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Remotely-controlled orthodontics: fundamentals and description of the Dental Monitoring system
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... Various companies have spent the last decade gathering big data regarding teeth movement resulting from aligner treatments, which have provided them with an essential foundation for advanced AI implementations supporting effective teeth movement. However, other major aspects of orthodontics-patient communication, coaching, and no less important, clinician control over treatment progress, have become a new domain for AI implementations [49,[91][92][93][94][95][96]. Many of these implementations were introduced as telehealth solutions, benefiting from the interpersonal contact restrictions of the COVID19 pandemic. ...
... Many of these implementations were introduced as telehealth solutions, benefiting from the interpersonal contact restrictions of the COVID19 pandemic. Some of them have even provided a useful AI-managed tool for the orthodontic retention phase or pre-treatment phase, so that clinical conditions, defined by orthodontic specialists, could be regularly evaluated by AI through patients' home-video recordings [93,94]. The aspect of the orthodontic specialty that is not significantly affected by AI is customized device designing and manufacturing. ...
... It is also possible to predict aging and facial growth by AI prediction and planning. Overall care of the orthodontic patient, from determining the movement of the teeth to communication, guidance, and telemedicine, is possible using AI [49,[91][92][93][94][95]. The literature research also showed that the scale of AI-affected orthodontic subfields is extensive, ranging from pre-treatment AI monitoring, through AI growth/aging 3D morphological predictions and virtual treatment planning [59,85,103,195] with later in-treatment decision-making, monitoring, and patient management, to post-treatment evaluation and retention monitoring [196,197]. ...
This literature research had two main objectives. The first objective was to quantify how frequently artificial intelligence (AI) was utilized in dental literature from 2011 until 2021. The second objective was to distinguish the focus of such publications; in particular, dental field and topic. The main inclusion criterium was an original article or review in English focused on dental utilization of AI. All other types of publications or non-dental or non-AI-focused were excluded. The information sources were Web of Science, PubMed, Scopus, and Google Scholar, queried on 19 April 2022. The search string was “artificial intelligence” AND (dental OR dentistry OR tooth OR teeth OR dentofacial OR maxillofacial OR orofacial OR orthodontics OR endodontics OR periodontics OR prosthodontics). Following the removal of duplicates, all remaining publications were returned by searches and were screened by three independent operators to minimize the risk of bias. The analysis of 2011–2021 publications identified 4413 records, from which 1497 were finally selected and calculated according to the year of publication. The results confirmed a historically unprecedented boom in AI dental publications, with an average increase of 21.6% per year over the last decade and a 34.9% increase per year over the last 5 years. In the achievement of the second objective, qualitative assessment of dental AI publications since 2021 identified 1717 records, with 497 papers finally selected. The results of this assessment indicated the relative proportions of focal topics, as follows: radiology 26.36%, orthodontics 18.31%, general scope 17.10%, restorative 12.09%, surgery 11.87% and education 5.63%. The review confirms that the current use of artificial intelligence in dentistry is concentrated mainly around the evaluation of digital diagnostic methods, especially radiology; however, its implementation is expected to gradually penetrate all parts of the profession.
... 3 At its forefront, is the Dental Monitoring ® software (DM, Montreal, France), a software used on smartphones that allows the patient to accurately capture their teeth, in photos and videos, with the aid of a patented cheek retractor. 4 However, studies demonstrate that, depending on the purpose of use, teledentistry can also be performed using photos and videos without the aid of a special retractor. 1,[5][6][7] Today there is a diversity of uses of teledentistry in orthodontics: Diagnosis, planning, consultation, monitoring of oral hygiene status, cooperation with elastics, evaluation of alignment or correction of malocclusion after the use of orthopedic appliances are some possibilities. ...
... 1,[5][6][7] Today there is a diversity of uses of teledentistry in orthodontics: Diagnosis, planning, consultation, monitoring of oral hygiene status, cooperation with elastics, evaluation of alignment or correction of malocclusion after the use of orthopedic appliances are some possibilities. 1,4,8,9 The training of other professionals and remote assistance to a colleague are also situations in which this tool can also be incorporated. 10 Torres DKB, Santos MCC, Normando D -Is teledentistry effective to monitor the evolution of orthodontic treatment? ...
Introduction
With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments.
Objective
To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment.
