Digitally aided telemedicine during the SARS‐CoV‐2 pandemic to screen oral medicine emergencies
Eleni A. Georgakopoulou
Abstract
A new human coronavirus, known as severe acute respiratory coronavirus 2 syndrome (SARS-CoV-2), emerged at the end of 2019 in Wuhan, China, and we are now facing a pandemic (WHO, 2020). The virus has been found in saliva (Meng, Hua, & Bian, 2020; Sabino-Silva, Jardim, & Siqueira, 2020). In vitro experimental findings suggest that SARS-CoV-2 remained viable in aerosols for 3 hr (Doremalen, Bushmaker, & Morris, 2020). Consequently, given the possibility of disease transmission to oral health workers and patients, dentists in most countries have been advised to limit their practice to emergency treatment (Guo, Zhou, Liu, & Tan, 2020). WHO suggested that virus transmission is highest at the early stage of the disease and that presymptomatic and asymptomatic people may also be infectious (WHO, Report 2020). Some writers have already suggested methods to reduce the formation of droplets in different dental disciplines (Ge, Yang, Xia, Fu, & Zhang, 2020). Regarding oral medicine, the U.S. dental association classifies tissue biopsy as emergency dental therapy (ADA, 2020). The Hellenic Dental Association suggested postponing visits and treating emergencies under strict cost/benefit calculation for patients, taking into account the risk of exposure to SARS-CoV-2. In our practice, we use telemedicine to monitor oral medicine emergencies. There are many ground-breaking telemedicine technology solutions available, most of which are used to address distance barriers to specialized health care, and a recent New England Medicine Journal (NEJM) paper considers telehealth to be a viable alternative in this difficult period (Hollander & Carr, 2020). In an article that sparkled vivid reactions from other specialists (Petruzzi & Benedittis, 2016), Petruzzi et al. screened oral medicine patients using WhatsApp mobile application with substantial "success rates." Under current circumstances, we have used all available software resources that allow users to share media (e.g., Viber and Messenger). Table 1 shows our experience. We had 16 patients of an average age of 41 years (March 16-April 11, 2020), all of whom were very pleased with the telemedicine solution. It is almost the same as one-fourth of the patients we usually treat in 4 weeks. Some of them were registered patients, others new. Evaluation of new patients with "clinical selfies" has not always been easy; common problems were the number of photographs and the quality of the information, which led to a number of communications in order to arrange them. Furthermore, the image resolution (Figure 1) varied, and even filtering could modify mobile phone images; hence, we clarified that no safe diagnosis is guaranteed. Patients submitted a variety of test results, medical history, and GDPR approvals for information processing. We could also perform electronic prescription. We have told all patients that we do not suggest a diagnosis based on cell phone pictures as our normal procedure, and we use it as a strategy to restrict non-emergency appointments during the pandemic. All patients were encouraged to contact us again if any changes in symptoms had been noted, and we urged them to schedule appointments after the pandemic ends. Digital consulting was free of charge as part of our social solidarity during the pandemic. If this takes longer, a more standardized telehealth system (i.e., video conference software with high-resolution cameras) with an adjusted electronic payment system is required. Given the urgency of minimizing unnecessary visits during this global pandemic, digitally assisted telemedicine can be an effective way to monitor oral medical emergencies. Eleni A. Georgakopoulou: Conceptualization; Data curation; Formal analysis; Visualization; Writing-original draft; Writing-review & editing.