In certain circumstances where a patient is seeking 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 Microsoft Teams, Skype, Google Meet or Zoom. 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.
Choose a secure platform
Dental healthcare providers should use one of the following videoconferencing systems which are listed in order of security level preference:
Do not use ‘social media’ platforms such as Facebook, Twitter or WhatsApp. These platforms, as the name implies, are designed for social interactions and are not secured for clinical consultations or discussions.
Manage your attendee list
Manage what you share
Although Zoom is not recommended for patient-care provider interactions, we recognise its increasing popularity in accessibility and ease of use. If there is no viable alternative to using Zoom, follow the steps below when setting up each session. The following may also be used as a general guide to setting up videoconferencing.
1. Use a randomly generated ‘Meeting ID’
Using an automatically generated code (ID) means you have a different link for each meeting, which increases security.
2. Add a Meeting Password
You can add a password when scheduling your meeting in the Meeting Password section:
This means even if someone manages to guess or steal your Meeting ID, they are unable to easily join without your Meeting Password. It changes the meeting link you send with an encrypted password, for example:
The session invite must be sent with the Meeting ID and the Meeting Password together.
3. Utilise the ‘waiting room’
When scheduling your Zoom session, you can also use a ‘waiting room’. Anyone attempting to enter your session will be sent to a waiting or holding area. You will need to manually allow them entry into the session. To manually allow entry into the session you must be logged into Zoom as the host.
4. Do not use ‘Enable join before host’
The ‘Enable join before host’, Zoom tick box allows sessions to be scheduled by another person in your organisation. This leaves the Zoom Meeting ID open outside of the session time. If you must use this option, make sure you use risk mitigation steps 1, 2 and 3 above.
Do not use this function as a general practice:
5. Check your background
Ensure there is no sensitive information in your background. Zoom allows you to have a virtual background for increased privacy.
To learn how to enable virtual backgrounds click on the link below: https://support.zoom.us/hc/en-us/articles/210707503-Virtual-Background
Stay cyber safe by staying alert in your sessions:
No, you do not need to be in the dental practice to provide telehealth services, but you should ensure you have secure access to patients’ clinical records.
You may use your provider number for your primary location and must provide safe services in accordance with normal professional standards.
Only if the person who conducts the consultation is the holder of a provider number.
Any new or existing patient who requires oral health care may be suited for teleconsultation. However, typically it is any patient who is in pain and/or dysfunction, has complications related to a recent dental procedure and requires follow up or is presenting with a potentially serious oral health problem. You may find teleconsultations especially useful in situations such as:
Outlined below is a series of examples where it would be appropriate to conduct a consultation remotely.
The following suggested questions may help you to determine if it is an acute odontogenic infection.
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.
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.
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.
Please refer to the International Dental Trauma Guide: https://dentaltraumaguide.org/free-dental-guides/permanent-teeth/
Remote monitoring of cases is now common and should be encouraged.
Ascertain if this is a situation for which the management may be deferred. The patient can contact their orthodontist if their arch wire 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 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.
Telehealth is warranted for patients with orofacial pain and headache, temporomandibular disorders and painful or potentially sinister orofacial pathology. In many cases, a working diagnosis and recommendations including triaging can be delivered via telehealth. Patient should be offered a telehealth consultation if the following conditions are suspected:
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