I have travelled to Dublin from Laois every day for 15 years to work as a dental nurse at the Dublin Dental Hospital and NCC. If someone had told me this time last year that it was possible to do anything useful in dentistry without having the patient in the chair or even in the building or do that journey every day by train I would have scoffed. But over the last 3 months I have learned that tele dentistry has been a crucial part of assuring our patients wellbeing at this difficult time

Prior to the Covid pandemic, to me the term ‘tele dentistry’ probably meant searching the web for information that might help patients or for perhaps partaking in online continuing education.  I could never have imagined that it would become the cornerstone of our dental services for patients with bleeding disorders and that we would have an urgent need to adopt it almost overnight.

I am not so very fond of change if I am honest, but I learned that several dentists had died in Spain and Italy from contact with asymptomatic patients during routine dental treatment as it’s impossible to social distance doing dental work and due to the high concentration of virus in saliva. However, when the New York Times listed dental nurses as the highest risk of all professions due to our additional role in decontamination in the dental surgery between patients I realised that I had to embrace the redesign of dental services for a few months and the NCC formal tele dentistry service was borne . 

I learned that the term “tele dentistry” was not a new concept and was first used in 1997, when it was defined as “… the practice of using video-conferencing and other communication technologies to diagnose and provide advice about treatment over a distance’ 

My initial job was to offer patients who had had their dental appointments cancelled, the opportunity to have a dental consultation with Dr Alison Dougall either by phone or by video. We were advantaged over many other countries or centres relying on tele dentistry because of The Lighthouse Project* and the availability and easy access to a confidential electronic record. This meant we had access to everything we required to give advice and record careful clinical notes and crucially we have been able to carry out those consultations every day from various locations offsite, even when we were not due to be at the centre. This also allowed us to make multi- disciplinary decisions together with the haematologists and specialist nurses and plan care…sometimes each working from a variety of locations.
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I always enjoy speaking to patients, many of whom I have known for years and my role was to assure all patients that there was a service available should they have an urgent problem and answer any queries they had about looking after their teeth or about preparing for an online consultation. I also was the first responder to any dental emergency calls that came into the centre. Before any booked emergency consultations via tele dentistry patients were asked to photograph any dental problems and send them to us and to this day we continue to be blown away by the quality of photographs that have been possible using a mobile cell phone. This is a practice we will continue with long after the pandemic is over. We have realised that this is a really valuable way to plan in advance what is likely to need to happen – whether a tooth can be saved or whether it needs to come out,  whether someone has an abscess and needs antibiotics  or whether a persistent  ulcer was something to worry about…this has opened new horizons.

So was the tele dentistry service useful? I can say a resounding yes. During the first 6-week period, 89 telephone or video consultations were conducted with patients with bleeding disorders from all over Ireland. 18 patients recorded pain scores of 7 or above with half of those reporting maximum scores of 10. 26 people indicated their dental problems were impacting significantly on relationship, sleep, nutrition or mood. 29 scripts were issued for patients who were not managing their dental pain adequately. 7 patients were tutored on self-placement of temporary fillings using kits from local pharmacies. Dental extractions were arranged for 22 patients. These were not all done at the NCC. For the first time we undertook remote ‘tele mentoring’ of dentists who were nervous or unsure of how best to manage a patient with bleeding disorder. We literally talked them through all of the required details so they were confident to proceed. There was no incidence of bleeding from the mouth requiring admission during the 6 weeks of our data collection. This is again something that we can continue in future for people living in remote areas of Ireland.

So, in conclusion I can say that during the pandemic dental problems impacted on quality of life. We provided care for people with bleeding disorders that we had never ever met in the last 10- years of working, in fact regular dental patients had very few problems. We have realised that tele-dentistry enabled urgent dental problems to be identified and addressed efficiently, effectively and safely using a patient centred team approach. Tele-dentistry has the possibility to reduce many barriers to care and although it can never replace a face to face treatment, it has a future in our service, and I am all for it.

Out challenge now is about how we start to slowly open up dental services. Dentistry is going to look a bit different for the time being. We have even more personal protective equipment than before, with upgraded masks and visors. We have to be careful with anything that produces an aerosol so are still very limited in our ability to provide fillings and cleanings. But slowly, slowly, the new normal of dentistry will emerge and risks will be reduced and we look forward to seeing you all soon should you need us…be phone, by video and soon enough we hope in person.

Laura Parkinson

* The Lighthouse project refers to the information technology project for Haemophilia in Ireland. It included the new electronic patient record system and a patient portal