Due to the current ongoing SARS-CoV-2 pandemic, teledentistry usage has increased as a way to provide safe access and delivery of dental care. In response to the pandemic, several North American Oral Medicine practices established tele(oral)medicine services to provide virtual patient care and clinical education continuity for dental and oral medicine trainees [14]. Tele(oral)medicine has been proven to be an effective tool to assess oral mucosal disorders in a timely manner and address orofacial pain conditions, or postoperative complications that may not necessarily require an in person consultation thus reducing the risk of potential exposure to COVID‐19 [15]. Similarly, our study confirmed that tele(oral)medicine during the COVID-19 pandemic was a successful tool to manage the symptoms of a variety of oral mucosal diseases. We found that there was a significant reduction in oral pain between the first video consultation and follow-up with a 65% self-reported improvement of oral symptoms.
Teledentistry has been also used in other dental specialties. A recent study from Sharma et al. showed that teledentistry was a helpful tool to manage pediatric patients with limited access to pediatric dentists, monitor dental conditions, conduct screening programs, and promote oral health in children [9]. Rollert et al. aimed to evaluate the effectiveness of telemedicine consultation for preoperative assessment of oral and maxillofacial surgery patients and showed that all patients were assessed correctly during the virtual consultation [16].
Most patients with oral mucosal conditions see several providers before having a correct diagnosis and travel long distances due to a paucity of oral medicine specialists in the United States [17]. The majority of oral medicine specialists work in academic settings in urban areas making it challenging for patients living in rural areas to easily access oral medicine services (e.g., dental schools or academic medical centers) [17]. A study from Brigham and Women’s Hospital in Boston, MA showed that patients traveled a median distance of 18.9 miles (range 0.2–525) to see an oral medicine specialist, with over 85% living within 60 miles away from the oral medicine clinic [17]. Similarly, another study conducted at the University of Alberta, Canada showed that the average distance traveled by patients to access the oral medicine clinic was 55.5 km (34.5 miles) and the average wait time for the patients to be seen was 105.5 days [18]. In our study, patients would have traveled a median distance of 65 miles (range: 0.9–100) if they had been seen in person. Since traveling long distances may result in increased costs to patients, Telemedicine offers a unique opportunity for patients who otherwise do not have an oral medicine specialist in the vicinity.
In our study, more than half of the patients were referred by physicians (60%). Similarly, Villa et al. (2015) in another US study showed that two-thirds of the patients were referred by physicians and the remaining one-third referred by dentists (22%) [17]. This was different from the study by Friesen and colleagues which showed that 81% of the oral medicine patients were referred by dental practitioners with the general dentist being the most common (74.5%) [18]. Similarly, another study characterizing an oral medicine practice at a dental hospital in the United Kingdom showed that nearly three quarters (75%) of the patients were referred by dentists [19].
In our study, when the patient’s insurance was considered, two thirds of our patients (67%) had private medical insurance, and (23%) had Medicare. Similar results were reported by Villa et al. and showed that the most patients (66%) had private medical insurance, with (16%) having Medicare coverage and (5.7%) having Medicaid; (11%) of patients had a mix of public and private coverages, with the remaining (0.8%) being uninsured [17]. Tele(oral)medicine charges remain similar to in person visits although patients do not have to pay for transportation.
The most common oral conditions specifically seen were reactive lesions (40%) followed by immune-mediated conditions (23%), and orofacial pain disorders (13%). A biopsy was ordered for 37% of the patients. This was similar to what has been reported in the past for in-person oral medicine visits in other practices in the US. Specifically, Villa et al. showed that the most common diagnoses included immune-mediated mucosal conditions (27%), orofacial pain disorders (25%), benign tumors or neoplasms (10%), and dysplasia and cancerous conditions (7.6%), oral biopsy was the most common procedure performed [17]. In addition, Friesen et al. reported that the most common conditions seen were red and white lesions (38%) and immune-mediated disorders (29%) [18].
During the recent COVID-19 pandemic teledentistry has been used as a remote facilitator of dental treatment, guidance and education and offered a novel solution to continue dental practices during the pandemic [7]. On the other hand, there has been several challenges around acceptance of teledentistry by the dental providers and patients who need urgent care due to the lack of the actual dental procedures [7]. Especially at this time, reliance on telemedicine has grown, and recent studies have shown that patients are usually satisfied with telehealth [14]. A study conducted in New York showed an 8729% increase in video visit use during the COVID-19 period compared to the pre–COVID-19 pandemic [20]. Our previous work showed that oral medicine patients were pleased with Tele(oral)medicine sessions (85%) [14]. Moreover, a study from Ghai at el. reported that acceptance of teledentistry has been increasing day by day by patients and health care providers [7]. Patient satisfaction with video visits is high and does not seem to be a barrier toward a paradigm shift away from traditional in-person clinic visits [20].
Our study has some limitations. This was a single study center study within a large academic medical center, as such it may not be generalizable to other oral medicine practices in the US. Future studies should include other private and academic centers. Furthermore, we were not able to look at the reimbursement of telemedicine visits and compare it to in-person consultations. The Center of Medicare Services (CMS) in the US reported that due to the COVID public health emergency, telemedicine visits would be reimbursed at the same level as in-person services. However, this may change in the future.