Integrating Oral Health into Pediatric Telemedicine Visits

ABSTRACT

Background: Connecting the mouth to the rest of the body is critical for providing whole-person, patient-centered, comprehensive healthcare. The COVID-19 crisis has provided an opportunity for elevation and expansion of oral health prevention education into telemedicine, particularly using video connections. Access to dental care substantially decreased during this time. Public acceptance and demand have increased simultaneously. Most oral health conditions are preventable (-30-85%) with improvement of personal habits and quality dental care. Integration of prevention-centric approaches to oral health care into telemedicine can overcome barriers and have a favorable impact on oral and overall health of all populations. Using a DEI lens, we propose to create a compendium of effective best practices/innovations for oral health integration in telemedicine (OHFT) that can be adopted widely at minimal cost to support the value of oral health to overall health throughout pediatric healthcare. Methods: To create comprehensive guidance around best practices/innovations incorporating oral health into telemedicine visits, we will conduct expansive focus groups (30+) to research and pilot an assortment of modalities and messages for OHFT in the next 12 months. HTHC at PAAAP will continue working towards collective impact with Primary Care Collaborative, the Oral Health Section of the American Academy of Pediatrics (AAP) and OPEN in subsequent years to 1) monitor pilots/innovations, 2) initiate establishing a CPT procedure code with RVUs, 3) seek USPSTF recommendation of “A” or “B”, and 4) work with AAP Bright Futures Guideline for inclusion of the procedure. We will seek and spread via publication and conference presentations best practices/innovations providing an assortment of modalities and messages for inclusion across the spectrum of telemedicine visits, beginning with pediatric telemedicine visits. Results: Implementation of OHFT will insure reaching all in need. Sustainability would be provided by assuring reimbursement for clinician time spent on implementing OHFT. We postulate a dramatic increase in population oral health and OH literacy from implementation of OHFT. Conclusion: In summary: • OHFT serves families without transportation, CSHCN who are difficult to transport, etc. Many occupy homes impacted by discriminatory practices and poverty. • Smartphone pictures of teeth, mouth, toothbrush, and toothpaste, emailed in advance of the visit ,can be used to aid in addressing the specific needs of the child via video telemedicine - all in about 2 minutes. • Best patient/family centered OHFT practices will be updated frequently for needs of specific communities - CSHCN, limited resources, persons of color, etc. • A CPT Code with RVUs for payment for the services as a procedure, will build profit center capacity increasing oral health literacy of the community along with adoption of good prevention practices. • Medical telehealth visits are demanded by the public. Best practices/innovations must be evaluated through lenses of quality as well as DEI.