January 30, 2023

What do our patients feel about teleorthodontics?

Teledentistry or remote treatment has developed rapidly over the past few years, particularly following the COVID pandemic when it was the primary source of advice to our patients during lockdowns.  While it may be increasing in popularity, we need to learn more about how our patients perceive this form of care. This new paper gives us great insight into this subject. The findings may be a surprise.

When we consider the possible advantages of teledentistry for orthodontics, it is commonly suggested that it may reduce office visits resulting in more efficient treatment delivery.  While this may be compelling, we also know that the Dr/patient relationship heavily influences patient satisfaction. So before we adopt these methods, we should consider the views of our patients.  This is the subject of this paper.  As a result, it is timely and relevant.

A team based in Virginia did the study. The American Journal of Orthodontics published the paper.

Patient perspectives on teledentistry and face-to-face doctor interaction during orthodontic treatment

Jackson K. Griffeth, et al. AJO-DDO online.  https://doi.org/10.1016/j.ajodo.2021.11.019


What did they ask?

“What is the perception of teleorthodontics amongst a sample of orthodontic patients”?

What did they do?

The team did the study in several main stages.

Firstly they developed and piloted a survey to capture patient perceptions of teleorthodontics.  The survey consisted of 10 demographic questions followed by 19 statements on teledentistry. The participants indicated their agreement with the statement using a 5-point Likert scale.

They designed the questions to obtain perceptions on 

  1. The value of face-to-face interaction, 
  2. Was this interaction prioritised with a desire for convenience and 
  3. Their attitudes towards specific uses of teledentistry in orthodontics.

The survey branched according to the age of the respondent.

The survey was distributed to the patients of 116 orthodontists practicing across the United States. These were members of the Virginia Orthodontic Education and Research Foundation Network.

What did they find?

Their findings were very interesting and different from what I expected.  The team provided a great deal of information; I cannot go into all this here. However, I have attempted to identify the main themes for adults and children.

  • Three hundred seventy-seven subjects responded to the survey.  31% (116) were adults having treatment and 67% (253) had a child receiving treatment.  66% of the children were 13-17 years old. 43% were males. 81% of the children were in fixed appliances. 
  • Most participants preferred to be seen face to face
  • They did not feel that attendance at the orthodontist was inconvenient. Appointments fitted in with their schedules.
  • There was a tendency for patients who were wearing aligners to be more interested in using teledentistry.
  • The participants were very interested in using teledentistry to enhance communication between visits.

Their most important conclusions were:

“Orthodontic patients prefer to be seen face to face and did not consider attendance inconvenient”.

What did I think?

This paper provided valuable information that should influence the development of teledentistry for orthodontics.  

The good points;

  • They managed to get a high number of respondents. 
  • The sample was from private orthodontic offices giving the surgery good generality.
  • The sample appeared to be representative and logical.

My concerns;

  • They did not present any information on the response rate and characteristics of non-responders. This is important because we need this information to identify possible response bias.
  • Is there any possible bias with a web-based survey? This may be minimal, bearing in mind internet access for this population.
  • There was no data on whether the participants had experienced both forms of care.  This is very important because we could suggest that this group could only pass an opinion on teledentistry if they had experienced it. I will return to this later.
Important discussion points.

Other research shows that patient preferences are closely associated with satisfaction with health care. These findings suggest that orthodontic patients do not like teledentistry. Importantly, they do not feel that attending the clinic is a problem.  In addition, they also emphasised the importance of face-to-face interactions.  In effect, they do not support the drive toward teleorthodontics. Is there a risk that the development of teleorthodontics may be driven by convenience for the orthodontist rather than the patient?

However, when we interpret this paper, we also need to remember that the patients had not experienced teledentistry to a marked degree. Therefore, if we are to come up with more certain findings, we must ensure that the participants are exposed to both traditional and teleorthodontics delivery methods. The best way to achieve this is to run a trial with random parallel or cross-over allocation.

Finally, we need to consider orthodontists’ views on teledentistry. I would not want to spend most of my days talking to patients on a screen giving them instructions for potentially compromised aligner treatment.

Final thoughts

In summary, this was a very important piece of research and provided valuable information.  I look forward to more research being done in this area of care.

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Have your say!

  1. The article is very interesting… If we only consider the preference of the patients (not the professionals), an important aspect would be the geographic one, that is, the distance that the patient needs to travel to reach the professional’s clinic… I think that in large cities, densely populated, with heavy traffic, we will have more patients accepting or opting for virtual appointments. As an orthodontist, I prefer face-to-face consultations, but I understand that there is room for virtual consultations… Here in Brazil, the topic still needs to be further discussed. As far as I know, legally virtual consultations are not yet well defined…

    • This is a topic that I’ve been thinking about recently so I found the post very interesting and timely. I certainly agree that during the pandemic when in-office visits were either not possible or very limited, teledentistry was a strategy that patients appreciated. The fundamental problem that I have with it now when used as described in this study is that are we not as orthodontists trending in the direction of direct-to-consumer products that avoid/limit face-to-face interactions with patients. Your comment regarding teledentistry being driven by orthodontist convenience rather than the patient is so true.

  2. Hello Kevin,

    Teledentistry program can do much more than reducing office visits. A program such as Dental Monitoring, can be used to evaluate treatment progress ( difference in overjet, overbite etc). As the company has over 3 Billion pictures, the deep learnjng data can be used. The orthodontist can upload the io scan, to improve the wuality of the pictures. DM can be used to evaluate the need to change wires. If a wire is still active there is no need to visit the office. Replacing wires to ofthen seems to slowdow tooth movement. Off course the patient and ortho shoul benefit from the use of DM or other remote control programs. Traveling less often to the office should reduce treatment costs. The orthodontist should be able to treat more patients. Scheduling control visits, nowing the brackets should be fixed, is an advantage for every orthodontic office. In the Netherlands distances to the orthodontis will be smaa. In other countrys distance can be a problem Australia, Zweden in winter etc.
    For aligner cases an orthodontist in the Netherland sees his patients every 3 months if everything goes well. So in concusion, one needs to know the possibilities of teledentistry. Reducing costs, incresing efficiency, improving treatment and oral hygiene and the correct use of elastics is beneficial.
    Especially in countries with a shortage in orthodontic specialists can benefit of teledentistry

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