A Systematic Review on the Validity of Teledentistry

Transitioning Adolescent Patients with Special Health Care Needs from Pediatric to Adult Dental Care

Health care transition from adolescence into adulthood is a complex process that often lacks care coordination, planning, and collaboration among the parties involved. Dental transition is significantly more challenging for adolescents with special health care needs. Shortage of qualified general dentists willing to treat these individuals and low dental reimbursement by public insurance programs are significant barriers to successful transition. Adequate training to increase dental workforce, insurance benefits, protocol development, and research are needed to ensure successful transition for this population. Meanwhile, it is important to target individuals less likely to access adequate oral health care and achieve satisfactory transition.

Delivery of a smoking cessation induction intervention via virtual reality headset during a dental cleaning

Smokers who are not motivated to quit are less likely to seek help or utilize medication for cessation, so it is critical to proactively reach them to motivate cessation. This study aims to determine feasibility and satisfaction of a smoking cessation induction intervention via a virtual reality (VR) headset worn during dental cleaning. Participants (n = 23) were adult dental patients who were current smokers. During their teeth cleaning, participants wore a VR headset to watch two 5-min smoking cessation videos, one targeted to smokers who are not ready to quit and one for those who are ready to quit. Questionnaires were administered pre- and postappointment, and 1 month later. Interviews were conducted immediately after the appointment. Implementation did not interfere with care delivery, including instrument manipulation and patient-provider communication. On a 1-7 scale, participants indicated satisfaction with the experience (M = 5.4, SD = 1.3), and a positive impact on their willingness to quit (15 of 22 rated ≥ 6) and their knowledge of the effects of smoking on their health (22 of 23 rated as ≥ 6). Participants were highly satisfied with the video content (M = 4.3; 1-5 scale). When prompted, 82.6% were able to recall three things from the video. One month later, four to five participants reported that they quit smoking (varied by measure) and 14 of 23 intentionally quit smoking ≥ 24 hr. Among nonquitters, motivation to quit increased from baseline to follow up. This study may help guide the integration of virtual reality headset use in the dental setting to promote smoking cessation regardless of motivation to quit.

Oral Health and Teledentistry Interest during the COVID-19 Pandemic

BACKGROUND

The COVID-19 pandemic outbreak has significantly changed access to dental treatments.

METHODS

The data related to oral health and teledentistry topics were collected from the open database Google Trends. The analyzed material was collected from 19 June 2016 to 6 June 2021 among anonymous search engine users. The following expressions were analyzed: "dental care", "emergency dental care", "oral health", "periodontitis", "teledentistry", "is it safe to go to the dentist", and "COVID-19" and "PPE dentist".

RESULTS

During the first lockdown in 2020, a significant increase in "emergency dental care" phrase queries was detected, with a simultaneous decrease in regular "dental care" questions, as well as a peak in the queries for "periodontitis" preceded by lower interest in "oral health." The number of searches stated for "teledentistry" increased during the time of the pandemic 5 times and for and "PPE dentist" 30 times. The risk of visiting the dental studio was seen in almost 40 times increase in the query "is it safe to go to the dentist."

CONCLUSIONS

The COVID-19 imprinted a stigma on oral health care. In this difficult epidemiological situation, teledentistry might become a helpful solution.

The role of teledentistry in oral cancer patients during the COVID-19 pandemic: an integrative literature review

OBJECTIVES

This integrative review aimed to assess the benefits of the use of teledentistry for patients undergoing treatment of oral and head and neck cancer during the COVID-19 pandemic.

MATERIALS AND METHODS

We searched in PubMed, Cochrane, Scopus, Web of Science, Lilacs, Embase, Open Grey, Google Scholar, and Jstor databases for studies referring to the management, control, and assistance, through teledentistry, to patients with oral and head and neck cancer during the COVID-19 pandemic.

RESULTS

We found 356 references in the databases, 209 after duplicates removal, 23 met criteria for full-text reading, and 11 studies were included for qualitative synthesis, in four categories: virtual visits, use of remote technology, patient's satisfaction, multidisciplinary approach in teledentistry. We found that 78% of patients currently preferred teledentistry; 92% of patients would recommend the use of video consultation to other patients. The continuity of dental care, the reduction of patient visits to the hospital, the reduction of the risk of infection with the coronavirus, and limitation of face-to-face consultations to protect health professionals are benefits that reinforce the use of teledentistry by health institutions. Two studies showed patients' satisfaction with the use of teledentistry in monitoring cancer patients and showed an improvement in quality of life.

CONCLUSIONS

The teledentistry, as a remote technology for monitoring patients with oral and head and neck cancer, is well accepted by patients in preliminary studies. Although these studies pointed out some benefits of using remote technologies for the care of cancer patients, further robust scientific evidence is still needed in this regard.

CariesCare International adapted for the pandemic in children: Caries OUT multicentre single-group interventional study protocol

Background

Comprehensive caries care has shown effectiveness in controlling caries progression and improving health outcomes by controlling caries risk, preventing initial-caries lesions progression, and patient satisfaction. To date, the caries-progression control effectiveness of the patient-centred risk-based CariesCare International (CCI) system, derived from ICCMS™ for the practice (2019), remains unproven. With the onset of the COVID-19 pandemic a previously planned multi-centre RCT shifted to this “Caries OUT” study, aiming to assess in a single-intervention group in children, the caries-control effectiveness of CCI adapted for the pandemic with non-aerosols generating procedures (non-AGP) and reducing in-office time.

