Frequently Asked Questions - Virtual Care

The Royal College of Dental Surgeons of Ontario’s (RCDSO) Professional Liability Program (PLP) considers the following factors when determining whether a person is an “Ontario patient” for the purposes of liability protection:

• If the person is in, or is seeking to be in, a dentist-patient relationship with an Ontario dentist^[1].
• If the person resides in Ontario.
• If the person is geographically (i.e., physically) located in Ontario when the virtual care is delivered.

Examples of scenarios where the person would, and would not be considered an “Ontario patient” include, but are not limited to, the following:

Note: the locations outside of Ontario that are used in these examples are hypothetical. The examples describe liability protection for Ontario dentists and do not reflect the licensing requirements in other jurisdictions.



Ontario dentists can contact PLP if they are unsure as to whether a person is an “Ontario patient” or have questions about liability protection.

^[1] The Virtual Care Standard of Practice defines Ontario dentists as registrants of the Royal College of Dental Surgeons of Ontario (RCDSO).

“Virtual care”, also known as “teledentistry”, is defined in the Virtual Care Standard of Practice and this FAQ document as including, but not limited to, the use of electronic information, imaging, communication, and patient engagement technology to provide and support the direct delivery of dental care to patients remotely. Virtual care does not include indirect patient care, such as consultations between health care providers.^[1]

Virtual care can be provided in a number of ways, including, as examples: 

• Live video (synchronous): Live, two-way interaction between a person (patient, caregiver, or provider) and a provider using audiovisual communication technology.
• Store-and-forward (asynchronous): Transmission of recorded health information (e.g., radiographs, photographs, video, digital impressions, and photomicrographs of patients) through a secure electronic communications system to a provider, who uses the information to evaluate a patient’s condition or render a service outside of a real-time or live interaction.
• Remote patient monitoring (RPM): Personal health and medical data collection from an individual in one location via electronic communication technology, which is transmitted to a provider (sometimes via a data processing service) in a different location for use in care and related support of care.
• Patient engagement technology: Health self-management, communication, and education tools or services that are available to patients on demand. These virtual tools or services can give patients the ability to complete routine tasks related to their health care when it works for them. 
• Mobile health (mHealth): Health care and public health practice and education supported by mobile communication devices, such as cell phones, tablet computers, and personal digital assistants (PDAs).

Some dental services that may be offered virtually include:

• screening and triage of patients to decide if they will benefit from education, advice, instruction, prescriptions, referrals, or an in-person appointment;
• assessment or evaluation of patients (e.g., for new or existing conditions), diagnosis, and provision of dental care;
• follow-up management of patients, including post-operative appointments or monitoring of patients; and
• consultation appointments between patients and their general dentist and/or specialist.

^[1] Requirements for referrals to another dentist for consultation and/or treatment purposes can be found in RCDSO’s Most Responsible Dentist Practice Advisory and Dental Recordkeeping Guidelines.

No. The Virtual Care Standard of Practice does not apply to dentists who provide indirect patient care. There are some dental specialties, such as oral and maxillofacial radiology and oral pathology, that typically interact with other dentists who consult with them. This Standard does not address consultations between dentists and would not apply unless the dentist is interacting with a patient directly (e.g., having a live video interaction with a patient to assess them, or obtaining a photograph of the patient’s mouth directly from the patient to assess them). 

No. Ontario dentists must deliver the same high quality dental care virtually as they would in person. Ontario dentists are required to meet the standard of care and all of the same legal, professional, and ethical obligations that apply to in-person, hands-on dental care. If Ontario dentists determine they would not be able to meet the same standard and obligations virtually, it would be inappropriate to provide virtual care.

Ontario dentists are required to take reasonable steps to verify and authenticate the patient’s identity before the patient’s personal health information (PHI) is exchanged. The steps Ontario dentists can take in order to satisfy this requirement may vary, depending on the nature of interaction and whether they have an existing dentist-patient relationship with the patient. For example:

• For synchronous dental care delivered via audio communication technology, Ontario dentists could ask the patient for two or more identifiers (e.g., date of birth, address, health card number).^[1]
• For synchronous dental care delivered via video communication technology, Ontario dentists could ask patients to hold up a piece of valid government-issued photo ID to the camera. This may not be necessary if the dentist already knows the patient by sight.^[2]
• For asynchronous dental care delivered via electronic communication technology, Ontario dentists could use some form of coded identification (e.g. patient number).^[3]

If staff are assisting with the verification and authentication of the patient’s identity, Ontario dentists may want to consider confirming the patient’s identity themselves prior to collecting, accessing, using, or disclosing the patient’s PHI to ensure that this requirement has been met.

