There is no worse moment than biting on a popcorn kernel and breaking a tooth, says Dr. Myron Cohen, Carolina’s associate vice chancellor for medical affairs and global health, particularly in the middle of a global pandemic.
“The COVID ‘shelter in place’ made that sinking feeling even worse,” said Cohen, who fractured the cusp of a tooth in May, nearly two months after most dental practices had to close their doors amid the viral spread of COVID-19 across the state.
He called the UNC Virtual Oral Health Care Helpline at the UNC Adams School of Dentistry, where he says he received immediate information on what to do next – get to the school’s emergency clinic.
“Working at UNC, I knew the dental school maintained an urgent care clinic that was sensitive to patient needs and patient safety. My trauma clearly was criteria for urgent care. They had a screening area to assure a mask was worn, and that I was afebrile and had no symptoms. Soon, my dentist, in full and safe PPE, took care of my tooth, my pain and my anxiety. This is a wonderful, and essential, resource to our community and the state,” he said.
On March 6, the Adams School had hosted its second statewide summit on teledentistry, a service the school already saw as a novel way to leverage innovations in telehealth to expand dental care access to all corners of the state and increase the capacity of the school to serve the needs of the most vulnerable North Carolinians.
“We could have never known, that one week later, we’d all be in lockdown,” said Dr. Shaun Matthews, who is the director of telehealth for the school. “The COVID-19 pandemic stopped the world in its tracks. But, as we all know, dental emergencies do not stop.”
By March 23, the helpline was up and running as a telehealth component to complement Carolina’s emergency dental clinic.
“The emergency clinic is a walk-in service on the first floor of the school, but we obviously wanted people to stay at home and stay safe, if they could. We also wanted to protect hospital emergency departments, where providers were needed to treat the very sick. The helpline allows us to determine if the patient we are consulting has concerns severe enough for our emergency clinic or an ED, if for example, their problems are impacting breathing. But, this service is actually much more than triaging emergencies – it’s true dental care.”
Matthews had long been involved in telehealth efforts, working with the North Carolina Dental Society, the State Board of Dental Examiners and partners at East Carolina University School of Dental Medicine to find a way forward for virtual care that would enable providers to reach rural areas, care for the disadvantaged and raise the profile of oral health in the state. With his expertise, the support of the school’s dean, Scott De Rossi, and faculty, staff and student buy-in, the Adams School was ahead of the game, ready to offer a service that did more than meet immediate needs in a health care landscape that had changed so completely in a short period of time, but provide care to callers from across the state and open the door wider to dentists who rely on the expertise of the school in their own practices.
Matthews said the school’s forward-thinking is what allowed them to create a service that cast a wide net across needs, offering asynchronous and synchronous care, interpreter and social services, provider-to-provider consultations and a quality-improvement team to continuously optimize care and improve the process.
“With synchronous care, a provider can have an audio and visual consultation with the patient to discuss their condition, assess pain, view any swelling, bleeding, broken fillings or other restorations, make a diagnosis, and determine what can be done to treat them. Many times, this could be done completely over the phone. With asynchronous care, we can receive photos, x-rays and other information to review by a provider at the school who can make an assessment on the best way to manage the patient.”
In the three months since it opened, the helpline has received 1,500 calls and treated those patients by referring them to emergency clinics or addressing their needs via computer or phone. Private dental practices across the state included the helpline’s phone number in their voice recordings. Providers who have referred their patients to the school have used the line to consult or share information on their patients, or to seek advice from faculty on tough cases.
“This service goes far beyond the boundaries of UNC,” said Matthews. “For dental practices to survive, they’ll have to reopen sooner rather than later, and they are beginning to do so. The school’s intentions with telehealth services have always been bigger than the pandemic. Even in typical times, its applications are an absolute necessity, and we’re collecting data that demonstrates this.”
The success of the helpline has set up the school to become a model for how other dental schools and health organizations can use robust teledentistry services to not only meet oral health needs in pandemic conditions but also make dental health more available and more convenient for patients everywhere – which Matthews said can have a huge impact on general health outcomes.
“We have continued to challenge the delivery of oral health care in our state, and this began because we were already thinking creatively about how to serve patients. What we’ve created is something that can be used to screen kids in schools, the elderly in nursing homes, at-risk populations in remote parts of the state where there are no dentists, the incarcerated in our prison systems, not to mention the busy professionals in our more urban environments that need more convenient services.
“I hope that we don’t go backward from here – there is still so much to do. The Adams School is moving forward boldly because our responsibility to our state and fellow North Carolinians is clear.”