DSOPro: Describe your background and how you came up with the idea for MouthWatch?

I come from a family of dentists. I knew I could never do the anatomy carving and the artistic side of dentistry, but I was interested in the healthcare field. I started and led some other business ventures before starting MouthWatch. While I was helping my family with their practice for a brief time in between companies, we started looking at the impact intraoral cameras had on their patients and began trying to find a way to connect that to support a form of self-generated recall. We saw the challenges practices had with recall, as well as the impact on patients when they saw inside their mouths and what that could lead to. That led to our original teledentistry product, which really engaged patients and allowed them to communicate with their dentist virtually.

Although patients could use it during live video consults or for messaging providers, the intraoral camera was challenging for some. This was 8 years ago, mind you, so it was early days for the technology. Plus, there was no ADA code for teledentistry, and it was perceived as being very public-health oriented and more for rural use, such as clinics in Alaska consulting with specialists in large cities and referring patients to them.

For those using it on the clinical side in a provider-to-provider model it worked really well. It was also empowering hygienists to see patients in new settings, communicate with their peers or with their supervising doctor, and then share case information with patients. It allowed everyone to work up to the top of their scope of practice act. We were able to bring them the supervision required to allow them to work in community settings in different, impactful ways.

We opened up care opportunities for nursing homes, elder care, corporate popups, screening programs, and schools. These settings could now have dental teams out in the field capturing data and providing services, and dentists could supervise remotely more efficiently.

We grew our hardware business and helped bring intraoral imaging into many practices that had previously been limited due to the cost and challenges of other cameras. Meanwhile, there was a type of teledentistry Renaissance. MouthWatch had created a powerful platform and it was working for patient-to-provider and provider-to-provider use. Then the pandemic came and really amplified the usefulness and value of teledentistry.

The pandemic significantly changed the perceptions of dentists and insurance carriers. Insurance companies started reimbursing for services conducted virtually and practices saw the need, even as the pandemic receded, to offer opportunities for patients who asked, “Do I have to come in if it’s just a consult? Or just a post-op?” Some practices, especially group practices who had been implementing teledentistry with TeleDent, saw the opportunity to shift and enhance their approach to care delivery through teledentistry, and find a path to either direct revenue from reimbursement or cost savings that made them more efficient to deal with the backlog of patients that needed to be seen.

DSOPro: Was that nationwide?

Almost. Texas just finally came around with teledentistry legislation, but we saw 49 states really thriving with it in a range of ways. Some states are more progressive and had more clear-cut opportunities for it and paths to revenue. But everyone got on board relatively quickly and insurance companies were actively encouraging it, which made all the difference in the world.

It’s one thing to deal with a lockdown and needing to handle emergency consults while every dentist was sitting at home and could do inbound video conferences and consults to triage a case. But we found that leadership in DSOs and practice groups were looking at the long-term benefit and need for teledentistry. We were able to really expand and capitalize on working with some large groups that implemented it in the last few years. We’re starting to see more implementation by enterprise organizations, DSOs, and groups, and their success in utilizing it.

Smaller practices can be more challenged with staff adoption and realizing the value of true teledentistry integration. When the business leader is also the clinical leader, it’s difficult for them to find the time to implement new processes and procedures. But groups have the business insight and goals to measurably improve patient experience and handle challenges that hit them on a larger scale, like addressing staffing shortages, increasing efficiency, and reducing new patient lag times.

All these things can be addressed in different ways with TeleDent. We work with dental groups to tailor a solution to what they want to accomplish. Then they can reveal value pretty quickly.

DSOPro: Tell us more about the camera technology.

We have two intraoral cameras now: the MouthWatch intraoral camera, which is in 36,000+ practices. And we recently introduced the MouthWatch Plus, a 1080P high-definition camera with some additional features.

MouthWatch Plus offers high-definition imaging at an affordable price point ($3,000 less than competitive products) and easily integrates with all the dental imaging software being utilized. It has the same value propositions of our original camera, but we expanded it to a higher image quality, which some practices found they wanted to have in at least one operatory for cosmetic cases or documentation for presentations with before and afters. Both cameras integrate with TeleDent teledentistry, if needed, for case referrals or sharing with patients.

DSOPro: What other needs does a teledentistry platform meet?

There are a range of solutions out there. Some are simply for video conferencing or patient messaging. They’re not really creating teledentistry workflows that make it easier for practices.

