Telemedicine, and specifically remote monitoring, is commonplace in general health care. Originally developed as a way to provide care to patients living in rural areas, it is now increasingly used as a tool for providing convenient health care to every patient. The fact is that however much a patient may like their doctor, they would prefer to not waste time traveling to the office or sitting in the waiting room.

A new tool offers orthodontists the opportunity to extend this technology to their patients. And all they need is one simple, ubiquitous tool: a smartphone.

With Dental Monitoring, distributed by Denver-based RMO® Inc in the United States, orthodontists can offer patients virtual treatment monitoring. The way it works: Patients first download the free Dental Monitoring app to their smartphone. From there, the doctor sets up a text alert schedule that reminds the patient when to send the 10 to 13 photos of their teeth. Currently, a video upload option is available for iPhone and some Samsung phones.

Once the patient uploads the pictures, or video, they go to Dental Monitoring which cleans up and analyzes the photos, calculating tooth movement since the last photo submission. Within 1 to 2 days, the photos and progress report, including 3D modeling, are sent to the orthodontist. An email notifies the doctor that the report is ready. The orthodontist can then look at the photos and the report and message the patient within the app’s communication tool to say, “Looks good. Keep up the good work,” or “Time to come in for an appointment.” Parents also receive all the messages so they can track their child’s care. The orthodontist can also use the communication function to message the referring dentist to virtually share patient progress. If a patient calls the office with an emergency, the patient can be advised to send in a photo via the app for an emergency virtual exam. The orthodontist can see the photo immediately and assess whether or not the patient needs to come into the office. The system is cloud-based and HIPAA compliant.

When a Dental Monitoring patient eventually does come into the office for an appointment, both the doctor and the staff know what to expect, and they can prioritize how to spend the patient’s time. “Now my visits are planned,” says C. William Dabney, DDS, a Virginia-based orthodontist who has been using the app since 2015 when he discovered Paris-based Dental Monitoring’s booth at the World Federation of Orthodontists meeting in London. He has since become a clinical director for the company. “[My visits are] not so much reactive as proactive. For example, before the patient sits in the chair, you can plan for adding a new bracket,” Dabney points out. “It allows you to get the most out of your visits in the office.”

Depending on the level of monitoring the doctor wants, Dental Monitoring’s photo monitoring costs approximately $8/month. Dabney says he does not charge patients an additional fee for remote monitoring as it saves him chair time. In addition, he sees it as a practice differentiator. “Patients choose me because I’m respectful of their time,” he says.

While much of Dabney’s patient base lives in metropolitan Richmond, Va, about 15% live in rural communities. Patients could drive anywhere from 30 to 90 minutes round trip to have him say, “Golly, you look great. Come back again in 3 weeks.”

Initially Dabney offered it to patients who lived far away and in active treatment. From there, he extended it to patients with busy schedules, then patients in pre-treatment. Now, he offers it to patients in post-treatment.

Dabney advises new users to pick one particular group to monitor at first. “If you try to monitor everyone at first, it can be overwhelming. And staff may not see the benefit at first. Pick your next 10 Invisalign® or expander cases so you can see how this is really going to work. Then once you are comfortable with the system, you can expand out.”

For parents who worry their child may not keep up with brushing or rubber band wear without the motivation of an upcoming in-office appointment, Dabney points out that he will actually be seeing their child more often—he favors 2 week intervals for his check-ins, allowing him to better track and motivate patients. For those patients that require more supervision, or motivation, Dental Monitoring allows the orthodontist to set custom alert intervals—for example, a patient who is failing to keep up with brushing might be required to submit a picture weekly so the orthodontist can hold the patient to account. In essence, he is offering patients more care.

Dabney says the quality of the remote monitoring has tracked just as well as if he had only seen the patients in-office. In addition, he says he feels more control over his day. “You know ahead of time what the problems are. The day runs a lot smoother and has less headaches,” he says.

As Dabney sees it, the notion of standardized medicine is no longer feasible in orthodontics. Patients want personalized and connective care. Simple technology, like a smartphone, and a remote treatment monitoring app make that possible. OP