^[1] Canada Health Infoway and Health Excellence Canada (2022). Providing safe and high-quality virtual care: A guide for new and experienced users. Clinician Change Virtual Toolkit.

^[2] Canada Health Infoway and Health Excellence Canada (2022). Providing safe and high-quality virtual care: A guide for new and experienced users. Clinician Change Virtual Toolkit.

^[3] Association of Canadian Psychology Regulatory Organizations. (2011). Model Standards for Telepsychology Service Delivery.

The existing legal obligations with respect to privacy and security that apply to in-person, hands-on dental care also apply to virtual care. Ontario dentists’ specific obligations are set out in the Personal Health Information Protection Act, 2004 (PHIPA)^[1] and some key obligations are highlighted below.

As health information custodians, Ontario dentists are responsible for ensuring that all staff and other agents acting on their behalf are aware of the requirements for maintaining the privacy and confidentiality of patient’s PHI set out in PHIPA. This includes, but is not limited to:

• only collecting, accessing, using, and disclosing PHI with the consent of the patient (or substitute decision-maker) or as permitted or required by PHIPA;
• not collecting, accessing, using, and disclosing PHI if other information will serve the purpose;
• not collecting, accessing, using, or disclosing more PHI than is reasonably necessary to meet the purpose;
• taking reasonable steps to ensure PHI in their custody or control is protected against theft, loss and unauthorized use or disclosure, and that the records containing PHI are protected against unauthorized copying, modification or disposal; and
• ensuring that PHI in their custody or control are retained, transferred, and disposed of in a secure manner.

The Information and Privacy Commissioner of Ontario (IPC) has published the following document to help health care providers who are health information custodians understand and comply with their legal obligations when using virtual care: Privacy and Security Considerations for Virtual Health Care Visits: Guidelines for the Health Sector. The guidance includes the following steps to enhance privacy and security in virtual health care:

• Conduct privacy impact assessments^[2] to identify and manage the specific privacy and security risks associated with virtual health care.
• Develop and implement a virtual health care policy that:
• addresses the purposes for which virtual care may be used in their office, any conditions or restrictions in doing so, and the administrative, technical and physical safeguards that will be in place; and
• explicitly states that staff and other agents acting on their behalf will have access to only the minimum amount of PHI necessary to perform their duties.
• Ensure that staff and other agents acting on their behalf participate in ongoing privacy and security training, including training on their office’s virtual health care policy.
• Have a robust security management framework to regularly monitor, assess, and mitigate any security risks that may arise in the use of virtual health care.
  • The framework must include the required administrative, technical, and physical safeguards expected of staff and other agents acting on their behalf, as well as any third-party service provider of portals.
• Have a privacy breach management protocol that sets out requirements for identification, reporting, containment, notification, investigation, and remediation of actual and suspected privacy breaches.
• Report privacy breaches at the first reasonable opportunity to affected individuals and, in certain situations, to the IPC.^[3]

[1] Personal Health Information Protection Act, 2004, S.O. 2004, c. 3, Sched. A.

[2] For more information about conducting a privacy impact assessment, refer to the IPC’s Privacy Impact Assessment Guidelines for the Ontario Personal Health Information Protection Act, as well as the IPC’s Planning for Success: Privacy Impact Assessment Guide.

[3] For more information about what to do when there is a privacy breach, refer to the IPC’s Responding to a Health Privacy Breach: Guidelines for the Health Sector and Reporting a Privacy Breach to the IPC: Guidelines for the Health Sector.

Patients (or their substitute decision-makers) may want to record their virtual dental appointments via audio or video. In many cases, these recordings benefit patients by helping them understand and remember the information they are being provided. However, recordings also have the potential to raise broader issues, such as dentists being recorded without their knowledge.