Material and Methods
Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed.
Results
Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low.
Conclusion
With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = −2.75[−3.95, -1.55]; I²=41%; p<0.00001) and the time for starting refinement (mean difference = −1.21[−2.35, -0.08]; I²=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.
Keywords:
Teledentistry; Orthodontics; Systematic review
... 3,6 Few studies have explored the scope of AIDRM and DM in orthodontics. 1,2,7 In 2019, 3 independent pilot studies demonstrated the reliability of DM's toothtracking algorithm during linear orthodontic tooth movement. [8][9][10] Other studies recorded several benefits to DM's ability to detect treatment parameters, such as unseated aligners or broken brackets, justifying its use and confirming its ability to reduce the number of inoffice visits. ...
... 16,23,24 The DM system is novel in that it accomplishes this almost entirely independent of in-office equipment, instead relying on devices in the hands of most Americans. 2,[7][8][9] As of 2021, the Pew Research Center estimated nearly 85% of U.S. adults owned and operated at least 1 smartphone, with the greatest number of users aged 18-49 years. 25,26 This demographic coincides with the population that most often seeks orthodontic interception for themselves or their dependents. ...
Introduction:
An in-vivo evaluation of the Dental Monitoring (DM; Paris, France) Artificial Intelligence Driven Remote Monitoring technology was conducted in an active clinical setting. Our objectives were to compare the accuracy and validity of the 3-dimensional (3D) digital models remotely generated from the DM application to 3D Digital Models generated from the iTero Element 5D intraoral scanner (Align Technologies, San Jose, Calif) of patients' dentition during in-vivo fixed orthodontic treatment.
Methods:
The orthodontic treatment of 24 patients (aged 14-55 years) was tracked across an average of 13.4 months. Scans of the maxillary and mandibular arches of each patient were taken by an iTero intraoral scanner and with the DM application before treatment initiation without (T0) and with (T1) the fixed orthodontic appliances and at every in-person adjustment appointment (T2-T10). The global deviation between the reconstructed digital models from the DM and iTero scans was compared at each time point using Geomagic Control-X 2020 (3D Systems, Rock Hill, SC). Descriptive analysis was conducted to determine the mean deviation at each time point for the maxillary and mandibular arches, to compare the maxilla and mandible mean deviations at each time point to the null hypothesis mean of 0 mm and the paired mean of the average at each time point between the maxilla and mandible.
Results:
The findings revealed no clinically significant difference between the reconstructed digital models generated by the iTero IOS and the remotely reconstructed digital dental models generated by the DM application.
Conclusion:
DM artificial intelligence tracking algorithm can track tooth movement and reconstruct 3D digital models to a clinically acceptable degree for orthodontic application.
... DM is a software-based programme and consists of three integrated platforms: a mobile app downloaded on the smartphone of the patient; a webbased Doctor Dashboard ® managed by the provider; and a movement-tracking algorithm, which allows the analysis of the pictures regularly taken by the patient (Kravitz et al., 2016;Sangalli et al., 2021a). As a means of remote monitoring, studies have claimed that the use of DM in addition to the standard care could allow to decrease the number of in-office visits, individualise the treatment care of each patient, and early detect incidents and misfit of aligners, thus preventing possible complications such as orthodontic relapse or avoidable delays (Roisin et al., 2016). ...
... To our knowledge, this is the first review that systematically examines outcomes such as the early detection of orthodontic emergencies, reduction in treatment duration and number of in-office and emergency visits, improvement in oral hygiene status and aligner fit, and decrease of orthodontic relapse, when DM is utilised in addition to the standard care. To date, existent reviews on DM have either focused on the novelty of this digital technology (Kravitz et al., 2016;Maspero et al., 2020) or thoroughly explained its use (Caruso et al., 2021;Roisin et al., 2016). ...
Background: Dental monitoring (DM) constitutes a recent technological advance for the remote monitoring of patients undergoing an orthodontic therapy. Especially in times of health emergency crisis, the possibility of relying on remote monitoring could be particularly useful.
Objectives: To assess the effectiveness of DM in orthodontic care.
Eligibility: Studies conducted on healthy patients undergoing orthodontic care where DM was applied, assessing a change in treatment duration, emergency appointments, in-office visits, orthodontic relapse, early detection of orth- odontic emergencies and improvement of oral health status.