We’ve worked with Advantage Dental, a large dental group with 80+ locations across several states. They implemented teledentistry with TeleDent by blending it into their call center for intake, new patients, and triaging emergencies. Their goal, which they hit and exceeded, was to shift 5% of appointments to a virtual appointment. They could also shift the emergencies if they needed to, giving more information to the patient and then right-sizing their appointment if they had to come in. So instead of just a vague description of clinical need generated by the patient, the clinicians can actually see and talk to the patient, determine if they need an hour appointment, etc. They can tell if a crown is likely necessary or if it’s just going to be a 15-minute appointment. This enables them to bring a lot of efficiency to their practices.

Think about 80+ practices and the amount of time saved when more than 5% of appointments shift to virtual, which frees up a lot of operatory time. They haven’t yet started shifting postoperative appointments to virtual or improving collaboration with outside specialists. We’re seeing really at-scale programs and groups bringing in revenue, whether it’s through additional billable services or through the cost savings, operatory time saved, or patient satisfaction and loyalty. It really engages them in a way that’s pretty significant and creates value for those groups.

DSOPro: Does it help grow practices? Are patients attracted by this approach?

You bet. We have a new kind of patient intake form process that allows patients to request a teledentistry consultation to begin their connection to a practice. Whether they call or go to the website, this is a way to generate loyalty. When I’m looking for a dentist, if I’m going to wait a week or two for an appointment, I will likely stick with the doctor I can have a brief video consult with, who I can see and get comfortable with. If they know it’s urgent, they can prioritize the appointment.

We see the attraction especially to a younger patient demographic. I think the pandemic has increased the number of patients interested in a convenient, tech-forward practice. They don’t always have to take off work if they need something checked or to seek dental expertise. It also helps with compliance checks, health information, and education. Those things don’t always have to take place in a dental chair.

And now with the staffing challenge, which is a real key point, DSOs may be having a hard time attracting and keeping doctors. To make it more efficient, give a doctor a chance to work from home one day a week doing virtual consults. It may lead to better team buy-in as well as create more efficiencies in the office where they are seeing the patients who need treatment as opposed to just a conversation or a consult.

DSOPro: Tell us about the case studies you are conducting on how this is working in DSOs.

We’re doing a case study with Advantage that should be available shortly. We’re also now working with Apple Tree Dental. And we’re doing pilot programs with several other DSOs as they aim to confirm the initial value of teledentistry and then roll it out to more locations. The case studies will demonstrate the revenue, efficiency, and patient satisfaction improvements.

DSOPro: What’s the future of teledentistry? Where do you see it going?

We see it expanding into making every care touchpoint across healthcare connected to dental care. We also see ways we can support dental groups, insurance plans, patients, and employers through virtual connection to care and care coordination. You could have a virtual consult as your first touchpoint and ultimately get routed into a practice that accepts your insurance while already understanding what your treatment needs might be.

We see artificial intelligence (AI) coming into play to help in educating patients and raising self-awareness of oral health with better engagement. We see a path where patients will be able to better understand—based on visual AI—inflammation, swelling, recession, and other conditions, and being able to self-monitor those more effectively. I believe there will be a move toward more remote patient monitoring, which is big in medical but hasn’t occurred yet in dental.

It will eventually streamline engagement between dental and oral health through a wider range of touchpoints for patients. Pediatricians, OB GYNs, and oncologists, among other medical providers, still require dental clearance for some procedures and responsibility still rests with the patient. If a patient needs a procedure at a hospital, the patient is being told they must see their dentist first, but there’s not really a direct referral and connection to care.

We’re looking to integrate between electronic healthcare records (EHRs) and dental practice management systems so practitioners can access more information about a patient than they may provide in their own health history. For instance, they could see if they had been in a hospital and what the hospital system knows. More group dental practices are shifting toward deeper understanding and approaches that support the systemic health of patients and trying to understand what role they can play as healthcare providers, not just dental care providers.

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About Brant Herman

Brant Herman, CEO & Founder of MouthWatch, grew his passion for building companies during the first Silicon Valley technology boom. He is widely known in the teledentistry world and is a frequent public speaker and author of articles in leading oral health-related publications. Since Brant founded the company in 2012, along with Bob Bellhouse and his father Dr. Jerry Herman, the company has grown dramatically. MouthWatch products are used by more than 15,000 practices in all 50 states and in many countries.

Brant lives in Central New Jersey. He loves spending time with his son and daughter, coaching sports, traveling, running, and cooking.

About MouthWatch, LLC

Headquartered in Metuchen, New Jersey, MouthWatch, LLC, is a leader in innovative teledentistry solutions, digital case presentation tools, and intraoral imaging devices. The company is dedicated to finding new ways to connect patients to care and improve the dental health experience for both patients and providers. To learn more, visit mouthwatch.com.