Benefits administrator blog from Delta Dental

Tag: teledentistry

COVID-19 by the numbers

The early days of the pandemic brought a tidal wave of changes to businesses and their employees. Navigating this new normal can be tricky, especially since the situation seems to be changing daily. Looking at the changes that occurred during the pandemic can help you understand what trends to anticipate and how to prepare your benefits offerings accordingly.

Let’s take a high-level look at how COVID-19 impacted workers, dentists and the dental insurance industry, as well as a deep dive into claims data, patient surveys and expert opinion.

The rise of teledentistry

During the early stages of the pandemic in the United States, dental offices were closed to physical appointments for weeks. This led to a massive surge in the popularity of teledentistry services. Synchronous appointments (those with live phone or video interaction between dentists and their patients) saw a 3,000% increase between 2019 and 2020, according to Delta Dental claims during that period. Asynchronous appointments (where patients took photos or videos that were sent to a dentist for later review) saw a 1,000% increase in the same period.

The use of teledentistry has declined as the pandemic has worn on and dentist offices have reopened, but 2021’s synchronous and asynchronous appointment numbers still remain six times and two times higher than 2019 levels, respectively.

More states also updated their teledentistry laws during the pandemic. Based on Delta Dental’s internal tracking, 14 states added teledentistry regulations to their laws or expanded existing regulations, including states such as Texas that previously hadn’t allowed the practice of teledentistry at all.

Most importantly, in a phone survey of teledentistry patients during the pandemic, patients expressed widespread satisfaction with their options. This aligns with pre-pandemic expectations about teledentistry. Of those surveyed before the pandemic, 78% expected to use teledentistry within the next five years. That same group anticipated that working people, children and people with disabilities would benefit the most from teledentistry.

Dentists also had praise for teledentistry, with over 80% of dentists identifying it as useful for improving access to oral care, increasing specialists’ access to rural and underserved communities and as a time-saving technique. 

Virtual visits may not replace in-person checkups, but they remain a valuable tool for employees to get expert opinions and feedback when they can’t make it into the dentist office or prefer a remote appointment.

Providing alternatives for employees who can’t make it to the dentist office

The beginning of the pandemic was marked by profound economic uncertainty as dental practices closed and people sheltered in place. General practitioner income dropped nearly 18% in 2020 compared to 2019.

To help keep dental practices open and seeing patients, Delta Dental offered network dentists loans and reimbursements for personal protective equipment (PPE) costs and made free teledentistry tools available to members.

Loans offered in partnership with Provide (formerly Lendeavor) allowed dentists to make purchases, stay on top of debts and pay staff to ensure that they could keep their doors open. Delta Dental also offered a supplemental reimbursement to help offset the costs of PPE and office cleanings, ensuring that dentist offices remained safe for staff and patients alike.

The pandemic saw the rollout of two teledentistry options for Delta Dental members:

  • Virtual Consult is a synchronous service where members can use a smart device to have a live video chat with a Delta Dental dentist.
  • Toothpic is an asynchronous service that allows members to take photos of problem areas and get an assessment from a Delta Dental dentist within 24 hours.

These teledentistry tools allowed Delta Dental members to get expert advice and feedback on their dental needs even when they couldn’t make it into the office.

How people used their benefits

The early stages of the pandemic saw a decline in the number of patients going to the dentist’s office. One of the main reasons for the decline was that the sharp economic shutdown led to over 20 million Americans losing their jobs (PDF) and their dental coverage as well.

This decline had a profound effect on the nation’s oral health. In 2019, the most common procedures according to Delta Dental claims data were either routine preventive care or evaluations for specific issues. This shifted in 2020, when some of the most common procedures were fillings and root planing. 

Instead of staying on top of their dental health with low-cost diagnostic and preventive care, people instead required more expensive procedures to address the effects of dental neglect.

In addition to the economic hardships COVID-19 brought to patients, COVID also increased mental and emotional strain. Since the pandemic began, the number of adults reporting symptoms of anxiety or depressive disorders has risen to over 40% from about 10%.

These symptoms can manifest in jaw clenching and teeth grinding. Based on Delta Dental claims data, the number of patients requiring occlusal guards to prevent damage rose nearly 10% in the second half of 2020 compared to the same period in 2019.

Anxiety and depression can also lead to an unhealthy diet or substance abuse, which can in turn lead to oral health issues such as cavities. This may also help to explain the surge in fillings and scaling and root planing procedures in 2020.

Health and safety in the dental office

Even though COVID-19 is spread by exhaled aerosolized droplets, visits to the dentist’s office proved safer than visiting any other medical professional during the pandemic. 

Nearly 100% of dentist offices rapidly adopted enhanced infection control measures like pre-appointment screenings, in-office air purification and antiviral mouthwashes. 