Information sources: PubMed, Web of Science and Scopus were searched for publications until November 2022. Risk of bias: Quality assessment was performed with the STROBE Checklist.
Data extraction: Data were extracted independently by two reviewers, and discrepancies were resolved with a third reviewer.
Included studies: Out of 6887 records screened, 11 studies were included.
Synthesis of results: DM implemented to the standard orthodontic care was found to significantly decrease the num- ber of in-office visits by 1.68–3.5 visits and showed a possible trend towards improvement of aligner fit. Conversely, evidence does not support a reduction of treatment duration and emergency appointments. The assessment of the remaining variables did not allow any qualitative synthesis.
Conclusions: This review highlighted that DM implemented to standard orthodontic care can significantly decrease the number of in-office visits and may potentially result in an improved aligner fit. Due to the low quality of most of the included studies and the heterogeneity of the orthodontic system where DM was applied, studies with different investi- gation team and rigorous methodology are advocated.
... The latest advancement is continuous monitoring of treatment progress through the patient's own activity. 63 He regularly scans his teeth with the smartphone and a special adapter, and monitors with support of artificial neural networks the progress of the orthodontic treatment (www.dentalmonitoring.com, Paris, France). ...
Over the past 50 years, digitization has gradually taken root in dentistry, starting with computer tomography in the 1970s. The most disruptive events in digital dentistry were the introduction of digital workflow and computer-aided manufacturing, which made new procedures and materials available for dental use. While the conventional lab-based workflow requires light or chemical curing under inconsistent and suboptimal conditions, computer-aided manufacturing allows for industrial-grade material, ensuring consistently high material quality. In addition, many other innovative, less disruptive, but relevant approaches have been developed in digital dentistry. These will have or already impact prevention, diagnosis, and therapy, thus impacting patients’ oral health and, consequently, their oral health-related quality of life (OHRQoL). Both software and hardware approaches attempt to maintain, restore, or optimize a patient’s perceived oral health. This article outlines innovations in dentistry and their potential impact on patients’ OHRQoL in prevention and therapy. Furthermore, possible future developments and their potential implications are characterized.
... One of such systems is Dental Monitoring ® (DM, Dental Monitoring SAS, Paris, France), a software-based program that allows the clinician to remotely monitor the patient through a mobile app for the user, an internet-based Doctor Dashboard ® , and a movement-tracking algorithm. Among other advantages, this system has been demonstrated to help the clinician check the orthodontic evolution of the patient at long-distance and to early detect any undesirable orthodontic emergency (Roisin et al., 2016;Dalessandri et al., 2021). Recently, other tele-monitoring systems have been introduced in the market (e.g., Grin ® digital teleorthodontic platform, FDA listed medical device and certified through Health Canada; Invisalign Virtual Care AI, Align technology, San Jose, CA), although their scientific validation remains to be demonstrated with clinical trials. ...
Moderate to severe cases of skeletal Class III malocclusion, where residual growth is no longer present and an orthodontic camouflage would not achieve satisfactory outcomes, are good candidates for a combined surgical-orthodontic approach. We present the case of a 34-year-old healthy male with skeletal Class III malocclusion, where aesthetics and masticatory function were further worsened by maxillary and mandibular transverse discrepancy, hyperdivergent pattern, moderate dental crowding, occlusal contacts present only on molars, negative overjet and overbite. The management of the case included a pre-surgical phase of surgically assisted rapid palatal expansion (SARPE) and an orthodontic treatment with fixed multi-bracket appliance, a surgical phase consisting in Le Fort I osteotomy and bilateral sagittal split osteotomy (BSSO), and a myofunctional physical therapy targeting orofacial muscles following the orthognathic surgery. The pre-surgical phase was additionally integrated with a system of remote digital monitoring, such as Dental Monitoring ® , to early detect any orthodontic emergency. As in-office visits were abruptly interrupted because of COVID-19 pandemic, the remote digital system also permitted to regularly monitor the patient at long-distance. In conclusion, a case of skeletal Class III malocclusion was successfully managed with a multidisciplinary approach which involved orthognathic surgery, orthodontic treatment, and myofunctional physical therapy. The additional integration of remote digital technologies, such as Dental Monitoring ® , may provide a continuity of care to orthodontic patients in times of COVID-19 pandemic, when the regularity of non-urgent chairside appointments might be disrupted.
