Remote clinical consultations in restorative dentistry

Specialist consultations are routine in medical and oral healthcare provision. These take place as an 'in-person' event in the secondary care centres. The primary outcome of the specialist consultation is to provide the dentist and the patient with a specialist assessment, diagnosis, prognosis and a proposed care plan.

This in-person procedure remains the gold-standard as it is a considered safe and effective. It presents a number of shortcomings: (1) The referring clinician is not actively involved in the decision-making process. (2) The patient must travel to the secondary care centre for the consultation, creating inequalities of care provision. (3) The patient travel has a carbon footprint. (4) The setting of the referral centre can be unfamiliar and intimidating to the patient. (5) The outbreak of COVID-19 highlighted the need for alternative system to address this need.

This clinical study assessed the feasibility and effectiveness of undertaking remote clinical consultations in restorative dentistry between a patient and dentist co-located in a clinical primary care dental practice and a specialist consultant in a remote secondary care centre.

Method: A remote clinical consultation in restorative dentistry was conducted that enabled full engagement between the remote consultant and the patient/General Dental Practitioner (GDP) in the dental surgery. A comprehensive bespoke high-speed secure internet connected hardware and software platform was used.

Each participant completed a semi-structured interview and a validated questionnaire covering four domains: Patient safety, communication between different parties, formulation of a treatment plan, and effectiveness of the technology.

Results: Effective and safe clinical consultations were carried out in all the cases, regardless of gender, age and presenting complaint. Neither the process nor the outcomes were inferior to an in-person consultation.

Conclusion: This pilot in-practice clinical effectiveness study identified that Remote Clinical Consultations (RCCs), as conducted in this study, are effective for the delivery of specialist consultations in restorative dentistry. They are not inferior to an in-person consultation. Secondary outcomes: Three-way discussion was very positive; high levels of acceptability from the patients and the referring GDPs; an alternative to patient travel, reducing travel inconvenience, cost and the environmental burden from the associated carbon dioxide emissions.