1. Assess blood pressure
1. Perform all procedures necessary for a complete prophylaxis
1. Discuss patient’s homecare procedures
2. Screen and photograph the oral cavity and surrounding structures
2. Apply dental sealants to teeth according to ADA and Centers for Disease Control and Prevention guidelines
2. Provide appropriate homecare instruction
3. Perform dental restorative charting and recording of clinical findings
3. Administer topical fluoride gels and varnishes as indicated according to ADA and Centers for Disease Control and Prevention guidelines
3. Provide tobacco cessation intervention and referral when appropriate
4. Expose and process dental radiographs according to ADA guidelines
5. Perform a caries risk assessment
6. Review medical and dental history
5.1.2 The Patient Protection and Affordable Care Act
The 2010 PPACA calls for mandatory pediatric dentistry for eligible children up to age 21 and expands Medicaid to all who are at or below 133 % of the Federal Poverty Level . Prior to the 2010 PPACA, the Surgeon General’s 2001 report on oral health found vastly disproportionate availability of oral healthcare amongst certain American populations . Since 2001, the increasing elderly population, the rising number of ethnic minority and immigrant populations, and the professional healthcare isolation present in many rural communities have added to the burden of providing oral healthcare for our diverse and already under-treated population. Additional considerations affecting future oral healthcare availability include the facts that, currently, two dentists will retire for each graduating dental student and enrolling dentists as Medicaid and PPACA providers will become more difficult due to burdensome administrative requirements . The PPACA cites as examples of alternate dental workforce models Alaska’s Dental Health Aide Therapist, the American Dental Association’s Community Dental Health Coordinator, and the American Dental Hygienists’ Association’s Advanced Dental Hygiene Practitioner .
5.1.3 NAU’s Teledentistry-Assisted Affiliated Dental Hygienist Model
As an additional workforce alternative, NAU has pioneered an innovative teledentistry-assisted affiliated practice dental hygiene model to answer the call of the PPACA to provide comprehensive preventive oral healthcare and diagnostic services for the growing population of underserved in both urban and remote areas. Using current teledentistry technologies, dental hygienists can digitally acquire and transmit diagnostic data to a distant dentist for triage, diagnosis, and patient referral while providing all of the preventive services within their scope of licensure as part of a digitally-linked member of a oral healthcare team. NAU’s digital diagnostic data acquisition equipment is state of the art and emerging technologies will only further the ability of distant dentists receiving the diagnostic data to properly diagnose, triage, and refer patients for appropriate treatment.
NAU’s initial training endeavors prove that teaching the data acquisition technologies to dental hygiene students and dental hygienists has been easily and successfully accomplished. With only 6-h of training, dental hygiene students and dental hygienists have shown their ability to set up and manage remote patient-service facilities. While providing preventive oral healthcare services within the scope of affiliated practice, the dental hygiene students and dental hygienists have also acquired and forwarded digital diagnostically efficacious data from remote locations both using store-and-forward and cloud technologies
NAU’s teledentistry-assisted affiliated practice dental hygiene has proven to serve the patient, the teledentistry-assisted affiliated practice dental hygienist, and the affiliated practice dentist. Patients benefit by the fact that they can receive preventive services locally, have their overall oral health evaluated by several members of a digitally-linked oral healthcare team, and schedule appropriate treatment with a minimum of travel and the associated costs of travel dollars and time off from work or out of school. Teledentistry-assisted affiliated practice dental hygienists benefit by being allowed to perform preventive services they are licensed to provide in a midlevel-practitioner model that promotes additional employment choices and professional opportunities. Affiliated practice dentists benefit by adding patients to their practice and filling their appointment schedules with patients receiving professional services only they can provide. The teledentistry-assisted affiliated practice dental hygiene model is easy to implement with existing technologies, provides a growing population of underserved with much-needed oral health services, and benefits all the members of the digitally-linked oral healthcare team.
5.2 Teledentistry Equipment and Training
In 2009, to develop the teledentistry-assisted affiliated practice dental hygiene workforce model and add teledentistry skills to its curriculum, NAU acquired two each of the following equipment:
Office management software
Digital imaging management software
Intraoral Digital Cameras
Digital x-ray film scanners
Portable hand-held X-ray units
All of the equipment chosen integrates seamlessly and has proven to be successful in both local and remote store-and-forward and cloud-based applications of teledentistry-assisted affiliated practice dental hygiene.
5.3 Teledentistry Training Materials
The NAU teledentistry curriculum has evolved over a 5-year period and has proven to be a successful hands-on educational program for interested parties, individuals intending to use teledentistry, and as a train-the-trainer apparatus for potential teledentistry educators. NAU has developed two specific tracks for teledentistry training including all required materials, visual presentations, participant handouts, and a teacher’s manual to guide the visual presentations and classroom discussions. The first track is specific to informational presentations for interested community organizations, professional providers, and funders. The four informational courses include:
Teledentistry-assisted Enhanced Dental Teams
The Affiliated Practice Dental Hygienist
HIPPA and Teledentistry