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Strengthen the Evidence for Maternal and Child Health Programs

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Evidence Tools
MCHbest. Preventive Dental Visit: Pregnancy.

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Strategy. Information about Teledentistry. (13.1)

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 understanding 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 services 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.
  • Utilization. This strategy improves the extent to which individuals and communities use available healthcare services.
  • Patient Experience of Care. This study improves individuals' perceptions, feelings, and satisfaction with the healthcare services they receive.

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. Health Teaching (Education and Promotion) (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. (Measures reach of teledentistry information dissemination)
  • Number of informational resources on teledentistry (e.g., fact sheets, policy briefs) developed and shared with partners. (Measures breadth and variety information products disseminated to partners)

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. (Measures level of customization of teledentistry informational materials)
  • Percent of partners engaged in two-way dialogue and feedback sessions on teledentistry information. (Measures level of interactive knowledge exchange between partners)

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

PROCESS MEASURES:

  • Number of state/local policies for regulations proposed to facilitate teledentistry. (Measures policy development activity on oral health care and teledentistry)
  • Number of MCH and oral health partners that integrate teledentistry into their strategic plans for funding priorities. (Measures organizational commitment)

OUTCOME MEASURES:

  • Number of pregnant women receiving oral health services via teledentistry. (Measures utilization of teledentistry among population of interest)
  • Number of community settings (e.g., FQHCs, WIC) offering teledentistry services to pregnant women. (Measures spread of teledentistry service availability)

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

PROCESS MEASURES:

  • Percent of teledentistry reimbursement policies that include provisions for language access. (Measures the level of access in teledentistry reimbursement policies)
  • Percent of teledentistry expansion resources tailored to communities with oral health service shortages. (Measures strength of focus on teledentistry and oral health services in areas)

OUTCOME MEASURES:

  • Percent of pregnant women with limited financial resources who utilize teledentistry services. (Measures utilization of teledentistry services)
  • Percent of community settings (e.g., FQHCs, WIC) offering teledentistry services to pregnant women. (Measures spread of teledentistry service availability)

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 Resources used to establish expert opinion:

Association of State and Territorial Dental Directors, Best Practice Committee. 2019. Best Practice Approach: Perinatal Oral Health. Reno, NV: Association of State and Territorial Dental Directors.
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.
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.
Lorenzo S, Goodman H, Stemmler P, Holt K, Barzel R, eds. 2019.The Maternal and Child Health Bureau–Funded Perinatal and Infant Oral Health Quality Improvement (PIOHQI) Initiative 2013–2019: Final Report. Washington, DC: National Maternal and Child Oral Health Resource Center.
Oral Health Care During Pregnancy Expert Workgroup. 2012. Oral Health Care During Pregnancy: A National Consensus Statement. Washington, DC: National Maternal and Child Oral Health Resource Center.
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.
3 Villalta Jennifer, Askaryar Hamida, Verzemnieks Inese, Kinsler Janni, Kropenske Vickie, Ramos-Gomez Francisco. (2019). Developing an Effective Community Oral Health Workers—“Promotoras” Model for Early Head Start. Frontiers in Public Health (7).

4 Systematic reviews of teledentistry:

Alabdullah JH, Daniel SJ. A Systematic Review on the Validity of Teledentistry. Telemed J E Health. 2018;24(8):639‐648. doi:10.1089/tmj.2017.0132
Estai M, Kanagasingam Y, Tennant M, Bunt S. A systematic review of the research evidence for the benefits of teledentistry. J Telemed Telecare. 2018;24(3):147‐156.
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.
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.
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.

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.