Methods

In this 1-year multi-centre single-group interventional trial the adapted-CCI effectiveness will be assessed in one single group in terms of tooth-surface level caries progression control, and secondarily, individual-level caries progression control, children’s oral-health behaviour change, parents’ and dentists’ process acceptability, and costs exploration. A sample size of 258 3–5 and 6–8 years old patients was calculated after removing half from the previous RCT, allowing for a 25% dropout, including generally health children (27 per centre). The single-group intervention will be the adapted-CCI 4D-cycle caries care, with non-AGP and reduced in-office appointments’ time. A trained examiner per centre will conduct examinations at baseline, at 5–5.5 months (3 months after basic management), 8.5 and 12 months, assessing the child’s CCI caries risk and oral-health behaviour, visually staging and assessing caries-lesions severity and activity without air-drying (ICDAS-merged Epi); fillings/sealants; missing/dental-sepsis teeth, and tooth symptoms, synthetizing together with parent and external-trained dental practitioner (DP) the patient- and tooth-surface level diagnoses and personalised care plan. DP will deliver the adapted-CCI caries care. Parents’ and dentists’ process acceptability will be assessed via Treatment-Evaluation-Inventory questionnaires, and costs in terms of number of appointments and activities. Twenty-one centres in 13 countries will participate.

Discussion

The results of Caries OUT adapted for the pandemic will provide clinical data that could help support shifting the caries care in children towards individualised oral-health behaviour improvement and tooth-preserving care, improving health outcomes, and explore if the caries progression can be controlled during the pandemic by conducting non-AGP and reducing in-office time.

Trial registration: Retrospectively-registered-ClinicalTrials.gov-NCT04666597-07/12/2020: https://register.clinicaltrials.gov/prs/app/action/SelectProtocol?sid=S000AGM4&selectaction=Edit&uid=U00019IE&ts=2&cx=uwje3h. Protocol-version 2: 27/01/2021.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12903-021-01674-1.

Knowledge and Associated Factors about Rare Diseases among Dentists in Israel: A Cross Sectional Survey

Aim: The current study aims to assess levels of knowledge among Israeli dentists about rare diseases with orofacial manifestations, and whether occupational, regional and social factors influence those levels. Materials and Methods: A total of 309 Israeli dentists participated in an online survey that provided basic demographic information pertaining to their knowledge about rare diseases, their clinical experience with rare diseases, what further information they considered necessary, and which sources of information they most frequently utilize. Results: Young age, country of dental education, practicing in both public and private settings, as well as the number of hours allocated to dental studies and the opportunity to acquire information on rare diseases with orofacial manifestations, all seem to affect the level of knowledge. Conclusions: Developments in the field of rare disease are constantly ongoing, and improvements in post-graduate dental studies about them should keep pace. The results of the current study reveal the areas upon which such curricula should focus with respect to dental practitioners.

Should dental schools adopt teledentistry in their curricula? Two viewpoints

INTRODUCTION

Teledentistry is a cutting edge technology that could be used to improve access to care to underserved populations and those in remote areas.

OBJECTIVES

To discuss the advantages and disadvantages of adopting teledentistry into the predoctoral dental curriculum.

METHODS

Two teams of dentists reviewed the pros and cons of introducing teledentistry into the predoctoral dental curriculum.

RESULTS

Viewpoint 1 produced evidence that teledentistry is a cutting-edge technology that can improve access to care for underserved populations in a practical, cost-effective manner. Viewpoint 2 showed evidence that teledentistry is too new to have an evidence base to support its widespread use, legal and regulatory requirements have not been established and there is no precedent for third party payers to reimburse for this service.

CONCLUSION

The authors feel that a national teledentistry policy should be developed starting at the state level with stakeholders from the dental profession, dental education, government, patient advocates, and third party payers working together to determine the best way forward.

Teledentistry in the diagnosis of oral lesions: A systematic review of the literature

OBJECTIVE

The purpose of this systematic review is to summarize information on the use of teledentistry in the diagnosis of oral lesions.

MATERIALS AND METHODS

A systematic literature search conducted in August 2018 included articles published until December 2018 in 4 databases. Two reviewers evaluated the search results separately. If they were uncertain as to whether to include an article, a third reviewer made the final decision. Studies related to the diagnosis of oral lesions using teledentistry were included. The methodological quality of the studies was analyzed using the Quality Assessment of Studies of Diagnostic Accuracy.

RESULTS

Eleven articles were included in the study. The selected articles were published between 1999 and 2018, predominantly in developing countries. The professionals acting as patient examiners are dental students and dentists, as well as other health professionals. Most of the patients evaluated in the studies were from rural populations or locations distant from large centers. The tools used to obtain patient data were smartphones, videoconference, email, questionnaires, histopathological exams, and telemedicine applications and systems. Most studies concluded that there is a high level of agreement between teledentistry and clinical consultation and that the use of this resource for diagnostic purposes can reduce costs and the travel time to consult a specialist personally. Nine of the 11 studies were of good quality.

CONCLUSIONS

Teledentistry has the potential to improve the care quality related to diagnosis and management of oral lesions, shortening distances between patients who need specialized diagnoses and specialists.

[Teledentistry during covid-19]

Objective

To describe the usefulness of teledentistry during the COVID-19 pandemic and how virtualization can benefit dentists and patients.

Methods

The bibliographic search will be carried out using the main data sources of international literature on health sciences (MEDLINE) databases up to September 30, 2020 with no language restriction. The information sought will include publications on the benefits in tele-dentistry during the COVID-19 pandemic using the search terms "Teledentistry, COVID-19, Telehealth, and video consultation".

