Comparing the outcomes of gold-standard dental examinations with photographic screening by mid-level dental providers

The utilisation of teledentistry in Australia: A systematic review and meta-analysis

BACKGROUND

Teledentistry is the usage of information-based technologies to deliver healthcare services remotely. It is used to deliver care in regional, rural and remote regions and was particularly useful to deliver care during the COVID-19 pandemic.

OBJECTIVE

This systematic review and meta-analysis aimed to determine teledentistry utilisation in Australia.

METHODS

The databases PubMed, Google Scholar, EMBASE and Web of Science were searched from inception to June-2024. The phrases "Dental" AND "Telehealth" AND "Australia" and "Teledentistry" AND "Australia" were used. Two authors completed the study selection and data extraction. The Joanna Briggs Institute Critical Appraisal Tools were used to assess quality and bias.

RESULTS

Eighteen articles met the inclusion criteria. There were six diagnostic tests, six cross-sectional studies, 4 economic evaluations, one qualitative study and one expert opinion. Teledentistry was accurate for screening caries (average sensitivity=69.7 %, average specificity=97.4 %). There also appeared to be a non-significant negative correlation between specificity and sensitivity (r = 0.432). Opinions regarding teledentistry were mixed from clinicians but positive from patients. Teledentistry may also lead to savings for patients and healthcare providers.

CONCLUSION

Teledentistry increases healthcare access especially for people in regional, rural and remote areas. It is an effective screening tool for caries. Whilst the opinions of clinicians were mixed, potential implementation barriers were identified which could improve opinions of clinicians and increase implementation.

CLINICAL IMPORTANCE

This study demonstrates teledentistry as a satisfactory tool for screening caries. This could be beneficial to those with difficulties visiting dentists in-person, particularly if they live in regional, rural or remote areas.

Teledentistry accuracy for caries diagnosis: a systematic review of in-vivo studies using extra-oral photography methods

BACKGROUND

Dental caries is a global public health concern, and early detection is essential. Traditional methods, particularly visual examination, face access and cost challenges. Teledentistry, as an emerging technology, offers the possibility to overcome such barriers, and it must be given high priority for assessment to optimize the performance of oral healthcare systems. The aim of this study was to systematically review the literature evaluating the diagnostic accuracy of teledentistry using photographs taken by Digital Single Lens Reflex (DSLR) and smartphone cameras against visual clinical examination in either primary or permanent dentition.

METHODS

The review followed PRISMA-DTA guidelines, and the PubMed, Scopus, and Embase databases were searched through December 2022. Original in-vivo studies comparing dental caries diagnosis via images taken by DSLR or smartphone cameras with clinical examination were included. The QUADAS-2 was used to assess the risk of bias and concerns regarding applicability. Meta-analysis was not performed due to heterogeneity among the studies. Therefore, the data were analyzed narratively by the research team.

RESULTS

In the 19 studies included, the sensitivity and specificity ranged from 48 to 98.3% and from 83 to 100%, respectively. The variability in performance was attributed to factors such as study design and diagnostic criteria. Specific tooth surfaces and lesion stages must be considered when interpreting outcomes. Using smartphones for dental photography was common due to the convenience and accessibility of these devices. The employment of mid-level dental providers for remote screening yielded comparable results to those of dentists. Potential bias in patient selection was indicated, suggesting a need for improvements in study design.

CONCLUSION

The diagnostic accuracy of teledentistry for caries detection is comparable to that of traditional clinical examination. The findings establish teledentistry's effectiveness, particularly in lower income settings or areas with access problems. While the results of this review is promising, conducting several more rigorous studies with well-designed methodologies can fully validate the diagnostic accuracy of teledentistry for dental caries to make oral health care provision more efficient and equitable.

REGISTRATION

This study was registered with PROSPERO (CRD42023417437).

The accuracy of asynchronous tele-screening for detecting dental caries in patient-captured mobile photos: A pilot study

Objectives

Unaided visual inspection is a primary dental screening technique. Given the uneven distribution of dental services and prolonged waiting periods, an alternative screening approach is required to increase access to dental care. The purpose of this study was to evaluate the accuracy and reliability of tele-screening for detecting dental caries using mobile intra-oral photos taken by participants.

