Synchronous Teledentistry (D9995 code in ADA) is delivery of patient care and education where there is live, two-way interaction between a person or persons (e.g. patient, dentist) at one real location, and an consulting dentist or dental provider at another location. Is also called, “Live Video” or “Real – Time” or “Videoconference”The communication is real-time and continuous between 2 or more participants who are working together as a group, with the usage of technology. Researchers at the University of Western Australia (http://www.uwa.edu.au/) and the Australian e- Health Research Center (https://aehrc.com/) developed a store-and-forward telemedicine platform called Remote-I to assist in oral disease screening, using an image acquisition Android application.

• Reduces the effort and the cost of getting a dental examination in a dental clinic
• Tele- consultation
• Tele- diagnosis
• Tele- treatment
• Tele- monitoring
• Tele- administration
• Consumer medical and health information
• Reduces health care inequalities: For example access to specialties in rural areas
• Enhancing early diagnosis
• Time saving for patient
• Convenient, safe, easy access, quality dental consultation for satisfied and well informed patients
• 24/7/365 including weekends and holidays for dental emergency cases
• Oral hygiene status
• Dentist- Labor Communication
• Collaboration and expansion in insurance market
• Suitable for patients with physical disabilities, developmental disorders or special needs which can not leave home (difficult accessibility)
• Patients get an expert answer how to maintain oral health at home
• Patients who live in long distance areas or other factors and limit their availability and accessibility to dental consultation.
• Supports dental practice worldwide
• Patients busy, who travel and have no time at all (frequent travelers)
• Patients looking for dental tourism
• Prescription instantly of medication (antibiotics, anti-inflammatory, non narcotic medication, e.t.c)
• Allows dentists and oncologists to collaborate for dental treatment
• Reduces travel time to dental care location for a dental exam
• Follow – up visits after or during dental treatment
• Explain and inform the patient which are the dental treatment alternatives
• Helps the patient to evaluate the dental goals and concerns
• Patient gets an expert second dental opinion
• Patient waiting time to obtain dental consultation is short.
• Reduces patient’s anxiety and fear for dental consultation
• Teledentistry helps patients to avoid dental neglect
• Dental emergency cases
• Personalized and comfortable dental teleconsultation
• Orthodontic monitoring, orthodontic status or diagnosis of treatment, orthodontical information or emergencies
• Gum Health status
• Post treatment check or follow up for dental treatment care
• Caries status
• Aesthetic dental improvement
• Personalized information in dental treatment options
• Oral diseases status
• Reduced time and cost for complications
• Dental surgery monitoring treatment
• Patient finds ideal certified dentist specialist by dental procedure
• Dental screening by general practioners for new patients referrals
• Virtual case evaluations
• Identify dental problems earlier (primary dental care)
• Teledentistry education and training program for dentists
• Emergency dental care (dental injury)
• Patient will be informed for any innovative technology used in dentistry
• Innovative dental care delivery models (e.g. schools, screening programs, dental clinics, elder dental care. prisons)
• Clinical collaboration (dental lab collaboration, dental care team collaboration, dental specialist referrals)
• Collaboration of specialized dentists for teleconsultation when is required
• Patient will be informed about his/her dental health and then knows exactly what will know exactly the dental treatment that has to follow in the dental chair – clinic (practice)
• Exchange of information will lead to improved patient care, and the ability to consult more efficiently with colleagues will lead to greater understanding of the treatment objectives and better treatment outcomes.[59]
• Patients fully protected and secured with HIPAA and COPPA compliance
• Post treatment check or follow up for dental implants, dental extractions, endodontics, orthodontics, prosthodontics, cosmetic dentistry, pediatric dentistry
• Teledentistry provides a remote video consultation for a dental exam. At the end of teleconsultation it may be recommended that the patient will have to arrange a physical appointment to a dental clinic
• Teledentistry is an innovative dental care for screening, dental diagnosis, dental emergency care, medical description, primary dental care, dental education, dental treatment plan, dental education and more..
• Dental teleconsultation brings together patient and dentist one click or fingertip away!

In some emergency cases, the patient must be treated immediately and through teleconsultation this can not be achieved, only by physical consultation.

The answer is no. For sure, we can advise what, how, where and when is necessary for the patient to visit a dental clinic.

• Teledentists must be licensed to practice dentistry
• Teledentists must provide identity proof and license status to the patient
• Teledentists must confirm patient’s identity
• Teledentists should obtain an informed consent about teledentistry (limitations, expectations, specific teledentistry services, availability of teleconsultation)
• Patients history and evaluation through teledentistry
• Teledentistry dentists should recognize situation that are beyond their expertise, ability, limits of available technology to manage or evaluate these dental issues and refer patients to the most appropriate dental care clinic.
• Teledentists should securely and confident maintain dental patients records according the laws and regulations
• Teledentists can prescribe medications according the current standards of dentistry. The teledentist must evaluate the medical history, indications, contraindications, complications and safety considerations for each Teledentistry dental medication prescription.
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The patient has to consent for exchanging personal info, personal medical history, videos, images and messaging. The patients are informed the use of Teledentistry provides live dental consultations but no replaces dental exam. At the end of teleconsultation, it may be recommended that the patient arrange a dental appointment to a dental care clinic.

Teledentistry securely stores personal information, including images that have not yet been uploaded, in the local computer. The patient information’s are transmitted through our secure cloud servers. Documents, images, videos and messaging are stored and encrypted database HIPAA, EHR and GDPR before being uploaded and then they are stored on our secure cloud services.

