Tele communication and tele-medicine- scope and applications in dentistry, with current Indian scenario and future prospective.

1. DR. NIDHI PRUTHI SHUKLA(BDS, MDS, FAGE)
PROFESSOR & HEAD
DEPARTMENT OF PUBLIC HEALTH DENTISTRY
RAMA DENTAL COLLEGE, HOSPITAL AND RESEARCH CENTRE,
KANPUR
TELEDENTISTRY IN
INDIA:
A NEW FUTURE BECKONING
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2. 1. INTRODUCTION
2. NEED FOR TELEDENTISTRY
3. HOW TELEDENTISTRY WORKS
4. APPLICATIONS
5. ADVANTAGES
6. TELECOMMUNICATION IN INDIA
7. CURRENT SCENARIO OF TELEMEDICINE IN INDIA
8. ITS CHALLENGES
9. FUTURE PROSPECTIVES FOR TELEDENTISTRY IN INDIA
10. IMPLEMENTATION STRATEGIES
11. CONCLUSION
12. BIBLIOGRAPHY
CONTENTS
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3. 3

4. Notmuch more than a century separates
painless Parker from today’s dentist, but practice has changed
dramatically during that time….
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5.  The term “Teledentistry” was first used in 1997, when Cook
defined it as “… the practice of using video-conferencing
technologies to diagnose and provide advice about treatment
over a distance.”
 Teledentistry is a newly emerging area of dentistry that uses
dental health records, telecommunications technology, digital
imaging and the Internet to link dental health care providers
in rural or remote communities with specialists in larger
communities to enhance communication, the exchange of
health-related information and access to dental care for
underserved patients.
Cook J. ISDN video conferencing in postgraduate dental education and orthodontic diagnosis.
Learning Technology in Medical Education Conference 1997 CTI Medicine. 1997:111-6. 5

6. Continuing education/
health-care research
NEED FOR TELEDENTISTRY
Medical and dental
knowledge is rapidly
changing
Cost of dental treatment
is going up
The urban-rural divide in
health care facilities
The dilemma of
unusual diagnosis
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7. Real –Time Consultation `
Store and Forward
Method
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8.  WEB-BASED SELF – INSTRUCTION
EDUCATIONAL SYSTEM
 A unique way to facilitate long distance
clinical training and continuing
education to practitioners .
 It can even facilitate patient education
about self care.
 INTERACTIVE VIDEO CONFERENCING
 includes both a live interactive video-
conference with a proper camera set up
where the patient’s information can be
transmitted;
 and supportive information (such as the
patient’s medical history, radiographs, etc)
that can be sent before or at the same time
as the videoconference.
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9. PATIENT CARE
EDUCATION
RESEARCH
ADMINISTRATION
PUBLIC HEALTH
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10. ADVANTAGES
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11. 11

12.  India, with a population of over 1.25 billion, has the second largest internet user
base in the world, with over 350 million internet users as of June 2015 (IAMAI)
 In contrast to the bleak scenario in healthcare, computer literacy is developing
quickly in India.
 Healthcare providers are now looking at Telemedicine as their newly found Avatar.
 Theoretically, it is far easier to set up an excellent telecommunication infrastructure
in suburban and rural India than to place hundreds of medical specialists in these
places.
 We have realized that the future of telecommunications lies in satellite-based
technology and fiber optic cables.
IAMAI says India will have 500 Million Internet users by 2017. Available at www.iamai.in
(Last accessed November 15, 2015)
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13.  Pilot project entitled “Development of Telemedicine Technology” was launched
in 1999 by the Department of Information Technology, the Ministry of
Communications and Information Technology (Government of India).
 MoHFW GoI has now adopted telemedicine into the National Rural Health
Mission
 In India, Telemedicine projects are actively supported by:
 Department of Information Technology (DIT)
 Indian Space Research Organization (ISRO)
 NEC Telemedicine program for North-Eastern states
 Apollo Hospitals
 Asia Heart Foundation
 State governments
 Other private organizations
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14. Geographic distribution of telemedicine nodes in the India map 14

