G-2109-17201

This is a collaborative proposal between the UNC School of Dental Medicine and Access Dental Care. Access Dental Care is a non-profit that was initially organized by the NC Dental Association in 2000, that does mobile, onsite care for residents in retirement communities, care for those with intellectual and developmental disabilities in nursing home facilities and group homes, and those in the Central NC Health Network HIV/AIDs program. Access Dental Care serves as a state and national model for special care dental services.

This research proposal is seeking to build and publish data that supports better access to care for patients with special healthcare needs, which often is complicated by behavioral or cognitive disabilities, lack of daily oral hygiene, extensive medical histories, and communication with responsible parties or caregivers.

The plan is to assess teledentistry’s ability to provide initial treatment decisions remotely for special care patients to increase and accelerate their access to dental care. This research responds to the ongoing expansion of teledentistry nationally and intentionally will apply an equity lens in assessing how care is accessed and how treatment decisions are made for special needs populations.

While there are national policy and rulemaking implications for this study, in NC, legislation just passed allowing dental hygienists to conduct assessments under the supervision of off-site dentists, which will increase North Carolina dentists' ability to provide teledentistry to the broader population. This policy shift could have a big impact on dentists treating patients with special health care needs if the dentist community actively chooses to see this patient population. This research intends to justify and build credibility to that end.

The findings of the survey will be shared throughout North Carolina, but also nationally with policymakers, providers, and insurers to expand access to special needs populations and justify the continuation of temporary teledentistry policies passed during the pandemic.

There are two primary points of value for CareQuest Institute. The first is that this research would directly support payment and policy that expands implementation of teledentistry, which correlates with the future trajectory of COrHT and CareQuest Institute’s interest in telehealth. Secondly, in terms of teledentistry nationally, this research can elevate how equity needs to be woven into teledentistry conversations to support teledentistry’s ability to serve all people, including those with special healthcare needs, which already have historically been marginalized by the oral health system.

Also of note is that UNC is currently in the IRB approval process for the study.

The requested budget for this proposal was $273,417 which goes to staff time and contractual support for Access Dental to implement the training of hygienists and implementation of the tele and onsite, mobile screening. The recommendation from the review committee is to reduce the budget of the proposal to align with existing budget, the potential value proposition from the work, and future strategic vision. The recommendation from the review committee is to fund at $200,000, which would represent less than 1% of the total UNC Dental School budget.