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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Child.

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Strategy. Information about Teledentistry. (13.2)

Approach. Provide information about opportunities and barriers related to teledentistry (e.g., state statutes, practice acts, reimbursement policies) to key state and/for local oral health partners

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Overview. States and jurisdictions contemplating the utilization of teledentistry could benefit from an understanding of the science behind the practice as well as opportunities and barriers associated with teledentistry. Providing information about services is an evidence-based strategy that has shown utility in increasing utilization of professional services other than oral health by MCH population groups. While limited research has been conducted to verify results with populations in need of oral health services, this research can serve as a proxy to gauge effect.[1]

Evidence. Expert Opinion. Strategies with this rating are recommended by credible, impartial experts, guidelines, or committee statements; these strategies are consistent with accepted theoretical frameworks and have good potential to work. Often there is literature-based evidence supporting these strategies in related topic areas that indicate this approach would prove effective for this issue. Further research is needed to confirm effects in this topic area.

Access the peer-reviewed evidence through the MCH Digital Library or related evidence source. (Read more about understanding evidence ratings).

Source. Peer-Reviewed Literature

Outcome Components. This strategy has shown to have impact on the following outcomes (Read more about these categories):

  • Access to/Receipt of Care. This strategy increases the ability for individuals to obtain healthcare services when needed, including preventive, diagnostic, and treatment services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.

Detailed Outcomes. For specific outcomes related to each study supporting this strategy, access the peer-reviewed evidence and read the Intervention Results for each study.

Intervention Type. Policy Development and Enforcement (Read more about intervention types and levels as defined by the Public Health Intervention Wheel).

Intervention Level. Community-Focused

Examples from the Field. Access descriptions of ESMs that use this strategy directly or intervention components that align with this strategy. You can use these ESMs to see how other Title V agencies are addressing the NPM.

Sample ESMs. Here are sample ESMs to use as models for your own measures using the Results-Based Accountability framework (for suggestions on how to develop programs to support this strategy, see The Role of Title V in Adapting Strategies).

Quadrant 1:
Measuring Quantity of Effort ("What/how much did we do?")

PROCESS MEASURES:

  • Number of state/local oral health partners provided with information on teledentistry opportunities and barriers. (Measures dissemination reach)
  • Number of informational resources on teledentistry developed and shared with partners. (Quantifies information products)

Quadrant 2:
Measuring Quality of Effort ("How well did we do it?")

PROCESS MEASURES:

  • Percent of teledentistry informational materials that are tailored to the needs and interests of different oral health partner types. (Assesses customization)
  • Percent of partners engaged in two-way dialogue and feedback sessions on teledentistry information. (Measures interactive knowledge exchange)

Quadrant 3:
Measuring Quantity of Effect ("Is anyone better off?")

PROCESS MEASURES:

  • Number of collaborative work groups for committees formed to advance teledentistry policies and reimbursement. (Measures collective action infrastructure)
  • Number of state/local policies for regulations proposed to reduce barriers and facilitate teledentistry. (Assesses policy development activity)

OUTCOME MEASURES:

  • Number of oral health providers adopting teledentistry modalities after policy and reimbursement changes. (Measures provider behavior change)
  • Number of children and youth receiving oral health services via teledentistry. (Assesses utilization of teledentistry among focus population)

Quadrant 4:
Measuring Quality of Effect ("How are they better off?")

PROCESS MEASURES:

  • Percent of teledentistry workgroups and committees with representation from communities experiencing oral health gaps. (Assesses community engagement in teledentistry planning)
  • Percent of teledentistry expansion resources tailored to communities with oral health service shortages. (Evaluates focus on areas with significant needs)

OUTCOME MEASURES:

  • Percent of partners who rate the teledentistry information received as relevant and actionable for their work. (Measures perceived usefulness)
  • Percent of partners who initiate plans for policies supportive of teledentistry within 6 months of receiving information. (Measures concrete behavior change)

Note. When looking at your ESMs, SPMs, or other strategies:

  1. Move from measuring quantity to quality.
  2. Move from measuring effort to effect.
  3. Quadrant 1 strategies should be used sparingly, when no other data exists.
  4. The most effective measurement combines strategies in all levels, with most in Quadrants 2 and 4.

Learn More. Read how to create stronger ESMs and how to measure ESM impact more meaningfully through Results-Based Accountability.

References

1 Perkins RB, Zisblatt L, Legler A, Trucks E, Hanchate A, Gorin SS. 2015. Effectiveness of a provider-focused intervention to improve HPV vaccination rates in boys and girls. Vaccine 33(9):1223–1229.

2 Holt K, Kolo S, Louie R. 2021. Title V National Performance Measure 13 (Oral Health): Strategies for Success. Washington, DC: National Maternal and Child Oral Health Resource Center. https://www.mchoralhealth.org/PDFs/NPM13_StrategiesForSuccess.pdf

3 Resources used to establish expert opinion:

Casamassimo P, Holt K, eds. 2016. Bright Futures in Practice: Oral Health—Pocket Guide (3rd ed.). Washington, DC: National Maternal and Child Oral Health Resource Center. https://www.mchoralhealth.org/pocket/index.php
Clark MB, Douglass AB, Maier R, Deutchman M, Gonsalves W, Silk H, Wrightson AS, Quinonez R, Dolce M, Dalal M, Rizzolo D. 2010. Smiles for Life: A National Oral Health Curriculum (3rd ed.). Leawood, KS: Society of Teachers of Family Medicine. http://www.smilesforlifeoralhealth.org
National Maternal and Child Oral Health Resource Center. 2010. Open Wide: Oral Health Training for Health Professionals. Washington, DC: National Maternal and Child Oral Health Resource Center. https:/www.mchoralhealth.org/OpenWide/
Wells J. 2019. Improving Oral Health Outcomes for Pregnant Women and Infants by Educating Home Visitors. Washington, DC: Association of Maternal and Child Health Programs. http://www.amchp.org/programsandtopics/BestPractices/InnovationStation/ISDocs/Oral%20Health%20Home%20Visiting.pdf

4 Systematic reviews of teledentistry:

Alabdullah JH, Daniel SJ. 2018. A systematic review on the validity of teledentistry. Telemedicine Journal and e-Health 24(8):639–648. https://www.liebertpub.com/doi/abs/10.1089/tmj.2017.0132
Estai M, Kanagasingam Y, Tennant M, Bunt S. 2018. A systematic review of the research evidence for the benefits of teledentistry. Journal of Telemedicine and Telecare 24(3):147–156. https://pubmed.ncbi.nlm.nih.gov/28118778
Fernández CE, Maturana CA, Coloma SI, Carrasco-Labra A, Giacaman RA. Teledentistry and mhealth for promotion and prevention of oral health: A systematic review and meta-analysis. 2021. Journal of Dental Research. 100(9):914–927. https://pubmed.ncbi.nlm.nih.gov/33769123
Flores APdC, Lazaro SA, Molina-Bastos CG, et al. 2020. Teledentistry in the diagnosis of oral lesions: A systematic review of the literature. Journal of the American Medical Informatics Association 27(7):1166–1172. https://pubmed.ncbi.nlm.nih.gov/33769123
Irving M, Stewart R, Spallek H, Blinkhorn A. 2018. Using teledentistry in clinical practice as an enabler to improve access to clinical care: A qualitative systematic review. Journal of Telemedicine Journal and Telecare 24(3):129–146. https://pubmed.ncbi.nlm.nih.gov/28092220

This project is supported by the Health Resources and Services Administration (HRSA) of the U.S. Department of Health and Human Services (HHS) under grant number U02MC31613, MCH Advanced Education Policy, $3.5 M. This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.