15. Statewide Telemedicine Network implemented in various states of India
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16. 1. West Bengal for diagnosis and monitoring of tropical diseases,
2. Oncology Network in Kerala and Tamil Nadu, the
3. Network for specialty healthcare access in rural areas in Punjab,
Maharashtra, the hilly state of Himachal Pradesh, and the North-Eastern
region.
The Telemedicine network connects the three premier Medical Institutes of the
country –
 All India Institute of Medical Sciences (AIIMS), New Delhi,
 Sanjay Gandhi Post Graduate Institute of Medical Sciences (SGPGIMS),
Lucknow and
 Post Graduate Institute of Medical Education and Research (PGIMER),
Chandigarh).
 Now it is being connected to include Medical centres in Rohtak, Shimla
and Cuttack.
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17.  In the past three years, ISRO's telemedicine network has expanded to
connect
45 remote and rural hospitals and 15 superspecialty hospitals.
 The remote / rural nodes include the offshore islands of Andaman and
Nicobar and Lakshadweep, the mountainous and hilly regions of Jammu
and Kashmir including Kargil and Leh, Medical College hospitals in Orissa
and some of the rural / district hospitals in the mainland states.
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18. A MODERN TELEMEDICINE SYSTEM
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19. Perspective of medical practitioners: Doctors are not fully
convinced and familiar with e-medicine.
Patients' fear and unfamiliarity: There is a lack of confidence
in patients about the outcome of e-Medicine.
Financial unavailability: The technology and communication
costs being too high, sometimes make Telemedicine
financially unfeasible.
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20. Lack of basic amenities: In India, nearly 40% of population lives
below the poverty level. Basic amenities like transportation,
electricity, telecommunication, safe drinking water, primary
health services, etc. are missing.
Literacy rate and diversity in languages: Only 65.38% of India's
population is literate with only 2% being well-versed in English.
Technical constraints: e-medicine supported by various types of
software and hardware still needs to mature. For correct diagnosis
and pacing of data, we require advanced biological sensors and
more bandwidth support.
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21. Quality aspect: In case of healthcare, there is no proper governing
body to form guidelines in this respect and motivate the
organizations to follow-it is solely left to organizations on how they
take it.
Government Support: Any technology in its primary stage needs
care and support. Only the government has the resources and
the power to help it survive and grow. There is no such initiative
taken by the government to develop it.
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22.  Concerns about confidentiality of dental information arise from the
transfer of medical histories and records.
 General security issues of electronic information stored in computers.
 Informed consent in teledentistry should cover everything that exists in
a standard, traditional consent form. The patient should be informed of
the inherent risk of improper diagnosis and/or treatment due to
failure of the technology involved.
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23. These problems arise primarily due to:
 A lack of well-defined standards.
 No method to ensure quality, safety, efficiency, or effectiveness of information or
its exchange.
 Remuneration, fiscal and taxation issues associated with electronic commerce.
Many of the legal issues, such as licensure, jurisdiction, and malpractice, have not
yet been definitively decided by legislative or judicial branches of various
governments.
In 2000, 20 states in the US enforced restrictive licensure laws requiring
teledentistry practitioners to obtain full licenses to practice across state lines.
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24.  In India, where a majority of population lives in rural areas and where
healthcare facilities are insufficient, teledentistry can have a significant
contribution in bridging the gap between the demand and the supply.
 Various measures that can be employed for the effective implementation of
teledentistry are:
 The instructors of the teledentistry education courses need to be well versed
