Using teledentistry to provide interceptive orthodontic services to disadvantaged children

Instructional strategies and challenges for implementing teledentistry in dental hygiene curricula: A qualitative study

PURPOSE/OBJECTIVES

Research has documented the implementation of telecommunications and virtual technology use in health care disciplines to expand accessibility. Despite the current trend of digital innovations in healthcare systems, telehealth technology is not readily adopted in the dental hygiene profession yet. Currently, no standardized educational framework exists in dental hygiene curricula to prepare professionals with the technical skill set and professional knowledge necessary for telehealth applications. The aims and objectives of this research were (1) to investigate existing dental hygiene educators' pedagogical frameworks for incorporating telehealth technology into dental hygiene curricula, (2) explore these educators' instructional strategies for teaching telehealth technology, and (3) examine the theoretical implications and practical outcomes of teaching telehealth technology for professional development and transferrable work-force ready skills.

METHODS

A nine-item, open-ended, semi-structured interview guide was prepared and approved by the Institutional Review Board (IRB) in January 2023 to qualitatively investigate accredited entry-level dental hygiene programs in the United States. Thematic interpretational analysis was conducted using NVivo software.

RESULTS

A total of 54 of the 328 dental hygiene programs volunteered for participation. Thirteen full-time and part-time dental hygiene educators met inclusion criteria. The core salient themes identified included (a) curriculum mapping, (b) technology integration, (c) professional collaboration, and (d) supplemental skill set.

CONCLUSIONS

These findings provide guidance to dental hygiene programs for bridging the teledentistry knowledge gap in curriculum development. Incorporating telehealth applications into dental hygiene curricula prepares future dental hygienists with the specialized training needed to function as a member of contemporary health care teams addressing access to care.

Perceptions and utilization of tele-orthodontics: a survey of the members of the American Association of Orthodontists

OBJECTIVE

This study aimed to investigate orthodontists' utilization and perceptions of tele-orthodontics.

MATERIALS AND METHODS

A 30-item online survey was distributed to members of the American Association of Orthodontists (AAO). The questionnaire encompassed topics concerning the orthodontists' utilization, perceptions, clinical applications, limitations, and concerns regarding tele-orthodontics. Descriptive statistics were employed, and comparisons between responses from users and non-users were conducted  using Wilcoxon rank-sum tests and Fisher's exact tests.

RESULTS

152 members completed the survey, (response rate: 2.4%). More than two third of respondents (69.74%) were users of tele-orthodontics. Users were more aligned with the belief that tele-orthodontics facilitates effective communication (mean ± standard deviation (SD) 4.06 ± 0.83 vs. 3.33 ± 0.94, p < 0.001). Both groups agreed on the requirement of patient fees for tele-orthodontic visits (mean ± SD: 3.62 ± 1.11 users vs. 3.74 ± 1.02 non-users, p = 0.659), and on the capability  of the system to reduce unwarranted referrals (p = 0.20). The majority of participants acknowledged  the utility of the system in monitoring aligners' patients (89% in users vs. 61% in non-users, p < 0.001). Non-users expressed greater concerns regarding privacy risks (mean ± SD: 3.06 ± 0.97 users vs. 3.57 ± 0.86 non-users, p = 0.002). Both groups stressed the significance of obtaining informed consent before utilizing tele-orthodontics.

CONCLUSIONS

The widespread acceptance of tele-orthodontics among AAO members was apparent, as demonstrated by their recognition of its effectiveness. There was notable variation in how users and non-users perceived tele-orthodontics. The study's results offer valuable insights into both the potential benefits and drawbacks of incorporating this technology into clinical practice from the clincians' perspective.

A novel questionnaire to perform teletriage of dental emergencies in children: A before-and-after study nested within a randomized clinical trial

Background: This will be a before-and-after study nested within a randomized clinical trial. Its objective will be to analyze the effectiveness of a teleconsultation and validate a questionnaire for performing teletriage in dental urgency/emergency situations in children aged 3 to 13, whose parents will have signed a free and informed consent form, and who have had full access to the internet. Methods: The Questionnaire for Teletriage of Emergencies and Urgencies in Pediatric Dentistry (QuesT-Odontoped)-will be validated by applying it to 140 randomized child parents/guardians. After validation, another 260 children seeking emergency dental care in the municipality of Carangola, Minas Gerais, Brazil, will receive a remote consultation, be randomized, and then allocated into two groups: G1, teleconsultation, and G2, teleconsultation and face-to-face consultation (immediately after the former) with a blinded evaluator, involving anamnesis and conventional clinical examination. The G2 sample will be used in the before-after study. Both groups will be followed-up for 7 and 14 days using pain and quality-of-life scales, applied at baseline and after each follow-up period. Clinical follow-up will be carried out after 12 and 24 months to assess the outcome of the tooth that had been indicated for treatment in the teletriage. The Mann-Whitney test will be used to assess pain; Student's t test or the Mann-Whitney test will be used to assess quality of life and the number of missing teeth after 24 months; and Poisson's regression analysis will be used to assess the influence of other variables. The significance level will be set at 5%. Conclusions: In conclusion, this study expects to confirm the hypothesis that remote urgency consultation (teletriage), through a validated questionnaire, will be able to define the planning of the clinical situation, reducing the chance of displacements and progression of infection, helping to eliminate patient pain and discomfort.

Is teledentistry effective to monitor the evolution of orthodontic treatment? A systematic review and meta-analysis

INTRODUCTION

With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments.

OBJECTIVE

To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment.

MATERIAL AND METHODS

Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed.

RESULTS

Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low.

CONCLUSION

With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = -2.75[-3.95, -1.55]; I2=41%; p<0.00001) and the time for starting refinement (mean difference = -1.21[-2.35, -0.08]; I2=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.

Applications and effectiveness of teledentistry in orthodontic practice during the COVID-19 restrictions

BACKGROUND

The aim of this study was to identify the areas of application for teledentistry and analyze its effectiveness in orthodontic practice during the COVID-19 pandemic.

