Management of impacted third molars based on telemedicine: a pilot study.
OBJECTIVE
The incorporation of new technologies into clinical daily practice is nowadays a fact in the field of medicine. Within these new technologies, telemedicine is turning out to be a working tool that is used with increasing frequency in medical centers. The systems of telemedicine have still not reached the same development in oral and maxillofacial surgery that they have reached in other medical specialties. This study describes the preliminary results of a store-and-forward telemedicine system (SFTMS) aimed at the presurgical management of impacted third molar pathology.


METHODS
A multicenter, longitudinal, descriptive, evaluative pilot study of an SFTMS aimed at the presurgical management of patients with impacted third molar pathology was conducted at the Oral and Maxillofacial Surgery Unit of Virgen Macarena University Hospital (Seville, Spain) and 4 primary care areas located between 15 and 95 km from the hospital. The study was carried out between January and December 2009.


RESULTS
Over a period of 12 months, 97 patients were enrolled in the study, from 102 teleconsultations received and evaluated within the same period. Patients managed through telemedicine were included on the surgical wait list on within a mean interval of 3.33 days (95% confidence interval [CI], 2-4.65 days) since the visit to the primary care dentist, with only 1 visit to the hospital that was on the day of surgery. The mean waiting interval of patients managed through the conventional referral system was 28 days (95% CI, 24.51-29.6 days), with at least 2 visits to the hospital before the final intervention. The on-the-day surgery cancellation rate of the series was 7.8% (95% CI, 3.8%-10.5%) because 8 patients did not have surgery on the scheduled day. The cancellation rate in the sample of patients managed through the conventional system was 8.85% (95% CI, 5.62%-11.81%; P < .005).


CONCLUSIONS
The SFTMS was effective and accurate as a preoperative tool for impacted third molar pathology. It avoids unnecessary visits to the hospital and shortens waiting intervals. Further randomized studies are needed, however, to establish real advantages, in clinical and economic terms, against the conventional presurgical management systems.
Department of Oral and Maxillofacial Surgery, Virgen Macarena University Hospital, Seville, Spain. javiherce@yahoo.es
Javier
J
Herce
Rodrigo
R
Lozano
Clara I
CI
Salazar
Angel
A
Rollon
Francisco
F
Mayorga
Silvia
S
Gallana
D000328:Adult; D000556:Ambulatory Surgical Procedures; D001071:Appointments and Schedules; D032962:Consent Forms; D003813:Dentistry; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007256:Information Systems; D007258:Informed Consent; D020407:Internet; D008137:Longitudinal Studies; D008297:Male; D016347:Medical Records Systems, Computerized; D008964:Molar, Third / Q000473:pathology* / Q000601:surgery; D010347:Patient Care Planning; D017060:Patient Satisfaction; D010865:Pilot Projects; D011300:Preoperative Care; D011320:Primary Health Care; D012017:Referral and Consultation; D019114:Remote Consultation; D017216:Telemedicine; D013997:Time Factors; D014095:Tooth, Impacted / Q000601:surgery / Q000628:therapy*; D014850:Waiting Lists