Results

Triage will be carried out virtually. Patient data, signs and symptoms of discomfort, medical history, among other variables. will be recorded. Cases of emergency or urgency will be treated in person, while a COVID-19 questionnaire including symptoms, travel history and contact with COVID-19 patients will be given by telephone.

Conclusions

Teledentistry is being used for giving advice and to triage patients with symptoms and emergency treatments.

Teledentistry and mHealth for Promotion and Prevention of Oral Health: A Systematic Review and Meta-analysis

The dental profession has experienced a dramatic acceleration in the use of communication systems and information-based technologies over recent years, originating new paradigms for the prevention and promotion of oral health. The purpose of this systematic review was to determine the effect of teledentistry-based (telematic) strategies, reported in randomized controlled trials and quasi-randomized trials, with a focus on oral health prevention and promotion-related outcomes in patients of all ages. We searched Medline via PubMed, SCOPUS, and Web of Science from inception until August 2020, regardless of the language of publication. We selected studies for inclusion and conducted data extraction, assessed risk of bias (Cochrane tool), and evaluated the certainty of the evidence (GRADE approach) in duplicate and independently. Out of 898 potentially eligible references, we selected 43 for full-text screening, of which 19 studies proved eligible: 18 randomized controlled trials and 1 quasi-randomized study. Virtual interventions were mostly asynchronous via apps (n = 9), text messages (n = 9), or computer-aided learning (n = 1). The use of teledentistry as compared with conventional strategies may result in a large reduction in the plaque index (standardized mean difference, -1.18; 95% CI, -1.54 to -0.82; I² = 92%; low certainty) and will likely result in a large reduction in the gingival index (standardized mean difference, -2.17; 95% CI, -3.15 to -1.19; I² = 97%; moderate certainty) and in the incidence of white spot lesions (risk ratio, 0.48; 95% CI, 0.35 to 0.66; I² = 0%; moderate certainty), with an increased effect over time. Evidence suggests that teledentistry, particularly mHealth (messages and apps), is a promising clinical tool for preventing and promoting oral health, especially under the accelerated virtualization of dentistry. Future studies should include a broader spectrum of the population, including adults and elders, to better inform policy and implementation of teledentistry (PROSPERO: CRD42020192685).

COVID-19 and Orthodontics: An Approach for Monitoring Patients at Home

Aim:

The aim of this study was to test an experimental approach involving the remote monitoring of orthodontic patients through the use of their smartphones.

Background:

Due to the COVID-19 emergency, dental offices were asked to stop elective treatments; suddenly orthodontic patients found themselves isolated at home, without the possibility of monitoring by their orthodontists. The use of telemonitoring via smartphones can be a quick way to recover the orthodontist-patient relationship, monitor and continue the treatment.

Objective:

The purpose of this study was to propose an innovative, simple and reliable approach for the remote management of orthodontic patients.

Methods:

137 patients were contacted verbally by phone and via WhatsApp®; they were asked to send a set of photographs taken with their smartphone. They were asked to complete a questionnaire to evaluate the effectiveness of the approach. Descriptive statistics (frequency with percent) of questionnaire results and the presence of procedural errors while taking pictures were calculated. Correlations between different questionnaire answers were analyzed with the Chi-Square test. Variables with p < 0:05 were declared as significant.

Results:

The majority of patients considered that this approach was positive and they did not feel abandoned. Difficulties emerged from a technical point of view, that is, in terms of photoshoot, and part of the patients expressed perplexity regarding the fact that telemonitoring can replace completely an outpatient visit.

Conclusion:

The use of telemonitoring managed to recreate a relationship with the orthodontist, especially in emergency periods.

Impact of COVID-19 on the Knowledge and Attitudes of Dentists toward Teledentistry

INTRODUCTION

The coronavirus disease 2019 (COVID-19) pandemic has created a new scenario for dental practice, and teledentistry (TD) is a field of relevance for dentists.

OBJECTIVE

To evaluate the impact of the COVID-19 pandemic on the knowledge, practices, and expectations of dentists toward TD and its association with sociodemographic variables.

METHODS

A cross-sectional survey was administered to dentists in Colombia as part of global research on the impact of COVID-19 on dentistry. The core questionnaire included 5 additional questions on TD that were added by the Colombian research team in 5 domains about TD: Q1, knowledge; Q2, practices; Q3, expectations; Q4, usefulness; and Q5, reimbursement. Sociodemographic variables were also measured. The questionnaire was validated in a pilot test and administered via digital media. Descriptive and bivariate analysis for sociodemographic and TD variables were done. For the evaluation of the chances of a determined answer, an ordinal multinomial logistic regression (Q1 and Q2) and binomial logistic regression (Q3 and Q5) analyses were made.

RESULTS

In total, 5,370 dentists answered the survey (women: 3,878; mean age: 45 y). The response rate of the survey was 16.84%. Knowledge and practice of TD before the COVID-19 pandemic were both low (25.75% and 12.42%, respectively); however, since the beginning of the current pandemic, knowledge increased by 62.72% and practice by 42.53%. Some 93.1% of respondents considered that TD could be useful in their clinical practice, and 59.55% would consider practicing it after the pandemic. A high number of dentists (88.58%) did not charge for these services. Logistic regressions showed significant differences according to sociodemographic variables.

CONCLUSIONS

The COVID-19 pandemic has had a great impact on TD, increasing knowledge and practice significantly. Dentists expect to continue practicing TD in the future. However, some geographical, technological, and attitudinal barriers need to be broken down to increase daily use of TD.

