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Presentation by Fred Summerfelt, RDH, MEd, Associate Professor of Dental Hygiene, Northern Arizona University
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MATRCTelehealth Summit
March 18, 20131
Teledentistry-Assisted Affiliated Practice
Dental Teams
Fred Summerfelt RDH, AP, M.Ed
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The AZ Affiliated Practice Dental Hygiene Model
Allows APDHs to see patients without general supervision!
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AZ’s Affiliated Practice Dental Hygiene Model• 2004 §32-1289 signed into law
• Allows an affiliated agreement, with standing orders, between a dental hygienist and a dentist
• APDHs may see patients of any age who are:
• enrolled in a federal, state, or local healthprogram – or
• enrolled in the National School Meal Program – or
• from a family with a household income of less than 200% of the federal poverty guidelines
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AZ’s Affiliated Practice Dental Hygiene Model• 2009 SB 1400 added to §32-1289
• Affiliated practice dental hygiene patients must be seen by a dentist within12 months of initial treatment by the dental hygienist otherwise further dental hygiene services are prohibited
• Specific language concerning elderly and medically-compromised patients
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APDH Services
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Affiliated PracticeDental Hygiene Services
• Assessment
• Blood pressure & medical history
• Screen and photograph oral cavity and surrounding structures
• Chart dental restorations and clinical findings
• Expose and process x-rays
• Conduct a caries risk analysis
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Affiliated PracticeDental Hygiene Services
• Preventive
• All procedures for a complete prophylaxis
• Apply sealants according to ADA and CDC guidelines
• Administer topical fluoride gels and varnish as indicated according to ADA and CDC guidelines
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Affiliated PracticeDental Hygiene Services
• Patient Education
• Discuss patient’s home care procedures
• Provide appropriate home care instruction
• Provide tobacco cessation intervention and a referral when appropriate
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Teledentistry
A Digitally-LinkedOral Healthcare
Team
Dental Hygienist
General Dentist
PedodontistDental Specialists
Allied HealthProfessionals
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Telehealth & Telemedicine• In use since the 1950s
• Prevalent in rural communities
• Effectively use telecommunications technology
• Transmitted Electronic Data
• Graphics, audio, and video images shared between physically separated professionals
• Diagnosis, consultation, and treatment planning
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Teledentistry• Presents as:
• An emerging Web-based intervention system
• A distance-learning framework
• A vehicle to decrease the phenomenon of professional isolation common to rural and underserved areas
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Teledentistry• Utilizing current technologies, it is
possible to acquire and digitally transmit all necessary subjective and objective diagnostic data to a distant dentist for:
• Triage
• Dental treatment planning
• Referral
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NAU’s Teledentistry Equipment
Are there digital technologies that allow us to see better than the eye can see in face-to-face examinations?
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Nomad Pro X-ray Unit
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Nomad Pro X-ray Unit• Certified by all 50 states
• Allows the operator to be in the room when the x-ray is exposed
• Easy to use
• Long battery life
• Protective carrying case
• Ideal for remote locations
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Nomad Pro X-ray Unit
Primary Protective Shielding
Lead and Glass Shield
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Nomad Pro X-ray Unit
Area of Protection
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Scan-X Duo Processor
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Scan-X Duo Processor• Sturdy piece of equipment
• Carrying case
• Easy to maintain - periodic cleaning strip
• Processes phosphor plates quickly
• Scans and erases phosphor plates, ready for reuse
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Scan-X Duo Processor
30,000 images per x-ray film!
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Acclaim Intraoral Camera
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Acclaim Intraoral Camera
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Acclaim Intraoral Camera• Has proven to be very valuable in the
public health environment
• Barrier sheaths prevent the need for sterilizing mirrors
• Projected images allow for excellent viewing of the intraoral environment
• Photographs are easy to take
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VELscope
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VELscope
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VELscope
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Spectra
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Spectra
Green Blue Red Orange Yellow
Sound Enamel
IncipientEnamelCaries
AdvancedEnamelCaries
IncipientRoot
Caries
Advanced Root
Caries
1.7
2.4
2.5
2.8
2.433 34
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Rather than take the patient to the typical dental home . . .
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. . . take many servicesto the patient!
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• Store and forward the diagnostic data
• On the laptop computer
• On a DVD, CD, or by e-mail
• On a thumb drive or other hard drive
• Direct real-time link to the team members
• Satellite link
• Hard wired into an Internet connection
Linking the Team Members
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Link via Cloud Computing!
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• Patient Privacy and HIPAA compliance
• Current technology exists - medical data
• Data encrypted to insure privacy
• Encrypt store-and-forward data
• Encrypt real-time data
• Encrypt live-action video
• Multiple group members can participate
Linking the Team Members
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• Approximately six hours
• Nomad training manual
• Nomad certification exam
• Phosphor plate management
• Scan-X Duo competency
• DXXTR x-ray exposure experience
• Acclaim intraoral photos on peers
Student Training
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Kaibab Band of the Paiutes
450 Mile Round Trip50
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• Screened and referred 23 kids for care• Five had immediate needs - acquired their digital
diagnostic data
• Forwarded diagnostic data to my affiliated dentist who confirmed the need for immediate care
• Forwarded the data to the pedodontist at Polacca
• The kids’ parents were told to call to be put right on the the pedodontist’s schedule - no further exam required
• An opportunity to save each patients' family a 450-mile round trip for an exam and treatment planning!
Kaibab Band of the Paiutes
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Havasupai
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• Courses complete with methods and materials
• Interested Parties
• Community leaders
• Funding agencies
• Continuing Education
• Dental professionals
• Comprehensive Training
• To form enhanced dental teams
Teledentistry Curriculum
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• The APDH
• Teledentistry
• HIPAA & Teledentistry
• Nomad Training
• Teledentistry Equipment Set Up
• Hands-on Training
• Future Trends in Teledentistry
Teledentistry Curriculum
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• NAU has partnered with VHI to provide teledentistry services to Verde Valley area schools
• Beaver Creek School in Rimrock, AZ
• Approximately 350 student patients
• Diagnostic and preventive services
• Hopefully expanding to other schools next year
Verde Health Initiative
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Questions?
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Thank You!
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Fred Summerfelt, RDH, AP, M.Ed.Associate Professor
Northern Arizona University(928) 523-0953
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References
McKinnon, M., Luke, G., Bresch, J., Moss, M., & Valachovic, R. (2007). Emerging allied dental
workforce models: Considerations for academic dental institutions. Journal of Dental
Education, 71(11), 1476-1491.
Patient Protection and Affordable Care Act, U.S.C. H. R. 3950 (2010).
Senate Bill 1400 Amending Section 32-189, A. R. S. § 32-1289 (2009).
Title 32 Professions and Occupations, A. R. S. § 32-1289 (2004).
U.S. Department of Health and Human Services. (2001). Oral health in America: A report of the
surgeon general. U.S. Department of Health and Human Services, National Institute of
Dental and Craniofacial Research: Rockville, MD.
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