Although the law indicates that patients (or their substitute decision-makers) can audio record^[1] virtual dental appointments without the dentist’s consent,^[2] Ontario dentists may want to be proactive and encourage patients to speak with them before doing so. It would be ideal for the Ontario dentist and patient to reach an agreement about whether the virtual dental appointment will be recorded, how it will be recorded, and how to ensure that the privacy of others will not be affected. If the patient records the virtual dental appointment, Ontario dentists are advised to note that fact in the dental record and to ask the patient for a copy of the recording to retain in the dental record.

Ontario dentists may want to record virtual dental appointments with patients for their own purposes (e.g., clinical, documentation). The RCDSO requires that Ontario dentists obtain the patient’s (or substitute decision-maker’s) consent for the collection of PHI via audio or video, and retain any recordings made as part of the dental record.^[3] Recordings made during virtual dental appointments are subject to the same collection, access, use, disclosure, retention, transfer, and disposal requirements as PHI recorded on paper.^[4] For more information, see the RCDSO’s Dental Recordkeeping Guidelines and Electronic Records Management Guidelines.

^[1] This may include a video recording with audio.

^[2] Section 184 of the Criminal Code, R.S.C., 1985, c. C-46 criminalizes the audio recording of private conversations unless one of the participants in the conversation consents to the recording. This exception is referred to as “one-party consent”.

^[3] For clarity, the requirements to obtain consent for recording and to retain any recordings made as part of the dental record are RCDSO requirements and not requirements set out in law.

^[4] PHIPA does not specifically address the collection of PHI via audio or video; however, it does contain requirements for collecting, accessing, using, disclosing, retaining, transferring, and disposing of PHI more generally.

Yes. Consent must be obtained from the patient (or substitute decision-maker). The consent process includes informing patients about the benefits, limitations, and potential risks of using the virtual modality, including those related to privacy and any clinical limitations, and any associated costs.

The IPC’s Privacy and Security Considerations for Virtual Health Care Visits: Guidelines for the Health Sector includes the following examples of limitations and risks related to privacy: potential privacy breaches resulting from physical or electronic eavesdropping, hacking, and software exploits; technical failures; and configuration errors.

The consent that is required for using a virtual modality is separate from the consent process for any proposed treatment. Consent for treatment requirements are set out in the Health Care Consent Act, 1996^[1] and on the RCDSO’s Informed Consent webpage.

^[1] Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A.

Yes. Regardless of how dental care is delivered (e.g., in-person or virtual), Ontario dentists may charge a fee for the care that they provide. The RCDSO does not set fees for dental care however the Professional Misconduct regulation enacted under the Dentistry Act, 1991 states that it is an act of professional misconduct to charge fees that are excessive or unreasonable.^[1]

^[1] See sections 31-32 of Professional Misconduct, O. Reg. 853/93, enacted under the Dentistry Act, 1991, S.O. 1991, c. 24.

The IPC’s document, Privacy and Security Considerations for Virtual Health Care Visits: Guidelines for the Health Sector, provides guidance to health care providers who are health care custodians on this very topic. The guidance includes:

• Ensure, through contractual agreements, that the service provider complies with the privacy and security measure to satisfy the requirements set out in PHIPA. The service provider should agree to:
  • Immediately notify the custodian in the event of a privacy breach,
  • Undergo periodic security audits at the request of the Ontario dentist,
  • Restrict access to PHI by employees or any person acting on their behalf on a need-to-know basis; and
  • Securely return or destroy PHI at the end of the agreement.
• Do not engage the services of providers that require, as a condition of service, that:
  • individuals register with the service provider; or
  • accept terms of service and privacy policies that require collection, use, or disclosure of personal information or PHI for purposes unrelated to the Ontario dentists’ provision of dental care.

Yes, Ontario dentists who are geographically located outside of Ontario may treat Ontario patients provided that they comply with the requirements set out in the Virtual Care Standard and have appropriate liability protection. Ontario dentists are protected by the RCDSO’s professional liability program (PLP) for professional services provided virtually to Ontario patients when the dentist is geographically located outside Ontario.

The RCDSO also strongly recommends that Ontario dentists be aware of any applicable licensing requirements of the jurisdiction in which the dentist is geographically located when virtual care is being provided. This is because licensing requirements may vary between jurisdictions and some dental regulatory authorities (DRAs) may require licensure if the Ontario dentist, or the Ontario patient, is geographically located in their jurisdiction when the virtual care is provided. Ontario dentists can check with the DRA of the jurisdiction in which they are geographically located.[1]

[1] For example, Canadian DRA’s contact information can be found on the Canadian Dental Reguatory Authorities Federation’s website.