KNOWLEDGE TRANSFER STATEMENT

This article provides an overview about the impact of COVID-19 pandemic in the knowledge and attitudes about teledentistry (TD) in general dentists and both clinical and nonclinical specialists. Although some barriers to the use of TD continue, this pandemic brought with it a new scenario for dental practice, which must be implemented through training for professionals to increase its use.

Use of smartphone video calls in the diagnosis of oral lesions: Teleconsultations between a specialist and patients assisted by a general dentist

BACKGROUND

Teleassistance in dentistry enables the support of dentists in areas without access to specialists. The aim of this study was to assess the feasibility and accuracy of synchronous teleconsultation in oral medicine.

METHODS

Patients referred for specialized care owing to oral lesions were evaluated in person by a general dentist who obtained photographs of the lesions with a smartphone. The images were sent via a mobile application to an oral medicine specialist, with whom a video call was initiated on the same instant messaging application. After interviewing the patient, the specialist formulated a diagnostic hypothesis and suggestions for case management. Then a second specialist, blinded to the first evaluation, assessed the oral lesion in person and defined a diagnosis, which was considered as the reference standard. Diagnoses from the remote and the face-to-face consultations were compared in percentage levels of agreement and κ coefficient.

RESULTS

Thirty-three patients, 25 through 83 years old, had 41 oral lesions. The average teleconsultation length was approximately 10 minutes. In 92.7% of the cases, there was concordance between the telediagnosis and the reference standard (κ = 0.922).

CONCLUSIONS

Synchronous teleconsultation can provide reliable remote diagnosis through the support to primary care health care professionals in management of oral lesions.

PRACTICAL IMPLICATIONS

Earlier diagnosis of malignancies, improvement of access for unassisted populations, and reduction of unnecessary referrals are possible practical implications of remote support of a specialist in the management and diagnosis of oral lesions.

Dental Emergencies Management in COVID-19 Pandemic Peak: A Cohort Study

Due to the global coronavirus disease 2019 pandemic, the high risk of cross-contamination and the overload of hospital facilities have resulted in a real urgency for restricting dental emergency patient flow. In this context, the objectives of the current work were to 1) measure the ability of a triage-based management strategy to limit patient admission and 2) evaluate the success rate of both on-site and remote emergency management regarding symptom relief and pain control over a 1-mo period. We included all patients contacting the dental medicine department for an emergency consultation during the lockdown, between April 1 and April 30, 2020 (N = 570). Following a telephone consultation and based on preestablished admission guidelines, a decision was made at baseline (T0) to either admit the patient for treatment or perform remote management by providing advice and/or drug prescription. Patients were then followed up systematically at 1 wk and 1 mo. Management failure was defined as the need for emergency admission for patients managed remotely since T0 and for new emergency admission for those admitted at T0. The global follow-up rate of patients with a complete data set was 91.4% (N = 521). Of included patients, 49.3% could be managed without admission for emergency reasons for 1 mo. The proportion of successful management was 71.8% and 90.2% at 1 mo for remote and on-site management, respectively. To conclude, the proposed triage-based emergency management strategy with systematic follow-up was a good compromise between limiting patient admission and ensuring effective symptom relief and pain control. The strategy can be useful in situations where regulation of the emergency patient flow is required.

The role of teledentistry in oral surgery during the COVID-19 pandemic

Objectives

Evaluation of patient experience of teledentistry during the coronavirus pandemic and establishing the clinical effectiveness of teleclinics in this context.

Methods

103 follow-up patients who had a telephone review during the pandemic were included. A five-item, five-point Likert-scale telephone survey was used to gauge patient experience. In addition, retrospective analysis of these patients' electronic records was done to establish effectiveness of the telephone review. Patients’ responses and data collected were then analysed.

Results

In terms of patient experience of their telephone review, 70% found the telephone review was useful, 77% felt their concerns were addressed, 99% felt it was easy to access and time saving, 94% felt they could discuss their healthcare matters on the phone, and 62% felt they preferred telephone reviews rather than face-to-face reviews for their follow-up appointments.

When analysing effectiveness of the telephone review, 62% of patients could be discharged following the teleconsultation, suggesting it was sufficient alone to complete these patients’ care. All relevant clinical information was present for 98% of the teleconsultations to proceed. Results showed teledentistry was particularly effective for follow-up patients requiring a post-operative review or finalisation of treatment plans.

Conclusion

Patients had a positive experience of telephone clinics for the provision of their routine follow-up care. In addition, teledentistry is shown to be a means of increasing capacity for face-to-face reviews, in turn reducing waiting times and further improving patient experience. Appropriate case selection for teledentistry is essential. Teledentistry is an efficient and effective tool for patient care when used suitably and can have an important role in routine patient care beyond the pandemic.

Role of Teledentistry in COVID-19 Pandemic: A Nationwide Comparative Analysis among Dental Professionals

OBJECTIVES

 To assess knowledge, awareness, and practice of health care workers about the role of teledentistry in coronavirus disease 2019 (COVID-19).

MATERIALS AND METHODS

 A prevalidated structured questionnaire was used to evaluate awareness of general dentists, postgraduate dental students, dental educators, and consultants with postgraduation degrees toward teledentistry. The acceptability, reliability, and language clarity were also pretested. A total of 510 dental professionals contributed to this study.

