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

For the duration of the COVID-19 crisis, dentists should consider the use of teledentistry for the remote assessment, triage, and provision of dental care where possible and appropriate.

Teledentistry, which involves the use of information and communication technologies to provide care remotely, enables dentists to serve a variety of dental care needs while avoiding close contact with patients.

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

Additional resources

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 dental 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 of COVID-19 that is present with in-person clinical encounters.

When can teledentistry be used? 

Teledentistry must only be used:

  1. by Ontario dentists (dentists are not required to be physically present in Ontario);
  2. to treat Ontario patients ; and
  3. to assist with the provision of care in accordance with the requirements set out in this document.

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 dental 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 another dentist for care needs;
    • 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.
  6. 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.
  7. 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. 
  8. 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. 
  9. 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.
  10. 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.