Application of teledentistry in oral medicine in a Community Dental Service, N. Ireland

Key Points Presents a pilot series of patients with oral mucosal problems who had high quality clinical photography of their lesions taken in primary care and then viewed online by an oral medicine specialist. Distance diagnosis of disease has the potential to significantly alter patient referrals. Most participants could be managed in primary care without attending a hospital specialist. Currently, patients with oral medicine conditions from all areas of Northern Ireland are referred by dentists and doctors to a small number of specialist services: predominantly, the Regional Oral Medicine Consultant at the School of Dentistry, Belfast. On receipt of the referral the consultant makes an assessment of the urgency of the case and the patient is placed on a waiting list. Until the recent implementation of waiting list initiatives (Elective Access Protocol, Department of Health, N. Ireland, 2006), patients remained on the waiting list for long periods of time. Analysis of these patient profiles highlights that many need both multiple treatment and review appointments of their chronic conditions, and consequently remain in the hospital system for significant periods of time. This increases the waiting time for these services. The idea of using teledentistry to triage referrals, and its potential as a tool to support locally based treatment, poses an alternative approach to the management of oral medicine referrals. It may be of particular interest to practitioners in rural locations where distance from the regional centre is significant. In 2005, to test this theory, a prototype teledentistry system was set up as part of a service improvement scheme by the Community Dental Service of the Homefirst Legacy Trust (now Northern Trust) in partnership with the Oral Medicine Department at the School of Dentistry, Royal Group of Hospitals Legacy Trust (now Belfast Trust). This paper describes the feasibility study.