STATISTICAL ANALYSIS

 A statistical analysis using SPSS (version 20.0) was performed. Responses were noted as yes or no. A p-value of ≤ 0.05 was considered to be significant. Frequencies described data. Chi-square test was performed for intergroup comparison to evaluate if the knowledge and attitude diverge with the increase in the level of seniority in the profession.

RESULTS

 Awareness regarding teledentistry is high among general dentists with bachelor of dental surgery qualification in comparison to final-year students and postgraduate dental students. The majority of participants agreed with improvement in health care (88.20%), access to rural areas (82.90%), and general practicing dentist agreed with statistically significant difference (0.00) on saving time by teledentistry.

CONCLUSION

 General practicing dentist was observed with high awareness of teledentistry as compared with postgraduate and undergraduate dental students.

Teledentistry awareness among dental professionals in Saudi Arabia

Background

Teledentistry is believed to improve dentalcare provided to patients and time management efficiency. In addition, teledentistry can be a useful tool for peer education, consultations and ensures proper channeling for referrals.

Objective

This study aimed to explore Saudi Arabian dental professionals' perceptions of teledentistry's benefits in improving dental practice and patient care.

Methods

A descriptive cross-sectional study involving an electronic survey of a sample of Saudi Arabian dental professionals. A validated 26-item, 5-point Likert-scale questionnaire was used to assess perceptions of dental professionals in four domains: usefulness of teledentistry for patients, the usefulness of teledentistry for dental practice; the potential of teledentistry to improve practice; and existing concerns about the use of teledentistry. Statistical analyses involved descriptive statistics, bivariate analysis using SPSS software. Significant differences were considered at a p-value of 0.05.

Results

With an overall response rate of 28.6%, 286 dental professionals participated in the study. More than 70% of respondents agreed or strongly agreed that teledentistry would improve dental practice through enhancing communication with peers, guidance and referral of new patients. A substantial proportion of respondents (60–70%) expressed uncertainty with technical reliability, privacy and diagnostic accuracy. The participants' qualification was statistically significant with usefulness of teledentistry for patients (p = 0.027), while work experience in years was statistically significant with both usefulness of teledentistry for dental practice and patients (p = 0.046 and <0.0001 respectively).

Conclusion

Generally, the feedback gained by this study showed readiness of the dental professionals to be engaged in the teledentistry approach. Further investigation of the business model of teledentistry is needed to understand the readiness and challenges. Directed campaign to educate dentists and the public of the technology and it is potential is necessary.

Telemedicine in Oral and Maxillo-Facial Surgery: An Effective Alternative in Post COVID-19 Pandemic

The aim of this work was to demonstrate the advantages of using telemedicine (TM) in the management of the outpatients with maxillofacial surgical pathologies during the COVID-19 pandemic. The study was conducted at the MaxilloFacial Surgery Unit of “Magna Graecia” University of Catanzaro, on two different groups of patients: a group of follow-up patients (A₁: patients in oncological follow-up after surgical treatment performed before the COVID-19 pandemic; A₂: suffering from chronic lesions such as precancerous lesions), and a group B of patients with first urgent visits (B₁: patients with suspected oncological pathology; B₂: patients with suspected urgent disease such as medication-related osteonecrosis of the jaws (MRONJ), odontogenic abscesses, temporomandibular joint (TMJ) dislocation, etc.). Participation in the study required possession of a smartphone with Internet access, e-mail and the use of a messaging service (WhatsApp or Telegram) to send photos and messages; completion by the patient of a COVID-19 screening questionnaire; submission of a satisfaction questionnaire by the doctors and patients. A total of 90 patients were included in this study. A high percentage of satisfaction emerged from the analysis of the satisfaction questionnaires of both patients and doctors.TM thus represents an excellent opportunity to improve accessibility to oncological and non-management activities, reducing the risk of Covid-19 dissemination and should be promoted and implemented in the post-pandemic era.

Accuracy of remote diagnoses using intraoral scans captured in approximate true color: a pilot and validation study in teledentistry

BACKGROUND

Intraoral scans (IOS) provide three-dimensional images with approximate true colors representing a possible tool in teledentistry for remote examination. The aim of the present cross-sectional validation study was, therefore, to evaluate the levels of agreement between remote diagnoses derived from IOS and diagnoses based on clinical examinations for assessing dental and periodontal conditions.

METHODS

The test sample comprised 10 patients representing different clinical conditions. Following the acquisition of IOS (Trios, 3Shape), a full-mouth dental and periodontal examination was done and periapical radiographs were taken. Ten dentists were asked to perform dental and periodontal scorings for each of the ten patients on a tablet computer presenting the IOS. Scores included diagnosis of gingivitis/periodontitis, and evaluated presence as well as amount of plaque and calculus, and presence of teeth exhibiting gingival recession, furcation involvement, erosion, tooth wear, stain, and non-carious cervical lesion, as well as presence of decayed, filled, and crowned teeth and implants. In a second round of assessments, the periapical radiographs were provided and the dentists were able to change the scores. The time for the remote assessment was recorded. The agreement between remote and clinical scorings (reference) was then analyzed descriptively.

RESULTS

The mean time for the tele assessment was 3.17 min and the additional consultation of the radiographs accounted for another 1.48 min. The sensitivity and specificity values were 0.61 and 0.39 for gingivitis and 0.67 and 0.33 for periodontitis, with no relevant changes when radiographs were provided for the diagnosis of periodontitis (0.72 and 0.28). The agreement for dichotomized dental and periodontal indices ranged between 78 and 95%. With the provision of radiographs, the remote examiners were able to detect existing filled teeth, crowned teeth, and implants, whereas the detection of decayed teeth (70%) was not improved.