METHODS

A total of 233 patients (159 women, 74 men) receiving orthodontic treatment were included. During the COVID-19 restriction period, patients were given teledentistry appointments. During these video conferences, remote orthodontic checkups were performed by one orthodontist, who asked the patients for photos or videos. The applications carried out during the interviews were recorded, classified, and analyzed. In addition, clinical emergency patients were identified. After the teledentistry consultations, two different questionnaires were presented to the patients, depending on their attendance at teledentistry appointments, and the results were statistically evaluated.

RESULTS

In all, 21.25% of the patients were identified as having clinical emergencies, including injury because of damage from brackets and wires; 10% of them reported bracket breakage; 17.5% were encouraged to use intermaxillary elastics; and 3.75% were in pain. However, 50% of them were found to be unproblematic. A total of 91% of the participants in the survey reported that online checkups were sufficient to understand and resolve their symptoms. However, 28% wanted to communicate with orthodontists by video call or with photos instead of meeting face to face (65.5%) when unexpected problems arose during the COVID-19 pandemic.

CONCLUSIONS

Teledentistry can be an effective method for motivating patients who are undergoing orthodontic treatments that require cooperation. It is also an effective way of understanding the patients' symptoms and reducing the risk of cross-infection by identifying patients who will require face-to-face emergency treatment during pandemics.

Patient's and Practionner's Experiences of a First Face-to-Face vs. Remote Orthodontic Consultation: A Randomized Controlled Trial

(1) Aim: The purpose of this study was to assess patients' and practitioners' reported experience measures (PREMs) following a first standard orthodontic consultation (face-to-face consultation) versus a first orthodontic teleconsultation (video-assisted remote orthodontic consultation).; (2) Materials and Methods: This study was designed as a randomized controlled trial in which 60 patients were randomly allocated to two groups. In the control group, patients received a first face-to-face consultation (n = 30) whereas, in the test group, patients received a first orthodontic teleconsultation (n = 30). Patients as well as the orthodontic practitioners completed questionnaires after the experience. (3) Results: From the patients' point of view, overall satisfaction was comparable between the control group and the test group (p = 0.23). Quality of communication with the clinician, understanding of the explanations provided and a sense of privacy were also comparable between the two groups. However, from the practitioners' perspective, overall satisfaction after the face-to-face consultation was significantly higher than after the first remote consultation (p < 0.01). (4) Conclusions: In the context of a first orthodontic consultation, teleorthodontics appears to be an interesting and complementary approach to a classical face-to-face appointment, but which should by no means become systematic.

Teledentistry use during the COVID-19 pandemic: perceptions and practices of Ontario dentists

BACKGROUND

Teledentistry has demonstrated to expedite oral health consultations, diagnosis, and treatment planning while mitigating COVID-19 transmission risk in dental offices. However, the use of teledentistry by clinicians remains suboptimal. Therefore, this study aimed to determine the perceptions and practices of teledentistry among dentists during the COVID-19 pandemic in Ontario, Canada, and identify associated factors.

METHODS

A cross-sectional study using an online 39 item survey was conducted among Ontario dentists in December 2021. The questionnaire inquired about socio-demographic attributes, as well as perceptions of teledentistry use during the pandemic, and its future application. Descriptive statistics including frequency distribution of categorical variables and univariate analysis of continuous variables were conducted. Chi-square test was used determine the associations between professionals' attributes such as age, gender, years of practice, and location of practice, and respondents use of teledentistry. SPSS Version 28.0 was used for statistical analysis.

RESULTS

Overall, 456 dentists completed the survey. The majority were general dentists (91%), worked in private practices (94%), were between 55 and 64 years old (33%), and had over 16 years of professional experience (72%). Approximately 49.3% reported using teledentistry; 13% started before the pandemic, and 36% during the pandemic. The most common reason for non-utilization was a lack of interest (54%). Respondents identified patient triage, consultation, and patient education as the three most important uses of teledentistry. Female dentists (p < 0.05), dentist working in private practice (p < 0.05), and those who worked in a single dental office (p < 0.05) adopted teledentistry more during the pandemic. Respondents who accessed more resources were more likely to report greater utilization of teledentistry, while those who reported being unconformable with teledentistry (p < 0.05) reported less utilization. Additionally, participants who reported feeling comfortable discussing teledentistry with others (p < 0.05), were more inclined to use it in the future.

CONCLUSIONS

Participants expressed mixed perceptions toward teledentistry with more than half indicating it is reliable for patient triaging and patient follow-ups. Despite the increased utilization during the COVID-19 pandemic, participants' lack of interest in teledentistry emerged as a barrier to its use. More education and knowledge dissemination about teledentistry's areas of application and technical aspects of use can increase interest in this tool, which may lead to a greater uptake by dental professionals.

Exploring challenges and mitigation strategies towards practicing Teledentistry

BACKGROUND

Since the beginning of the COVID-19 pandemic, many dentists have opted for Teledentistry as a mechanism for patient consultation, oral lesion evaluation, diagnosis, and monitoring. The current study explores the challenges faced and potential solutions proposed by dentists practicing Teledentistry in a developing country like Pakistan.

METHODS

A qualitative case study was carried out from January to December 2021. A purposive maximum variation sample of 10 dentists was interviewed in two focus groups. The interview guide was developed using the technology-organization-environment framework. The data was transcribed verbatim using otter.ai. The analysis involved immersion in the data and open coding. The conceptually related codes were synthesized into themes and subthemes.

FINDINGS

The study found various Personnel, Technological and Organizational challenges, and potential solutions from those practicing Teledentistry. The challenges included operational cost, minimal financial returns, lack of awareness, hardware and software support, and other challenges related to the availability of specialization, accessibility, and institutional encouragement. They suggested Institutional Based Practice, staff training, hiring, development of government regulations, and supporting infrastructures such as designated space, central registry, internet, and using/building software to provide 3D images as solutions.

