Introduction

Teledentistry: Genesis, Actualization, and Caveats

The genesis of this issue of the Journal of the California Dental Association rests with many people. I want to acknowledge the chancellor of the University of California as Los Angeles, Dr. Albert Carnasale, who awarded an intramural grant to the Schools of Nursing, Medicine, and Dentistry to assist with the development of innovative collaborative programs at UCLA. Through this award, I was able to develop a program in teledentistry. I also wish to acknowledge a School of Nursing faculty member, Professor Betty Chang, who led the telehealth team, of which teledentistry was one part. Most importantly, I want to acknowledge Dr. Jack Conley who encouraged me to pursue the idea that an entire issue of the CDA Journal could be devoted to teledentistry.

Following the genesis of an idea comes its actualization, and the individuals who assisted in this effort are many. The guest authors of the component parts of this volume were selected for their expertise and willingness to write the constituent pieces. In addition to my own thoughts on teledentistry, honed during my struggles to set up and operate a teleconsulting service, this issue has a cyber-law expert discussing several aspects of the legality of telehealth Web sites; three community dentistry experts comparing the pros and cons of practicing in a rural setting (where teledentistry will play an important role in patient care); an experienced telehealth industry executive offering his views on the future of teledentistry; and, two oral medicine authorities presenting a pilot study they conducted on the validity of oral mucosal disease consults conducted via e-mail. Each author was solicited to write these components with only vague directions from me, but they turned these vague ideas into crystal-clear reality. I can’t thank them enough for contributing their efforts to this journal and to the advancement of teledentistry in California. Of course, there were at least three ideas that I would have liked to include but was unable to find the proper authorities to bring them to fruition. I was looking for an article on teledentistry in extremely inaccessible environs such as outer space, polar ice cap settlements, mountain climbing expeditions, and ocean-going vessels. I would have also liked an article where precedent-setting case law was discussed. As of yet, these cases have not been widely litigated. Lastly, I would have requested an article replete with the sage wisdom of a teledentistry practitioner with years of experience to share with readers. Alas, this field is in its infancy, and we cannot learn from the mistakes of others at this point.

Before concluding, I must discuss some caveats associated with teledentistry. The clear-cut advantage it holds is making accessible to general dentists individuals who have spent lifetimes gathering expertise in specific areas of patient care. This advantage should far outweigh the drawbacks, the primary one being that if the proper information is not provided or not accurate, the resulting opinion will not be either. A good teledentistry consultant is one who makes sure that adequate information is provided by the consultee (e.g., good photographs, adequate patient history, general health and review of systems information, and accurate physical examination findings). The two major undeterminables in the teledentistry process are the accuracy of the consultation and the legal liability of the expert. As for the accuracy, this information will take a series of studies.  One could study the results of a patient consultation with an expert as compared to information received via the same patient consulting with a non-expert who has had access to the original expert via a teleconsult. There is a high likelihood that some of the myriad of orofacial diseases will lend themselves to high accuracy and some will not.

As for liability, fear of medical-legal actions should not dictate medical procedures and policy. Moreover, liability is yet undetermined since case law is not available. It would, however, seem logical that providing consultations directly to licensed dentists and physicians is no more likely to result in a lawsuit than giving a lecture on a topic. In both cases, the treating doctor could misapply the information. On the other hand, cyberdentistry (directly dealing with patients over the Internet) is inherently more dangerous, both from the patient’s perspective and from the perspective of the legal actions against the consultant. For the dentist or physician who is considering seeking a teleconsult, the safe bet is to use a consultant of impeccable credentials. The path that telehealth experts and their consultees travel and the adventures and misadventures they have along the way are yet to be determined. I would like to think this issue of the Journal will help keep their misadventures to a minimum and will define the best direction for others to follow.

Contributing Editor

Glenn T. Clark, DDS, MS, is a professor at the University of California at Los Angeles School of Dentistry. He is also director of the Oral Medicine and Orofacial Pain Faculty Practice at UCLA.