CONCLUSIONS

The remote examination using IOS was effective in detecting dental findings, whereas periodontal conditions could not be assessed with the same accuracy. Still, remote assessment of IOS would allow a time-efficient screening and triage of patients. Improvement of the image quality of IOS may further allow to increase the accuracy of remote assessments in dentistry. According to the Swiss Regulation this investigation is not a clinical trial and therefore no registration in a WHO-registry is needed.

Palliative dental care: Ignored dimension of dentistry amidst COVID-19 pandemic

Palliative care (PC) represents an approach that encompasses the procedures to relieve pain and distressing symptoms and maintain function as much as possible in the terminally ill patient until death. PC dentistry (PCD) is an approach for providing supportive and palliative dental care in patients with serious life-threatening illness (cancer, chronic heart failure, chronic obstructive pulmonary disease and cognitive impairment). The care is provided at different time points of diseases (i.e., from in-therapy care to survivorship care to end-of-life care). Dentists have a significant role to play in the multidisciplinary team of PC. Oral health problems (ulcers, mucositis, pulpitis and abscess) have a negative impact on general health and quality of life and can be acutely debilitating in these patients. These patients with existing comorbidities are at increased risk of developing oral complications. Furthermore, social isolation can cause an increase in anxiety, hopelessness, psychosocial and existential suffering amongst these patients. It is essential to incorporate PCD in the guidelines of critical dental care during the COVID-19 pandemic to decrease the suffering of these patients by symptom management. Teledentistry can be used with caution to provide at-home care to such patients during the pandemic.

Teledentistry during COVID-19 pandemic

BACKGROUND AND AIMS

Dentistry involves close face-to-face interaction with patients, hence during the COVID-19 pandemic, it has mostly been suspended. Teledentistry can offer an innovative solution to resume dental practice during this pandemic. In this review, we provide a brief overview of applications of teledentistry.

METHODS

Articles on teledentistry, relevant to this review, were searched and consulted from PubMed, Google Scholar, and Cochrane database.

RESULTS

Teledentistry is the remote facilitating of dental treatment, guidance, and education via the use of information technology instead of direct face-to-face contact with patients. Teleconsultation, telediagnosis, teletriage, and telemonitoring are subunits of teledentistry that have important functions relevant to dental practice. There are many challenges for acceptance of teledentistry by the dentists as well as patients, which need to be addressed urgently.

CONCLUSION

Teledentistry can offer a novel solution to resume dental practice during the current pandemic, hence, the need of the hour is to incorporate teledentistry into routine dental practice. If not fully replace, at least teledentistry can complement the existing compromised dental system during the current pandemic.

A Dental Response to the COVID-19 Pandemic-Safer Aerosol-Free Emergent (SAFER) Dentistry

Dental services are significantly impacted by the COVID-19 pandemic. Almost all dental procedures carry a high infection risk for providers and patients due to the spread of aerosols. As a consequence, public health agencies and professional associations have issued guidelines for enhanced infection control and personal protection equipment and have also limited care to urgent or emergency services. However, there is no dental service concept for pandemic disaster preparedness or response that might be applied. Moreover, pathways to dental care provision in a post-pandemic future with persisting risks are needed. We propose Safer Aerosol-Free Emergent Dentistry (SAFER Dentistry) as one approach to dental services during and emerging from the pandemic. The concept's starting point is the identification of the most common patient needs. The next step is to replace common treatments addressing the most frequent needs with alternative interventions involving a lower infection risk because they do not generate aerosols. SAFER Dentistry is innovative, avoids risk, and responds to the requirements of a pandemic and post-pandemic emergency where the risk of airborne disease transmission remains high. SAFER Dentistry thereby ensures continuity of dental services while protecting providers and patients from infectious pathogens. Moreover, SAFER Dentistry allows dental service providers to remain operational and generate income even under pandemic conditions. Potential implementation and policy options for SAFER Dentistry include universal availability without co-payments by patients and a uniform bundled payment scheme for providers to simplify budgeting, reimbursement, and administration during a pandemic. Adaptations and adjustments of the concept are possible and encouraged as long as the principle of avoiding aerosol-generating procedures is maintained.

Application of the unified theory of acceptance and use of technology model to predict dental students' behavioral intention to use teledentistry

Teledentistry is an innovative technology that can be used to improve access to care and oral health outcomes. Dental students' intention to use teledentistry after completing dental school has not been investigated.

PURPOSE

The unified theory of acceptance and use of technology (UTAUT) was used to predict intentions to use teledentistry among 4th-year U.S. dental students.

METHODS

A cross-sectional approach was performed for a 7-week period in Spring 2019. All U.S. dental schools (N = 66) were invited to participate and 16 schools agreed to participate. An anonymous survey link was emailed to academic deans for dissemination to students. A total of 1416 4th-year dental students received the anonymous survey link and 210 students completed the survey (response rate = 14.8%). The survey included questions and scales that measured the UTAUT constructs of performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), and behavioral intentions (BI). Data were analyzed using SPSS version 24. The study was deemed exempt by institutional review board.

RESULTS

The dental students' BI to use teledentistry was significantly predicted by PE (R² = 33%, P < 0.01), EE (R² = 24%, P < 0.01), SI (R² = 24%, P < 0.01), and FC (R² = 14%, P < 0.01). The UTAUT model was statistically significant in predicting the BI and explained 40% of BI variance (R² = .40, P < 0.01).