CONCLUSION

Teledentists face Personnel, Technological and Organizational challenges and related potential solutions from those practicing Teledentistry in Pakistan. Government should encourage Teledentistry to reduce long-term costs, encourage preventive services and enable rural access to dental care. They should also involve all stakeholders to develop regulations for practicing Teledentistry in Pakistan.

Evaluation of Tele-Dentistry and Face-to-Face Appointments during the Provision of Dental Services in Poland

Tele-dentistry is a rapidly growing field, especially in the era of the COVID-19 pandemic. Due to the COVID-19 pandemic, remote services are of increasing interest to both patients and dental personnel. They allow for reduced person-to-person contact and thus a reduced risk of transmission of the SARS-CoV2 virus. The COVID-19 pandemic has affected the functioning of all areas of life, including dental treatment. The aim of the study was to assess the possibility of using tele-dentistry for dental services and analyse the attitudes of patients and dentists towards this solution. The period analysed was between March 2019 and February 2021 in five healthcare entities in Cracow in Central Europe. The study’s retrospective analysis shows a positive attitude of patients towards tele-dentistry at every stage of treatment, from diagnosis through postoperative care, and a significant reluctance of dentists in the majority of dental specialties towards tele-dentistry. Consequently, a significant percentage of patients were invited to dental offices for a face-to-face appointment during the COVID-19 pandemic. The negative attitude of dental personnel towards tele-dentistry compared with the positive attitude of patients towards tele-dentistry is somewhat worrying in view of the possibility of a further pandemic. At the same time, it provides important information about the need to educate and support dental personnel in tele-dental solutions and improve solutions for the future. Taking into account the potential reduction in dental care costs for patients and countries after the implementation of tele-dentistry solutions, this is an important topic, while current studies do not comprehensively address the attitudes of patients and dental personnel towards tele-dentistry. In other parts of the world, a similar approach to tele-dentistry is used by patients and dentists.

A Teledentistry Pilot Study on Patient-Initiated Care

COVID-19 has challenged the public dental workforce in their ability to continue providing routine oral health care services. To mitigate the risk of COVID-19 transmission to staff and patients, Teledentistry was implemented in many parts of the world, mainly to provide remote consultations, undertake triage, and offer preventive educational sessions. The aim of this paper is to describe Dental Health Services Victoria’s (DHSV) patient-initiated Teledentistry model of care implemented during peak COVID transmission in Victoria. The Teledentistry model supported patient-centered care involving active collaboration and shared decision making between patients, families, and clinicians in designing and managing remote care plans. DHSV’s eligible patient cohort includes disadvantaged population groups with greater oral health needs. Strong emphasis was placed on the simplicity and user friendliness of the Telehealth platform, as well as the support for patients with low technology literacy. Consumers and dental workforce were consulted and modifications to the use of language and services were undertaken before the launch. A total of 2492 patients accessed Telehealth services between May 2020 and April 2021. Approximately 39% of patients were born in a country other than Australia. A total of 489 patient-reported experience measures (PREMs) were received. Patients agreed or strongly agreed that the care they received met their needs (87%); they received answers to their questions (89%); they left their visit knowing what is next (87%); they felt they were taken care of during their visit (90%); and they felt involved in their treatment (89%). Teledentistry enabled patients to initiate access to care and consult with dental workforce remotely and safely during peak pandemic.

Accuracy and effectiveness of teledentistry: a systematic review of systematic reviews

Introduction The COVID-19 pandemic has urged healthcare systems to develop new ways to safely provide care. Telehealth has become a compelling alternative. Our purpose was to evaluate the accuracy and effectiveness of teledentistry for screening, diagnosis and therapeutic management of dental care in children and adults.Methods We conducted a systematic review (SR) of systematic reviews. Multiple databases, the grey literature and conference archives were searched. Eligible SRs included those reporting virtual screening, diagnostic investigations and therapeutic interventions. Two investigators independently reviewed abstracts, articles, critically appraised SRs and extracted the data.Results We identified 817 citations and included six SRs. The accepted SRs involved >7,000 participants, used primarily asynchronous communication for diagnostic/screening outcomes and used synchronous communication for treatment outcomes. SRs were of low quality and included 30 primary studies of our interest. Sensitivity and specificity for dental referrals and diagnostic treatment planning were higher than other index/reference tests, ranging from 80-88% and 73-95%, respectively. Treatment outcome measured patient compliance and professional supervision.Conclusion This SR provides the best existing evidence for clinical decision-making involving teledentistry. Current evidence supports teledentistry as an effective means for dental referrals, treatment planning and compliance and treatment viability. Asynchronous communication and the adoption of smartphones for image capturing are feasible and convenient for the implementation of teledentistry.

Development of a checklist to assess COVID-19 information on orthodontic webpages

OBJECTIVE

To create a COVID-19 information checklist and critique all available webpages of hospitals with an orthodontic department in England.

DESIGN

Cross-sectional analysis.

SETTING

World Wide Web.

METHODS

A 16-item COVID-19 webpage checklist was developed using up-to-date COVID-19 government advice, and the General Dental Council Principles of Ethical Advertising. Presence of advice on managing orthodontic appliance breakages, information on outpatient appointment changes and video consultations was also assessed. The checklist was used to undertake a cross-sectional analysis of all available webpages of hospitals with an orthodontic department in England between September 2020 to October 2020.

RESULTS

A total of 61 webpages were assessed. Of them, 95% had a COVID-19 section on the homepage, including advice on the use of face coverings during hospital visits. Only 18% of websites provided information on orthodontic appliance care and breakages. Four orthodontic department websites stated the department was closed during this study. The mean update interval of the webpages was six weeks (range = 1-28 weeks). Only one webpage fully conformed with the COVID-19 checklist.

CONCLUSION

Availability and completeness of COVID-19 information on webpages of hospitals with an orthodontic department varied, which may be due to the absence of a formal COVID-19 information webpage checklist. The checklist produced in this research may prove valuable to encourage uniform patient support and positive patient experience across orthodontic services. Principles behind the development of the checklist could be adopted during prolonged service disruptions to ensure optimal patient communications. The checklist is equally applicable to primary and secondary care settings.