Once vaccines became available, they saw widespread adoption amongst dentists, even before state and federal mandates. By the second quarter of 2021, over 90% of dentists had received at least one vaccination shot for COVID-19.

Patients also view dentists as valuable sources of information about their overall health in addition to their oral health. Two-thirds of dentists reported receiving questions from patients about the COVID-19 vaccine, according to the ADA (PDF).

Dentists rose to the occasion, with over 80% reported feeling prepared for these discussions and 95% believing it was important to have such discussions with patients. For employees who may be hesitant to get the COVID vaccine, speaking with trusted health professionals like dentists may help persuade them of the efficacy of getting vaccinated.

What did we learn from COVID-19?

Here are three key takeaways for employees and your business as you look to the future.

  • Encourage employees to use their benefits even during times of crisis. During the early stages of the pandemic, going to the dentist for a teeth cleaning was likely far from most people’s minds. Letting oral health slide in the short term can lead to costly and painful issues in the long term. Teledentistry tools can help employees get expert evaluation, even when they can’t make it into the dental office.
  • Let employees know what resources are available to them. Studies have shown that most people don’t really understand how insurance works. Your help as an insurance expert can go a long way towards letting employees know what kind of coverage and resources are available to them. There are plenty of benefits materials available for you to download and share with employees. Additionally, initiatives like Smile On can help employees maintain their coverage even in the face of economic uncertainty.
  • Consider benefits as part of your employees’ total wellness. Dental benefits are essential for helping employees maintain their overall health and wellness. Many ailments have symptoms that manifest in the mouth, including stress and anxiety. Valuable employee benefits can also help ease employees’ stress about staying healthy and paying for care. When your employees know how to make the most of those benefits, they’re more likely to catch and treat minor issues before they become major ones.

How COVID-19 brought challenges and solutions in dentistry for seniors

Times of crisis call for creative solutions, and that’s never been more evident than during the COVID-19 pandemic. Innovative dentists have sought to adapt many aspects of their practices, but especially those involving the most vulnerable segment of our population: older adults.

New challenges for seniors’ oral health

For many seniors, even before the advent of COVID-19, physical limitations, systemic disease, cognitive decline and dependence on caregivers could all lead to an overall decline in oral health. What’s more, the pandemic worsened many of these same problems while presenting new ones.

“COVID-19 laid bare weaknesses in our elder care system,” said moderator Stephen K. Shuman, DDS, MS, in a webinar on pandemic-related disruptions in oral health care hosted by the Gerontological Society of America.

Some of the challenges in oral health care for seniors during the pandemic have included:

  • Reduced access. Early in the pandemic, many dentists’ offices shuttered, and even when they reopened, fear of COVID-19 led many older adults to delay or entirely forego visits to the dentist’s office. Nearly half of U.S. adults reported delaying dental care due to the COVID-19 pandemic during the spring of 2020, and the increased risk posed by COVID-19 to seniors likely exacerbated the problem among older adults.
  • Reduced care. In long-term care facilities, daily brushing, flossing and other routine care tasks were sometimes put on the back burner as COVID-19 diverted staff members to provide more urgent care to those affected or at risk. Proper oral care could also be challenged by staff members’ fears about the potential for oral transmission of COVID-19. Staffing shortages in facilities and on oral care teams made the situation worse. Georgia and Minnesota reported staffing shortages in long-term care facilities of more than 25% during the pandemic, and a recent poll from the ADA Health Policy Institute found that more than 80% of owner dentists who are currently hiring consider recruitment of dental hygienists and assistants to be extremely or very challenging at this time.
  • Psychosocial problems. The loneliness, anxiety and depression caused by shelter-at-home orders could themselves worsen oral health among older Americans.

Solutions in oral health care for seniors during the pandemic

Just as the COVID-19 presented new problems, it also created potential for positive long-term change.

Teledentistry and teletriage

Through necessity, many dentists began refining techniques for the use of teledentistry and teletriage, using telecommunications technology to deliver health services and information.

Some companies began implementing or built up their existing “pandemic teledentistry.” Teams used cloud-based electronic health records and taught long-term care facility staff how to take useful images of patient mouths and send them to centrally located dentists.

At the height of the pandemic, 24.8% of responding dentists reported they were conducting remote problem-focused evaluations through virtual technology or telecommunications, according to polling from the American Dental Association’s Health Policy Institute.

Some innovative dentists used what they referred to as assisted, or guided, oral hygiene during the pandemic. They used the latest audio and video technology to guide a patient or caregiver as they carried out oral hygiene on a regularly scheduled basis.

Mobile dentistry

While the pandemic restricted mobile care in some cases, its primary advantage of reducing the need to transport at-risk seniors also caused it to emerge as another possible solution.

