Telehealth Project Brings 'Virtual Dental Home' to Patients

by George Lauer, California Healthline Features Editor

TOPIC ALERT:

EAST PALO ALTO -- It has four basic parts, fits in the trunk of a car and represents what experts predict will be a major breakthrough in access to dental care for California kids.

The "virtual dental home" -- a collapsible dental chair, laptop computer, digital camera on the end of a dental probe and a handheld X-ray machine -- was put through its paces last week in a portable classroom of Magnolia Head Start Preschool in the parking lot behind St. Francis of Assisi Church in this less-than-affluent community in the middle of affluent Silicon Valley.

The event was a sort of coming out party for the dental telehealth project created by the University of the Pacific Arthur A. Dugoni School of Dentistry. Local and state politicians, officials from First 5 San Mateo County -- which is funding the project -- and members of the media watched dental hygienist Ushma Patel and dental assistant Leslie Estrada examine a nervous but willing four-year-old preschool student, Janelle Jimenez.

Digital photos and X-rays of Janelle's teeth were sent through the laptop via the Internet to a dentist in a dental office several blocks away who makes a diagnosis and prescribes treatment.

For Janelle and about 800 other kids in San Mateo County, the virtual dental home represents access to dental care that might not happen without telehealth.

"Here we are in Silicon Valley," said state Sen. Jerry Hill (D-San Mateo). "If we can't take advantage of what technology has to offer in health care, who can?"

Moving From Experimental to Everyday Process

Although words like "new," "pilot" and "innovative" were used to describe the virtual dental home project, Paul Glassman -- introduced at the press conference as the "visionary" behind it -- said the process is maturing beyond the experimental stage.

"We've been at this long enough now to show that it does work," Glassman said. 

Glassman, director of the Pacific Center for Special Care at UOP's dental school, said demonstration sites across the state as well as studies comparing dentists who look at pictures and X-rays taken remotely and those who do in-person examinations show very little difference in diagnosis and treatment.

"It's actually highly reliable," said Glassman about the virtual dental home. "Dentists almost always make the same decisions in both scenarios."

The San Mateo County project started in September last year and has provided more than 180 remote exams, X-rays, cleanings and dental referrals in six Head Start sites. The program will expand to 12 sites this year.

Yogita Thakur, dental director at Ravenswood Family Health Center, which operates the dental clinic at the receiving end of virtual dental home data in the San Mateo pilot, said dental care is a particularly appropriate area to use technology for vulnerable populations.

"We know from epidemiological studies that children from low-income minorities across the U.S. have some of the highest rates of dental disease and some of the lowest numbers in terms of utilization," Thakur said. "The landscape in San Mateo County is no different. Children from low-income ethnic minorities often seek care in response to pain, problems eating or sleeping as a result of dental caries [decay], a condition that is preventable.

"Dental caries is the number one chronic disease of childhood, often cited as the silent epidemic that affects children because of lack of access to routine preventive and restorative dental services in a timely fashion," Thakur said.

"The virtual dental home project extends the opportunity to offer dental diagnostic and preventive services in the comfort of their familiar and non-threatening pre-school environment and introduces the child and the family to preventive dental services and education at a very young age."

California's 'Shameful' Oral Health Disparities

"Dental care experts say the oral health disparities are more severe here than other parts of the country," Hill said. "That's shameful for California. With programs like this we have an opportunity to break through that," Hill said.

Glassman said studies have shown that "25% of all children in California have never seen a dentist by the third grade."

"If 25% of all children haven't seen a dentist, you can imagine how that differs by the affluence of a community. In a community like the one being served here, the percentage is much higher," Glassman said.

East Palo Alto, a city of almost 30,000 celebrating its 30th year as a city, is markedly different than the upscale community to the west it shares a name with. Palo Alto, home of Stanford University, is in Santa Clara County and has a significantly different demographic makeup. Although East Palo Alto in San Mateo County is changing with the arrival of new Google and Facebook employees, the town is still largely low-income minorities. 

The East Palo Alto virtual dental home project is a partnership of the Institute for Human and Social Development, which administers San Mateo County's Head Start programs, Ravenswood Family Health Center and UOP's Pacific Center for Special Care.

Potential Beyond Children's Dentistry

Although most telehealth dental programs in California have been aimed at children, there is potential for using the technology for other populations, according to Glassman and other experts.

"The same technologies can be used for portable dentistry in all kinds of settings -- nursing homes, community centers, senior centers," Glassman said.

"This new delivery model can provide community-based virtual dental home for our state's most vulnerable people -- of all ages," Glassman said.

Robert Tumelty
Gentlemen: As the former Director of Dental Health Education for the California Dental Association (1958-1964), I can vouce for the need to develop alternative means to meet the dental care needs of children, and in particular for those wchildren who do not have the economic means to obtain dental care. This is a first step, and there are on record other steps available as the Dental Nurse movement in the UK. Readers may do a GOOGLE search, using the term dental nurse to view summaries of these successful programs as in Australia and New Zealand. Yes, there will be resistance to the Dental Nurse concept, but a series of trial efforts using Dental Nurses should dispel the fears of those who would resist this approach and would be a most forward and very much needed effort. Robert E. Tumelty, professor emeritus and founding chair, Department of Health Care Administration, California State Univ. Long Beach

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