Inside Dentistry
September 2021
Volume 17, Issue 9

The Dynamic Duo of Case Acceptance

Combining teledentistry with in-office care can boost practice profitability

Margaret Scarlett, DMD

How is your practice planning to correct for the lost revenue that the American Dental Association is projecting that dental offices will experience this year?1 If your plan doesn't include implementing teledentistry, it should.

I have experienced firsthand how, when combined with in-office care, teledentistry can boost practice profitability by increasing workflow efficiency—especially during the case presentation process. The hybrid workflow that I use, which includes a virtual consultation, an in-office exam, a virtual case presentation, in-office treatment, and a virtual follow-up, is simple and effective. Using teledentistry to schedule and conduct virtual patient consultations facilitates safe and efficient routine follow-up visits, postoperative visits, and assessments of emergencies when they arise.

The transition from traditional in-person patient encounters to virtual visits increases productivity and helps compensate for the chair time lost to the longer operatory room turnovers that have resulted from the need for new disinfection protocols and hesitant patients.

Teledentistry enables you to talk to patients to assess the condition of their oral health without the barrier of personal protective equipment (PPE). Among other advantages, conducting an unmasked virtual consultation allows clinicians to stay connected with patients, provide optimal care based on their best judgment, and present personalized options for each patient with a treatment plan.

Reimbursement for teledentistry is now provided by most oral healthcare insurers. In addition, alternatives to dental insurance are being offered by some practices. These operate like dental discount plans for regular services but encompass other paid benefits, including teledentistry consultations. New payment models have expanded during the COVID-19 pandemic, strengthening the transactional relationship between patients and practices without the middleman of insurance.

Regardless of reimbursement, teledentistry ensures that you are available to your patients when they need you and, equally important in a postpandemic world, can help new patients find and meet you. In fact, teledentistry may provide you with a competitive edge to attract and retain patients. During this year of fighting COVID-19, many patients have become accustomed to the convenience of scheduling telehealth appointments and telecommuting to work, and now, they're interested in teledentistry with a dentist who offers it. Shouldn't that be you?

Patients appreciate having the ability to see their dentists without having to fight traffic or arrange childcare or eldercare. Thanks to teledentistry, they can visit with you virtually to plan the best possible care that you can provide. This can be important to patients, especially those who have delayed necessary treatment during the pandemic.

As a result of these and other factors, today, virtual case presentations have widespread patient appeal. This article presents highlights of a virtual case presentation powered by a teledentistry platform that utilized digital images captured by my hygienist with an intraoral camera.

Case Report

A healthy 44-year-old woman presented as a new patient with the chief complaint that she had not had her teeth cleaned for more than a year. The reason for this was that she had not felt comfortable visiting the dentist during the pandemic.

Virtual Consultation

My hygienist and I utilized teledentistry to discuss our new safety procedures with the patient to help put her at ease. The virtual consultation took only 14 minutes, required no PPE, and resulted in a less apprehensive patient who scheduled an appointment for a comprehensive examination and diagnostic imaging in our office. A review of her medical history revealed no significant findings; however, she stated that chewing certain types of food was a challenge.

In-Office Examination

When the patient arrived for her first in-person appointment, a full-mouth series of radiographs was acquired. In addition, the hygienist captured digital photographs with an intraoral camera (MouthWatch® Intraoral Camera System, MouthWatch) and provided the patient with some key oral hygiene instructions. This in-office exam required 55 minutes and full PPE, but it turned out that the patient needed more than just a routine cleaning.

Virtual Case Presentation

The intraoral camera images were uploaded to the patient portal of the teledentistry platform (TeleDent, MouthWatch) and reviewed during the patient's next virtual appointment. The first image reviewed was of the maxillary right side, which showed caries on the distal and buccal surfaces of tooth No. 15. In another image, gingival recession on the lingual surface of tooth No. 6 and the absence of tooth No. 5 could be visualized. The patient also exhibited extensive lingual recession associated with a bridge on the left side, and her mandibular anterior teeth also demonstrated light staining, gingival attachment loss, and inflammation on the lingual aspects. Prior to this virtual case presentation, the patient was not aware that she had any caries, gingival recession, or occlusal issues. However, after seeing the images, she was able to understand her oral healthcare needs.

Successful Case Acceptance

Although the teledentistry visit to review the intraoral photographs took only 30 minutes and required no PPE, it resulted in complete case acceptance by the patient. She became highly motivated to improve her oral health. After receiving enhanced oral hygiene instructions that were located on the patient portal, she kept a daily electronic record of her ability to carry them out.

A treatment plan was developed that included scaling and root planing, a prescription mouth rinse to be used as a part of the patient's oral hygiene routine, and a periodic, 4-month periodontal maintenance plan. In addition, the patient accepted treatment involving caries removal, an occlusal equilibration, a new 5-unit bridge on the upper right side, and an implant to replace tooth No. 14.

All in all, the patient accepted treatment totaling $9,800.00. The scaling and root planing, caries removal, occlusal equilibration, and 5-unit bridge were all billable for $4,500.00. However, due to insurance limitations, the implant, implant crown, and remaining replacement of old amalgam restorations as well as a new bridge on the upper left side will be started early next year. We couldn't have made this patient feel comfortable enough to come into the office for diagnostics, much less for treatment, without the connection of teledentistry.


Teledentistry can be used in conjunction with in-office visits to help improve patient case acceptance. On average, dentists' case acceptance rates are only approximately 23%.2 Teledentistry offers a proven method for gaining new insights and perspectives from patients in order to better understand their needs as well as a way to present treatment plans face to face without the need for PPE.

The patient in the case report presented had been treated by several dentists within the last 5 years as she moved from one city to another for her job. However, none had taken the time to present a comprehensive plan designed to restore her mouth and maintain it following treatment. The photographs taken and uploaded to the teledentistry portal allowed the patient to visualize her oral healthcare issues and motivated her to accept treatment.

Treatment planning and achieving case acceptance involves a combination of science and art. Teledentistry can provide a way to communicate the patient's oral health status, but his or her motivation, financial status, and trust play a part as well. In this case, teledentistry provided the proper vehicle to address the patient's needs and enabled a candid virtual discussion using the intraoral camera photographs as visual aids that built the necessary trust with the patient.


1. Nasseh K, Vujicic M. Modeling the Impact of COVID-19 on US Dental Spending - June 2020 Update. American Dental Association website. https://www.ada.org/~/media/ADA/Science%20and%20Research/HPI/Files/HPIBrief_0620_1.pdf. Published June 2020. Accessed July 30, 2021.

2. Kesner M. How to Help Patients Want What They Need. Dental Economics website. http://www.dentaleconomics.com/articles/print/volume-104/issue-8/personal-enrichment/how-to-help-patients-want-what-they-need.html. Published August 18, 2014. Accessed July 30, 2021.

About the Author

Margaret Scarlett, DMD, is the CEO of Scarlett Consulting International.

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