teledentistry-assisted affiliated practice dental teams

MATRCTelehealth Summit

March 18, 20131

Teledentistry-Assisted Affiliated Practice

Dental Teams

Fred Summerfelt RDH, AP, M.Ed

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The AZ Affiliated Practice Dental Hygiene Model

Allows APDHs to see patients without general supervision!

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AZ’s Affiliated Practice Dental Hygiene Model• 2004 §32-1289 signed into law

• Allows an affiliated agreement, with standing orders, between a dental hygienist and a dentist

• APDHs may see patients of any age who are:

• enrolled in a federal, state, or local healthprogram – or

• enrolled in the National School Meal Program – or

• from a family with a household income of less than 200% of the federal poverty guidelines

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AZ’s Affiliated Practice Dental Hygiene Model• 2009 SB 1400 added to §32-1289

• Affiliated practice dental hygiene patients must be seen by a dentist within12 months of initial treatment by the dental hygienist otherwise further dental hygiene services are prohibited

• Specific language concerning elderly and medically-compromised patients

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APDH Services

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Affiliated PracticeDental Hygiene Services

• Assessment

• Blood pressure & medical history

• Screen and photograph oral cavity and surrounding structures

• Chart dental restorations and clinical findings

• Expose and process x-rays

• Conduct a caries risk analysis

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Affiliated PracticeDental Hygiene Services

• Preventive

• All procedures for a complete prophylaxis

• Apply sealants according to ADA and CDC guidelines

• Administer topical fluoride gels and varnish as indicated according to ADA and CDC guidelines

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Affiliated PracticeDental Hygiene Services

• Patient Education

• Discuss patient’s home care procedures

• Provide appropriate home care instruction

• Provide tobacco cessation intervention and a referral when appropriate

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Teledentistry

A Digitally-LinkedOral Healthcare

Team

Dental Hygienist

General Dentist

PedodontistDental Specialists

Allied HealthProfessionals

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Telehealth & Telemedicine• In use since the 1950s

• Prevalent in rural communities

• Effectively use telecommunications technology

• Transmitted Electronic Data

• Graphics, audio, and video images shared between physically separated professionals

• Diagnosis, consultation, and treatment planning

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Teledentistry• Presents as:

• An emerging Web-based intervention system

• A distance-learning framework

• A vehicle to decrease the phenomenon of professional isolation common to rural and underserved areas

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Teledentistry• Utilizing current technologies, it is

possible to acquire and digitally transmit all necessary subjective and objective diagnostic data to a distant dentist for:

• Triage

• Dental treatment planning

• Referral

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NAU’s Teledentistry Equipment

Are there digital technologies that allow us to see better than the eye can see in face-to-face examinations?

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Nomad Pro X-ray Unit

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Nomad Pro X-ray Unit• Certified by all 50 states

• Allows the operator to be in the room when the x-ray is exposed

• Easy to use

• Long battery life

• Protective carrying case

• Ideal for remote locations

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Nomad Pro X-ray Unit

Primary Protective Shielding

Lead and Glass Shield

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Nomad Pro X-ray Unit

Area of Protection

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Scan-X Duo Processor

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Scan-X Duo Processor• Sturdy piece of equipment

• Carrying case

• Easy to maintain - periodic cleaning strip

• Processes phosphor plates quickly

• Scans and erases phosphor plates, ready for reuse

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Scan-X Duo Processor

30,000 images per x-ray film!

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Acclaim Intraoral Camera

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Acclaim Intraoral Camera

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Acclaim Intraoral Camera• Has proven to be very valuable in the

public health environment

• Barrier sheaths prevent the need for sterilizing mirrors

• Projected images allow for excellent viewing of the intraoral environment

• Photographs are easy to take

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VELscope

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VELscope

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VELscope

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Spectra

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Spectra

Green Blue Red Orange Yellow

Sound Enamel

IncipientEnamelCaries

AdvancedEnamelCaries

IncipientRoot

Caries

Advanced Root

Caries

1.7

2.4

2.5

2.8

2.433 34

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Rather than take the patient to the typical dental home . . .

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. . . take many servicesto the patient!

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• Store and forward the diagnostic data

• On the laptop computer

• On a DVD, CD, or by e-mail

• On a thumb drive or other hard drive

• Direct real-time link to the team members

• Satellite link

• Hard wired into an Internet connection

Linking the Team Members

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Link via Cloud Computing!

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• Patient Privacy and HIPAA compliance

• Current technology exists - medical data

• Data encrypted to insure privacy

• Encrypt store-and-forward data

• Encrypt real-time data

• Encrypt live-action video

• Multiple group members can participate

Linking the Team Members

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• Approximately six hours

• Nomad training manual

• Nomad certification exam

• Phosphor plate management

• Scan-X Duo competency

• DXXTR x-ray exposure experience

• Acclaim intraoral photos on peers

Student Training

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Kaibab Band of the Paiutes

450 Mile Round Trip50

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• Screened and referred 23 kids for care• Five had immediate needs - acquired their digital

diagnostic data

• Forwarded diagnostic data to my affiliated dentist who confirmed the need for immediate care

• Forwarded the data to the pedodontist at Polacca

• The kids’ parents were told to call to be put right on the the pedodontist’s schedule - no further exam required

• An opportunity to save each patients' family a 450-mile round trip for an exam and treatment planning!

Kaibab Band of the Paiutes

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Havasupai

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• Courses complete with methods and materials

• Interested Parties

• Community leaders

• Funding agencies

• Continuing Education

• Dental professionals

• Comprehensive Training

• To form enhanced dental teams

Teledentistry Curriculum

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• The APDH

• Teledentistry

• HIPAA & Teledentistry

• Nomad Training

• Teledentistry Equipment Set Up

• Hands-on Training

• Future Trends in Teledentistry

Teledentistry Curriculum

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• NAU has partnered with VHI to provide teledentistry services to Verde Valley area schools

• Beaver Creek School in Rimrock, AZ

• Approximately 350 student patients

• Diagnostic and preventive services

• Hopefully expanding to other schools next year

Verde Health Initiative

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Questions?

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Thank You!

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Fred Summerfelt, RDH, AP, M.Ed.Associate Professor

Northern Arizona University(928) 523-0953

fred.summerfelt@nau.edu

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References

McKinnon, M., Luke, G., Bresch, J., Moss, M., & Valachovic, R. (2007). Emerging allied dental

workforce models: Considerations for academic dental institutions. Journal of Dental

Education, 71(11), 1476-1491.

Patient Protection and Affordable Care Act, U.S.C. H. R. 3950 (2010).

Senate Bill 1400 Amending Section 32-189, A. R. S. § 32-1289 (2009).

Title 32 Professions and Occupations, A. R. S. § 32-1289 (2004).

U.S. Department of Health and Human Services. (2001). Oral health in America: A report of the

surgeon general. U.S. Department of Health and Human Services, National Institute of

Dental and Craniofacial Research: Rockville, MD.

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