e-Health Care in Dentistry and Oral Medicine (eBook)

Nicolas P.B. Giraudeau gained his DDS from the University of Montpellier, France, in 2009 and completed an MSc at the university in the following year. In 2014 he successfully completed a thesis on legal considerations relating to teledentistry at the Centre Européen d’Enseignement et de Recherche Droit et Santé (European Center for Education and Research in Law and Health), Faculty of Law and Political Science, University of Montpellier. Since 2010, Dr. Giraudeau has worked in the Odontology Service of  University Hospital of Montpellier, in the Departments of Pediatric Odontology, operative dentistry and Public Health. He is now an associate Professor in University of Montpellier. Dr. Giraudeau is the author of a number of articles and other publications on teledentistry. He has delivered presentations on teledentistry across the world and since 2017 he is the treasurer of the « e-oral health network » in IADR. He is also the secretary of the Chaire e-health in the Foundation of University of Montpellier. 

Contents 3
Part I: General Aspects of e-Oral Health 7
1: Definition of Teledentistry 8
1.1 Introduction 8
1.2 Telehealth and Telemedicine Defined 10
1.2.1 Telemedicine: Applications and Mechanism of Delivery 11
1.3 Teledentistry Defined 13
1.3.1 Reasons for Teledentistry 14
1.4 Towards e-Oral Health as a Scientific Field of Inquiry 15
References 17
2: e-Oral Health Tools 20
2.1 Introduction 21
2.2 Tools for e-Oral Health and Teledentistry 22
2.2.1 Teleconsultation and Telediagnosis 22
2.2.2 Monitoring Applications 23
2.2.3 Smart Glass as an Oral Health Clinical Tool 24
2.2.4 Personally Controlled e-Records 25
2.2.5 e-Tools for Primary Prevention 25
2.2.5.1 Gamification (gHealth) 25
2.2.5.2 Web Portals 25
2.3 Arrangement for Wider Implementation of e-Oral Health and Teledentistry 26
2.3.1 Technical 26
2.3.2 Behavioural 27
2.3.3 Organisational 28
2.3.3.1 Sustainability and Institutionalisation 28
2.3.3.2 Confidentially, Security and Liability Issues 28
Regulation Framework 28
2.3.4 Economical 29
2.4 Final Remarks 30
References 31
3: Development of Teledentistry: From Pilot Projects to Successful Implementation 34
3.1 Introduction 34
3.2 Assessment of Pilot Projects 35
3.3 Decision to Adopt Telemedicine Technology 36
3.4 Critical Factors for Telemedicine Implementation 36
3.4.1 Technology Issues 36
3.4.2 Acceptance Issues 38
3.4.3 Financing Issues 38
3.4.4 Organizational Issues 39
3.4.5 Policy and Legislation Issues 40
References 40
4: Ethics and Teledentistry: Challenges and Questions 44
4.1 Introduction 44
4.2 International Ethical Framework [1] 45
4.3 What Are the Ethical Issues in Dentistry with Regard to Telemedicine? 46
4.3.1 Telemedicine’s Place Within Health Care 46
4.3.2 Prevention: A Major Ethical Issue 46
4.3.3 The Patient’s Freedom of Choice 47
4.3.4 Protecting the Person 48
4.3.5 Assessment and Research in Telemedicine 49
4.3.6 A Public Health Social Challenge 49
4.4 Discussion/Conclusion 49
References 51
5: The Economics of Teledentistry 52
5.1 Introduction: Efficiency Is a Key Dimension of Health System Performance 52
5.2 Assessing the Efficiency of Telemedicine: A Theoretical Framework 53
5.2.1 Efficiency 53
5.2.2 Definitions, Advantages and Disadvantages of the Three Forms of Economic Evaluation 54
5.3 Practical Approaches to the Economic Evaluation of Teledentistry 55
5.3.1 Economic Evaluation Alongside Clinical Trials 55
5.3.1.1 Quantifying Uncertainty in Stochastic Cost-Effectiveness Analysis 57
5.3.2 Economic Evaluation of a Teledentistry Programme Through Modelling 57
5.3.2.1 Requirements for Economic Evaluation for Decision-Making 57
5.3.2.2 Role of Decision-Analytic Models 58
5.3.2.3 Stages in the Development of a Decision-Analytic Model 59
5.3.2.4 Markov Models 59
5.4 Literature Review 60
References 62
Part II: E-health Care in Oral Medicine 63
6: A Clinical Evaluation of Teledentistry in Oral Health Promotion 64
6.1 Social Relevance (Introduction) 65
6.2 Materials and Methods 66
6.2.1 Objectives 66
6.2.2 Research Protocol 67
6.2.3 Research Design 67
6.2.3.1 Gold Standard 68
Evaluation of Patients Concerns 68
Caries Detection 68
Plaque Index 70
Denture Plaque 70
Calculus 71
Posterior Occluding Couples of Teeth 71
Gingivitis Index 71
Soft Tissue Lesions 71
Experience + Feedback Patient 71
Experience + Feedback Researcher 71
Compliance Patient 71
Mental 71
Physical 72
Time Needed to Do the Oral Examination 72
