Understanding The Limitations of TeleDentistry

added on: May 6, 2020

Following the most recent mandates issued by the Michigan governor, our Shelby Township dental office remains closed through May for all but urgent needs. While we know this period of staying indoors has caused oral wellness concerns for some of our patients, we hope they are following our tips for maintaining healthy gums and teeth, which was sent to our patients this week.

In case you missed this, the message included:

1). Follow your hygienist’s recommendations shared with you at previous visits.

2). Morning routines should include using mouth rinse with an antibacterial for 30-60 seconds (preferably non-alcohol based such as Breath Rx or alcohol-free Listerine) and brushing for 2 minutes.

3). Afternoon routines should include flossing, brushing, and rinsing with fluoride (if you were prescribed it) or non-alcohol antibacterial. 

4). Drink lots of water throughout the day to deter potential cavities from forming, (especially if doing a lot of snacking!).

Our patients with urgent needs (such as unusual sores or spots in the mouth, tooth ache, broken or chipped teeth, broken dental appliance, etc.) can arrange to be seen during this time by calling 239-437-8000. Or, emailed us at: office@brbdds.com.

One of the bonuses of adjusting to ‘life on the inside’ has been to expand the use of online technology. For example, for people who have had symptoms of springtime pollen allergies, TeleMedicine has been a tremendous help in keeping otherwise healthy patients out of the doctor’s office while being able to assist with at-home care recommendations or determining appropriate perscriptions.

Too, for patients who only need a follow-up visit for previously treated illnesses, ‘e-visits’ have been helpful in minimizing exposure to doctors and nurses as the patient is able to feel a sense of treatment conclusion.

However, TeleDentistry has more challenges when it comes to diagnosis. Because so much of the problems associated with dental health can have few, obvious symptoms or even symptoms that seem unrelated, relying on a patient to accurately relay problems to a dentist can be risky.

It is in the visual examination of one’s mouth and review of diagnostic imaging that is the truly reliable method to determine what is actually occurring. This allows for proper steps to be taken to halt the problem’s progress or resolve it.

Let me give you an example. Let’s say I’m driving along and begin to hear a knocking that seems to be coming from underneath the hood of my car. If I call the auto service department and describe it, that may help the mechanic think of where the problem “may” be. Yet, he or she cannot say, with any certainty, that the sound is occurring because of one problem or another. The mechanic’s response may be: “it sounds like… “ or “what it may be is…” There are simply too many variables going on with the interworkings of a vehicle to be able to narrow down a mere sound (which may even be something caught in the axle rather than a problem under the hood).

As complex as your automobile is, your mouth is far more complex, housing tissues, glands, teeth, tooth roots, nerves, bone structures, veins, and on and on. What you SEE – teeth, gums, and tongue, are mere ‘surface’ components of a very complex system. What’s beneath the surface is far more complicated – and delicate – than is understood.

In order to diagnose something like a tooth ache, I need to examine the tissues around the mouth, review images that show the inside of the tooth, and look at factors in neighboring areas. Unfortunately, a televisit only allows me to guess what the problem may be based on the symptoms that have actually become obvious for the patient.

As a dentist, I have also seen the repercussions to oral health that can occur when people assume their problems are minor. This is especially problematic when an individual assumes that “nothing is wrong if nothing hurts”. For example, periodontal (gum) disease typically begins without obvious symptoms. And, bite problems can mask themselves as something beyond the mouth, such as sore jaw joints or headaches.

I also see the devastation caused when people try to self-treat. For example, when a crown comes off, I’ve seen several patients who felt that something like Super Glue would provide a solution. Yet, this glue contains toxins that seep out into the mouth and into the body. Additionally, trying to remove a crown that has been glued on with an inappropriate adhesive can result in damage to the remaining natural tooth structure. Tooth removal is not unusual because of this ill-fated attempt to ‘re-cement’ dental restorations.

Our goal is to provide a safe, comfortable and comprehensive environment for all dental needs (throughout your lifetime). We pride ourselves on our compassionate and respectful care that includes a gentle touch in all procedures. Here, our patients enjoy the specific benefits of having our ongoing involvement in their dentistry and understand it is uniquely connected to their overall health.

My staff and I look forward to resuming a ‘normal’ schedule again, as we all do! Once the ‘sheltering in place’ order is lifted and we begin to see regular-care patients in the office, we will be taking steps for the added protection of our patients and staff. In addition to even more disinfecting of equipment and furnishings with protective gear worn by staff., these will include:

  • Upon arrival to your appointment, call our office (586-739-2155, press 1) to alert us. Please remain in your vehicle. A team member will come out to get you.
  • Only the patient will be allowed to enter unless accompanying a child or patient needing assistance.
  • Temperatures of patients will be taken prior to being seen.
  • If a patient has symptoms of fever, cough, cold, fatigue or flu-like aches the day of or prior to their appointment, they will be asked to reappoint.

In the meantime, if you have concerns or symptoms you wish to discuss prior to this time, don’t hesitate to contact us. Certainly, if you are experiencing pain or discomfort (such as sore, bleeding gums), contact us at 239-437-8000 or email: office@brbdds.com.


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Dr. Ban R. Barbat

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