…Being in the same room with a patient also makes us more empathetic and better listeners. We’re able to read a patient’s body language and get an overall sense of where they are mentally so we can adjust how the exam is performed and help put them at ease. With any patient, the goal is to keep them as a longstanding patient, so aside from the clinical relationship, dentists also try to build a personal relationship by engaging in conversations. Teledental visits don’t always allow us to have that same type of connection.
… My biggest concern is both patients and dentists becoming too reliant on remote exams. Teledental visits have a lot of benefits and provide more access to care when and where patients want it, but the only way to receive definitive care and long-term solutions is by in-person dental exams. Teledentistry is an adjunct, not a replacement to traditional dentistry.
One of the outcomes of the pandemic is the dramatic growth of telehealth. But how can providers best take advantage of the increase use in telehealth? What should healthcare providers tell their patients in order to best leverage this technology? How can telehealth approximate and even improve upon the healthcare that traditional healthcare provider visits can provide?
In this interview series, called “Telehealth Best Practices; How To Best Care For Your Patients When They Are Not Physically In Front Of You” we are talking to successful doctors, dentists, psychotherapists, counselors, and other medical and wellness professionals who share lessons and stories from their experience about the best practices in telehealth.
As a part of this series, I had the pleasure of interviewingDr. Katina Spadoni, Dental Director at Anthem Blue Cross and Blue Shield, about how telehealth systems are being used by dentist to provide patients with timely and convenient access to teledental care.
Katina Spadoni, DDS, is the dental director for Anthem Blue Cross and Blue Shield where she provides her expertise in dental claims administration. Dr. Spadoni also sees patients in her private practice in Illinois and virtually on The TeleDentists®. She has been a practicing dentist and dental consultant for 33 years.
Thank you so much for joining us in this interview series! Before we dive in, our readers would love to “get to know you” a bit better. Can you tell us a bit about your ‘backstory’ and how you got started?
My older sister and I had braces when we were growing up and we were fascinated by the dentist’s work and thought it seemed like a fun job. During my senior year of high school my sister approached me with the idea of becoming dentists together.
After we both graduated, we opened our practice and, 33 years later, we’re still together. Over the years, we’ve always collaborated and complemented each other well. She focuses more on cosmetic dentistry, working with bonding and veneers, and I prefer more traditional dentistry, like working with deep scaling and extractions.
Can you share the most interesting story that happened to you since you began your career?
Several years ago, I saw a young, single mom who seemed to be in perfect health. Before I look at a patient’s teeth, I always do a head and neck exam and during her exam I found what looked like a black freckle on her palette. That’s an unusual place for a dark pigmented lesion, so as an extra measure of caution, I referred her to an oral surgeon for a biopsy. Unfortunately, it turned out to be a highly aggressive melanoma.
This story stuck with me because oral melanomas are rare — accounting for around 2 percent of all melanomas — and it’s an important reminder of why we conduct head and neck exams. Had I not done the exam, the lesion would have spread further and progressed much faster before it was diagnosed.
Can you please give us your favorite “Life Lesson Quote”? Can you share how that was relevant to you in your life?
My mantra is “slow and steady wins the race.” What that means to me — especially as a mother, wife and professional — is that it’s important to slow down and focus on the task at hand. No one can do everything well at one time but by giving my full attention to each moment I’m able to accomplish so much more. It also means taking time out for myself, whether that’s getting in a quick workout or treating myself to a massage.
None of us are able to achieve success without some help along the way. Is there a particular person who you are grateful towards who helped get you to where you are? Can you share a story about that?
While I am grateful to my sister who influenced and encouraged me to pursue a career as a dentist, I want to acknowledge one of my dental instructors, Dr. Al Harris, who had a major impact on my career trajectory. Dr. Harris worked for a dental insurance company, and while I initially planned to pursue traditional clinical dentistry, he convinced me to consider a career in dental benefits. At the time, I was very green and didn’t even know dental insurance existed. Dr. Harris set up a meeting for me with his boss, which turned out to be an interview, and ended up with an offer to become a dental consultant.
For my entire career, I’ve worked in clinical dentistry and dental benefits simultaneously and I can’t imagine giving up either. I’ll always be grateful to Dr. Harris for opening my eyes to alternative dental career paths and for providing me with the opportunity to pursue dental benefits.
Ok wonderful. Let’s now shift to the main focus of our interview. The pandemic has changed so many things about the way we behave. One of them of course, is how doctors treat their patients. Many doctors have started treating their patients remotely. Teledentistry can of course be very different than working with a patient who is in front of you. This provides great opportunity because it allows more people access to medical professionals, but it can also create unique challenges. To begin, can you articulate for our readers a few of the main benefits of having a patient in front of you?
As a dentist, the most obvious benefit of in-person exams is being able to use more of your senses to identify any issues. We have a clear view into the patient’s mouth, we can touch their gumline and their teeth, and at times we can even detect different odors that can indicate certain conditions. If we notice a patient has periodontal or gum problems, we can probe dental pockets, which are gaps between the teeth and gums where infections can develop. If necessary, we can also take X-rays and study models. The additional information that dentists can gather from in-person exams gives us a more complete picture of our patients’ overall oral health.
Being in the same room with a patient also makes us more empathetic and better listeners. We’re able to read a patient’s body language and get an overall sense of where they are mentally so we can adjust how the exam is performed and help put them at ease. With any patient, the goal is to keep them as a longstanding patient, so aside from the clinical relationship, dentists also try to build a personal relationship by engaging in conversations. Teledental visits don’t always allow us to have that same type of connection.