Methods

Dental care seekers attending Umm Al-Qura University Teaching Dental Hospital in 2022 were invited to participate in this study. The participants were initially examined by dental interns at the hospital under the supervision of faculty dentists (reference standard) before intra-oral photos were acquired by a trained sixth-year dental student using a Samsung S10 camera. Following an introduction to the photography guide, the same participants then took intra-oral photos of their teeth at home using their mobile devices, which were all uploaded to WhatsApp for later review. Two trained dental reviewers (sixth-year dental students) independently reviewed the intra-oral photos. Sensitivity, specificity, and Kappa scores were estimated to assess the performance of the tele-screening approach relative to the reference unaided dental examination.

Results

Twenty-three participants, with a mean age of 30 ± 12 years, were enrolled. The mean decayed, missing, and filled teeth (DMFT) was 13.43 ± 5.48. Patient-delivered tele-screening demonstrated a sensitivity, specificity, and inter-rater reliability kappa of 94 %, 90 %, and 0.81, respectively, when compared to unaided dental examination. Dentist-delivered tele-screening approach demonstrated a sensitivity of 88-89 %, specificity of 88-91 %, and kappa score of 0.75-0.79 relative to unaided dental examination.

Conclusions

This study demonstrated that the tele-screening approach based on reviewing intra-oral photos taken by participants can be a valid and reliable alternative to unaided dental examination. This is important for ensuring sustainable access to dental care.

Comparative Evaluation of Dental Caries Score Between Teledentistry Examination and Clinical Examination: A Systematic Review and Meta-Analysis

Dental caries is a common dental health problem affecting all age groups across the globe. Accurate detection and assessment of dental caries are crucial for effective treatment and preventive measures. Teledentistry, which involves remote dental assessment using digital technologies, has shown promise as a potential tool for caries screening. This systematic review and meta-analysis aims to compare the dental caries scores obtained from clinical examinations and teledentistry assessments. Literature searches were conducted across databases such as PubMed, Embase, the Cochrane Library, Scopus, the Web of Science, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), and PsycINFO by using predefined search terms and inclusion criteria. Two reviewers separately extracted the data. The study designs, evaluation techniques, dentition types, mean scores, and follow-up times of the included studies were examined. The New Castle-Ottawa Scale was used to assess the risk of bias. Review Manager (RevMan) (computer program) Version 5.4, The Cochrane Collaboration 2020, was used for the quantitative assessment of the data. Eight studies met the inclusion criteria and were included in the review. The findings revealed that teledentistry assessments (based on intraoral photographs captured using smartphones or intraoral cameras) demonstrated comparable accuracy to traditional clinical examinations in detecting and assessing dental caries. Among the four studies that were quantitatively analysed, no significant difference was noted at p = 0.09. A mean difference of 0.64 (95% confidence interval (CI): -0.10; 1.38) suggested that clinical examination and teledentistry-based checkup were on par with each other for the detection of dental caries. The New Castle-Ottawa scale (NOS) grading indicated that the studies were of good quality. Teledentistry may be an effective approach for identifying and evaluating dental caries. However, further research is required to substantiate the findings observed in the present review.

The feasibility of a digital health approach to facilitate remote dental screening among preschool children during COVID-19 and social restrictions

BACKGROUND

Tele-dentistry can be useful to facilitate screening of children, especially those living in rural and remote communities, and during the COVID-19 pandemic.

AIM

This study evaluated the feasibility of tele-dental screening for the identification of early childhood caries (ECC) in preschoolers using an app operated by their parents with remote review by oral-health therapists.

DESIGN

This cross-sectional study was a sub-project nested in ORIGINS Project, a longitudinal birth cohort study in Western Australia. Initially, children were visually examined by a paediatric dentist (gold standard). Subsequently, dental photographs were taken by parents using a smartphone camera. Two trained oral health professionals asynchronously evaluated dental photographs. The presence of dental caries was recorded as per the International Caries Detection and Assessment System-II classification. The diagnostic accuracy and reliability of the tele-dental screening and the gold standard dental examinations were then compared.