... Dental Monitoring ® (DM) (Dental Monitoring Co., Paris, France) has invented new technology to evaluate 3D tooth position from video-scan taken by a patient's smartphone and by using original 3D model from intraoral scan it is able to reconstruct intraoral 3D situation [19]. ...
This paper explores the impact of Artificial Intelligence (AI) on the role of dental assistants and nurses in orthodontic practices, as there is a gap in understanding the currently evolving impact on orthodontic treatment workflows. The introduction of AI-language models such as ChatGPT 4 is changing patient-office communication and transforming the role of orthodontic nurses. Teleden-tistry is now heavily reliant on AI implementation in orthodontics. This paper presents the proof of a novel concept: an AI-powered orthodontic workflow that provides new responsibilities for an orthodontic nurse. It also provides a report of an assessment of such a workflow in an orthodontic practice that uses an AI solution called Dental Monitoring over a period of three years. The paper evaluates the benefits and drawbacks of daily automated assessments of orthodontic treatment progress , the impact of AI on personalized care, and the new role of a dental assistant. The paper concludes that AI will improve dental practice through more precise and personalized treatment, bringing new roles and responsibilities for trained medical professionals but raising new ethical and legal issues for dental practices.
... Likewise, the quality of treatment is improved, and the time needed to resolve problems is reduced. Although the benefits for the patient are not yet fully known, since the willingness to use the modern aids is not yet as high as the doctor would like, the demand is increasing [11,25,25,30,32,42,51,56,57]. ...
This scoping review examines the contemporary applications of advanced artificial intelligence (AI) software in orthodontics, focusing on its potential to improve daily working protocols, but also highlighting its limitations. The aim of the review was to evaluate the accuracy and efficiency of current AI-based systems compared to conventional methods in diagnosing, assessing the progress of patients' treatment and follow-up stability. The researchers used various online databases and identified diagnostic software and dental monitoring software as the most studied software in contemporary orthodontics. The former can accurately identify anatomical landmarks used for cephalometric analysis, while the latter enables orthodontists to thoroughly monitor each patient, determine specific desired outcomes, track progress, and warn of potential changes in pre-existing pathology. However, there is limited evidence to assess the stability of treatment outcomes and relapse detection. The study concludes that AI is an effective tool for managing orthodontic treatment from diagnosis to retention, benefiting both patients and clinicians. Patients find the software easy to use and feel better cared for, while clinicians can make diagnoses more easily and assess compliance and damage to braces or aligners more quickly and frequently.
... Orthodontic therapies are frequently lengthy, mainly when undesirable side effects arise and the practitioner does not detect them for several months [19]. In order to save time and avoid or, at least, limit the effects of unanticipated complications, it is essential to monitor the process of treatment strictly, regardless of the employed technique [20]; this is also applicable when using removable functional appliances, so the continuous adjustment of removable functional appliances is an important step to ensure its retention inside the patient mouth, with continuous monitoring of the treatment effect; fortunately about 72% of participants are aware of the importance of this step. ...
Objectives:
This study evaluated the use and preference of different types of functional appliances among a sample of Iraqi orthodontists.
Materials and methods:
About 200 orthodontists were invited to fill out an online Google form questionnaire with multiple-choice questions. The questions were modified from previous England and Malaysian studies. The data were tabulated as frequency tables.
Results:
The response rate was 61%. About 91.80% of the participants used functional appliances, with the removable type being the most used. The twin block was thought to be the best compliance one but not the most used functional appliance. About 62% depended on the clinical observations in determining the growth spurt and asked patients to wear the appliance full-time except at meal time. The majority preferred a period of retention of about 4-6 months and frequent visits for adjustments.
Conclusions:
Removable functional appliances are the most frequently used among the studied sample.
Objectives
This pilot study aimed to quantify the magnitude and type of tooth movement occurring in short time intervals within the regular monthly orthodontic visits for patients with fixed appliances and undergoing maxillary canine retraction. Additionally, this pilot study aimed to provide a descriptive evaluation for the accuracy and reliability of the Dental Monitoring (DM)‐captured scans to those of an iTero digital scans in an extraction space closure model.
Settings and Sample Population
3D intraoral photographic scans (DM) for 12 patients with maxillary first premolar extractions in a single‐centre academic institution.