CONCLUSIONS

Dental students' perceptions about PE, EE, SI, and FC were associated with BI. Therefore, exposure to teledentistry while in dental school could increase the likelihood of use as a practicing provider.

COVID-19 and Inequities in Oral Health Care for Older People: An Opportunity for Emerging Paradigms

KNOWLEDGE TRANSFER STATEMENT

This article provides an overview of the oral health situation imposed by COVID-19 and the minimal intervention alternatives to provide care to older people who are at risk and have reduced access to care.

Feasibility and acceptability of an oral pathology asynchronous tele-mentoring intervention: A protocol

Introduction: Oral cancer remains prevalent, despite being largely preventable. The widespread use of technology at chairside, combined with advances in electronic health record (EHR) capabilities, present opportunities to improve oral cancer screening by dentists, especially for disadvantaged patients with severe health needs. Design and methods: Using a mixed-methods approach, we will evaluate the feasibility and acceptability of integrating a telementoring component into the identification of oral lesions using the following 3 methods: 1) administering provider surveys that consist of a checklist of 10 key components of the intervention based on process, and asking the dental provider subjects if each one was covered; 2) conducting semi-structured interviews informed by the Consolidated Framework for Implementation Research and the Implementation Outcomes Framework with dental resident subjects to assess specific barriers to sustaining the intervention and strategies for addressing these barriers to facilitate integration of the intervention into the routine workflow of the dental clinics; and 3) administering brief exit interviews with patient subjects regarding the acceptability of the intervention to assess satisfaction with the use of intra-oral cameras at chairside to screen for and refer patients with oral lesions and identification of these oral lesions via EHR and secure e-mail tele-mentoring with an oral pathology expert. Expected impact of the study for public health: If successful, then later clinical trials will maximize the external validity of the intervention and facilitate the widespread implementation and dissemination of the model for the teaching of dentists and residents, with the ultimate goal of improving patient care.

Can Teledentistry Improve the Monitoring of Patients during the Covid-19 Dissemination? A Descriptive Pilot Study

The aim of this pilot study was to describe the advantages of telemedicine (TM) in dental practice during the current national emergency condition due to the Covid-19 dissemination. At Department of Oral Surgery and Pathology—Magna Graecia University of Catanzaro, regional reference center for Covid-19—two groups of patients were determined: patients with urgent conditions (group U) and patients in follow-up (group F). Both groups were instructed to implement remote consultations using a messaging service (WhatsApp Messenger, WhatsApp Inc., Mountain View, California, USA) to send photos. A total of 418 photos were collected by 57 patients. Thirty-four photos were obtained by five patients in the U group after surgical procedures. All patients sent photos on the established evening, except for two patients who sent two photos outside the set days. In the F group, 384 photos were collected by 52 patients. None of them sent more photos than the number that was established by the protocol. Telemedicine allowed a monitoring of all patients, reducing costs and limiting human contact, decreasing the risk of Covid-19 dissemination.

How Has Teledentistry Been Applied in Public Dental Health Services? An Integrative Review

Background: There are inequities in the provision of oral health care, and a large proportion of the population face challenges in accessing public dental health care options. Introduction: Teledentistry (TD), a new branch of telemedicine dedicated to dentistry, is a potential approach that can be used to overcome these challenges. Therefore, the purpose of this integrative review was to collect information regarding the inclusion of the application of TD tools in the public dental health services. Methods: Five electronic databases (PubMed/Medline, Virtual Health Library, CINAHL, Scopus, and Web of Science) were searched for relevant articles if they reported on original data related to the use of TD in public dental health services. Results/Discussion: Twenty-four studies met the inclusion criteria and were, consequently, included in the review. Our key findings indicated that TD can be used for training and continuing education of professionals, for remote patient care, to exchange information among health professionals, and orientation. It increases the access to dental care and enables general practitioners to interact with specialties. The benefits include cost-effective health equity services, improve dental knowledge, and reduce consultation waiting time. However, despite the advances made with the use of this technology, there are still some obstacles to overcome, such as limited infrastructure, low levels of motivation and the lack of compliance, professional resistance, and legal and security issues. Conclusion: TD may be very a useful tool for dental public health increasing the quality of the care by improving access, professional education, and patient satisfaction.

Effectiveness of the Distance Learning Strategy Applied to Orthodontics Education: A Systematic Literature Review

Introduction: Tele-education refers to the use of interactive distance learning technologies. The objective of this systematic review was to evaluate the impact of tele-education in the field of orthodontics. Methods: This systematic review has been registered in PROSPERO and followed PRISMA guidelines. Two independent researchers reviewed the literature available in the databases of PubMed/MEDLINE, Bireme, the Cochrane Library, EMBASE, TRIP, SCIELO, LILAS, SCIENCEDIRECT, and Google Scholar using the following descriptors: "Education, Distance" OR "e-learning" AND "Orthodontics," including only interventional studies. The descriptive synthesis was conducted according to the Center for Reviews and Dissemination. The analysis of the biases was conducted using the MINORS protocol, and the analysis of the interventions using Kirkpatrick's method was evaluated. Results: Of the 15 remaining articles for complete reading, 4 were excluded for not meeting the inclusion criteria, leaving 11 articles for evaluation in the systematic review. Eight articles emphasized the evaluation of the distance education materials available, achieving a high percentage of acceptability among students, two cited only satisfaction, and one article evaluated the practical performance of the students. Conclusion: The results showed that orthodontic distance learning is an effective but complementary element, with no significant differences, to the traditional method of teaching.