6.2.3.2 Teledentistry System 72
Evaluation of Patient Concerns 73
Caries Detection 73
Plaque Index 73
Denture Plaque 73
Calculus 73
Posterior Occluding Couples of Teeth 74
Gingivitis Index 74
Soft Tissue Lesions 74
Time Needed to Collect Information with SoproCare 74
Time Needed to Interpret Information from SoproCare Evaluation 74
6.2.3.3 Visit and Examination Provided 75
6.2.3.4 Number of Patients + Method of Recruitment 75
6.2.3.5 Criteria for Inclusion 75
6.2.3.6 Criteria for Exclusion 75
6.2.3.7 Criteria for Ending the Participation in the Study 76
6.3 Results 76
6.3.1 Correspondence Between Caries Seen During SoproCare and Visual Examination 76
6.3.2 Difference Between the Gradation of Caries with SoproCare and Visual Examination 77
6.3.3 Gingivitis Index Measured With SoproCare Versus Visual Examination 77
6.3.4 Time Needed to do SoproCare Examination Compared to Visual Examination 78
6.3.5 Plaque Index Measuring in SoproCare Compared to Visual Examination 78
6.3.6 Relationship Between Calculus and Gingivitis Index 79
6.3.6.1 Visual Exam (VE) 79
6.3.6.2 SoproCare Exam 79
6.3.7 Relationship Between Pain and Caries 80
6.3.7.1 With Caries Present at Visual Exam (VE) 80
6.3.7.2 With Caries Present at SoproCare Exam 80
6.3.8 Correspondence Between Soft Tissue Lesions During SoproCare Versus Visual Exvam 80
6.3.9 Soft tissue Lesions Seen During Visual Exam Related to Pain 81
6.3.10 Mental and Physical Cooperation During SoproCare Versus Visual Exam 81
6.3.11 Patient Feedback of Visual Examination Compared to SoproCare Protocol 82
6.3.12 Examiners Feedback of Visual Examination Compared to SoproCare Protocol 82
6.3.13 Dry Mouth and Bad Breath 82
6.3.14 Subjective Rating of Oral Health 83
6.3.15 Presence of Pain 83
6.3.16 Satisfaction About Denture(s) 84
6.3.17 Chewing Comfort 84
6.3.18 Need of Care 85
6.4 Discussion 86
6.4.1 Methods and Materials 86
6.4.1.1 This Part Will Handle Difficulties Using SoproCare 87
6.4.2 Processing and Results 87
6.5 Conclusion and Future Work 88
References 88
7: e-Implantology 90
7.1 Introduction 91
7.2 Technical Note 91
7.3 Discussion 98
References 100
8: Teledentistry and Orthodontics 101
8.1 Introduction 102
8.2 Referrals and Consultancy 102
8.3 Use of TD for Diagnosis and Patient Monitoring 106
8.4 Final Considerations 108
References 108
9: E-Health Care in Oral Cancer 111
9.1 Introduction 112
9.2 Teleconsulting 112
9.2.1 Description 112
9.2.2 Types of Teleconsulting 113
9.2.3 Cons 113
9.2.4 Pros 113
9.3 Tele-education (2010–2017) 115
9.3.1 Webpalestra (Weblecture) (Fig. 9.3a, c, e) 115
9.3.2 TeleRS Explica (Telers Explains) 116
9.3.3 E-Learning 117
9.3.3.1 Phase 1 117
9.3.3.2 Phase 2 118
9.4 Telediagnosis (2015–2017) 118
9.5 RegulaSUS: An Initiative Focused on the Health-Care Work Process/Referral System (2015–2017) 121
9.6 Challenges and Perspectives 122
References 123
Part III: A Global View on Teledentistry 125
10: Teledentistry in the United States 126
10.1 Introduction 126
10.2 Development of Teledentistry 127
10.3 Influences on Adoption 129
10.4 Future 130
References 130
11: Teledentistry in Brazil: Tools to Improve the Quality of Oral Health in the Primary Care Setting 132
11.1 Introduction 133
11.2 Oral Health in the Primary Care Setting in Brazil: State of the Art 133
11.3 Telehealth Brazil Networks 134
11.4 Teleconsulting 134
11.5 Telediagnosis 137
11.6 Tele-education 137
11.7 Web Lectures 138
11.8 E-Learning 138
11.9 App Development 139
11.10 Formative Second Opinion 139
References 142
12: Teledentistry in France: Example of the e-DENT Project 144
12.1 Introduction 145
12.2 Telemedicine, a Fundamental Legal Tool for Healthcare Democracy 147
12.2.1 A Clear Legal Framework 147
12.2.2 The Parties 148
12.2.3 The Main Observed Principles of Health Law 148
12.3 The System 149
12.3.1 Inclusion of a Technological Third Party 149
12.3.1.1 An Equipped Healthcare Professional 149
12.3.1.2 Specific Equipment 149
12.3.1.3 Necessary Technical Organisation 149
12.3.2 Functioning 149
12.3.2.1 An Asynchronous Act 149
12.3.2.2 A Formalised Workflow 150
12.3.2.3 The Starting Point for an Adapted Dental Treatment Plan 151
12.4 Building a Permanent Economic Model 151
12.5 Trial Setup in Languedoc-Roussillon 152
12.5.1 Benefit for Persons with Special Needs 152
12.5.2 Benefit for Inmates 153
12.5.3 Benefit for the Chronically Ill 153
12.5.4 Benefit for High-Level Athletes 153
12.5.5 Next Communities to Be Targeted 154
References 154