What to know about the use of teledentistry in your practice

Originally published in December 2014

Teledentistry involves the use of information communication technologies to provide or assist in the provision of patient care at a distance. This includes treating patients, communicating patient information and/or referring patients via teledentistry.

As technology provides opportunities for developing new approaches to the delivery of care, teledentistry is in a constant state of evolution. The College recognizes the value of teledentistry and, in particular, the way in which it may benefit both dentists and patients by improving access to care and increasing efficiencies in the delivery of care.

Whether teledentistry is an appropriate way to provide or assist in the provision of patient care will depend on the circumstances of each case. This article sets out the College’s expectations of members who wish to practise teledentistry for out-of-province patients, as well as members who wish to refer patients to out-of-province dentists.

General Expectations for Teledentistry

The practice of teledentistry is still the practice of dentistry. Accordingly, members’ professional, ethical and legal responsibilities with respect to practising the profession are not altered because care is provided via teledentistry, as opposed to in-person. Members are reminded that a dentist-patient relationship is established via teledentistry in the same circumstances as when the relationship is established in-person.

Members must evaluate whether teledentistry is an appropriate way to provide or assist in the provision of care by considering whether practising in this manner will enable them to satisfy all relevant and applicable professional, ethical and legal responsibilities, and meet the standard of care.

Members Who Wish to Practise Teledentistry for Out-of-Province Patients

The College maintains jurisdiction over its members regardless of where (physical location) or how (in-person or via teledentistry) they practise dentistry. In keeping with its statutory obligations as a dental regulatory authority, the College will investigate any complaints made about a member, regardless of whether the patient is physically located in Ontario.

When providing or assisting in the provision of patient care in another province, territory or country via teledentistry, members must comply with the licensing requirements of that jurisdiction. This may require that members hold an appropriate dental license with the dental regulatory authority of the jurisdiction in which they are practising via teledentistry.

Members Who Wish to Refer Patients to Out-of-Province Dentists

Members who wish to refer patients to out-of-province dentists are required to take additional steps to ensure that quality care is provided. In this regard, members should have reasonable grounds to believe that the out-of-province dentist to whom they are making a referral has the appropriate knowledge, skill and judgment to provide the required care or information to assist in the provision of care, and is appropriately licensed.

As with in-person care, referring dentists must evaluate the information the out-of-province dentist provides to determine how it should be used to inform patient care. In addition, members should inform their patients that the out-of-province dentist is not physically located in Ontario, and may or may not be licensed in Ontario.

Liability Issues

Through the Professional Liability Program (PLP), the College provides members with $2 million in malpractice protection for dental services performed in Ontario. The College’s current insurer considers services to be performed where the dentist is located. Therefore, as long as the member is physically present in Ontario, PLP’s protection extends to care provided to patients in another jurisdiction.

However, non-Ontario residents may choose to commence legal proceedings for alleged dental malpractice in their provinces or countries as a matter of convenience or take advantage of more favourable legal climates in foreign jurisdictions, including the potential for higher damages awards.

Because members are exposed to personal liability for damages beyond the protection provided through PLP or the excess coverage purchased by them, and because PLP is not financially or structurally set up to defend foreign actions, members are advised not to treat non-Ontario residents electively.

Of course, emergency treatment should be provided to foreign patients as required, but only as is necessary to stabilize the situation. Except in emergencies, members who do treat non-Ontario residents should have each foreign patient sign a Governing Law and Jurisdiction Agreement as part of the consent process before commencing any new treatment.