Many dentists were already accustomed to setting up mobile units in long-term care facilities even before the pandemic. Mobile dentistry helps reduce the potential for stress and confusion caused by moving older patients or those with dementia.  With the latest mobile equipment deployed to long-term care facilities, dentists are able to perform simple extractions, restorative work and more in a timely manner. As in many dental offices, mobile units often add an external dental suction that uses ultraviolet light and filters to remove pathogens from the air.

How to support your senior employees and relatives through the pandemic

COVID-19 presented extraordinary challenges to your senior employees, retirees and those caring for elderly relatives. The new solutions that helped maintain health care for older adults during the pandemic are likely here to stay.

To support your senior employees throughout the pandemic:

  • Communicate. Oral health care should never be placed on the back burner, and maintaining good communication with your employees is crucial to emphasize the importance of oral health. As always, keep in mind the systemic relationship between oral health and overall well-being. Use email campaigns, social media and other reminders to encourage the maintenance of oral hygiene routines among your senior employees throughout the pandemic.
  • Discuss new approaches. Teledentistry can now connect older adults with oral health care providers when they can’t visit a dental clinic or if there are restrictions on dental providers visiting residential facilities. The option is available at no added cost under Delta Dental PPO™ and Delta Dental Premier® plans, so discuss teledentistry with your employees if you think it might be right for them.

New teledentistry options: Toothpic and Virtual Consult

Two new teledentistry options have come to Delta Dental PPO™ and Delta Dental Premier® plans to deliver more value to members. Say hello to Toothpic and Delta Dental – Virtual Consult.

Utilizing these options doesn’t require any changes to the way your employees use their plans or cost your organization extra. Instead, they’re a new way for your employees to use their existing plan benefits — remotely. These new tools are an ongoing covered benefit and have no additional administrative costs or access fees for your group or your employees.1 When your employees use either of these tools, they can rest easy knowing that they’ll be connected with a licensed Delta Dental dentist they can trust.

Toothpic

Toothpic is a secure HIPAA-compliant app that provides a photo-based virtual diagnostic assessment from anywhere you have a smart device and an internet connection. It’s perfect for those who want a dental checkup with a Delta Dental dentist without an appointment. Toothpic lets your employees:

  • Get evaluations on their own schedule by submitting pictures of their mouth, teeth and gums
  • Receive a personalized in-depth report from a Delta Dental dentist within 24 hours
  • Check in for diagnoses on areas of concern and get info about their next steps

Virtual Consult

Virtual Consult is a secure HIPAA-compliant video-based tool for having a virtual appointment with a dentist. It’s ideal for your employees who have urgent oral care needs, like pain or a cracked or chipped tooth, and want to speak directly with a Delta Dental dentist. With Virtual Consult, your employees can:

  • Schedule and have a video appointment with a Delta Dental dentist without leaving home
  • Have quick real-time consultations on urgent issues even if they don’t have a dentist they see regularly
  • Get an e‑prescription and aftercare instructions for pain or infection

Virtual dentistry allows your employees to check in on their oral health from the comfort of their own home. Whether they’re just looking for a quick check-in or have an urgent concern, these teledentistry options can help them meet their needs with all the ease telehealth offers.

1. Members who have 100% coverage for oral evaluations and who have not exceeded their frequency limitations for office visits or limited oral evaluations are eligible to use Toothpic and Virtual Consult. Using Toothpic to receive a diagnostic report or using Virtual Consult for a remote visit each count as one office visit/oral evaluation for the purpose of frequency limitations.

5 ways Delta Dental is responding to the COVID-19 pandemic

Delta Dental is working to support our customers, dentists and local communities during the COVID-19 pandemic. Here are some of the ways we’re responding to this health and financial crisis.

1. Charitable giving to vital services

The Delta Dental Community Care Foundation has provided nearly $15 million this year to help nonprofits respond to the pandemic. These unrestricted grant funds have supported essential services, including dozens of dental and medical clinics serving low-income communities across our 15-state service area and the District of Columbia.

To help feed vulnerable communities during skyrocketing food insecurity, we’ve also contributed $2.5 million to food banks in Alabama, California, Delaware, Florida, Georgia, Louisiana, Maryland, Mississippi, Montana, Nevada, New York, Texas, Utah, West Virginia and the District of Columbia.

2. Dentist loan program

Partnering with Provide (formerly known as Lendeavor), Delta Dental has offered over $300 million in loan programs to provide economic relief for qualifying independent network dentists.

The loan program, which extends through the end of the year, covers cash flow relief as well as interest savings. It also includes loans that dentists can use to acquire, refinance, expand or equip a practice, as well as to acquire or refinance commercial real estate for a practice.

3. Relief for groups, individuals and brokers

We’ve offered various forms of premium relief to all lines of our business to help alleviate the financial strain of the pandemic on our individual customers and group clients. To provide further support, we’ve made adjustments to many of our contract policies to help clients weather the financial impact of the pandemic.