Teleorthodontics: Where Are We Going? From Skepticism to the Clinical Applications of a New Medical Communication and Management System

Teleorthodontics represents the orthodontic care system involving remote management of orthodontic treatment. Despite skepticism, there are several advantages of including teleorthodontics in the clinical orthodontic practice. In the present review, we discuss the lights and shadows of this new communication healthcare system and its applications in the field of orthodontics that is destined to change the future of our clinical practice. For this purpose, we have provided a point-to-point analysis based on data from the most valuable scientific evidence on this topic. The information and data discussed in the present paper were obtained from the most relevant studies evaluating the performance of teleorthodontics and remote monitoring systems in clinical practice.

The World Wide Web of orthodontics- A comprehensive narrative on teledentistry pertaining to the orthodontics of the 21st century

Teledentistry has proven effective in practically all dental fields. It also allows access to inaccessible and underdeveloped locations. Better treatment outcomes were documented in patients treated by an orthodontist supervised by teledentistry than by a general dentist with minimal orthodontic experience alone. It may also help to focus referrals to specialists and weed out those who do not need them. But, on a critical note, a doctor-patient relationship is much more than a business transaction. A face-to-face initial consultation instills trust that a remote session cannot. Teledentistry includes professional networking of doctors. This contact includes digital information exchange, CPD programs, case discussions, and analysis that bring dentists from all around the world together to improve patient care. Teledentistry has not only spanned the distance between dentists worldwide, but has also served as a conduit between customer (patient) and manufacturer. This spawned Direct to Consumer (DTC) dentistry, sparking substantial debate among dentists worldwide. In DTC dentistry, inadequately trained customers conduct complex procedures on themselves with minimal guidance of a dentist. One of the major issues today is the general availability of clear aligners to patients without the requirement for an intermediary skilled orthodontist. The American Association of Orthodontists (AAO) has publicly questioned the validity of Smile Direct Club, a private firm that dominates the DTC industry. European Federation of Orthodontic Specialists Association, on the other hand, has sponsored a joint declaration with the representative orthodontic associations in Europe to highlight and alert patients about the potential risks of DTC products. Unfortunately, public shaming hasn't slowed commercialization of DTC firms. Teledentistry has been a boon for healthcare, but a nightmare for our profession, raising fundamental questions like what is the difference between a customer and a patient? Is dentistry a just another discipline of cosmetics? Is teledentistry making us less connected with our patients?

Teledentistry as a Supportive Tool for Dentists in Pakistan

The current scenario of the COVID-19 pandemic has forced dentists to seek different options for delivering healthcare services other than the in-person direct examination in clinical practice. Teledentistry is one of the options for remote patient care and monitoring. Objective. The present survey was conducted to assess the knowledge and perception of the dentists in Pakistan regarding teledentistry as an emergent supportive tool. Materials and Methods. A self-administered, close-ended, and prevalidated survey questionnaire was used, comprising 21 questions, and distributed electronically via e-mail, WhatsApp, and Facebook Messenger to evaluate the knowledge and perception of dentists regarding teledentistry. The data collected was compiled in a systematic manner and analyzed in terms of frequency (yes/no). Results. Out of a total of 350 dentists, 325 responded to the questionnaire, and it was seen that 62.5% of them did not have knowledge about teledentistry prior to COVID-19. 65.8% of dentists considered the practice of teledentistry in nonpandemic situations in the future. Conclusion. In the present study, it was observed that most of the dental professionals had inadequate knowledge about teledentistry before COVID-19, but the awareness and perception regarding teledentistry were currently satisfactory among the dental professionals in Pakistan. This emerging trend gives a positive hope for the implementation of teledentistry in the healthcare setup of Pakistan in the near future, as it will prove to be beneficial for safe dental practice during times of pandemic and even after.

Knowledge, Awareness, and Attitude among Practicing Orthodontist on Teledentistry during COVID Pandemic in Kerala: A Cross-Sectional Survey

Background:

Considering the gravity of coronavirus disease 2019 (COVID-19) and its potential to unfold within the dental workplace or institutions, a shift from traditional dental practice to a newer method is needed. Teledentistry is widely being practiced in this pandemic era for the diagnosis and to give instructions to the patients. Hence, an attempt has been made to explore the knowledge, attitude, and awareness of practicing orthodontists regarding the usage of teledentistry during COVID lockdown, in Kerala.

Materials and Methods:

A cross-sectional, descriptive study was done on about 150 orthodontic professionals. A pretested, self-organized, close-ended survey was managed through online stages that comprised of 15 questions. The information gathered was assembled in a systematic way and investigated regarding recurrence and Chi-square test was utilized for the examination of frequencies.

Results:

It was observed that 93.3% orthodontic practitioners had knowledge regarding teledentistry and a positive attitude toward teledentistry was shown by younger age group practitioners and those who were working in institutions (P < 0.05). 77.3% believed that teledentistry can save dentist's time and 71.3% responded that the new technology can be helpful in reducing the cost of treatment for patients.

Conclusion:

The knowledge, awareness, and attitudes were discovered to be acceptable among the orthodontic practitioners. Younger practitioners had more positive attitude toward teledentistry, and there was an overall positive attitude for using teledentistry as a temporary alternate for direct patient contact in COVID-19 pandemic time.

Teledentistry System in Dental Health Public Services: A Mixed-Methods Intervention Study

INTRODUCTION

Health information and communication technologies, such as Teledentistry, can help expand access to dental health public services making it more effective.

OBJECTIVE

To analyze the factors that affect the implementation of a Teledentistry system in dental health public services.

METHODS

The study follows the Implementation Research methodological framework. A mixed-method approach was applied using a triangulation design-sequential model to collect, analyze, and interpret qualitative and quantitative data about the implementation of a Teledentistry system. A compulsory teleconsultation from the general dentist was planned to access periodontics specialized care. The study was developed in a South Brazilian capital city and the platform of the Santa Catarina Telehealth Center was used. Qualitative and quantitative data were collected sequentially to achieve a better understanding of implementation research issues.

