Teledentistry is here to stay - Blake Johnson Los Angeles

Note: This article was originally published onHarvard Health Publication on May 16, 2020.

The COVID-19 pandemic has created an urgent need for telehealth services. With social distancing orders in place and non-emergent healthcare services postponed or cancelled, people at home are turning to technology-enabled healthcare services en masse for the first time. The Centers for Medicare & Medicaid Services has temporarily broadened access to telehealth services by reimbursing telehealth appointments that previously required onsite visits. The Health and Human Services Office for Civil Rights has even elected to exercise enforcement discretion and waive penalties for violations of the Health Insurance Portability and Accountability Act (HIPAA), openly encouraging healthcare providers to utilize communication technologies such as FaceTime and Skype. The combination of government deregulation, provider adoption, and patient need has resulted in a dramatic increase in telehealth usage.

Private insurance claims for telehealth services increased twelvefold between early March 2020 and early April 2020. This shift has happened so rapidly that many services have yet to publish data on their increase in usage, but the general buzz in the market is that telehealth usage has exploded. The adoption has been so drastic and welcome that many healthcare experts think that the shift to remote healthcare will prove to be lasting once the pandemic panic is under control. Cynthia Hundorfean, CEO of Allegheny Health Network recently gave an interview in which she described how the outpatient area of her organization had flipped almost entirely to virtual visits and how she believes that this will become the “new normal” following the COVID-19 panic.

The staying-power of telehealth services is driven largely by convenience of access. Think about how many services Americans now expect to receive right in their home. Amazon, Netflix, and Uber Eats all bring things that people historically traveled for right to their doorstep. It is a trend that is broaching the healthcare industry at long last. In fact, a 2019 survey from Massachusetts General Hospital (MGH) found that 79% of patients questioned after their first virtual visit reported that it was easier to schedule a virtual visit than an onsite visit. 68% of them rated the quality of the visit a 9 or 10 on a 10 point scale. The shift to virtual visits has been on the horizon for quite some time. The deregulation surrounding this public health crisis was the last push that both patients and healthcare institutions needed to finally adopt telehealth services on a large scale.

The Acceleration of Teledentistry

Not surprisingly, the qualities and benefits of telehealth services are present in the teledentistry industry as well. Amidst the COVID-19 pandemic, the American Dental Association has published guidance for dentists across the nation, stating that “The American Dental Association (ADA) recognizes the unprecedented and extraordinary circumstances dentists and their patients face. Our guiding principles are to mitigate transmission while also supporting emergency care for patients so as to help prevent overwhelming hospital emergency departments over the next few weeks. Under these circumstances, while some services will continue to be performed in dental offices, the ADA recognizes that patients would be best served when telecommunication technology can be leveraged to support dental care.”

This is an important step forward in the teledentistry industry. The COVID-19 pandemic, while devastating and horrific in so many ways, has provided a real-world use case for teledentistry services. Prior to this health crisis, questions about the legality of practicing across state lines and concerns about maintaining patient confidentiality over the Internet have held teledentistry back. Given the state of emergency we are all living in, the benefits of teledentistry have finally been illuminated in a way that greatly outweighs prior concerns.

Adoption of at-home dental services had been steadily rising over the last several years, however the COVID-19 pandemic has accelerated usage significantly. The large scale benefits of teledentistry services will doubtlessly lead to a lasting adoption among patients due in large part to the overall health benefits of quality dental care.

How Oral Health and Overall Health are Connected

Our mouths are teeming with bacteria and in addition they are the entryway to our digestive and respiratory systems. Poor oral health has been linked to Endocarditis (heart infection), cardiovascular disease, pregnancy and delivery complications, and Pneumonia. Certain diseases can also result in poor oral health. Diabetes, Osteoporosis, and even Alzheimer’s disease can all negatively impact someone’s oral wellness. Quality dental care is not just a fix for bad breath and crooked teeth. Quality dental care can actually save someone’s life.