Materials and Methods
Twelve patients treated with fixed appliances and undergoing space closure for maxillary premolar extraction(s) were included. Nickel‐titanium (200 g) closing coil springs were used for canine retraction. At initiation of space closure (T1), iTero scans were acquired, and patients were instructed to take DM scans every 4–5 days until their next visit in 4–5 weeks (T2). At T2, a final iTero scan in addition to a DM scan was taken. The number of patients who did the scans regularly as instructed declined as time elapsed. Stereolithography (STL) files generated from the DM scans were superimposed with the STL files from the iTero scans using GOM Inspect software to determine the accuracy of the DM 3D models. To assess rate, type and direction of tooth movement, each of the 3D image STL files generated from the DM scans, taken every 4–5 days by each patient, was superimposed on the previously captured scan. The rate of tooth movement for the maxillary molars and canines was calculated in the 3 planes of space ( X , Y , Z ) at each time point, until the end of the experiment.
Results
Preliminary results indicated that the maxillary canines appeared to be displaced the greatest amount in the first 4–5 days with initial distolateral movement. As time elapsed, the rate of tooth movement decreased, and the tooth started moving distolingually.
Conclusions
Dental monitoring software provides a high‐tech platform to monitor tooth movement in a ‘real‐time’ approach. Accuracy of the photographic scans in relationship to the intraoral scans appears promising. There seems to be some evidence that the greatest amount of movement occurs initially in the first few days after activation, dropping thereafter to become a slower constant rate of tooth movement.
Introduction
The prevalence of gestational diabetes mellitus (GDM) is rising in the UK. Good glycaemic control improves maternal and neonatal outcomes. Frequent clinical review of patients with GDM by healthcare professionals is required owing to the rapidly changing physiology of pregnancy and its unpredictable course. Novel technologies that allow home blood glucose (BG) monitoring with results transmitted in real time to a healthcare professional have the potential to deliver good-quality healthcare to women more conveniently and at a lower cost to the patient and the healthcare provider compared to the conventional face-to-face or telephone-based consultation. We have developed an integrated GDm-health management system and aim to test the impact of using this system on maternal glycaemic control, costs, patient satisfaction and maternal and neonatal outcomes compared to standard clinic care in a single large publicly funded (National Health Service (NHS)) maternity unit.
Methods and analysis
Women with confirmed gestational diabetes in a current pregnancy are individually randomised to either the GDm-health system and half the normal clinic visits or normal clinic care. Primary outcome is mean BG in each group from recruitment to delivery calculated, with adjustments made for number of BG measurements, proportion of preprandial and postprandial readings and length of time in study, and compared between the groups. The secondary objective will be to compare the two groups for compliance to the allocated BG monitoring regime, maternal and neonatal outcomes, glycaemic control using glycated haemoglobin (HbA1c) and other BG metrics, and patient attitudes to care assessed using a questionnaire and resource use.
Ethics and dissemination
Thresholds for treatment, dietary advice and clinical management are the same in both groups. The results of the study will be published in a peer-reviewed journal and disseminated electronically and in print.
Trial registration number
NCT01916694; Pre-results.
Objective This study aimed to explore Australian dental practitioners' perceptions of the usefulness of teledentistry in improving dental practice and patient outcomes.Methods A descriptive cross-sectional study involving an anonymous electronic survey of a sample of 169 Australian dental practitioners. We designed a 24-item, 5-point Likert-scale questionnaire assessing perceptions of dentists in four domains: usefulness of teledentistry for patients; usefulness of teledentistry for dental practice; capability of teledentistry to improve practice; and perceived concerns about the use of teledentistry.Results Of the 144 respondents (response rate 85%), 135 completed responses that were suitable for analysis. More than 80% of respondents agreed or strongly agreed that teledentistry would improve dental practice through enhancing communication with peers, guidance and referral of new patients. The majority also felt that teledentistry is quite useful in improving patient management, and increasing patient satisfaction. A substantial proportion of respondents expressed uncertainty with technical reliability, privacy, practice expenses, the cost of setting up teledentistry, surgery time and diagnostic accuracy.Conclusion Dental practitioners generally reported optimism and support to the concept of teledentistry and its integration into current dental practices. Addressing how teledentistry can benefit specific practice issues, would encourage more dentists to use telemedicine in routine practice.