RESULTS

In seven months, 68 teleconsulting was performed by 22% of the general dentists, prior to the referrals on periodontics. Only one reported not needing to refer the patient to the periodontist as a result of the teleconsulting guidance. Teledentistry system implementation and usage were influenced by the managers' political and administrative awareness to deploy and maintain the intervention. Lack of sufficient resource investment, lack of system integration, and internet failures were relevant limiting factors. The teleconsultant guidelines contributed to general dentistry's better decision-making regarding treatment, urgency of case management, and prioritization of referrals to the periodontists CONCLUSION: Identifying the factors that influence the implementation and finding solutions to overcome them, can prevent future failures and improve usage of the system.

Comparative evaluation of webinar, powerpoint presentation and lecture as oral health educational interventions among school children: a randomized controlled trial

The study compared the effectiveness of three teaching methods on the oral health status of high school children. The study population of 791 school children selected from three different schools was randomly allocated to one of three intervention groups: (i) Webinar group (Online presentation)-260 subjects, (ii) Face to Face lecture using PowerPoint presentation (F2F PP group)-261 subjects and (iii) Control group (Only lecture)-270 subjects. Subjects from the Webinar group and F2F PP group received oral health education at an interval of 15 days starting from baseline. Subjects from the control group received oral health education only at baseline. Oral Hygiene Index (OHI) and Gingival Index (GI) were measured at baseline, at 1 month, 2 months' and 3 months' interval. OHI and GI showed a significant reduction (P = 0.001) in the Webinar group and F2F PP group; However, in the control group, OHI and GI reduced from baseline till second month and showed an increase at 3 months' interval. F2F PP group showed a maximum reduction in OHI and GI followed by the Webinar group. It can be concluded that F2F PowerPoint-based oral health education was most effective followed by the webinar method.

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.

Teledentistry: A Boon Amidst COVID-19 Lockdown-A Narrative Review

The recent spread of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and its associated coronavirus disease (COVID-19) has caused widespread public health concerns. Despite huge efforts to contain the disease spread, it is still on the rise because of the community spread pattern of this infection. In order to prevent the community spread, a nationwide lockdown was implemented, due to which many restrictions were imposed on movements of citizens within the country. Since the dental professionals were at the forefront of acquiring the infection, the majority of the dental clinics were shut for routine dental procedures. Only emergency treatment was provided to the patients. However, due to restrictions in movement, it was difficult for the patients to visit the clinics for routine check-ups. This was overcome by the advancements in technology which has a major impact on medicine. Due to increased usage of smartphones and related software applications, the clinical data exchange was facilitated between patients and clinicians which has been termed as "teledentistry." Teledentistry is a combination of telecommunications and dentistry, involving the exchange of clinical information and images for dental consultation and treatment planning. This technology served as a boon for the dentists to manage dental emergencies during the lockdown period. This narrative review discusses teledentistry and its applications in general and specialty dental practice amidst the COVID-19 lockdown.

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.

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

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.

An evidence-based review of the scope and potential ethical concerns of teleorthodontics

PURPOSE

The aim was to evaluate the scope and potential ethical concerns related to the use of teledentistry in clinical orthodontics.

METHODS

Indexed databases were searched up to and including October 2020. The eligibility criteria were as follows: (a) original clinical studies, and (b) case reports/series. Historic reviews, commentaries, experimental studies, and letters to the editor, were excluded. The pattern of the present review was customized to summarize the relevant information.

RESULTS

A total of 4 clinical studies (out of 1016) were included in the present evidence-based review. Three studies reported that teledentistry is useful in clinical orthodontics. In 1 study, a clear conclusion could not be derived regarding the benefits of teledentistry in clinical orthodontics. Two out of 4 studies did not obtain prior approval from an Institutional Review Board or Ethical Committee. Three studies did not report any measures that were undertaken to safeguard the electronic transfer of patient-related health information.

CONCLUSIONS

Teleorthodontics facilitates treatment planning/monitoring by sharing orthodontics-based patient records among oral healthcare providers; however, the importance of direct patient supervision and routine follow-ups during orthodontic therapy cannot be overlooked. Further studies are needed to establish ethical guidelines and a standard of care in this emerging field.

The effective use of an e-dentistry service during the COVID-19 crisis

In 2020, we experienced the largest disruption to normal life recorded in recent years with the COVID-19 global pandemic. Creative thinking was required to ensure patient care was maintained. In this article, we share a service evaluation and experiences dealing with the crisis through using a virtual office approach with video conferencing to manage emergency consultations, treatment reviews, new patient and multidisciplinary clinics in a hospital orthodontic unit.

Available Technologies, Applications and Benefits of Teleorthodontics. A Literature Review and Possible Applications during the COVID-19 Pandemic

Background: COVID-2019 spread rapidly throughout the world from China. This infection is highly contagiousness, has a high morbidity, and is capable of evolving into a potentially lethal form of interstitial pneumonia. Numerous countries shut-down various activities that were considered “not essential.” Dental treatment was in this category and, at the time of writing, only non-deferrable emergencies are still allowed in many countries. Therefore, follow-up visits of ongoing active therapies (e.g., orthodontic treatment) must be handled taking special precautions. This literature review aims at reducing in-office appointments by providing an overview of the technologies available and their reliability in the long-distance monitoring of patients, i.e., teledentistry. Methods: A literature review was made according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses Protocols (PRISMA-P) guidelines. Randomized clinical trials, cross sectional, observational, and case-control studies were evaluated with the Mixed Methods Appraisal Tool for quality assessment and study limitations. Results: A primary search found 80 articles, 69/80 were excluded as non-relevant on the basis of: the abstract, title, study design, bias, and/or lack of relevance. Twelve articles were included in the qualitative analysis. Conclusions: Teleorthodontics can manage most emergencies, reassuring and following patients remotely. The aim set by dental teleassistance was met as it reduced patients’ office visits whilst maintaining regular monitoring, without compromising the results. Although our preliminary findings should be further investigated to objectively evaluate the efficacy, cost-effectiveness, and long-term results, we are confident that teleassistance in orthodontics will have a role to play in the near future.

