ORAL MEDICINE VIA TELEHEALTH

Clinical Feature

Oral Medicine via Telehealth

BY A/PROFESSOR RAMESH BALASUBRAMANIAM OAM Oral Medicine Specialist

Discipline Lead Oral Medicine UWA Dental School

Telehealth in dentistry is now acceptable clinical practice. Due to service restrictions related to the COVID-19 pandemic, dentists have been obliged and continue to triage and manage patients over the phone or video call (virtually)1 .

The rationale for the push towards teledentistry and virtual consultations is to reduce the risk of COVID-19 transmission, and this has been adopted with success in many countries. Although oral medicine practice is not typically aerosol generating, the patient population cared for by oral medicine specialists are often medically complex and/or elderly. Virtual consultations can facilitate triage of urgent new cases and continuity of care of existing patients that do not require face to face consultations1. Clinical scenarios that warrant telehealth consultation in oral medicine during mandated service restrictions include: • Orofacial pain including TMJ closed lock,

TMJ open lock, and psychosocial distress • Acute neurological changes such as sensory deficit and facial palsy • Trigeminal neuralgia • Orofacial swelling • Oral lumps, blisters and ulceration • Oral mucosal diseases including white and red patches There are now a number of publications that support the provision of telehealth in oral medicine as standard of care based on data acquired during the pandemic. Although there were initial reservations among clinicians on the use of telehealth in oral medicine, 84% of patients in one study were satisfied with a virtual consultation. Similarly, oral medicine specialist providers reported telehealth as adequate care for 49% of patients (i.e. they did not require subsequent face-to-face consultation). Of interest, a third of patients required a biopsy after the virtual consultation, which would necessitate a face-to-face appointment1 . A major concern is the risk of misdiagnosis given the limitations of not carrying out a physical examination of the patient. On this issue, one study investigated the utilisation of a mobile-phone application to review images and identify oral cancers and oral potentially malignant disorders. The researchers found this tool to be reliable for early detection of high-risk lesions2. Another study reported that patients had a 3-point median reduction in pain from their initial virtual consultation to the first review appointment. These patients reported 65% improvement in oral symptoms3 . While these early studies have found telehealth in oral medicine to be useful and reliable, there is a need to educate and train dentists and staff on how to optimally utilise telehealth to maximise its efficiency4. Also there appears to be a shift in mindset among patients, with 74% of patients reporting interest in using telehealth and 49% preferring telehealth over conventional appointments. As anticipated, there was correlation between the patient’s interest in virtual consultations and computer skills5 , highlighting the need to also train patients so they become accustomed to using telehealth.

The pandemic has forced dentistry, in particular the oral medicine community, to reassess their approach to patient care. With nearly 30% of Australians living in rural areas and a significant shortage of oral medicine specialists in Australia, telehealth presents an opportunity to address the issues related to access to care. Virtual consultations can also be extended to Australian defence force personnel and offshore workers. Telehealth in oral medicine will prove to be a cost-effective tool; whereby patients will be able to access oral medicine services from anywhere without the financial burden associated with travel, accommodation and loss of income. The goals of telehealth in oral medicine are congruent with early diagnosis, prompt management, and prevention of morbidity and mortality.

FURTHER READING

Jessri M, Balasubramaniam R, Yeoh S, Chaw S, Phoon Nguyen A, Savage N. Tele-Oral Medicine. Australian Dental Association News Bulletin 2020, June. 20-23.

REFERENCES

Villa et al. Patient and providers’ satisfaction with tele(oral)medicine during the COVID-19 pandemic. Oral Diseases 2020;00:1–4. Haron et al. High referral accuracy for oral cancers and oral potentially malignant disorders using telemedicine. Oral Diseases 2021;00:1–10. Alsafwani et al The Role of Telemedicine for Symptoms Management in Oral Medicine: Retrospective Study. Article in Press: https://doi. org/10.21203/rs.3.rs-1033087/v1 Tenore et al. Evaluation of Patient’s Perception and Acceptance of Tele(oral)Medicine for Care during the COVID-19 Pandemic: A CrossSectional Pilot Survey. Appl. Sci. 2021, 11, 7443. Mohaya et al. Telemedicine Among Oral Medicine Practitioners During COVID-19 Pandemic and Its Future Impact on the Specialty. Risk Management and Healthcare Policy 2021;14:4369–4378.

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