Objective:
It is widely considered that telemedicine can make positive contributions to dental practice. This study aimed to evaluate a cloud-based telemedicine application for screening for oral diseases.
Methods:
A telemedicine system, based on a store-and-forward method, was developed to work as a platform for data storage. An Android application was developed to facilitate entering demographic details and capturing oral photos. As a proof-of-concept, six volunteers were enrolled in a trial to obtain oral images using smartphone cameras. Following an onsite oral examination, images of participants' teeth were obtained by a trained dental assistant. Oral images were directly uploaded from the smartphone to a cloud-based server via broadband network. The assessments of oral images by offsite dentists were compared with those carried out via face-to-face oral examinations.
Results:
A complete set of 30 oral images was obtained from all six participants. Out of 192 teeth reviewed, the proportion of ungradable teeth was 8%. Sensitivity and specificity of teledental screening were 57% and 100% respectively. The inter-grader agreement estimated for two examination modalities and between two teledental graders was 70% and 62% respectively. Findings indicate that the proposed system for screening of oral diseases can be implemented to provide a valid and reliable alternative to traditional oral screening.
Conclusion:
This study provided evidence that a robust system for store-and-forward screening for dental problems can be developed, and leads to the need for further testing of its robustness to confirm the accuracy and reliability of the teledentistry system.
Background: The use of technology in the form of smart phones
and other electronic media in day to day life has become an
integral part of life today. Technology today is seeing a paradigm
shift towards better inter-professional communications which
can help doctors, patients and the masses as a whole. Putting
these technological advancements to good use evolves
as a major milestone in medicine/ dentistry in the form of
telemedicine/teledentistry.
Aim: The present study was aimed at knowing the knowledge
and awareness of teledentistry among dental professionals of a
dental college in India.
Settings and Design: The study was conducted in a dental
college in India and was circulated among dental professionals.
Materials and Methods: A questionnaire was prepared to
assess the knowledge and awareness of teledentistry and
was circulated among dental professionals in a dental college.
The data thus collected was statistically analysed and results
obtained.
Statistical analysis: The data collected was statistically
analysed using SPSS software.
Results: A total of 406 persons responded to the questionnaire.
In the present study it was found that the knowledge and
awareness about teledentistry was very low among post
graduates (7.23%) and interns (9.38%) when compared to I & II
BDS while most of them agreed that teledentistry is a practice of
dentistry through various media options with limited application
in dentistry without a legal issue.
Conclusion: In the present study, it was apparent that most
of the respondents were lacking adequate knowledge and
awareness on teledentistry. Hence, there is an immense need to
create awareness among dental professionals on teledentistry
as the future lies in technological advancement. Tele dentistry
can mark the beginning of a new era in dentistry. This can
be achieved by conducting CDE programs and awareness
campaigns/programs which helps in various levels.
It is generally believed that telemedicine has a tremendous potential to improve health care. This publication reviews the current knowledge available on telemedical concepts for heart failure, diabetes and chronic pulmonary diseases, discusses existing difficulties, and suggests how such concepts could best be used in the near future.
This Viewpoint uses the Nightscout Project, a patient-developed mobile technology system, to discuss safety, legal, and regulatory challenges to the broader use of mobile health technology.The US health care system has typically embraced a top-down model of health production, in which large-scale organizations, such as pharmaceutical or medical device companies or academic health centers, produce the tools and technologies for improving health. The underlying assumption is that physicians, researchers, and industry professionals are health experts rather than the patients. However, in 2014, the Nightscout Project, an innovative do-it-yourself mobile technology system for type 1 diabetes, was created by patients for patients and was rapidly scaled to a US and global population within a relatively short period. This bottom-up, patient-driven approach to health production has important lessons for a new era of medicine powered by patient engagement, mobile technology, cloud computing, and social media. This Viewpoint describes the Nightscout Project, including the challenges it poses for the current health care system, and the opportunities yielded from this new form of health production.
Do-it-yourself health care technology has become a hot area, as smart devices promise to transform homes, workplaces, and cell phones into accessible sites for health monitoring and intervention. Yet claims of novelty require a decidedly short-sighted view of history.
