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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. Teledentistry. (13.1)

Approach. Develop and provide training. (for professional development) for oral health professionals at the state and/for local level about teledentistry. (including state practice acts and reimbursement policies), and provide teledentistry services for expectant parents

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Overview. Telemedicine, sometimes called telehealth, uses telecommunications technology to deliver consultative, diagnostic, and health care treatment services.[1] Teledentistry is a form of telemedicine. Teledentistry can facilitate the delivery of oral health care, including education, diagnosis of oral diseases, and provision of preventive and limited restorative care.[2] Teledentistry offered an innovative solution to providing oral health care during the COVID-19 pandemic and may be especially important for expectant parents who need to receive oral health care, especially during the second trimester.[3] Provider education 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 of provider education with population groups in need of oral health care, this research can serve as a proxy to gauge effect.[4,5] As an incentive for oral health professionals to complete training, offer continuing education credits. Examples of preventive oral health care include education and anticipatory guidance. (eating practices, oral hygiene practices, smoking prevention/cessation), and fluoride varnish application, and silver diamine application.

Evidence. Scientifically Rigorous Evidence. Strategies with this rating are most likely to be effective. These strategies have been tested in multiple robust studies in a variety of populations and settings with consistently positive results, both on their own and in combination with other strategies. (Clarifying Note: The WWFH database calls this "scientifically supported evidence").

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 teledentistry training hours for continuing education credits delivered to oral health professionals. (Measures intensity of teledentistry training)
  • Number of expectant parents provided with information on accessing oral health care via teledentistry. (Measures breadth of teledentistry promotion to population of focus)

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

PROCESS MEASURES:

  • Percent of oral health professionals who demonstrate proficiency in teledentistry competencies after training. (Measures effectiveness of workforce development efforts around teledentistry)
  • Percent of teledentistry services that adhere to practice guidelines and clinical quality standards. (Measures fidelity of teledentistry services to evidence-based care)

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

PROCESS MEASURES:

  • Number of community sites (e.g., WIC clinics, libraries) equipped to host teledentistry visits for expectant parents. (Measures breadth of expansion of teledentistry service access points)
  • Number of policy briefs for testimonials shared with policymakers on the impact and value of teledentistry for expectant parents. (Measures breadth of oral health policy education efforts)

OUTCOME MEASURES:

  • Number of expectant parents receiving preventive oral health services via teledentistry who maintain continuity of care. (Measures sustained engagement between oral health services and expectant parents)
  • Number of health plans and payers providing reimbursement for teledentistry services for expectant parents. (Measures financial sustainability of oral health services via teledentistry)

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

PROCESS MEASURES:

  • Percent of teledentistry training and education materials that are tailored for oral health professionals serving various communities. (Measures relevance of teledentistry training materials)
  • Percent of teledentistry expansion efforts focusing communities that have additional needs in the oral health system. (Measures allocation of teledentistry resources)

OUTCOME MEASURES:

  • Percent reduction in gaps in oral health access and outcomes between expectant parents using teledentistry vs. traditional care. (Assesses teledentistry impact on closing gaps in oral health outcomes)
  • Percent of expectant parents with higher-risk pregnancies who receive timely oral health interventions via teledentistry. (Measures responsiveness of teledentistry system to crucial needs)

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

1Ghai S. 2020. Teledentistry during COVID-19 pandemic. Diabetes and Metabolic Syndrome: Clinical Research and Reviews. 14(5):933–935.

2 Shaygani F, Marzaleh MA. 2022. COVID-19 pandemic: An opportunity for using tele-dentistry for a better dental care. Prehospital and Disaster Medicine 15:1–3.

3 Lipper J. 2016. Advancing Oral Health Through the Women, Infants, and Children Program: A New Hampshire Pilot Project. Hamilton, NJ: Center for Health Care Strategies.

4 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.

5 Additional Resources:

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.
Association of State and Territorial Dental Directors, Best Practice Committee. 2021. Best Practice Approach: Teledentistry—Opportunities for Expanding the Capacity and Reach of the Oral Healthcare System. 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.
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.
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.
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.
6 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.

7 Systematic reviews of teledentistry:

Alabdullah JH, Daniel SJ. 2018. A systematic review on the validity of teledentistry. Telemedicine Journal and e-Health24(8):639–648.
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.
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. Telemedicine Journal and e-Health 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.