with computer knowledge and they should have adequate teaching
experience.
 The practitioners who are engaged in teledentistry must have a license in
each state in which they practice.
 Dentists who are engaged in teledentistry must make every effort to ensure
the security of their systems, as well as of any data that they may transmit.
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25.  Primary health centre and community health centre can be equipped with
modern telehealth and teledentistry to facilitate the education and better
services in the society.
 General dental surgeon and dental hygienists can be appointed at the sub-
centres, who can provide cost-effective dental care when supported through
teledentistry by specialists.
 Similarly, graduate dentists with knowledge in teledentistry can be appointed
at the primary health centers and community health centers for discussing
about the diagnosis and treatment plan of the difficult cases with the
specialists.
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26.  The dental colleges with a predetermined catchment area could be ideal
places to serve as hub sites for teledentistry consultation as they encompass
all the specialists serving under a common roof.
 A team of specialists could communicate for a few hours on a daily basis with
the dentists/hygienists/patients at the remote clinics.
 Government should take the initiative to highlight the importance and
benefits of teledentistry in the society by providing infrastructure and basic
facility by diverting some of the responsibility of higher institutions and
centers located all around the states.
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27.  Dentistry has definitely reached a new horizon with a fast and technology savvy
pace.
 Utilizing current teledentistry technologies, oral health care providers can
digitally acquire and transmit diagnostic data to a distant dentist for triage,
diagnosis and patient referral.
 Day by day, the use of this new field is attracting dentists across the globe and
bringing the fraternity closer as well as improving the quality of the services
rendered.
 However, with few drawbacks and constant efforts to combat them,
teledentistry has a very promising future and a long way to go.
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28.  Bauer JC, William TB. The digital transformation of oral health care. Teledentistry
and electronic commerce. J Am Dent Assoc 2001; 132: 204-9.
 Clark GT. Teledentistry: Genesis, ActualizatIon , and Caveats, An Introduction to the
Issue. J Can Dent Assoc 2000; 28(2): 119-20.
 Cook J. ISDN video conferencing in postgraduate dental education and orthodontic
diagnosis. Learning Technology in Medical Education Conference 1997 CTI Medicine.
1997:111-6.
 Clark GT. Teledentistry: What Is It Now, and What Will It Be Tomorrow? J Can Dent
Assoc 2000; 28(2): 121-26.
 Friction J, Chen H. Using Teledentistry to Improve Access to Dental Care for the
Underserved. Dent Clin North Am 2009; 53(3): 537–49.
 Biegel S. Virtual Health Care: Unresolved Legal Issues. J Can Dent Assoc 2000; 28(2):
128-31.
 Birnbach JM. The Future of Teledentistry. J Can Dent Assoc 2000; 28(2): 141-43.
 IAMAI says India will have 500 Million Internet users by 2017. Available at
www.iamai.in (Last accessed November 15, 2015)
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29.  Reddy KV. Using teledentistry for providing the specialist access to rural Indians.
Indian J Dental Res 2011;22:189.
 Jampani ND, Nutalapati R, Dontula BSK, Boyapati R, Applications of teledentistry: A
literature review and update, J Int Soc Prev Comm Dent 2011;1:37-44.
 Chhabra N, Chhabra A, Jain AL, Kaur H, Bansal S. Role of Teledentistry in Dental
Education: Need Of The Era. JCDR, 2011; 5:1486-88.
 Chandra G, Rao J, Singh K, Gupta K. Teledentistry in India: Time to deliver. J Educ
Ethics Dent 2012;2:61-4.
 Mishra SK, Singh IP. Telemedicine in India: Current Scenario and the Future.
TELEMEDICINE and e-Health 2009; 15(6): 568-75.
 Dasgupta A, Deb S. Telemedicine: A New Horizon in Public Health in India. Indian J
Community Med. 2008 Jan; 33(1): 3–8.
 Joshi Vinod K. Teledentistry :Tackling issues of confidentiality on the Internet.
Dentistry Magazine Article 18 April, 2002.
 Joshi Vinod K. Teledentistry : E-Consultations. Dentistry Magazine Article February 9,
2002.
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