There also appears to be a strong connection between oral health and mental health. Oral maintenance requires healthy habits and daily attention. It is no surprise, then, that declining oral health is often seen in people suffering from depression and anxiety. The link between mental and oral health can be biological as well. The stress of a mental condition has been known to incite the overproduction of cortisol, a hormone that can weaken the immune system when seen in large numbers. A weakened immune system has been known to cause gingivitis (inflamed gums), and even periodontitis (a persistent gum disease). General anxiety has also been linked to increased canker sores, dry mouth, and bruxism (teeth grinding). The conclusion being that if someone is not mentally healthy, their oral health will likely suffer in conjunction.

But that is not the only way mental health and oral health are linked. There is a chicken and the egg phenomenon surrounding the connection between oral and mental health. If someone’s oral health is not ideal, it can lead to very real mental strife that can have long term deleterious effects.

A straight, white smile has long been considered an attractive trait and contributes to an overall appealing appearance. This is reinforced by societal beauty standards, celebrity culture, and the general understanding that oral health is important. A study from the ADA recently found that 23% of adults feel embarassed by the condition of their mouth and teeth, and 25% of adults avoid smiling. Considering that the physical act of smiling releases both dopamine and serotonin, hormones that cause feelings of happiness and the reduction of stress, not smiling is literally robbing people of happiness.

Considering that oral care is inextricably linked to overall physical and mental well-being, it becomes clear that access to quality dental services is incredibly important. People going without regular oral care are suffering both physically and mentally. Fortunately, teledentistry can provide access where it was not previously available. Home-based care has a much lower barrier to entry, and is much more cost effective than traditional dental care, which means that more people can engage teledentistry services.

How Teledentistry Inspires Health Habits

There are several key players in the teledentistry world, including SmileDirectClub, Candid, and byte. byte, an invisible aligner company that provides remote dentistry nationwide, relies on a network of more than 160 dentists and orthodontists that review client dental records electronically. Invisible aligners are then sent to clients at a fraction of the cost of traditional aligners. byte is currently the world’s fastest growing doctor directed, direct-to-consumer aligner therapy company.

What we have found through product reviews and testimonials is that once consumers make the investment to straighten their teeth, they then feel a desire to continue to take care of their smile. These aligners are in many ways making oral care top of mind for consumers to improve their overall dental hygiene and seek ongoing regular dental treatment. As we already know, quality dental treatment is a significant factor in overall health and so this massive shift to teledentistry has the potential to improve the general health of a large population. In many cases, the people seeking teledentistry services do not regularly visit local dentists for cleaning and maintenance. If teledentistry continues to inspire clients to keep up with their oral care, we stand to see a noteworthy drop in disease rates across the nation.

Which Teledentistry Players Will Emerge Strong Following This Pandemic

The COVID-19 pandemic has effectively shut down all non-essential operations, which means that the majority of brick and mortar dental offices are closed. Fortunately, dental companies that operate remotely are looking strong. Some companies, like SmileDirectClub offer a mixed model of service that includes teledentistry and in-office visits. Other teledentistry companies, like byte, are operating completely via doctor driven remote treatment for mild and moderate clean aligner cases.

byte’s clients are consistently satisfied, and their sticking power is significant considering that their services can reach every corner of the United States without requiring an in-office visit for those with mild to moderate dental cases. There is obviously a large addressable market for byte and it’s clear aligner therapy. They are offering forward-thinking solutions and have demonstrated an ability to quickly and efficiently address market needs.

There is a bright future for teledentistry. The COVID-19 crisis has presented a pressure test for which companies will rise to fill the market need and which will crack under pressure.

The writing is on the wall for teledentistry services. Strong oral health can and does affect physical and mental wellness, and studies have shown that there is a significant lack of access to dental care in the U.S. The COVID-19 crisis has proven that remote healthcare services are vital and effective, and that the adoption of teledentistry services has the potential to inspire people to better look after their oral health. This health crisis we are experiencing is cataclysmic, but it is accelerating at-home oral care for a variety of reasons that will doubtlessly outlast our concern for contracting the Coronavirus.

Teledentistry is a significant part of the future of oral health, and that future is closer than we think.