The tsunami of digital technology tools and solutions has revolutionized how the global population communicates and consumes. Social behavior, new business models, and on-demand access to information have converged to drive expectations of how to best provide services in the digital age.1
In the United States, the Affordable Care Act and widespread adoption of the electronic medical record (EMR) provide the medical consumer with new financial accountability, the ability to access and digitally transfer medical information and to engage in their medical care in ways that were previously not possible. The impact on the American physician is equally profound and brings both unprecedented scrutiny into practice patterns and enforcement levers to control physician behaviors for compliance and reimbursement mandates.2 Most physicians recognize that active patient engagement in their healthcare improves outcomes, but many are concerned that digital patient engagement means a heavier workload and potential liability risk or payment penalties for not meeting meaningful use criteria.3 Physicians themselves use mobile healthcare applications (apps) mostly to access point of care tools, like risk calculators, treatment guidelines, or prescribing information.4 Nearly 90% of physicians report that they would recommend a mobile app to their patient but only 30% have done so, mostly because of a lack of knowledge or ability to adequately assess the quality of a medical application.5,6 Academic and nonacademic healthcare institutions often lack policies or procedures for vetting mobile health applications and do not provide support to physicians to identify applications across a spectrum of disease conditions.
Disruption of traditional health care has introduced new mechanisms for the medical consumer to access health care using digital tools in new and nontraditional venues. Large pharmacy chains, like CVS (Woonsocket, RI), Rite Aid (Camp Hill, PA), and Walgreens (Deerfield, IL), that already have contact …
Introduction:
The purpose of this research was to conduct a cost-analysis, from a public healthcare perspective, comparing the cost and benefits of face-to-face patient examination assessments conducted by a dentist at a residential aged care facility (RACF) situated in rural areas of the Australian state of Victoria, with two teledentistry approaches utilizing virtual oral examination.
Methods:
The costs associated with implementing and operating the teledentistry approach were identified and measured using 2014 prices in Australian dollars. Costs were measured as direct intervention costs and programme costs. A population of 100 RACF residents was used as a basis to estimate the cost of oral examination and treatment plan development for the traditional face-to-face model vs. two teledentistry models: an asynchronous review and treatment plan preparation; and real-time communication with a remotely located oral health professional.
Results:
It was estimated that if 100 residents received an asynchronous oral health assessment and treatment plan, the net cost from a healthcare perspective would be AU$32.35 (AU$27.19-AU$38.49) per resident. The total cost of the conventional face-to-face examinations by a dentist would be AU$36.59 ($30.67-AU$42.98) per resident using realistic assumptions. Meanwhile, the total cost of real-time remote oral examination would be AU$41.28 (AU$34.30-AU$48.87) per resident.
Discussion:
Teledental asynchronous patient assessments were the lowest cost service model. Access to oral health professionals is generally low in RACFs; however, the real-time consultation could potentially achieve better outcomes due to two-way communication between the nurse and a remote oral health professional via health promotion/disease prevention delivered in conjunction with the oral examination.
The purpose of this research was to assess the compliance rate with recommended dental treatment by rural paediatric dental patients after a live-video teledentistry consultation.
A retrospective dental chart review was completed for 251 rural paediatric patients from the Finger Lakes region of New York State who had an initial teledentistry appointment with a paediatric dentist located remotely at the Eastman Institute for Oral Health in Rochester, NY. The recommended treatment modalities were tabulated and comprehensive dental treatment completion rates were obtained.
The recommended treatment modality options of: treatment in the paediatric dental clinic; treatment using nitrous oxide anxiolysis; treatment with oral sedation; treatment in the operating room with general anaesthesia; or teleconsultation were identified for the 251 patients. Compliance rates for completed dental treatment based on initial teleconsultation recommendations were: 100% for treatment in the paediatric dental clinic; 56% for nitrous oxide patients; 87% for oral sedation; 93% for operating room; and 90% for teleconsultations. The differences in the compliance rates for all treatment modalities were not statistically significant (Fisher's exact test, p > 0.05).
Compliance rates for completed comprehensive dental treatment for this rural population of paediatric dental patients were quite high, ranging from 56% to 100%, and tended to be higher when treatment was completed in fewer visits. Live-video teledentistry consultations conducted among rural paediatric patients and a paediatric dentist in the specialty clinic were feasible options for increasing dental treatment compliance rates when treating complex paediatric dental cases.
© The Author(s) 2015.