Laird Harrison

May 02, 2012

May 2, 2012 (San Jose, California) — Children of migrant farm workers were several times more likely to get treatment for early childhood caries if they were enrolled in a teledentistry program, researchers reported here at the American Telemedicine Association 17th Annual International Meeting.

The treatment rate increased from 15% to 95% at 1-year follow-up, said Terry Yonker, RN, MS, telemedicine clinical coordinator at Finger Lakes Community Health in Marion, New York.

"We were totally amazed by how much the kids liked this," she said.

A high proportion of children from low-income families suffer from early childhood caries, partly as a result of poor hygiene and diet, said Yonker.

The problem is widespread in the Finger Lakes region of New York, where about 10,000 migrant farm workers come, mostly from Latin America, to pick apples and work in other agricultural jobs. The average worker earns $7 an hour; some make only $4000 a year, said Yonker.

From 40% to 60% of the children in this population suffer from early childhood caries, she reported.

With funding from the US Department of Agriculture and the US Health Resources and Services Administration, among others, Yonker and her colleagues turned to teledentistry to see if they could help these children.

They had to rely on grant funding to pay the dentist because Medicare and Medicaid will not reimburse for teledentistry, Yonker explained.

The program enlisted a dental hygienist to make videos of the children's teeth using an intraoral camera at the Head Start centers where the children were enrolled. The hygienist applied fluoride varnish, gave out information about good dental hygiene, and made the videos during the same appointment.

The video was transmitted to a pediatric dentist in Rochester, New York, who also collected information about the children's behavior to see if they could be treated with nitrous oxide or would need general anesthesia.

From April 2010 to April 2012, the team completed 102 consultations. The children were more likely to show up for consultation and treatment than similar patients at other dental clinics, Yonker reported.

The no-show rate for consultations was 15.7% in the teledentistry program and about 30.0% at the Eastman Institute for Oral Health and the University of Rochester, she said.

The mean number of miles saved through the teledentistry consultation was 79, she said.

Not all of the program's success can be attributed to teledentistry alone, she noted. The program also made use of a community health worker to educate families about the importance of dental care and to help them navigate the healthcare system.

The community health workers were people who had grown up in the migrant farm worker community and could literally speak the language of the farm workers. "They are people with a high-school education or an associate degree," she said. "New York State does not have a curriculum; we trained them on the job." These workers helped "break down barriers" to healthcare for their patients.

But teledentistry was an important component, Yonker noted. Saving the patients one trip to Rochester for consultation encouraged them to take the other trip for treatment, she said.

"Teledentistry has a lot of promise," she concluded.

Session moderator Neil Herendeen, MD, MBA, director of pediatric practice at Golisano Children's Hospital at Strong in Rochester, told Medscape Medical News that he agrees.

One key to the success of such programs is building relationships, he said. Ten years ago, "more technology meant more impersonal care," he said. "Now, with texting and tweeting and email, you can continue relationships you started in person."

Dr. Herendeen and Ms. Yonker have disclosed no relevant financial relationships.

American Telemedicine Association (ATA) 17th Annual International Meeting: Abstract 244. Presented April 30, 2012.


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