Dental emergencies at sea: A study in the French maritime TeleMedical Assistance Service

INTRODUCTION

The aim of the study was to assess the frequency, features and management of dental emergencies at sea in France.

METHODS

A descriptive study was carried out by retrospectively examining medical records of patients who were assisted by the French maritime TeleMedical Assistance Service (TMAS) from 2012 to 2016. Data were ranked in different categories: socio-demographic data, diagnosis, prescription, and monitoring or treatment prescribed.

RESULTS

The TMAS recorded 9122 medical files for all medical emergencies. Among these medical records 135 concerned oral diseases. The main causes for dental emergencies are dental abscess (51.8%), tooth decay (33.3%), and dental fracture (8.9%). Even where teledentistry is validated for remote screening and oral lesion diagnosis, management of dental emergencies mostly requires a dental procedure. On board, without special equipment and/or specifically trained healthcare workers, this management often results in the prescription of medication.

DISCUSSION

The International Medical Guide for Ships published by the World Health Organization could be updated to suit the latest recommendations of dental emergency management. This could facilitate the addition of a medical act to dental management, resulting in more effective treatment. Furthermore, simple and specific equipment could be added to the medical supplies.

Analysis of the asynchronous dental teleconsulting of Telehealth Brazil Networks in Minas Gerais

This cross-sectional study aimed to evaluate the asynchronous dental teleconsulting of Telehealth Brazil Networks Program in Minas Gerais. Data were collected from secondary databases of the Clinical Hospital of the Universidade Federal de Minas Gerais (CH/UFMG) and Medical School of UFMG (MS/UFMG), from July 2015 to July 2017. The variables analyzed were telehealth center, sex and profession, date and time questions and answers, response time in days, whether the issue was duly addressed, whether the teleconsulting was attended, post status, professional's satisfaction, conduct adopted after teleconsulting, dental specialty area, and type of issues. Sociodemographic data from the Intermediate Geographical Regions (IGR) of Minas Gerais, including the Municipal Human Development Index (MHDI) and Gini Index were also collected. The results were analyzed using SPSS v.22.0. In total, 3,920 teleconsulting were recorded, with increasing demand in the study period. Most were requested by dentists (93.3%) and female professionals (78.6%), during office hours (78.6%), and related to general conducts (72.1%). Almost all were attended (99.7%), with a maximum response time of two days (75.0%). A low feedback on satisfaction and resolution of issues (missing data of 57.2% and 70.2%, respectively) was recorded. Only 5.2% had information on whether patients were referred. The most common inquires were of issues about Pathology/Stomatology specialties (19.0%) and Pharmacology/Anesthesiology (18.8%). The response occurred within the expected time, with prevalent issues in basic dental areas and general conducts. Feedback from professionals must be encouraged to allow a better analysis and improvements of the program.

Assessment of early orthodontic treatment on functional shifts by telemonitoring mandibular movements using a smart phone

Introduction

To assess effect of orthodontic treatment on anterior or lateral functional shift in mixed dentition stage by telemonitoring mandibular movements in four-dimensions using a novel objective method that can assist in orthodontics and other dental specialties without the need of expensive, bulky or complicated equipment.

Methods

A sample of 60 patients was divided into two groups. Group I included 30 patients with normal occlusion and TMJ functions. Group II included 30 patients that were diagnosed with an abnormal path of closure in antero-posterior or transverse directions due to disharmony between centric occlusion and centric relation. The latter group was orthodontically treated and mandibular movements were measured before, during, directly after orthodontic treatment, and one year after treatment using our proposed method. To evaluate validity and reliability of our method, it was compared with two methods, a commercially available mandibular scanner, and a low-cost graphical method that utilizes a sheet of wax and a stylus.

Results

It was found that the overall differences between opening and closing curves of our proposed method and the other two methods were small and negligible (p > 0.05).

Discussion

It was found that our proposed method is offering a reasonably accurate, simple and rapid way to telemonitor the mandible movements in four-dimensions using the rear/front camera of any smart-phone.

An integrated oral health program for rural residential aged care facilities: a mixed methods comparative study

BACKGROUND

People in residential aged care facilities (RACF) are at very high risk of developing complex oral diseases and dental problems. A multidisciplinary approach incorporating oral health professionals and RACF staff is important for improving and sustaining oral health in RACFs. However, difficulties exist with access to oral health services for RACFs, particularly those in regional and rural areas. This study investigated the impact and experience of an integrated oral health program utilising tele-dentistry and Oral Health Therapists (OHT) in RACFs in a rural setting within Australia.

METHODS

A mixed method comparison study was undertaken. Two hundred fifty-two clinical audits were completed across nine facilities with and without access to the integrated oral health program. Twenty-seven oral health quality of life surveys were completed with eligible residents. One focus group discussions (FGD) and eight interviews were completed with RACF staff. Thematic analysis was conducted on the transcribed FGDs and IDIs. Quantitative data were analysed using descriptive statistics.

RESULTS

Audits showed an improved compliance to Australian Aged Care Quality Accreditation Standards for oral health in the facilities with access to the integrated program compared to those without the program. Thematic analysis revealed that facilities with the integrated program reported improvements in importance placed on OH, better access to OH services and training, and decreased disruption of residents, particularly those with high care needs.

CONCLUSIONS

The integrated oral health program incorporating OHTs and tele-dentistry shows potential to improve the oral health outcomes of residents of RACFs. Improvements for managing oral health of residents with high care needs were observed. RACFs without easy access to an oral health service will also likely benefit from the increased support and training opportunities that the program enables.