Can a virtual dentist help after hours? What teledentistry can and can't do

What’s probably going on

It’s late, your tooth hurts, and your dentist’s office is closed. You want to know two things: is this serious, and what should you do until morning?

That’s the question teledentistry is best at. A live video visit puts you in front of a dentist who can see your mouth through your phone camera, hear what’s going on, and help you decide what happens next. The American Dental Association lists live video as one form of teledentistry, along with sending photos for a dentist to review later.

A video visit is a triage and advice call. It is not a repair.

What a video visit can do

• Tell you how urgent it is. A dentist can ask the questions that separate “this can wait until your dentist opens” from “get seen today.” That alone can save a sleepless night of guessing.
• Walk you through tonight. Rinsing, cold packs, pain relievers, what to do with a lost filling or a chipped edge. The same steps as our right-now guide, but from someone looking at your mouth.
• Prescribe some medicines, if needed. The TeleDentists say their dentists can prescribe non-narcotic medicines or recommend over-the-counter ones. Whether you get a prescription is the dentist’s call. Don’t expect opioid pain medicine from a video call.
• Point you to the next step. Many services will refer you to a local office if you need treatment. Delta Dental notes that if you need urgent treatment, it has to be scheduled as an in-person visit.

Video visits tend to work well for a chipped tooth, a lost filling, a sore spot or bump on the gum, jaw pain, or the question “is this worth an emergency visit?”

What it can’t do

• It can’t fix the tooth. Only an in-person dentist can fill a cavity, do a root canal, place a crown or take a tooth out. If the problem needs one of those, you’ll pay for the video visit and the office visit.
• It can’t take an X-ray. Many toothaches can’t be pinned down without one. A deep cavity, a crack and an infection at the root can look alike on a phone camera.
• It can’t feel or tap the tooth. Dentists often press, tap or test teeth with cold to find the one that’s sick. On video, they rely on what you describe and what they can see.
• Antibiotics won’t fix it either. If you get a prescription, it can help an infection that’s spreading, but it doesn’t remove the cause. Cleveland Clinic notes that antibiotics can’t get rid of the source of an abscess: the tooth itself. Never take leftover antibiotics.

The ADA’s position is that care by teledentistry should meet the same standard as care in person, and that the dentist should be licensed in the state where you are. It’s fair to ask who you’re seeing and where they’re licensed.

When to skip the video visit and go to the ER

Some problems shouldn’t wait for any call to connect. Go to an emergency room if you have:

• Swelling in your face with a fever
• Trouble swallowing or breathing
• Swelling that spreads toward your eye or down your neck
• Confusion, or a racing heart along with a tooth infection

Cleveland Clinic lists fever of 100.4°F or higher, confusion, trouble swallowing, a fast heart rate and facial swelling as reasons to go to the ER with a tooth abscess. A spreading infection needs hands-on care quickly.

What it costs

The TeleDentists list a video consult at $64 without insurance. They say patients whose insurance partners with them (they name Aetna, Anthem Blue Cross Blue Shield and Envolve) pay a co-pay of $50 to $59, depending on the plan’s contract. Other services charge different amounts, and some dental insurers cover video visits, so check your plan before you pay.

Keep in mind that the video visit is usually a first step, not the whole bill. If you need a filling, root canal or extraction, that’s a separate charge at an office. See what an emergency dentist visit costs. If you don’t have dental insurance, a dental savings plan (a discount membership, not insurance) can lower the price of the in-person fix.

How to get the most out of the call

1. Find good light. A bathroom mirror plus a second phone’s flashlight works. Pull your cheek back with a clean finger.
2. Know where it hurts. Upper or lower, left or right, front or back. Is it one tooth or several?
3. Know what sets it off. Cold, heat, biting, lying down, or nothing at all. Pain that lingers after cold or throbs on its own points one way; a quick zing points another.
4. Have your list ready. Medicines you take, allergies, and the pharmacy you’d use.
5. Ask what happens next. Who should you see, how soon, and what makes it an emergency before then?

How to keep it from coming back

A video visit gets you through the night. It doesn’t stop the next toothache.

• Book the in-person visit the dentist recommends, even if the pain fades. Pain that stops isn’t the same as a problem that’s gone.
• Brush twice a day with fluoride toothpaste and clean between your teeth daily.
• See a dentist for regular checkups, so small cavities and cracks get fixed before they hurt.
• Keep a few basics at home: a cold pack, a pain reliever you can take, and a temporary filling kit. See the dental emergency kit.