Pilot tele-dentistry programme incorporating artificial intelligence to provide homebound and nursing home seniors better access to preventive oral care

• The Tele-Dentistry Oral Care for Seniors (T-DOCS) programme provides access to oral healthcare through remote monitoring and detection of oral conditions in vulnerable seniors, to enable early detection

• Capturing, storing, interpreting and comparing oral images using artificial intelligence (AI) to detect the presence of tooth decay, gum disease and abnormalities for timely intervention is a first for Singapore’s dentistry

Singapore, 21 October 2022 – The National Dental Centre Singapore (NDCS) and Temasek Foundation are jointly piloting the Tele-Dentistry Oral Care for Seniors (T-DOCS) programme, the first tele-dentistry programme in Singapore, to provide preventive oral care for vulnerable seniors who are homebound or living in nursing homes with mobility challenges. In partnership with St. Andrew’s Community Hospital (SACH) and Vanguard Healthcare, the T-DOCS programme is a new model of care to improve the oral care of seniors in the community through early detection and regular monitoring. Temasek Foundation has committed $1.23 million to the programme over three years.

Oral health is a key indicator of good health. Older adults may have poorer oral health, which can affect their general health, well-being and quality of life. A 2017 study found that seniors in Singapore have relatively poor oral health, of which 31% were found to be edentulous or using dentures and 38% having fewer than 20 natural teeth1. Thus, in addition to tele-dentistry, the T-DOCS programme trains SACH and Vanguard Healthcare nurses on oral care procedures and use of oral hygiene aids to build community capability in improving and maintaining the oral health of vulnerable seniors.

Clinical Associate Professor Christina Sim, Principal Investigator, T-DOCS & Senior Consultant, Department of Restorative Dentistry – Prosthodontics, NDCS said, "The T-DOCS programme leverages technology for tele-dentistry to provide regular screening and monitoring of the seniors’ oral health. This enables early detection of oral diseases and fills the crucial gap in preventive oral care for our vulnerable seniors, of which dental issues (such as dental caries and periodontal disease) were found among 80% of about 200 seniors recruited for the pilot T-DOCS programme. This new model of care provides timely oral care to seniors, convenience to caregivers and our partners and optimises resources for better community care."

Mr Lim Hock Chuan, Head, Programmes at Temasek Foundation, said: "Many vulnerable seniors have physical or cognitive disabilities and need to depend on their caregivers or healthcare aides for oral care. Some of them are unable to communicate their oral care needs; others require special arrangements in order to access oral care in the community. Recognising these needs, Temasek Foundation is happy to support the T-DOCS programme to bring preventive oral care to these seniors."

The T-DOCS programme piloted with SACH and Vanguard Healthcare in early 2021. Participating seniors are first examined by a dentist and thereafter regularly screened and monitored every six months by trained SACH or Vanguard Healthcare staff using an intra-oral camera with fluorescence technology. The intra-oral camera can detect early signs of tooth decay and gum inflammation and is able to differentiate between existing and newly formed dental plaque. The intra-oral scans along with the patients’ medical information are then uploaded to an electronic system from which NDCS dentists retrieve the patients’ records for remote assessment. The findings and recommended treatment plan are then relayed back to SACH and Vanguard Healthcare staff for follow-up with the participating seniors and their families, including oral hygiene education and necessary referrals for dental treatment.

The electronically captured images also serve as a repository of oral health information which can be aggregated and analysed with the use of artificial intelligence (AI) software that is being developed by this pilot programme to automate the interpretation of the images. The AI will alert the remote dentist on the problematic areas, hence reducing the time taken to examine and interpret the images. It can also provide the home care nurse with a visual prompt on the areas that require greater attention.

Mdm Teo, aged 89, is a patient of SACH Home Care Services and participant of T-DOCS. She is unable to walk and has lost mobility in her hands. Under the T-DOCS programme, a SACH nurse visits her at her home every six months to conduct regular oral screenings. The information is then uploaded and sent to the dentist for remote assessment. Her son, Mr Richard Lim, shared, "We discovered T-DOCS through the home medical team, who recommended the programme to us. After we embarked on the programme, we found it quite beneficial as the nurse was able to make (oral hygiene care) recommendations and make appointments, if needed, to the nearest Community Health Assist Scheme (CHAS) dental clinic on our behalf."

Dr Patricia Lee, Head, Home Medical Services, SACH, shared, "We saw T-DOCS benefiting patients in SACH Home Care who participated in the pilot programme. With one single visit by the Home Care team, the patients can have their medical and dental issues addressed. For caregivers with loved ones constrained by physical movements, this can help manage or even reduce their stress in having to make arrangements when their loved ones require dental treatment."

The pilot T-DOCS programme currently has 199 participating seniors and has trained more than 40 nurses in the nursing homes and home care team to perform oral health screenings with intra-oral imaging of seniors’ oral cavities and provide basic oral and denture hygiene care. NDCS is looking to expand the T-DOCS programme to more seniors such as those in day care centres, senior activity centres, special needs centres and prison.

Members of the public who have a question about T-DOCS may email [email protected].

1 Chiu C.T., Malhotra R., Tan S.M., Lim J., Chan A., Teoh K.H., Gan S.T., Saito Y. Dental health status of community-dwelling older Singaporeans: findings from a nationally representative survey. Gerodontology 2017; 34: 57–67