It is possible, under some circumstances. First of all, the teleconsultation dentist is fully updated of medical and dental history of the patient. In case that a patient has a irresistible and persistent pain, the dentist can prescribe electronically (e-script) antibiotics and anti-inflammatory, non narcotic pain medication until they can have a physical appointment to a dental clinic.

Dental health providers are obliged to comply with their new requirements and adopt new technical measures. Fines for non-compliance are very high. Businesses acting as controllers are required to conduct a data protection impact assessment to evaluate individual rights risks from data processing operations.Anonymous data that cannot be attributed to an individual are not considered as personal data.

First of all:

1. The patient has to register, your personal info will not be published, will be private.
2. Atypical store-and-forward Teledentistry system consists of – a computer with substantial hard drive memory, adequate RAM, and a speedy
   processor; an intraoral video camera and a digital camera for the capture of pictures; a modem and an Internet connection. A fax machine, a scanner, and a printer may also be required in some cases. [6,11,13]
3. Then, you must have access to internet connection and connect using your laptop or Smartphone. You will access through free web browser Google Chrome
4. Email and specify to us your questions or concerns here. Also let us know your phone number, time and day to may contact you.
5. Please fill out new patient information and medical health history here
6. For General, Cosmetic, Prosthodontics dentistry, we will need five views of the teeth (front, left, right, occlusal upper and occlusal lower) and extra oral panoramic X-ray
7. For Orthodontic teleconsultation, with braces or clear aligners, we will need orthodontic photographs, a gallery view showing four views of the face (lips relaxed closed, smiling, profile and profile smiling) and five views of the teeth (front, left, right, occlusal upper and occlusal lower). Send us a extra oral panoramic X-ray and a extra oral cephalometric X-ray (lateral head film)..
8. For Oral -Maxillo surgery teleconsultation (dental implants), Dental Scan (CBCT) images will be necessary.
9. For Periodontics dentistry we will need an extra oral panoramic X-ray or full – mouth intraoral periapical x-ray.
10. For Endodontic teleconsultation, we will need the initial or final intraoral periapical x-ray.
11. Any previous records, photographs or X-rays showing previous treatment may be helpful.

Necessary equipment may include:

• High-speed broadband networks (Wi-Fi/3G/4G)
• Desktop or laptop computers
• Computer software, including imaging storage and retrieval programs, electronic
• Dental records, and administrative and billing modules
• Encryption and security software
• Camera
• Live video conferencing technology, including monitors
• Voice-over-IP for telephones for communication

For sure, there is no possibility of teleconsultation without internet connectivity. You must access in a high – speed broadband connection. If you have an internet connection issue, during teleconsultation, you can simply switch the audio-only and your connection will be improved

1. You have a right to choose the dentist and schedule an appointment in a timely manner.
2. You have the responsibility to provide, to the best of your ability, accurate, honest and complete information about your medical history and current health status.
3. You have the responsibility to report changes in your medical status and provide feedback about your needs and expectations.
4. You have the responsibility to participate in your health care decisions and ask questions if you are uncertain about your dental treatment or plan.
5. You have a right to know the education and training of your dentist and the dentist.
6. You have a right to arrange to see the dentist for dental follow – ups, subject to any state law exceptions.
7. You have a right to adequate time to ask questions and receive answers regarding your dental condition and treatment plan for your care.
8. You have the responsibility to inquire about your treatment options and acknowledge the benefits and limitations of any treatment that you choose.
9. You have the responsibility to keep your scheduled appointment.
10. You have the right to know what the dentist feels is the optimal treatment plan as well as the right to ask for alternative treatment options.
11. You have a right to an explanation of the purpose, probable (short and long term) results, alternatives and risks involved before signing consent to a proposed treatment plan
12. You have a right to be informed of continuing heath care needs.
13. You have a right to know in advance the cost of Teledentistry visit and the payment methods.
14. You have a right to accept, defer or decline any part of your treatment recommendations.
15. You have a right to reasonable arrangements for dental care and emergency treatment
16. You have a right to receive considerate, respectful and confidential treatment by your dentist and dental team.
17. You have the right to contact immediately with your dentist, in case of emergency, otherwise please contact with hospital
18. You have a right to inquire about the availability of dental treatment processes and which dental specialists are needed.

• In 1933 Professor and MP, Skevos Zervos, was using telemedicine and teleconsultation from Egypt, Africa and Athensand rural areas
• In 1976 cardiologist Mr. Papakonstantinou cooperates with National Technical University of Athens present a system of analog transmission ECG via phone.
• In 1987 was created the first medical center of guidelines for the Greek Red Cross.
• In 1989 the medicine lab of Universityof Medicine of Athenscooperates with Sismanogleio Public Hospitaland presents a telemedicine system for primary health care and creates the first connected network between health centers and public hospitals.
• In 1991 Medical Center of Athens created a teleradiology network and connected with Methodist Hospital Network
• In 1998 operates several regular telemedicine services in Onaseio Cardiac Surgical Hospital
• In Crete island, operates telemedicine www.hygeia.net and Thessalonikireceives messages from the boats.
• In 1998 was operating the program “Emergency 112”
• In 1999 was accomplished the program “Hermes” for telemedicine services available for pregnant women in Aegean islands.
• In 2000 the Korydallos Prison operated telemedicine services.
• In 2002 mobile company “VODAFONE” started a telemedicine children program for monitoring daily children with disabilities and brain paralysis. In 2006 started Telehealth services for patients with chronic diseases with 17 municipalities and in 2011 expanded in 30 municipalities and are addressed to high – risk group of population.