Fibre to the Mouth: Australians Sinking their Teeth into NBN Dentistry

It may not have been what the architects of the NBN had in mind, but it seems that Australia's new broadband network will be used for teledentistry...

They haven’t perfected the remotely-operated cavity drill yet, but broadband researchers are nonetheless enthusiastic about early success in teledentistry trials that promise to negate Australians’ last excuses for avoiding visits to the dentist.

Early trials have shown strong success with the technique, which uses a special toothbrush-sized camera – inserted into a patient’s mouth for extreme closeups of the teeth, gums and mouth – to pump high-resolution video to a dentist who might be located several suburbs over, or in a capital-city hospital hundreds of miles away. This allows for much faster evaluation of dental decay, orthodontic assessment and the management of dental trauma of the sort when heads collide during middle-school soccer and football matches.

The idea of teledentistry has been around for some time, but limited bandwidth severely limited the resolution and usefulness of transmitted images. However, researchers at the University of Melbourne’s Oral Health Science Cooperative Research Centre (OHS CRC) have reinvigorated the technique with a trial over the country’s expanding national broadband network (NBN).

NBN connectivity – which will deliver speeds of up to 1Gbps as the network is rolled out nationwide over the next decade – is crucial to moving the large, high-resolution files in which the Logitech/LifeSize Mirial software deals, says Rodrigo Marino, an associate professor with the Melbourne Dental School and principal research fellow of the Oral Health Science CRC.

“The dental images are huge – consuming around 1GB per minute – and using current broadband it can take minutes or hours to transmit them all,” he explains. “It would probably be easier to take the car there, pick up the patient, and bring them back to the dentist. But with the NBN that could be a matter of seconds.”

So far, the team has conducted 35 examinations using the technique, with early trials focused on an inner-city aged-care facility and another facility in rural Stawell, around 150 miles north-west of Melbourne. The inner-city facility has NBN access, while the Stawell facility does not.

Even without formal dental training, aged-care staff have proven capable of transmitting high-resolution images that can be analysed in real time by the remote dentist or downloaded for later viewing. Some 50 nursing-home patients expected to be evaluated in total and Melbourne’s Royal Children’s Hospital (RCH) has now signed on to do an additional 50 consultations.

“We are trying to see if, using teledentistry, we can avoid some unnecessary trips to the city or to the RCH for treatment of orthodontics or dental trauma that may occur in remote places,” Rodrigo explains. “Even outer-suburban areas, which are at least an hour from the city, would mean at least two hours’ driving for a 15-minute consultation; if this could be avoided, it would be a good thing for society.”

Molar close-ups may not be exactly what the architects of Australia’s A$37.4 billion ($32.88 billion) NBN had in mind when they signed off on the massive and controversial project, but it’s one of a growing number of use cases – shepherded by the government-backed Institute for a Broadband-Enabled Society (IBES) – that are slowly showing how ubiquitous broadband would affect Australians’ everyday lives.

Although Australia has a well-established socialised medicine program in the form of Medicare, regular dental care has traditionally been left to the private sector – meaning huge swathes of the population go for long periods without evaluation or intervention by the country’s 29,000 dentists.

Recent Australian Bureau of Statistics figures found that only 49% of Australians aged 15 and over had visited a dentist in the previous 12 months, with 90% going to a private dentist and just 9% going to public clinics.

The numbers are much lower amongst residents of aged-care facilities, which often struggle to attract dentists due to their general lack of dental capabilities; it is equally hard to get residents to a dentist for regular check-ups. The ABS figures reflect this, with a peak in dental visits among 55 to 64-year-olds but a sharp decline in dental visits for older residents.

 “The best examination is face to face, but we’re talking about groups that don’t have that possibility,” Rodrigo says. “They cannot see a dentist or oral care professional, and it’s been unlikely that dentists or allied professionals go to see patients in nursing homes.”

Furthermore, specialist dental expertise is heavily concentrated in the country’s capital cities – meaning that the millions of Australians living in regional or remote areas have virtually no access to anything more than basic dental services.

Even for those in outlying suburbs of Melbourne, Sydney or Brisbane, a trip to the city’s dental hospital can represent a four-hour round trip. NBN-enabled examinations that will allow dentists – or even non-dental allied healthcare providers, acting under the guidance of the remote dentist – to appropriately assess the situation, decide whether an on-site visit is necessary, and know what tools would be required.

“Even in the city there are groups and areas that are underserviced,” Rodrigo explains. “We think, with this technology, that we can improve access for those groups.”

While the camera has been proven to work well given enough bandwidth to move its files, Rodrigo’s team now faces the tricky part: building an effective enough business case to attract the support of private-sector organisations to further extend its scope. By year’s end, Rodrigo hopes to have completed a proposal that could see a broader pilot implemented in 2014.

Manuals and online training modules have been developed to support the camera’s use, and the team is thinking of design improvements to the camera that could facilitate its usage for teledentistry – including modifications to allow the transmission of 3D images of the patient’s mouth. That may fall into the too-much-information category for many of us, but for Australia’s dentists it’s just reinforcing the idea that there’s almost no place that broadband won’t eventually reach.


David Braue is an award-winning technology journalist who has covered Australia's IT industry since 1995.