Yes, Ontario dentists may treat patients who are geographically located outside of Ontario provided that they comply with the requirements set out in the Virtual Care Standard and have appropriate liability protection. Ontario dentists are protected by the RCDSO’s professional liability program (PLP) when Ontario dentists are geographically located in Ontario for professional services provided virtually to any patient, or if the Ontario dentist is not geographically located in Ontario, for professional services provided virtually to Ontario patients.

^[1] For example, Canadian DRA’s contact information can be found on the Canadian Dental Reguatory Authorities Federation’s website.

The Virtual Care Standard does not apply to consultations between health care providers and referrals. General requirements for referrals to another dentist for consultation and/or treatment purposes can be found in RCDSO’s Most Responsible Dentist Practice Advisory and Dental Recordkeeping Guidelines. These College documents do not currently address cross-border consultations and referrals; however, the general obligations set out in these documents may be applied in the virtual care context. These general obligations include:

• Making an appropriate referral to a dentist with the required expertise;
• Helping patients understand:
  • the reason, nature, and scope of the referral (e.g., how they came to the determination that a referral is recommended, and the procedures and protocols involved);
  • the anticipated outcome of the referral and the potential risks/consequences of refusing the referral recommendation; and
  • the credentials of the referral dentist (e.g., what training or expertise they have, which jurisdiction(s) they are licensed in).
• Confirming the patient is in agreement with the referral recommendation and obtaining the patient’s consent before sending any information to another dentist (e.g., before making a referral); and
• Ensuring the patient’s PHI is appropriately safeguarded when it is shared virtually with the referral dentist.

Ontario dentists are reminded that if they rely on an opinion provided by another dentist, Ontario dentists are still required to obtain the patient’s valid consent^[1] for any treatment proposed on the basis of the opinion.

^[1] See the Health Care Consent Act, 1996, S.O. 1996, c. 2, Sched. A and RCDSO’s Informed Consent webpage for more information.

It depends. Ontario dentists may ask health care providers^[1] or other staff persons (e.g., receptionists) to assist in the provision of virtual care by, for example:

• obtaining information regarding patients’ medical history and the reason they are seeking care;
• discussing compliance with orthodontic treatment; or
• providing post-operative care.

Ontario dentists are not permitted to delegate controlled acts to others,^[2] but they may assign tasks (not controlled acts) that are within health care providers’ scope of practice and for oral health care providers, that are in accordance with the RCDSO’s Standard of Practice on the Performance of Intra-Oral Procedures that are Not Controlled Acts by Preventive Dental Assistants, Level II Dental Assistants and Registered Dental Hygienist. Ontario dentists may also assign tasks that are not controlled acts to other staff (e.g., receptionists), as appropriate.

Ontario dentists would also need to take into consideration what the health care provider’s own regulatory authority (i.e., College) or association requires with respect to the provision of virtual care, as the requirements may differ from the RCDSO’s.

When a task is assigned to another health care provider or other staff person to assist in the provision of virtual care, the Ontario dentist is ultimately responsible for ensuring that the requirements set out in the RCDSO’s Virtual Care Standard of Practice are met.

^[1] For example: dental assistants, dental hygienists, dental technologists, denturists, nurses.

^[2] Section 2, paragraph 3 of Professional Misconduct, O. Reg. 853/93, enacted under the Dentistry Act, 1991, S.O. 1991, c. 24.

Yes, in specific circumstances. RCDSO’s Standard of Practice on the Performance of Intra-Oral Procedures that are Not Controlled Acts by Preventive Dental Assistants, Level II Dental Assistants and Registered Dental Hygienist requires that Ontario dentists provide the appropriate level of supervision for intra-oral procedures provided by preventative dental assistants, level II dental assistants, and registered dental hygienists. For some intra-oral procedures, supervision may occur remotely using technology, and other intra-oral procedures require that the dentist be physically present in the office to supervise.

See Appendix 3 in the Standard for a chart that summarizes the intra-oral procedures and corresponding supervision requirements.