4. PPE and infection control reimbursement for dentists

The new costs of practicing during a pandemic have added to the financial strain on our network dentists. To help, Delta Dental launched a supplemental reimbursement program for network dentists.

The temporary program, which runs through the end of the year, is meant to help dentists adjust to the new conditions under COVID-19 as they plan for 2021. Under the program, network dentists receive an additional $10 per patient per qualifying service to help cover the costs of additional personal protective equipment and other infection control practices.

5. Teledentistry resources

Delta Dental has encouraged dentists and patients to consider teledentistry options for diagnostic and emergency dental services. Teledentistry, or virtual consultation via phone, text or video, offers a safe, convenient choice and can expand access to care for patients who might otherwise not see a dentist.

We’re offering discounts and free trials on HIPAA-compliant teledentistry services to Delta Dental dentists and are building partnerships with teledentistry companies to improve the experience for our customers and network dentists.

Teledentistry 101: the virtual office visit

As businesses, schools and organizations continue to adapt to COVID-19, dental offices are embracing new conferencing tools to deliver care safely.

As part of the reopening efforts, more dentists and their patients have turned to teledentistry, an emerging trend that has the power to reshape the industry as we know it. Approximately 25% of dentists reported using some form of virtual, limited evaluation of patients, according to an April COVID-19 economic tracking poll from the American Dental Association’s Health Policy Institute. In July, the HPI poll showed usage slipping to 12%, noting that larger group practices are more likely to use teledentistry than solo practices.

Dr. Nathan Suter, owner of a House, Missouri, dental practice and a consulting firm, Access Teledentistry, predicts teledentistry will become more mainstream. This is due to its multiple uses, such as when a dentist is traveling or if there is a schedule conflict.

For your employees, this is a valuable option in maintaining their oral health. As a primer on teledentistry, here are insights on its use and impact and how Delta Dental is supporting this advance in care.

What is teledentistry?

Teledentistry is when a dentist conducts a virtual consultation via phone, text or video to diagnose issues, offer care advice and determine if an in-person visit is necessary.

Teledentistry appointments can be synchronous, such as a video call where the dentist and patient are interacting with each other, or asynchronous, such as when the patient sends a description of his or her situation and a photo and waits for a reply.

What kind of equipment is needed for teledentistry appointments?

The equipment and software needed may vary based on dentists’ preferences and capabilities. Teledentistry may require nothing more than a phone or may require a smart device, computer or specialized app. Businesses now incorporate videoconferencing software for team meetings, and this can be used in dental consultations.

If dental offices have reopened, why is teledentistry relevant?

Dentist offices may be open, but that doesn’t mean that your employees won’t benefit from teledentistry solutions. Just as working from home has shown the value of video meetings and connecting with co-workers without being in person, employees may find teledentistry a useful option when seeking dental care.

In a public opinion survey, 70% of respondents indicated they would take a COVID-19 vaccine once it is available, and 12% are waiting for a vaccine to go back to the dentist, according to Sports and Leisure Research Group’s “Back to Normal Barometer” in July.

Whether your employees are eager or hesitant to return the dentist, teledentistry is the perfect tool for staying in touch, getting care and getting advice without going into the dentist’s office. The ADA has issued guidelines for teledentistry, specifying patient rights regarding this delivery of care.

What is Delta Dental doing with regards to teledentistry?

Delta Dental covers teledentistry appointments at the same benefit levels as diagnostic services to ensure that employees have coverage for their dental needs while staying safe from COVID-19. We’re encouraging dentists to use teledentistry for emergency diagnoses and non-emergency consultations.

What’s more, Delta Dental is looking into partnerships with teledentistry companies to improve the experience for both dentists and their patients.

How will teledentistry change the benefits industry?

Even as vaccines are distributed and control of the COVID-19 virus can be managed, your employees may expect teledentistry to be included as a standard part of any insurance plan (for example, Kaiser Permanente is launching plans with a heavy focus on telehealth). Employees may shy away from plans and dentists that can’t accommodate teledentistry. Those who live in remote areas may gain better access to professional care through teledentistry.

Dentists may incorporate teledentistry as a viable option in their scheduling so your employees can receive care when and how they need it.

Is teledentistry covered by Delta Dental plans?

Delta Dental covers teledentistry services as problem-focused exams. That means they fall into the category of diagnostic care, and are subject to the same rules and limitations (for example, diagnostic and preventive services are usually covered at no cost to the patient, but only a certain number of such appointments are covered each year).

With dental offices adapting to safety needs, you can encourage your employees to maintain their oral health. Teledentistry provides a vital option for them to manage their care through regular checkups and access to expert consultation.

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