the underlying structures that create food inequity, we must understand how points of limited access are influenced by generations of intentional disinvestment.

 

The ability — or lack thereof — to build generational wealth has been fundamental in creating inequities. According to the Duke World Food Policy Center, barriers to building generational wealth should also be front and center in policy work to address and reverse inequities.

“When we think about food, or when we think about anything in the United States, history has demonstrated that the white community has continually gotten investment through policies, programs, and initiatives,” said Zuckerman. “And communities of color have continually gotten programs and services, which do not build wealth.”

While programs and services for those who lack access are incredibly valuable, it is simultaneously important to take conversations of equity a step further to encompass the financial, policy, and power structures at play.

 

Oral Health Takeaway

What does ownership look like in the oral health space? According to a 2015 ADA report, 74.2 percent of licensed dentists are White, while only 3.8 percent are Black, 5.2 percent are Hispanic, 15.7 percent are Asian, and 1.1 percent are other non-White ethnicities.

 

Zuckerman pointed to housing as an example of racist policies that have created lasting impacts on generational wealth. White veterans returning from World War II were able to buy homes through the GI bill, while returning Black veterans were disproportionately blocked from homeownership due to redlining and other policies rooted in racism.

“Broadly speaking, instead of home loans, Black veterans got public housing from government support,” said Zuckerman. While policies like redlining are illegal today, “think about the wealth built over generations of homeownership versus the wealth you cannot build by living in public housing.”

 

Oral Health Takeaway

In North Carolina, the racial disparity among dentists is even wider. Around 82 percent of practicing dentists in North Carolina are white, according to a 2005 report from the UNC Sheps Center for Health Services Research. Which communities have been able to benefit most from generational wealth thanks to the dental industry, and which communities have not?

 

Racist policies, no matter when they were enacted or ended, have contributed to an historic disparity in wealth between white and BIPOC communities. Because of this, a lack of direct racism is not enough to reverse past racism. Whether we are aware of it or not, there are still people, policies, and structures in place today that have disproportionate negative impacts on communities of color.

So, how do we actually change racist systems and create equitable structures?

According to Zuckerman, ownership, which refers to both wealth creation and agenda setting, is a central piece of the puzzle.

“There need to be changes in financing and philanthropic investments,” Zuckerman said. “More philanthropic dollars need to be invested in BIPOC-led organizations, and those community organizations need to be able to set the agenda for what they would like their community to have.”

In oral health, significant focus is given to providing low-cost oral health services to those who have historically lacked access. While these programs and services are incredibly important, and this post is not in any way meant to downplay the hard work that so many people do to extend access, oral health champions can learn a lot from the Duke World Food Policy Center’s perspective.

As oral health policy champions, how can we help create more equitable structures that include a diverse workforce more representative of the population as a whole? Where is wealth being built in the dental industry, and how can we work to increase access to and equity in that side of the equation?

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Teledentistry in Action at Piedmont Health

“Technology has really changed the field of dentistry since March,” said Dr. Katrina Mattison-Chalwe, Piedmont Health’s dental director, referring to the need for dramatic shifts in how providers approach patient care to adapt to the COVID-19 pandemic.

As COVID-19 closed economies across North Carolina and the U.S., health departments and the American Dental Association recommended that dental providers reduce services to only treat patients with emergent needs. As a result, many practices and clinics began to re-think how they could use teledentistry to maintain patient care.

“When we were all confined to our homes and only able to come out for essential needs, teledentistry came into play,” said Dr. Mattison-Chalwe. “It has opened up our ability to treat patients—we are now able to talk with someone face-to-face without actually being face-to-face.”

 


 

While a full slate of dental services cannot be provided remotely—your dentist can’t reach through the computer screen to perform a filling—many diagnostic, education, and consultation services can be performed remotely, connecting patients to a provider for these essential services.

“Teledentistry has enhanced our abilities tremendously,” said Melvin Williamson, a dental assistant at Piedmont Health. “We are able to reach out to our community, especially the younger kids, who need help really bad right now.”

Remote care technology is also helping providers reduce the amount of time a patient needs to be in the office to receive care.

“Teledentistry has allowed us to triage our patients better,” said Dr. Lauren Harrison, a general dentist at Piedmont Health. “It has allowed us to screen our patients without exposing ourselves to anything that’s not necessary, and we’ve also been able to reserve more clinic time for patients who really need that time.”

Traditionally, dental care can require several appointments from start to finish, beginning with an examination, where a dentist and staff would assess the patient, develop a treatment plan, and schedule a follow-up appointment to deliver the care needed. With teledentistry, providers have been able to perform the initial examination remotely, minimizing the time a patient would need to be physically present in clinic.

Earlier this year, NCOHC launched a teledentistry fund with support from the Blue Cross and Blue Shield of North Carolina Foundation. The fund has helped award 20+ grants, including one for Piedmont Health, to purchase annual teledentistry subscriptions. These subscriptions will help health centers and other clinical facilities provide remote patient care both during and after the COVID-19 pandemic.

“We were not prepared for COVID-19. No one was. As a result of that, we didn’t have extra funds to be able to purchase teledentistry licensing for all our providers,” said Dr. Mattison-Chalwe. “The (NCOHC) Teledentistry Fund helped us purchase licenses for all 12 of our providers, so we are able to be on the teledentistry platform while we were all in quarantine, and we are still able to use it now.”

Want to see teledentistry in action?

Join NCOHC for Oral Health Day Part 2 to tour a Federally Qualified Health Center like Piedmont Health this October.

Learn more and register here.

Whether we meet in person or virtually, dental directors like Dr. Mattison-Chalwe will provide teledentistry demonstrations, highlighting remote possibility in oral health care, and answer your questions regarding its use or impact on community care.

NCOHC is a program of the Foundation for Health Leadership & Innovation. For more information and to stay up to date, subscribe to the NCOHC newsletter. If you are interested in becoming an NCOHC member, you can also fill out our membership form. It’s free!