Counterpoint response: The Virtual Dental Home

I want to thank the editors of DrBicuspid.com and Jay W. Friedman, DDS, MPH, for the opportunity to provide these comments following Dr. Friedman's Second Opinion about the recent Pew Charitable Trust report on expanding the dental team and the inclusion of the Virtual Dental Home (VDH) model in that report.

I appreciate Dr. Friedman's recognition of the value of the Virtual Dental Home system in reaching children and adults who do not access the traditional dental care system. I believe we share the same goals. Perhaps it would be helpful to provide some additional information to better understand the VDH system.

Paul Glassman, DDS, MBA.

Dr. Friedman correctly explains that the VDH system uses dental hygienists and dentists working in telehealth-connected teams to collect diagnostic records and perform preventive and early intervention dental services, including interim therapeutic restorations (ITR) in community settings. These settings include Head Start centers, elementary schools, residential facilities, and nursing homes.

With the combination of the procedures described above and the integration of oral health information and education into the community agencies, the majority of the children seen in this program can be kept healthy in schools with the services provided by hygienists. The majority of the other children who have advanced disease needing treatment by a dentist have had successful referrals to dentists for those advanced restorative and surgical services, and then return to the community setting for ongoing checkups and preventive care.

Because the diagnostic records, including x-rays, photographs, and charting, are entered into a cloud-based record system, they are available for the dentist who is not on site to review and provide recommendations and instructions for onsite care. When a child needing advanced services does visit a dental office, they require fewer visits than in a traditional system because the dentist is already familiar with the child's history and treatment needs, and preventive procedures and practices are already in place. In addition, dentists find that when children have been seen previously by a hygienist in a Head Start program or school, they are more used to someone working in their mouth, and the treatment in the dental office goes more smoothly.

The VDH expands the ability of current dental practices and safety-net clinics, using a low-cost approach, to reach and serve populations of people who often do not take advantage of the traditional system until they have advanced disease, pain, or infection.

While the VDH system is not a complete solution for every situation, the costs to train current dental professionals and develop and deploy a VDH system are very low; it can be put into service relatively quickly; and it can reach and provide critical preventive and early intervention services for many underserved groups.

We also need to recognize that the poor oral health and limited access to services of a very large portion of the U.S. population is unlikely to be solved by any single solution. We need to try a number of approaches and learn from them as we continue our efforts to address this complex problem in the most cost-effective way possible. I believe that there is lots of common ground among advocates for various system and workforce solutions to improving oral health, and we can all benefit from following and learning from various models.

Paul Glassman, DDS, MBA, is a professor of dental practice, the director of community oral health, and the director of the Pacific Center for Special Care at the University of the Pacific Arthur A. Dugoni School of Dentistry in San Francisco. He can be reached at [email protected].

The comments and observations expressed herein do not necessarily reflect the opinions of DrBicuspid.com, nor should they be construed as an endorsement or admonishment of any particular idea, vendor, or organization.