The College of Dental Medicine (CDM) at Western University of Health Sciences is training its students and Registered Dental Assistants in Expanded Functions (RDAEFs) in teledentistry, which provides greater dental care access to underserved and rural areas.

CDM has implemented its teledentistry training of students and RDAEFs in El Monte, where CDM has a comprehensive school-based oral health center at the Jeff Seymour Family Center (JSFC), part of the El Monte City School District. The city is divided by the San Bernardino (10) Freeway. The south part of El Monte is part of the Mountain View School District. Although the two school districts are only a few miles apart, many Mountain View families have difficulty traveling to JSFC because it requires three bus transfers.

“For families with children, transportation is one of the key barriers in access to care to oral health care, as it can take up to an hour or more to arrive for the child’s dental care,” said CDM Assistant Dean for Community Patient Care Marisa Watanabe. DDS, MS. “One of our priorities is determining the best alternative delivery system to bridge this gap.”

JSFC and the Dental Center at WesternU, on the Pomona campus, serve as the dental hubs where CDM faculty are located. The Mountain View School District Head Start headquarters at Mountain View School serves as the auxiliary location.

Third-year CDM student Katie Chapman, left, works on five-year-old patient Katie Rincon, as WesternU RDAEF Veronica Lozano, left, and Nicole McBain assist Tuesday, March 19, 2019. (Jeff Malet, WesternU)

Through a “hub and spoke” model, the allied dental professional – a specially-trained and certified hygienist or RDAEF – collects data on a patient at the “spoke” location and shares the information with the dentist via the shared electronic health system. The dentist (connected remotely) and allied dental personnel work with the patient’s parents or guardians to determine the best treatment plan for the child. The allied dental personnel can provide certain preventative dental services depending on their scope of practice in the state of California; if the patient requires additional comprehensive services, they are referred to the JSFC hub.

“The goal is that once treatment is completed at the Jeff Seymour Family Center with our dental students, then these children are able to return to their respective school site (spoke location based on the hub and spoke model) and follow a customized preventative care model based on their risk for cavities. This way, we limit the examinations, data collection, and preventative services to the spoke sites – minimizing the amount of time off work for parents and guardians, as well as absences at the student’s school,” Watanabe said. “The difference in our model versus other models is our dental students are being trained as both the on-site RDAEFs as well as the remotely located dental providers. They’re learning both from the allied dental professional and the dentist perspective.”

CDM Assistant Dean for Community Patient Care Marisa Watanabe, DDS, shows records of a patient with CDM student Natalie Cronan. WesternU is starting a teledentistry program through Mountain View School District Children’s Center seeing children in one of its Head Start programs. (Jeff Malet, WesternU)

CDM developed its teledentistry program with Dr. Paul Glassman, Professor Emeritus at the Arthur A. Dugoni School of Dentistry at the University of the Pacific, who pioneered teledentistry.

CDM students learn about how teledentistry can benefit the community during their first year in school, said fourth-year CDM student Katie Chapman.

“We wrote a paper on how we would design our own clinic to optimally operate teledentistry and how it would benefit the community,” she said. “Now we practice what we learned in class.”

Chapman assisted at the Mountain View School District Early Childhood “spoke” location, putting into practice what she learned in class. She said the experience has given her a better understanding of the potential of teledentistry.

“It allows you to serve the maximum number of people with the limited resources you have,” she said. “The clinic at school is designed to have maximum functionality, with spaces for everything such as large sterilization units. Everything is organized like a private practice. Offsite, you have less instruments and you learn to make that work.”

Students see the entire cycle of the teledentistry model, from collecting information from the patient to providing comprehensive care at JSFC, Watanabe said.

“The goal is very much a team-oriented process,” she said. “Without the buy-in and trust from the school district, community and dental institution, teledentistry would be very difficult.”

Very few dental schools incorporate hands-on clinical teledentistry into their curriculum, said CDM Associate Dean for Community Partnerships and Access to Care Jenny Tjahjono, DMD.

“Not only do we incorporate teledentistry, we host training for allied dental personnel to be certified for interim therapeutic restoration (ITR),” she said. “Personnel such as RDAEFs can perform these special procedures without anesthesia.”

The teledentistry model allows WesternU to reach out to more school districts, Tjahjono said. Not every site has the required electricity needs and space to house a dental clinic, even with portable equipment.

WesternU Dental Center staff members Veronica Lozano, RDAEF, and Nicole McBain, RDAEF2, became the first Registered Dental Assistants with Extended Functions (RDAEFs) in California to be certified in interim therapeutic restorations (ITRs) utilizing the Virtual Dental Home delivery system.

McBain and Lozano also help train and guide CDM students while performing ITR, cleanings, and X-ray diagnosis, McBain said. ITR certification allows them to see patients in their own community.

“It’s nice to help out the kids that need to see a dentist and are not able to,” McBain said. “It is satisfying to help them in any way we can.”

Some patients are afraid to go to a traditional dentist’s office. They don’t want to receive anesthesia, said Lozano, who is the lead Registered Dental Assistant at the WesternU Dental Center.

“ITR takes less time, there is no anesthesia and it helps the children feel more trusting of dentists,” Lozano said.

WesternU RDAEF Veronica Lozano (blue shirt) and Nicole McBain talk to first-year CDM students about teledentistry and their roles as RDAEF’s. (Jeff Malet, WesternU)

After allied dental personnel such as Lozano collect the intraoral photographs, radiographs, and any other data required for appropriate diagnosis and treatment planning, the dentist will review the data and create a treatment plan. If the treatment plan includes ITR and is discussed and consented to by the child’s parent or guardian, certified allied dental personnel can begin the ITR procedure.

“I don’t want to leave any children behind just because they’re scared of the dentist,” Lozano said. “This is a good way to help them believe in oral health, trust the health provider, and prevent cavities for good, healthy teeth.”

Dental care is always going to be one of the highest needs in this community, said Claudia Salazar, health technician for the Mountain View School District Head Start program.

Mountain View students receive dental screenings, but families often don’t go to the dentist for follow-up treatment. Some children and parents have negative experiences at the dentist or have anxiety about seeing a dentist. By providing dental care at the Mountain View School District Early Childhood main site, children – and their parents – are learning to become more comfortable receiving dental care. Mountain View School District staff help make children comfortable. The first goal is for the patient to sit in a chair. The next step might be brushing their teeth with fluoridated toothpaste.

“Any time we have an encounter with parents, we provide education,” Salazar said. “It is going to take time, but we are starting early. We are seeing pregnant moms and infants. We are starting education with parents even before their baby has teeth. We’re hoping by the time they are 4 years old, the child has been going to the dentist every six months since they were a year old.

“For us it’s all about school readiness,” she added. “We want to get kids ready for school. If dental pain is not addressed, they won’t be able to learn. It will affect attendance. If we eliminate medical or dental needs, we address the child’s ability to be in school.”