Tele-monitoring and tele-sedation for systemic management during dental treatment.

With medical progress and the increasing aging of the population, dentists are required to manage patients with various systemic diseases in the perioperative period. Given the small number of dental anesthesiologists (DAs), few dental patients are provided with systemic management by DAs. The Ministry of Health, Labour and Welfare defines telemedicine as “health promotion and medical practices using information and communication equipment”. Telemedicine is routinely applied to various medical situations. Telemedicine also has the potential to improve the safety and comfort of patients during dental treatment. Here we report a series of cases in which tele-monitoring and tele-sedation were used in dental treatment.

Four patients provided written consent for the publication of this report: patient 1 (female, aged 24), patient 2 (male, aged 30), patient 3 (female, aged 31), and patient 4 (male, aged 63). Medical histories revealed that patient 1 had 22q11.2 deletion syndrome and patient 4 had hyperlipidemia. Treatments undertaken in the dental clinic were cavity preparation (patient 1) and dental implant surgery (patients 2–4). Patients were equipped with a device to measure pulse rate, arterial oxygen saturation and electrocardiogram. Data were uploaded to the cloud via the network and monitored on a personal computer by a remote DA. Two cameras recorded the patient's facial expression, chest movement, and blood pressure measurements on an automatic sphygmomanometer, and the images were simultaneously sent to the DA (Fig. 1). The DA conducted tele-monitoring for patients 2–4, and managed tele-sedation for patient 1 because of dental anxiety. A nurse maintained venous access and administered midazolam under instruction from the remote DA. No abnormal vital signs were observed in any of the patients. After the treatment, positive feedback was received from the dentists (being able to concentrate on the treatment) and the patients (feeling reassured).

Figure 1

(A) A small vital sign monitoring device (Checkme Pro, Sanei Medisys Co., Ltd, Kyoto, Japan) attached to the patient's arm. (B) Camera set in the surgical light arm of the dental chair. (C) iPad built-in camera beside the chair. (D) Screen monitored by the dental anesthesiologist.

Our application of telemedicine provided highly satisfactory medical support to both dentists and patients. Tele-anesthesia has previously been used for cholecystectomy and liver transplants, but this was the first report describing the application of telemedicine for systemic management during dental treatment. With our system, the DA can easily be incorporated into medical support without the need for an onsite DA, allowing the vital signs of patients to be expertly evaluated. The use of tele-sedation allows patients to more easily receive dental treatment under intravenous sedation with less stress and relieve from dentists' stress on monitoring. The most important issue in the use of these modalities is the maintenance of patient safety. All dental clinic staff should be trained in the management of patients in emergency situations. The American Society of Anesthesiologists recommends that non-anesthesiologists receive education and training on systemic management and resuscitation when performing sedation. We have established a study group (AneStem) to provide dental anesthesiology education for dental providers. We encourage the staff of dental clinics planning to introduce telemedicine to attend our education programs.

In conclusion, we reported the first four cases to use telemedicine for systemic management in dentistry. To provide patients with safer and more comfortable treatment, we continue to promote telemedicine and encourage dental anesthesiology education.

Declaration of Competing Interest

N. Kishimoto, L. Saida, and K. Seo received travel fees and medical equipment (Checkme Pro) from Sanei Medisys Co., Ltd.