Lastly, when we have a patient in front of us, we’re able to get a more comprehensive medical background. It’s much easier to ask follow-up questions in person. For example, if a patient says they’re always thirsty, we can ask additional questions to figure out if there’s an underlying cause or issue. It could be that the patient is diabetic, it could be the side effect of a medication they are taking, or there may be some other information that isn’t recorded in their medical history. In teledentistry, it’s more difficult to ask a lot of questions because we’re under a time constraint and the patient may be in pain and just looking for quick answers.
Fantastic. Here is the main question of our interview. Based on your experience, what can one do to address or redress each of those challenges? What are your “5 Things You Need to Know” to best care for your patients when they are not physically in front of you? (Please share a story or example for each.)
- The most important thing we need is a complete medical history that includes any past surgeries, illnesses, or allergies because this information is invaluable when providing treatment. The mouth is connected to the rest of the body, so understanding what other conditions a patient has helps us alter and adjust our treatment method to provide the best overall care and avoid any complications.
- We also need to know any medications a patient is taking because a lot of medications have oral side effect. For example, if a patient uses an inhaler it can dry out the tissue in the mouth, so I might prescribe artificial saliva to keep the tissue moist and avoid any pain, itching or burning.
- When a patient is in pain, it’s very important that they tell us how long they have been experiencing it and describe the type of pain. If it’s a zinging pain that tells me something completely different than if it’s a dull, throbbing pain. For example, a dull, throbbing pain indicates that the nerve is involved and there could be an abscess, but a zinging pain can indicate a cracked tooth or lost filling.
- Beyond describing the issue they’re currently experiencing, patients should be completely honest about how often they seek medical care. Sometimes I find patients are embarrassed to tell the truth and I understand because we may be discussing a sensitive issue. However, as doctors, we aren’t judging anyone. So, when we ask about the last doctor’s exam, whether it was 6 months or 20 years ago, or how often you brush and floss, that can influence my approach to what an issue could be, its severity, and how to best treat the patient.
- The last thing to know is that dentists are cheerleaders and advocates for our patients, regardless of whether we are seeing them virtually or in-person. Even if a patient has a lot of issues that need our attention, it’s important that they understand we’re here to help them. Patients need to be encouraged to regularly visit their dentist to maintain good oral health and understand how issues in their mouths can affect the rest of their body. For example, the bacteria that causes periodontal disease can enter the bloodstream through the gums, causing inflammation to spread and damage to blood vessel. This can lead to higher rates of cardiovascular issues such as stroke or heart attack, so I always emphasize the importance of regular check-ups.
Can you share a few ways that teledentistry can create opportunities or benefits that traditional in-office visits cannot provide? Can you please share a story or give an example?
A big benefit of teledental visits is that patients can schedule the consultation when it’s convenient for them and they don’t have to take off from work or schedule their day around a visit — I’ve seen patients at their work cubicles and in their homes. Teledentistry is also great for people who are unable to make routine visits to a dental office, like those who travel frequently and may find it difficult to schedule time for an in-office visit, or for those who live in rural areas and don’t have access to local care.
Beyond the convenience, teledentistry is also more affordable than an in-person visit and can keep patients from an expensive visit to the emergency room. However, it should be noted that teledentistry is not a replacement for in-person care. While it can help alleviate pain or address urgent issues, patients are still encouraged to seek further treatment for long-term solutions.
It’s important to note that patients must schedule their virtual consultations with a doctor or dentist who practices in the state where they reside. For example, I practice in Illinois, so if an Illinois resident is traveling to California, they can schedule a consult with me while on their trip. Teledental visits are currently available just about anywhere in the U.S.
Finally, teledentistry is also beneficial to dentists. Dental emergencies come up and we’ll do everything we can to accommodate patients, but that can be disruptive to our regular workflow. I may have a full day of appointments and one emergency call can impact not only my schedule but my other patients who already have scheduled appointments. Teledental visits can help triage some of these emergencies and reduce the need for patients to be seen immediately.
Let’s zoom in a bit. Many tools have been developed to help facilitate teledentistry. In your personal experiences which tools have been most effective in helping to replicate the benefits of being together in the same space?
Teledentistry has been around for decades but with advances in technology it is now much easier for the general public to take advantage of it. Video chat features are now common on cell phones and computers, which allows doctors and dentists to see their patients from anywhere that they have an internet connection. When I conduct a video exam, patients can show me the area that is bothering them and I can see any swelling or irritation, which helps me to be more comprehensive in diagnosing and treating any issues.
Electronic prescribing is another great tool. It offers a more streamlined process as opposed to calling the pharmacy and having the patient go wait for the prescription. I usually suggest patients wait 30 minutes to an hour after the exam ends before they go to the pharmacy, so the prescription is ready when they arrive.
If you could design the perfect teledentistry feature or system to help your patients, what would it be?
I’d design a camera attachment, whether it be for a patient’s phone or computer so they can take a good, high-quality photo of the problem area to help me assess the issue. For instance, if someone has a broken tooth, the image would allow me to see if it’s a broken filling close to the nerve or an irritation on the gum. Even if they were having an issue with their tongue, I could determine whether it’s something as simple as a pizza burn or more severe like an infection.
Is there a part of this future vision that concerns you? Can you explain?
My biggest concern is both patients and dentists becoming too reliant on remote exams. Teledental visits have a lot of benefits and provide more access to care when and where patients want it, but the only way to receive definitive care and long-term solutions is by in-person dental exams. Teledentistry is an adjunct, not a replacement to traditional dentistry.
How can our readers further follow your work online?
Readers can visit Anthem Blue Cross and Blue Shield — Dental, to learn more about our benefits and how integrated care can improve patient care.
Thank you so much for the time you spent doing this interview. This was very inspirational, and we wish you continued success.