Clinical outcomes and patient perspectives of Dental Monitoring® GoLive® with Invisalign®-a retrospective cohort study

Background

The aims of the study were to compare the effects of Invisalign® with and without Dental Monitoring® (DM) GoLive® on the following parameters: treatment duration, number of appointments, number of refinements, total number of refinement aligners, and time to initial refinement. The patients’ perspectives on Dental Monitoring® were also evaluated using an online questionnaire. A sample of 155 consecutively treated Invisalign® patients (67 control, 88 DM) fit the inclusion and exclusion criteria.

Results

The two groups were homogeneous (P > .05) for age, gender, angle classification, Little’s Irregularity Index, and number of initial aligners. The DM group had significantly fewer office visits compared to the control (7.56 vs 9.82; P < .001). There were no significant differences between the DM and control groups respectively pertaining to treatment duration (14.58 vs 13.91), number of refinements (1.00 vs 0.79), number of refinement aligners (19.91 vs 19.85), and time to first refinement (9.46 vs 9.97). Questionnaire results showed that 68.8% (44 respondents) indicate that DM scans were “easy” or “very easy” to perform while 16 responders (25%) found it “difficult” or “very difficult.” 71.9% (46 responders) were “satisfied or very satisfied” with the level of communication with the orthodontist using DM and 16% (10 responders) were “dissatisfied” or “very dissatisfied.” The mean duration observed by patients to take a scan was 5.16 ± 3.6 min. Eighty-eight percent (56 responders) of patients prefer few office visits as possible, while 12% (8 responders) would actually prefer additional office visits. Overall, the mean satisfaction of patients with DM was 4.25 on the 5-point Likert scale.

Conclusion

The DM group had a significantly reduced number of appointments (7.56) compared with the control group (9.82) (a reduction of 23%) over the treatment duration. There were no significant differences between the two groups in treatment duration, number of refinements, number of refinement aligners, or time to 1st refinement. Overall, DM was well received by patients. However, there was a small percentage (usually less than 15%) that was generally unsatisfied with DM in varying aspects and preferred more frequent, traditional office visits.

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.

Clinical applications of intraoral camera to increase patient compliance - current perspectives

Technological advancements in the field of dentistry have reformed the concept of photography as a powerful medium of expression and communication. It also offers a spectrum of perception, interpretation, and execution. One of the widespread clinical applications of computerization in dentistry today is the intraoral camera (IOC). It helps in the revelation of the hidden and overlooked defects in teeth and other parts of the cavity. Dental world constitutes of microstructures that have to be recorded in a detailed manner to perform patient education, documentation of records and treatment, illustration of lectures, publication and web connectivity of complicated cases. This review emphasizes the significant applications of IOC in dentistry and its possible impact on patient compliance for dental care.

Advancement Of Teledentistry At The University Of Rochester's Eastman Institute For Oral Health

Dental caries is the most prevalent infectious disease among US children. National surveys have shown that poor and minority-group children are not only disproportionately affected by dental caries but also have limited access to oral health care. Following successful exploratory applications of both synchronous and asynchronous models at the Eastman Institute for Oral Health, teledentistry has been demonstrated to be a practical and cost-effective way to improve oral health care for rural and disadvantaged children. These models support the role of teledentistry in reducing the costs of and barriers to accessing oral health care, improving oral health outcomes, increasing use of oral health care resources, and leading to the establishment of a dental home for underserved children. The advancement of teledentistry underscores the need for its integration with local, regional, and national telehealth programs and the role of policy makers in establishing a balanced framework for teledentistry within the overarching health care system.

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.

Formative evaluation of a teledentistry training programme for oral health professionals

INTRODUCTION

The objective of this study was to conduct a formative evaluation of a teledentistry (TD) programme that was developed for a predominantly rural state in the Midwestern United States.

MATERIALS AND METHODS

Formative evaluation data were collected on programme activities from the TD programme records. In addition, the effectiveness of the TD training programme was evaluated using a self-administered paper-based survey administered to the participants, immediately following completion of the training activity. Ninety-three dental students, oral health and other health professionals participated in the TD training programme.

RESULTS

Overall, the trainees rated the TD training programme highly, with regard to the content, format and skills improvement. The evaluation also demonstrated a positive change in all trainees' attitudes following the training sessions, with most trainees acknowledging a positive impact of the training on their knowledge and competency.

DISCUSSION AND CONCLUSIONS

We identified challenges in the development of the TD programme and in expanding access to oral health care for rural communities. Challenges included reimbursement and a limited interest amongst established dental offices. Dental schools can play an important role in preparing both dental health professionals and other health professionals in the use of TD by providing training and oral health expertise. The use of TD by non-dental providers for consultation, referral and disease management has the potential to improve oral health outcomes, particularly for rural and underserved populations. Evaluation data provide critical feedback to programme planners and administrators.

A Systematic Review on the Validity of Teledentistry

OBJECTIVES

The aim of this systematic review was to evaluate the validity of using teledentistry in oral care examination and diagnosis.

METHODS

In June 2016, a systematic search of the literature was conducted without time restrictions in three electronic databases (Ebscohost, Pubmed, and Scopus). Two reviewers screened the retrieved articles first by title and then by abstract to determine relevant articles for full text review. Studies included were as follows: (1) related to teledentistry, (2) available in full text and English, (3) compared teledentistry application to a gold standard, and (4) provided clear statistical tests for validity. The methodological quality of studies was determined using the "Quality Assessment of Studies of Diagnostic Accuracy (QUADAS)."

