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Dental Surgeons of Ontario
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COVID-19: Guidance for the Use of Teledentistry

The use of information and communication technologies to provide dental care remotely (teledentistry) can enable dentists to triage emergency and urgent dental care and provide non-essential services while avoiding close contact with patients. In the longer term, teledentistry can also form part of broader efforts to support dentists in returning to a wider degree of practice through a staged approach.

The following document provides guidance to Ontario dentists on the acceptable use of teledentistry. Teledentistry must only be used in accordance with this guidance.

Refer to our COVID-19 FAQs for additional guidance

PDF version available here. 

What is teledentistry? 

Teledentistry is the provision of patient dental care at a distance, using information and communication technologies (e.g., “virtual visits”).

Teledentistry can be provided in a number of ways, including, as examples: 

  • Live video (synchronous): Live, two-way interaction between a person (patient, caregiver or provider) and a provider using audiovisual telecommunications technology.
  • Store-and-forward (asynchronous): Transmission of recorded health information (e.g., radiographs, photographs, video, digital impressions and photomicrographs of patients) through a secure electronic communications system to a practitioner, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.
  • Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technologies, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support of care.
  • Mobile health (mHealth): Health care and public health practice and education supported by mobile communication devices, such as cell phones, tablet computers and personal digital assistants (PDA). 

Principles

The following principles form the foundation for the guidance contained in this document:

  1. The practice of teledentistry is the practice of dentistry: all Standards of Practice, legal requirements, and professional obligations that apply to in-person dental care also apply to care provided via teledentistry.
  2. The use of teledentistry can help to ensure the continuity and ongoing provision of necessary dental care while mitigating the risk of transmission that is present with in-person clinical encounters.
  3. Teledentistry provides an opportunity for dentists to return to a wider degree of practice, and to service a broader spectrum of patient needs.

When can teledentistry be used? 

Teledentistry must only be used:

  1. by Ontario dentists (licensed and physically present in Ontario);
  2. to treat Ontario patients (physically present in Ontario); and
  3. to assist with the provision of emergency, urgent, and non-essential care, as specified below.

Emergency and Urgent Care

Emergency and urgent care includes the assessment and triage of patients’ oral health care needs and the determination of next steps.

A full emergency examination will not be possible using teledentistry alone. 

In those cases where telephone or virtual/remote management is insufficient, live/in-person clinical assessment may be necessary provided the dental practice has appropriate safety precautions and PPE in place.

Detailed guidance for in-person patient appointments is available here.

Non-essential Care

Teledentistry enables the remote provision of “non-essential” (i.e., non-emergency and non-urgent) care to patients while ensuring ongoing physical distancing. Examples of non-essential care include:

  1. patient education, instruction, advice, or counselling;
  2. assessment or evaluation (e.g., for new or existing conditions or lesions, and for the fit of appliances);
  3. monitoring or follow-up (e.g., for existing ongoing treatment, new devices, or following recent treatment); and
  4. consultations and treatment planning (e.g., for new patients or those of record, and for existing or new conditions).

Examples of emergency, urgent, and non-essential care are available here

Requirements for using Teledentistry

The practice of teledentistry is the practice of dentistry. 

Ontario dentists who practise teledentistry must continue to meet existing Standards of Practice and the professional, legal and ethical obligations that apply to oral health care that is provided in person. 

When practising via teledentistry, Ontario dentists must:

  1. Use their professional judgment to determine whether teledentistry is appropriate and will enable them to meet all applicable Standards of Practice, legal requirements, and professional obligations.
  2. Identify the resources (e.g. information and communication technology, equipment, support staff, etc.) that are required to provide teledentistry, and only proceed if those resources are available and can be used effectively in each case.
  3. Consider each patient’s existing health status, specific health-care needs, and specific circumstances, and only use teledentistry if the risks do not outweigh the potential benefits and it is in the patient’s best interest to do so.
  4. Confirm the identity of the patient and provide the patient with proof of their identity and licensure status (if assessing a new patient). The College recommends that where possible, dentists use teledentistry to assess and triage existing patients.
  5. Obtain an appropriate medical history, verbal history of the patient’s condition and confirm the nature of the emergency before recommending next steps, which may include, among other things: 
    • advice and appropriate pharmacotherapy (if indicated);
    • asking the patient to visit the practice for an in-person clinical examination or treatment appointment;
    • facilitating a patient referral to an emergency office listed on the RCDSO’s website
    • facilitating a patient referral to allied health care providers for care needs that are outside the scope of dentistry, or;
    • facilitating a patient referral to hospital for extreme emergency cases that cannot be managed in the dental office, including loss of life and limb.
  1. Ensure that the reliability, quality, and timeliness of the patient information obtained via teledentistry is sufficient to justify providing or assisting in the provision of dental care.
  2. Use technology that will allow dentists to gather necessary information needed to proceed with treatment. For instance, should dentists need to prescribe medication for a new patient, technology with audio-video capacity will be required to allow for an adequate assessment prior to prescribing medication.
  3. Protect the privacy and confidentiality of the patient’s personal health information, specifically by: 
    • using technology that has privacy and security settings in accordance with the Personal Health Information Protection Act, 2004. At minimum, technology must have controls to ensure only the intended patient has access to the appointment and where personal health information is stored and/or transmitted, strong encryption must be used. If unsure, dentists can confirm with the service provider that the technology meets Ontario privacy requirements.
    • conducting the teledentistry appointment in a private environment that will ensure patient information is not overheard or seen by other individuals; and
    • confirming with the patient that they are in a private setting and that the technology they are using is secure. 
  1. Keep appropriate records of the teledentistry appointment, in compliance with College’s Dental Recordkeeping Guidelines and note specifically that the care was provided through teledentistry.
  2. Establish quality assurance mechanisms via ongoing monitoring and evaluation to ensure that care provided via teledentistry is safe, effective, and consistent with legal and professional obligations.

Additional Requirements

  1. Dentists who do not offer teledentistry must continue to meet their ongoing professional obligation to respond to inquiries and not abandon patients. This would include, at a minimum, a secure telephone line with a confidential voicemail message option and/or a secure and private professional email account. With either option, patient messages must be checked regularly and replied to in a timely manner.