By Sydne Enlund and Erik Skinner
Rural Americans are more likely to experience tooth decay and twice as likely to lose their adult teeth as their urban counterparts.
Access to oral health care is one of the most common reasons cited for the disparity in oral health in rural communities. Geographic isolation, acute provider shortages, and providers who may face challenges in caring for the complexity of oral health needs of rural populations are just a few of the factors cited by the recent report “Improving Oral Health Care Services in Rural America.”
Poor oral health contributes to diabetes, obesity and heart disease, makes it more difficult to eat and speak, furthers social isolation, increases the difficulty to find/retain employment and reduces quality of life.
In addition to their large, sparsely-populated geographic areas, rural communities experience other unique social, demographic and regional differences that contribute to the challenge of achieving a robust and responsive oral health system. Rural areas have higher rates of poverty and a larger older adult population than non-rural areas, and transportation to and from the dentist can be difficult for some rural residents.
Teledentistry is among several state strategies to connect rural patients to oral health providers. Teledentistry—offering oral health services remotely—is designed differently by states to meet the unique needs of the population. Specific services often include face-to-face consultation between oral health providers and patients via video conference (i.e., synchronous) and sharing images and records among providers (i.e., asynchronous or store-and-forward).
Teledentistry can also act as an educational tool for dental providers to enhance the delivery of oral health services for patients. For example, providers can conduct live consultations or electronically share dental records for consultation purposes.
Some states establish teledentistry through legislation by incorporating it into general telehealth or scope of practice legislation as well as authorizing pilot programs to explore teledentistry.
In recent legislative sessions, some states now define teledentistry in their statutes instead of only including the practice in broader legislation. For example, Illinois defined teledentistry in its statutes in 2019 by stating “teledentistry means the use of telehealth systems and methodologies in dentistry and includes patient care and education delivery using synchronous and asynchronous communications under a dentist’s authority.”
Twenty states have adopted reimbursement policies related to teledentistry in their Medicaid programs and/or private payer policies. Medicaid typically requires reimbursement for live video interactions. Additionally, private payer teledentistry policies typically require coverage and/or reimbursement that is comparable to what is covered and/or reimbursed for an in-person visit (i.e., payment parity). For example, Montana adopted private payer teledentistry legislation in 2017. The language ensures that teledentistry services are subject to the same deductible, coinsurance and copayment provisions as the corresponding in-person service. The law also includes data privacy requirements and technology considerations.
At least four states have introduced teledentistry legislation this legislative session. For more information on teledentistry and related legislation, please visit the NCSL website ScopeofPracticePolicy.org.
Sydne Enlund is a policy specialist in NCSL's Health Program.
Erik Skinner is a policy associate in NCSL's Health Program.