Abdelrahim Adham, Shimpi Neel, Hegde Harshad, Kleutsch Katelyn C, Chyou Po-Huang, Jain Gaurav, Acharya Amit
Post-doctoral fellow, Center for Oral and Systemic Health, Marshfield Clinic Research Institute, Marshfield, Wisconsin, USA.
Computational and Informatics in Biology and Medicine program, University of Wisconsin-Madison, Madison, Wisconsin, USA.
Am J Dent. 2020 Feb;33(1):48-52.
Non-traumatic dental condition visits (NTDCs) represent about 1.4% to 2% of all Emergency Department (ED) visits and are limited to palliative care only, while associated with high cost of care. Feasibility of establishing a tele-dental approach to manage NTDCs in ED and Urgent care (UC) settings was undertaken to explore the possibility of utilizing remote tele-dental consults.
Participants with NTDCs in ED/UCs were examined extra and intra-orally: (1) directly by ED provider, (2) remotely by tele-dental examiner (trained dentist) using intra-oral camera and high-definition pan-tilt-zoom (PTZ) camera, (3) directly by treating dentist post ED/UC visit (if applicable) and, (4) secondary assessment by tele-dental reviewer. Comparisons were drawn between differential diagnoses and recommended managements provided by ED/UC providers, tele-dental examiner, treating dentist, and tele-dental reviewer.
13 patients participated in the study. The overall inter-rater agreement between the tele-dental examiner and tele-dental reviewer was high while it was low between tele-dentists and the ED providers. The preliminary testing of tele-dental intervention in the ED/UC setting demonstrated potential feasibility in addressing the NTDC landing in ED/UC. Larger interventional studies in multi-site setting are needed to validate this approach and especially evaluate impact on cost, ED/UC workflow and patient outcomes.
Using tele-dentistry to triage non-traumatic dental visits to the emergency room may be a promising approach. Once this approach is validated through a larger study, tele-dental outreach could help in directing non-traumatic dental emergency patients to the appropriate dental setting to provide treatment for the patients.
非创伤性牙科疾病就诊（NTDCs）约占所有急诊科（ED）就诊病例的1.4%至2%，且仅限于姑息治疗，同时护理成本高昂。本研究旨在探讨在急诊科和紧急护理（UC）环境中建立远程牙科方法来管理NTDCs的可行性，以探索利用远程牙科咨询的可能性。
对急诊科/紧急护理中心患有NTDCs的参与者进行口腔内外检查：（1）由急诊科医护人员直接检查；（2）由远程牙科检查人员（经过培训的牙医）使用口腔内摄像头和高清云台变焦（PTZ）摄像头进行远程检查；（3）由治疗牙医在急诊科/紧急护理中心就诊后直接检查（如适用）；（4）由远程牙科评审员进行二次评估。比较了急诊科/紧急护理中心医护人员、远程牙科检查人员、治疗牙医和远程牙科评审员提供的鉴别诊断和推荐治疗方案。
13名患者参与了研究。远程牙科检查人员和远程牙科评审员之间的总体评分者间一致性较高，而远程牙医与急诊科医护人员之间的一致性较低。在急诊科/紧急护理中心环境中对远程牙科干预的初步测试表明，在处理急诊科/紧急护理中心的NTDC方面具有潜在可行性。需要在多地点进行更大规模的干预性研究来验证这种方法，特别是评估其对成本、急诊科/紧急护理中心工作流程和患者结局的影响。
使用远程牙科对急诊室的非创伤性牙科就诊进行分诊可能是一种有前景的方法。一旦通过更大规模的研究验证了这种方法，远程牙科服务可以帮助将非创伤性牙科急诊患者引导至合适的牙科机构，为患者提供治疗。
