Will COVID-19 push orthodontics further into the digital space?
LEIPZIG, Germany: Patient volumes at orthodontic practices are expected to rebound quickly when practices reopen. Digital tools have helped orthodontists to continue providing care while their clinics are closed, but although these tools will serve to ease the transition into the resumption of dental practice, orthodontists admit that chairside consultations cannot be replaced. The leading clear aligner manufacturer says that its new digital tools that have been developed in response to the crisis will continue to be used well after restrictions are lifted.
Orthodontic practices in the UK are still closed, more than two months after the British Orthodontic Society (BOS) advised its members to halt the provision of care owing to the SARS-CoV-2 outbreak. “Currently, all orthodontic care is [still] suspended across the four home nations,” a BOS spokesperson confirmed to Dental Tribune International (DTI). He explained that any orthodontic emergencies in England, Scotland and Wales were being treated in those nations’ designated urgent care centres, and only emergency treatment was being provided at orthodontic practices in Northern Ireland.
In guidance to its members, the BOS stated that most orthodontic appliances can be left in situ for some months without detriment if patients follow the usual care instructions, such as good oral hygiene and the avoidance of sugary and hard or sticky foods that may damage them.
For the provision of urgent care, the BOS recommends that cases first be triaged by telephone or online video by an orthodontist in order to assess the clinical urgency, but also to minimise the risk of infection at emergency care centres. Director for External Relations Dr Peter McCallum told DTI that digital interfaces are being recommended in order to minimise the disruption to treatment for patients wearing fixed appliances.
“For our patients, we have given advice on taking pictures and videos for their orthodontist and provided videos on home repairs,” he said. This information and advice on what patients can expect from their next visit to a dental clinic are available on the association’s website.
Orthodontists say that digital tools help, but cannot replace chair time
Although his practice has been closed so far for the duration of the pandemic, digital communication tools have allowed follow-up appointments to continue—this was the message from Dr Thiago Gregnanin Pedron, a specialist in orthodontics in private practice in São Paulo in Brazil. “The challenge, in fact, was minimised, because we usually maintain a contact list of patients at the clinic in a mobile app,” Pedron explained. “Although the clinic was closed from the declaration of the pandemic and there was no face-to-face service, online follow- up was carried out and guidance provided on hygiene and the care of orthodontic devices and clarification of possible doubts.”
These digital consultations have been of significant help, but Pedron says that they cannot replace chairside consultations. “I believe that digital communication tools are allies in the control and care of any orthodontic system, but clinical attendance is sovereign in all respects, whether for aligners or fixed orthodontics,” he commented. “I use the self-ligating orthodontics technique, which in addition to the known benefits and advantages, is particularly useful owing to the longer time between orthodontic maintenance sessions, particularly in these current times of isolation.”
“Digital communication tools have been very useful in this crisis to support stranded patients and to keep the number of visits at a low level”
– Dr Anna Hajati, orthodontist, Stockholm
Dr Anna Hajati, who runs a private orthodontics practice in Stockholm in Sweden, told DTI that keeping in touch with her patients digitally has been better than not at all. “Digital communication tools have been very useful in this crisis to support stranded patients and to keep the number of visits at a low level, and indeed, it is the future. We have been using digital communication for aligner patients as well as for fixed appliance patients. Today, such tools can help occasionally, but cannot replace a physical check-up,” she said.
Sweden has not implemented strict lockdown conditions during the crisis, leaving it up to dentists in the country to decide whether to keep their practices open. Social distancing guidelines, however, have resulted in a drop in patient volumes, and Hajati said that visits to her clinic have decreased by around 50%. One of the greatest challenges so far, she admitted, was deciding whether to keep her clinic open. Closing the clinic, she explained, would have helped to protect staff, reduce infections and conserve personal protective equipment. She decided to keep the clinic open, but with increased hygiene routines and clear guidelines issued to patients. This decision was taken to ensure the survival of the business and the continued provision of care to patients.
“My greatest concern and challenge now is the patients that I have in another country and those who live abroad that I could not see,” Hajati said. She believes that the tele-orthodontics industry will effect changes to the pretreatment process, but she also believes that orthodontists are extremely aware of their responsibilities, regardless of the type of appliance that is being used to carry out treatment and the mode of consultation. “Every view or action/non-action has a responsible dentist behind it, and we want to look our patients in the eyes and say with 100% confidence that ‘this does or doesn’t look fine’. It is about so much more than tooth alignment.”
Dental companies are increasing their focus on digital treatment options
Since the SARS-CoV-2 pandemic was declared, the dental companies that supply the industry have increased their already strong focus on digital tools. Henry Schein recently launched medpod, a teledentistry clinical decision tool. The company said that the tool will allow dentists to continue to communicate with patients and monitor treatment as the pandemic continues. A spokesperson from Henry Schein confirmed to DTI that medpod is suitable for orthodontists.
In a recent investor call, Align Technology CEO Joseph Hogan outlined a number of initiatives that the Invisalign manufacturer has put in place to support dentists as they resume the provision of orthodontic care. The company accelerated the development of virtual tools that were being piloted, such as virtual appointment and care tools for Invisalign. The company has also begun providing relief and deferrals on payments for Invisalign practices, and has increased clinical education and training through online platforms.
Hogan told listeners in the call, “We honestly feel that, particularly in the orthodontic community, there’ll be a much harder leaning toward a digital kind of environment because of the chance of reinfection rates with COVID-19 and concerns about future shutdowns or slowdowns […] So we’ll be going to our customers with programmes that really help them to figure out how to convert more and more of their volume to a digital environment.”
At the time of writing, Align was working to roll these tools out to the market through its Invisalign mobile and online applications. “Feedback to date has been relatively positive, and we believe that doctors will continue using these tools to improve patient experience and increase efficiencies well after COVID-19 restrictions have been lifted,” Hogan said. He asserted that, “together with doctors, we’re going to leverage that power of digital for dentistry and orthodontics more than ever. Doctors are not going back to before”.