The American Teledentistry Association (ATDA), launched in May, is “an effort to shape the conversation around the practice of teledentistry as a tool to increase access to care for millions of Americans through the use of innovative technological advancements,” the organization announced in its press release. It’s currently comprised of about 50 members, including at least four companies that provide mHealth-based orthodontic services, and is processing applications from roughly 50 practitioners.
“Teledentistry is really in its infancy,” says Dr. Marc Ackerman, DMD, MBA, FACD, the group’s founder and Director of Orthodontics at Boston Children’s Hospital. Like other medical specialties, he says, it needs an advocacy group to guide practitioners, develop best practices and ensure the technology is available for those who want to use it.
Ackerman, an assistant professor of developmental biology at Harvard School of Dental Medicine who served as Editor-in-Chief of Special Care in Dentistry Journal from 2013-2016, said the teledentistry field to this point has consisted primarily of orthodontists using mobile health channels to give consults and direct-to-consumer companies developing clear aligners, or custom-made mouthpieces designed to replace more expensive braces.
That growth in direct-to-consumer services mirrors that of another healthcare specialty: eye care.
The growth of companies like 1-800-CONTACTS and Opternative has given rise to the ocular telehealth field, populated by companies and providers looking to deliver eye care services through digital channels, reducing cost and improving access for underserved populations. This, in turn, has spurred a strong backlash from state medical boards and some practitioners who feel the technology isn’t reliable enough to use for eye exams.
Ackerman says the teledentistry field has seen a similar backlash.
“Most of the profession went bonkers” when the first direct-to-consumer companies appeared on the market, he says. Among the most vocal critics has been the American Association of Orthodontists (AAO), which has filed numerous complaints with state medical boards and launched a PR campaign targeting online teledentistry services.
“It has been a challenge” gaining acceptance, he says.
Hence the ATDA.
As with ocular telehealth – and a lot of the other medical specialties – Ackerman’s goal is to expand access to orthodontic and dental care to underserved populations. He estimates roughl6 60 percent of the nation’s counties don’t have an orthodontist.
There’s also the matter of cost.
“Most of what we do in orthodontics is elective,” Ackerman says, so the service is heavily screened by payers. As a result, orthodontic and dental services are expensive, putting them out of reach for a large segment of the population.
“We want to increase access to care for those vulnerable populations,” he says.
According to a position paper published by the ADTA, the average cost of an orthodontic procedure for an adult was almost $6,000 in 2015, an increase of nearly $1,000 over the previous decade. And while the AAO, acknowledging in 2006 that cost is a “major barrier” to orthodontic care, urged more providers to donate free services to the less advantaged, there’s little evidence that such care is available.
“There is ample evidence in the scientific literature that confirms the efficacy of teledentistry and how it increases access to care for the patient,” the position paper states. “The new orthodontic delivery model of doctor-directed at home clear aligner treatment facilitated by teleorthodontics has the potential to bridge the gap in the access to care divide. Patients who for many different reasons had been previously denied access to orthodontic care now have a viable option for addressing front tooth alignment issues and improvement in their social smile.”
Ackerman says telehealth and telemedicine technology can contribute to what he and others have called the “democratization” of healthcare, enabling those with access issues (due to cost, geography or societal constraints) to get the care they need.
He notes the success of teledentistry programs in California, where connected care platforms are used to provide dental care to senior care and assisted living facilities as well as in public health programs. In the future, he sees more teledentistry programs in schools and other locations where large populations can be served by a mobile health platform.
"The immediate goal of the ATDA is to educate dental professionals and the public about the benefits of teledentistry," Ackerman said in the companys press release. "Teledentistry has the ability to help patients get access to needed dental care they deserve, both affordably and conveniently. It's our mission to modernize access to care through teledentistry with advocacy for the implementation of innovative teledentistry guidelines and solutions."