Six-year old Jason Green squirms in a dental chair at a clinic in Sodus, New York while a hygienist probes his mouth with an unusual instrument. It looks like an electric toothbrush, but it is a camera and it’s capturing images that allow Jason’s dentist to inspect his teeth in detail--from 30 miles away. The dentist, Dr. Sean McClaren, practices at the Eastman Institute for Oral Health in Rochester, NY, but he sees several patients a week in this rural community, via a secure internet connection and a video call.
For Jason’s mom Melissa Green, this set-up is a lifesaver. Without Dr. McClaren’s services, she would have been dependent on a friend to drive her, her son and infant daughter an hour west from their home in Wayne County, NY every time Jason needed an appointment.
The practice of teledentistry is helping bring oral healthcare to patients in rural areas where there are few full-time dentists or dental hospitals. In New York, a recent policy change has expanded the number of clinics that can bill Medicaid for teledentistry services. And New York is among several other states, including California, that are expanding access to such programs, helping fill a gap for low-income families or communities with less access to care, such as migrant farm workers. These parents might otherwise need to lose wages and travel long distances to get the treatment their children need.
For many children, it can be dangerous to go without treatment for their teeth. Tooth decay is the number one most common chronic childhood disease-- more than a quarter of children between the ages of 2 and 5 suffer from it. It can lead to bacterial infections, malnourishment, and a host of other dangerous outcomes.
Dr. McLaren says many of his rural patients have dental health needs that require multiple visits. “The kids that we’re typically taking to the operating room probably have anywhere from 10 to 20 cavities on their baby teeth,” he says. Seeing them via video connection cuts down on the number of in-person diagnostic visits each patient needs. They only have to drive to the dental hospital in Rochester for surgery, not diagnosis.
Alejandra Hernandez Morales, a mother of four who works in Wayne County’s apple orchards, sought McClaren’s care for her daughter Adela, who had extensive tooth decay when she was a toddler. It was so bad her front teeth were rotted and required caps. Hernandez Morales says she would have found a way to get the work done even without teledentistry. But it would have been more difficult, requiring her to lose a day of work and a day’s wages.
One problem with teledentistry is that the patients it is designed to benefit often struggle to follow through on appointments. When McClaren first launched the program in 2010, he says many patients didn’t actually make it to scheduled visits. Now McClaren says, they work with care coordinators who serve as a go-between with the patient, the doctors and the clinic. When people have problems getting enough food or housing, making and keeping dental appointments is often not their priority, explains Patricia Hall, a care coordinator for Finger Lakes Community Health.
Hall’s job is to get to know the patients and help them find the the assistance that will best address their needs. “After we build a rapport with them, then we find exactly what’s happening,” she says. “Sometimes, it may not be transportation or housing, it can be other personal things going on in their family.”
Since 2010, McLaren has treated more than 400 children through the teledentistry program reaching kids in rural communities who wouldn’t get care otherwise.