The Dark Side of Paradise: How Teledentistry Is Brightening Hawaiian Smiles

Hawaii offers breathtaking natural beauty and the spirit of Aloha, which makes it a dream vacation destination for many. It boasts a strong and healthy economy with only a 2% unemployment rate. However, there is a dark cloud looming over the archipelago, and it’s not just from the recent eruption of the Kilauea volcano or Hurricane Lane.

Hawaii’s children have the highest prevalence of tooth decay in the nation. According to a recent Hawaii Department of Health survey, Hawaii Smiles report, more than 7 out of 10 third graders (71%) are affected by tooth decay. That is substantially higher than the national average of 52%. Less than 19% of local 6-year-olds bear cavity-free permanent teeth, compared to more than 94% of their mainland counterparts, according to Healthy Smiles Hawaii statistics.

Some say that one of the reasons for the high numbers is that in 2004, fluoride, which is commonly added to public water supplies to reduce tooth decay, was banned by authorities from all publicly supplied water.

Other reasons are access and cost. Isolated approximately 2,400 miles from the mainland, there are no dental schools, which among other things, means no school sponsored dental clinics or local pool of dentists from which to draw. Most US states fund emergency dental services for adult Medicaid patients. Hawaii does not. The island chain has among the lowest Medicaid reimbursement rates relative to fees.

It may rank at the bottom of the nation for children’s oral health, but Hawaii is now taking big steps to improve its oral health, making the state a trailblazer in teledentistry.

The DOH, Pacific Center for Special Care at the University of the Pacific’s Dugoni School of Dentistry, and Hawaii Dental Services Foundation have teamed up to form the Virtual Dental Home (VDH), which is their name for teledentistry. The VDH project, now entering its third year, is based on the success of a six-year demonstration project in California which involved 3,400 patients.

The VDH public-private partnership provides oral health education as well as diagnostic and preventive dental services to participants at a Women, Infants, and Children’s (WIC) site and three Head Start sites on the Big Island.  A majority (approximately two-thirds) of the patients received the care they required right there at the community site, such as schools, preschools and nursing homes.

This pilot project has successfully demonstrated the value of teledentistry and how using technology for virtual dental visits increases access, reduces ER visits, and improves outcomes. In fact, the project is now expanding to another island, Maui.

According to Duguoni School of Dentistry, “VDH creates a community-based oral health delivery system in which people receive preventive and simple therapeutic services in community settings where they live or receive educational, social or general health services. It utilizes the latest technology to link practitioners in the community with dentists at remote office sites.  This system promotes collaboration between dentists in dental offices and these community-based dental hygienists and dental assistants. Most importantly, it brings much-needed services to individuals who might otherwise receive no care.”

How the VDH model works:

  • The care is provided in community settings.
  • Specially trained dental hygienists and assistants collect dental records use portable imaging equipment and an internet-based dental record system to capture and upload patient information. In addition to x-rays, a hygienist also collects photographs, charts of dental findings, and dental and medical histories for electronic records.
  • Collected information is sent through a secure telehealth system to a dentist at a clinic or dental office.
  • The dentist examines the patient virtually by securely reviewing the records and x-rays and then establishes a diagnosis and creates a dental treatment plan.
  • Hygienists provide preventative procedures, such fluoride varnish, dental sealants, dental prophylaxis and periodontal scaling.  Hygienists may also provide an “interim therapeutic restoration” (ITR), a type of small protective filling which stabilizes the tooth until the dentist determines that further treatment is required.
  • Dental education is provided for patients, parents, and caregivers by the dental hygienist
  • Referrals are made for more complex treatments which must be performed by a dentist.

Hawaii-based dental support organizations (DSOs) like Premier and Hawaii Family Dental, as well other Hawaiian providers, are poised to utilize teledentistry to assist in reducing barriers to preventative and basic dental care in Hawaii’s vulnerable communities, which will in turn help decrease the side affects of dental problems, including psychological issues, lost work or school days, avoidable health ailments, and even death.

Teledentistry will not solve all of this paradise’s dental issues, but will certainly help brighten Hawaiian smiles, hopefully for generations to come.

Sources: Pacific Center for Special Care at the University of the Pacific, Arthur A. Dugoni School of Dentistry, Big Island Now, Honolulu Civil Beat, Board of Water Supply, Hawaii Dental Service

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