Dentistry at a distance: Filling gaps in southeast Georgia

SouthEast Health District Teledentistry Project

In the small towns and rural counties of Georgia, telemedicine has become a viable alternative to the shortage of physicians willing to provide health care to a seriously underserved population.

With physician assistants and nurse practitioners doing the hands-on work, doctors using computer monitors and specialized medical instruments can diagnose and treat many common ailments for patients that if left unchecked could lead to serious, chronic diseases. By all accounts, Georgia is among the nation’s leaders in providing primary care through the use of telemedicine.

But what about dental care? The shortage of emergency dental services in rural Georgia is just as acute –- maybe even worse –- than it is for primary care.

With the exception of one large health district in southeast Georgia, there is no ongoing teledentistry program operating in the state. And the experience there indicates that while important –- teledentistry is proving to be an effective screening tool, especially for young children –- it will probably have a more limited application than its medicine counterpart.

“We’re finding it is a great introduction to oral health for young students and to some extent even for their families,” said Jackie Woodard, telehealth coordinator for the southeast district of the Georgia Department of Public Health in Waycross. “Many of the students have never been seen by a dentist before and come into the program with little or no training in how to take care of their teeth. And we’ve been able to catch more than a few problems before they get worse.”

The first school-based teledentistry clinic opened in Brantley County in the 2010-2011 school year, serving 164 students. With $250,000 in funding from the federal Health Resources Services Administration, the program has expanded to two other counties (Clinch and Charlton) and screened more than 900 students during the last school year. Parents are asked each year if they would like to have their children participate.

With the money, the southeast district places dental hygienists and dental chairs, sterilization, water, suction and imaging equipment at two schools within the three counties. Additionally, the sites have videoconferencing capability so the hygienists can speak and provide detailed oral images to a dentist –- usually a pediatric specialist –- at Georgia Health Sciences University in Augusta. (A local dentist provides backup consultation via teleconference when GHSU dentists aren’t available.)

Woodard said that at least one child who was screened was sent to Augusta for excessive dental decay and wound up having all but four teeth extracted. Others with problems have been referred to local dentists for follow-up care, including extractions, fillings and crowns. The screening program in the schools is free, but local dentists have been good about working out payment plans for families whose children need immediate help so their oral health problems don’t get worse.

Counties are chosen based on their level of uninsured and low-income residents and their lack of access to dental care, Woodard said.

Issues of cost and practicality

The teledentistry service will soon move into Atkinson County, Woodard said. “We are excited about this particular county because the school system has a very high Hispanic population  –-  about 45 percent.’’ Many of the children there are underinsured or uninsured and receiving no dental care, she said.

Even with the success of the small teledentistry project in the southeast district, Woodard and others say that expansion to other regions of the state may be challenging.  The cost –- about $100,000 for each site because of the equipment involved –- may be prohibitive for a statewide roll-out.

Moreover, teledentistry differs significantly from telemedicine because the work of a dentist can’t be practiced remotely. A family practice physician using telemedicine can see the results of a medical exam being conducted by a nurse practitioner or physician assistant, write a prescription to deal with an obvious infection, or oversee assistants as they suture a wound. But it still takes a dentist, in person, to remove a tooth or fill a cavity.

The scope of practice for dental hygienists is limited in Georgia and most other states. They can do cleanings and examinations for gum disease and other oral health problems, but they can’t go beyond that. Georgia Dental Association representatives and state public health officials don’t expect that to change any time soon.

Teledentistry is very limited nationally, Woodard said.

But as the state gathers more information about the gaps in dental care around Georgia, the screening tool that teledentistry provides –- especially for young children –- may expand to other parts of the state. It could be helpful in targeted areas, especially where there is an acute shortage of dentists, said Heather Peebles, a nutritionist at the Waycross Public Health office who did her master’s in public health thesis on the project.

“On the first day of the clinic in Charlton County, we found three cases of children who had significant decay,” she said. “They ranged in age from 5 to 8. Some of these kids had no toothbrush at home. Had they not come into our program, I’m not sure what they would have done.”

Mike King is a medical and health policy writer based in Atlanta. He worked at The Courier-Journal in Louisville, Ky., and served as the editor of The Atlanta Journal-Constitution’s science and medicine staff.