RESULTS

Forty-two children aged <4 years were enrolled in the study. Twenty-five per cent of examined children had dental caries (mean dmfs = 0.7). A total of 370 dental photographs were obtained. Parents were able to take good-quality photographs, with 90% of photographs rated as good to fair quality. Tele-dental screening demonstrated high specificity (>=95.5%) for both reviewers compared to the gold standard dental examination. However, the sensitivity scores for the two reviewers varied, ranging from 44% to 88.4%.

CONCLUSION

Tele-dental screening for ECC was shown to be a feasible approach following a brief training for primary caregivers. This approach can offer a potential low-cost and sustainable alternative for visual dental examinations for young children, particularly in times of COVID-19-related restrictions.

Feasibility of oral health evaluation by intraoral digital photography: a pilot study

Objectives

This study investigated the accuracy and duration of intraoral digital photograph examination (IDPE) for evaluating oral health status and explored the feasibility of remote oral health assessment.

Methods

Thirty-one healthy college students underwent evaluations of oral health status via clinical examination (CE) combined with panoramic X-ray assessment at baseline, followed by IDPE 1 month later using photos taken at baseline. Methods for evaluation of gingival health included the Modified Gingival Index (MGI) and Plaque Index (PI). Examinations of caries status included the decayed, missing, and filled teeth and surfaces indexes (DMFT and DMFS indexes, respectively). The duration of each evaluation was also recorded.

Results

There were significant differences in MGI and PI between CE and IDPE. There were no significant differences in DMFT and DMFS indexes between CE and IDPE, and there were positive correlations between CE and IDPE for each of the two indexes (DMFT index: r=0.56; DMFS index: r=0.69). The IDPE duration was shorter than the CE duration.

Conclusions

The feasibility of caries status assessment via IDPE is promising. Digital oral health evaluation merits further clinical consideration.

Trial registration

Xiamen University Training Program of Innovation and Entrepreneurship for Undergraduates, project number: 2018X0583. Registered 1 April 2018; http://cxw.xmu.edu.cn/admin/Innovation/NewInnovationDetail?id=6ce0a415-6131-496b-891a-6a1ae44e556d

Mobile photographic screening for dental caries in children: Diagnostic performance compared to unaided visual dental examination

OBJECTIVES

This study was conducted to compare the use of intraoral photographs with the unaided visual dental examination as a means of dental caries detection in children.

METHODS

Children aged 4- to 14-year-olds were visually examined at their schools. Following dental examinations, children had five photographs of their teeth taken using a smartphone camera. Four dental reviewers, who are different from those who visually examined the children, assessed intraoral photographs for dental caries. Sensitivity, specificity, and inter-rater reliability agreement were estimated to assess the diagnostic performance of the photographic method relative to the benchmark visual dental assessments. Caries prevalence was measured using dft/DFT (decayed and filled teeth) index.

RESULTS

One hundred thirty-eight children (67 male and 71 female) were enrolled and had a mean age of 7.8 ± 2.1 years. The caries prevalence (dft/DFT > 0) using photographic dental assessments ranged from 30 percent to 39 percent but was not significantly different from the prevalence (42 percent) estimated with the visual dental examination (P ≥ 0.07). The sensitivity and specificity of the photographic method for detection of dental caries compared to visual dental assessments were 58-80 percent and 99.7-99.9 percent, respectively. The sensitivity for the photographic assessments was high in the primary dentition (63-82 percent) and children ≤7-year-olds (67-78 percent). The inter-rater reliability for the photographic assessment versus the benchmark ranged from substantial to almost perfect agreement (Kappa = 0.72-0.87).

CONCLUSIONS

The photographic approach to dental screening, used within the framework of its limitations, yielded an acceptable diagnostic level of caries detection, particularly in younger children with primary dentition.