RESULTS

Seventy-nine studies met the initial search criteria. Following removal of duplicate articles, only 58 were remaining and reviewed by title and abstract, yielding 14 full-text articles. Nine of the full-text articles met the inclusion criteria. Results of the QUADAS assessment varied from 9 to 13 out of 14 items; therefore, studies demonstrated high quality (>60%). Validity of teledentistry varied and is reported by range for the following statistics: sensitivity (n = 8, 25-100%), specificity (n = 7, 68-100%), positive predictive value (n = 5, 57-100%), and negative predictive value (n = 5, 50-100%). Kappa statistics were also reported for evaluation of reliability between gold standard and teledentistry examination (n = 6, 46-93%).

CONCLUSIONS

Teledentistry could be comparable to face-to-face for oral screening, especially in school-based programs, rural areas and areas with limited access to care, and long-term care facilities. Identification of oral diseases, referrals, and teleconsultations are possible and valid. The need for methodologically designed studies with appropriate statistical tests to determine the validity of teledentistry exists.

Reliability of intra-oral camera using teledentistry in screening of oral diseases - Pilot study

Objective

Reliability of intra-oral camera using teledentistry in screening of oral diseases.

Methodology

A trained and calibrated examiner used intra-oral camera to capture videos of oral cavity along with clinical examination to evaluate caries, plaque, calculus, tooth wear and fluorosis, stains in children.

Results

The mean DT and DMFT were significantly higher with use of intra-oral camera than with clinical examination (p = 0.001 and 0.001) respectively. A positive strong significant correlation was seen between intra-oral camera and clinical examination with respect to DT, MT, FT and DMFT (r = 0.721, p < 0.001; r = 0.908, p < 0.001; r = 0.869, p < 0.001; r = 0.876, p < 0.001) respectively. Reliability of intra-oral camera when compared with clinical examination varied from substantial to almost perfect agreement various oral conditions. Disclosed immature plaque was not clear while mature plaque was clearly demonstrated.

Conclusion/recommendations

Intra-oral camera was shown to be a reliable tool to identify common oral diseases. Further studies involving applications like sealant retention, pre-malignant lesions, recurrent apthae, gingival recession and dental malocclusion and effectiveness in regular screening are needed.

A systematic review of the research evidence for the benefits of teledentistry

Objective This review is designed to inform future decisions about the benefits of integrating teledentistry into routine health services, by presenting an overview of the evidence for the effectiveness and economic impact of teledentistry. Methods Two reviewers searched PubMed, EMBASE and CINAHL databases through November 2016 to identify published peer-reviewed studies in English. Teledentistry studies were included if they were; (a) controlled (randomised or non-randomised) assessment studies; and (b) compared outcomes of a teledentistry intervention in terms of clinical or economic evaluation with the outcomes of traditional clinical alternatives. The quality of the studies was evaluated using a quality appraisal tool that considered study performance and design. Results This review identified 385 publications, of which 217 full-text articles were retrieved for further inspection. Of these, only 11 articles met the inclusion criteria. Nine of the included articles showed some clinical outcomes; the other two were primarily economic analyses. The balance of these studies assesed the efficacy of teledentistry interventions rather than their effectiveness. Four studies (36%) achieved higher quality scores and have greater potential to influence health-care decision-making. To date, the most convincing published evidence regarding the efficacy of teledentistry was provided by studies on paediatric dentistry, orthodontics and oral medicine. The economic analysis referred only to cost-minimisation, suggesting that the use of teleconsultation in dentistry can be cost-saving when compared to a conventional consultation. However, high-quality economic studies on teledentistry are rare. Conclusion There is emerging evidence supporting the efficacy of teledentistry. However, there is not yet enough conclusive evidence, particularly for its effectiveness, cost-effectiveness and long-term use, to make evidence-based policy decisions on teledentistry.

Using teledentistry in clinical practice as an enabler to improve access to clinical care: A qualitative systematic review

Background Access to dental care is important for overall health, but can remain problematic for those in rural or isolated locations. It can be difficult to encourage clinicians to choose or continue a rural health career. Teledentistry is showing some promise as a strategy to support rural, isolated and new health care workers. This study aims to explore the quantitative and qualitative framework associated with teledentistry in an effort to uncover the interaction of multiple influences on its delivery and sustainability. Methods A systematic search of the literature was undertaken and studies were included if they evaluated consultative teledentistry, reports on implementation of teledentistry in practice or attitudes to teledentistry. Studies were evaluated qualitatively. Results Thirty-nine studies were included focusing on the accuracy, effectiveness or description a teledentistry project in practice. Five main themes were identified in the qualitative analysis: (1) using information and communication technology (ICT), (2) regulatory and system improvements, (3) accuracy of teledentistry, (4) effectiveness, including increasing access to clinical services, efficiencies and acceptability, and (5) building and increasing clinical capacity of the dental workforce. Conclusion Teledentistry provides a viable option for remote screening, diagnosis, consultation, treatment planning and mentoring in the field of dentistry. Rapidly developing information and communication technologies have increasingly shown improving cost effectiveness, accuracy and efficient remote assistance for clinicians. There is high acceptability for teledentistry amongst clinicians and patients alike. Remuneration of advising clinicians is critical to sustainability.

A teledentistry system for the second opinion

In this paper we present a Teledentistry system aimed to the Second Opinion task. It make use of a particular camera called intra-oral camera, also called dental camera, in order to perform the photo shooting and real-time video of the inner part of the mouth. The pictures acquired by the Operator with such a device are sent to the Oral Medicine Expert (OME) by means of a current File Transfer Protocol (FTP) service and the real-time video is channeled into a video streaming thanks to the VideoLan client/server (VLC) application. It is composed by a HTML5 web-pages generated by PHP and allows to perform the Second Opinion both when Operator and OME are logged and when one of them is offline.

Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia

Despite great progress in oral health over the past three decades, the rates of caries remain high in Australia, particularly among underserved populations. The reasons for poor oral health amongst underserved populations are multiple, but rests with socio-economic determinants of health. The present review considers international workforce models that have been created to enhance the recruitment and retention of dental providers in rural areas. Several strategies have been developed to address care access problems in rural areas, including the use of telemedicine and mid-level dental providers (MLDPs). Despite ongoing opposition from dentistry organisations, the Alaska and Minnesota workforce models have proven that developing and deploying dental therapists from rural communities has the potential to address the unmet needs of underserved populations. It is more efficient and cost-effective for MLDPs to perform triage and treat simple cases and for dentists to treat complicated cases. The use of MLDPs is intended to increase the capacity of the dental workforce in areas that are too isolated to entice dentists. Telemedicine has emerged as one solution to address limited access to health care, particularly in locations where there is a lack of providers. Telemedicine not only provides access to care, but also offers support, consultations and access to continuing education for practicing dental providers in rural areas. This strategy has the potential to free up resources to increase care access and reduce oral health disparities, thereby contributing to closing the rural-urban oral health gap.

Narrative review of telemedicine consultation in medical practice

BACKGROUND

The use of telemedicine has grown across several medical fields, due to the increasing number of "e-patients".

OBJECTIVE

This narrative review gives an overview of the growing use of telemedicine in different medical specialties, showing how its use can improve medical care.

METHODS

A PubMed/Medline, Embase, Web of Science, and Scopus search was performed using the following keywords: telemedicine, teleconsultation, telehealth, e-health, and e-medicine. Selected papers from 1996 to 2014 were chosen on the basis of their content (quality and novelty).

RESULTS

Telemedicine has already been applied to different areas of medical practice, and it is as effective as face-to-face medical care, at least for the diagnosis and treatment of some pathological conditions.

CONCLUSION

Telemedicine is time- and cost-effective for both patients and health care professionals, encouraging its use on a larger scale. Telemedicine provides specialist medical care to patients who have poor access to hospitals, and ensures continuity of care and optimal use of available health resources. The use of telemedicine opens new perspectives for patients seeking a medical second opinion for their pathology, since they can have remote access to medical resources that would otherwise require enormous costs and time.

Comparative effectiveness study to assess two examination modalities used to detect dental caries in preschool urban children

BACKGROUND

Dental caries affecting the primary dentition of U.S. children continues to be the most prevalent chronic childhood disease. Preventive screening for dental caries in toddlers by dental professionals is labor-intensive and costly. Studies are warranted to examine innovative screening modalities that reduce cost, are less labor-intensive, and have the potential to identify caries in high-risk children.

SUBJECTS AND METHODS

Two hundred ninety-one children were randomized into two groups: Group 1 received a traditional, visual tactile examination initially and follow up-examinations at 6 and 12 months, and Group 2 received a teledentistry examination initially and follow-up examinations at 6 and 12 months. The mean primary tooth decayed and filled surfaces (dfs) scores were calculated for all children at baseline and 6 and 12 months.

RESULTS

At baseline, the mean dfs score for children examined by means of teledentistry was 2.19, and for the children examined by means of the traditional method, the mean was 1.27; the means were not significantly different. At the 12-month examination, the mean dfs score for the children examined by means of teledentistry was 3.02, and for the children examined by means of the clinical method, the mean dfs was 1.70; the means were not significantly different. At 12 months the mean fillings score for the children examined by means of teledentistry was 1.43 and for the children examined by means of the clinical method was 0.51; the means were statistically significantly different (p<0.001).

CONCLUSIONS

These results suggest that the teledentistry examinations were comparable to clinical examinations when screening for early childhood caries in preschool children. The data further showed that color printouts of teeth with cavities provided to parents of children who received teledentistry screenings promoted oral healthcare utilization, as children from the teledentistry study group received more dental care than children from the clinical study group.

Teledentistry: a systematic review of the literature

We conducted a systematic review of teledentistry applications. We searched the MEDLINE/PubMed, Embase and Cochrane Library databases for relevant articles published from 1992 to 2012. The reference lists of all retrieved articles were hand-searched. Studies were included after assessing the eligibility of the full-text article. A total of 878 studies were identified, of which 59 fulfilled the inclusion criteria of the review. The articles covered several dental specialties, mostly oral surgery, oral medicine and oral pathology. The most common type of teledentistry application was education (n = 21), followed by diagnosis (n = 16), consultation (n = 3) and treatment (n = 2). Teledentistry studies were reported in a total of 15 countries. The largest number of studies were conducted in the US (n = 22) and there were no studies from developing countries. Most of the reports referred to pilot projects and short-term outcomes, and most of the studies were descriptive. The review indicates that although teledentistry is an area of expansion, there are still some barriers to its increased use.

Teledentistry in practice: literature review

Teledentistry can be defined as the remote provision of dental care, advice, or treatment through the medium of information technology, rather than through direct personal contact with any patient(s) involved. Within dental practice, teledentistry is used extensively in disciplines like preventive dentistry, orthodontics, endodontics, oral surgery, periodontal conditions, detection of early dental caries, patient education, oral medicine, and diagnosis. Some of the key modes and methods used in teledentistry are electronic health records, electronic referral systems, digitizing images, teleconsultations, and telediagnosis. All the applications used in teledentistry aim to bring about efficiency, provide access to underserved population, improve quality of care, and reduce oral disease burden.

Teledentistry: distant diagnosis of oral disease using e-mails

OBJECTIVE

The purpose of this study was to evaluate the applicability of telediagnosis in oral medicine, through the transmission of clinical digital images by e-mail.

SUBJECTS AND METHODS

The sample included 60 consecutive patients who sought oral medicine services at the Federal University of Paraná, in the state of Paraná, located in southern Brazil. The clinical history and oral lesion images were recorded using clinical electronic charts and a digital camera, respectively, and sent by e-mail to two oral medicine consultants. The consultants provided a maximum of two clinical hypotheses for each case, which were compared with biopsy results that served as the gold standard.

RESULTS

In 31 of the 60 cases (51.7%), both consultants made the correct diagnosis; in 17 cases (28.3%), only one consultant made the correct diagnosis; and in 12 cases (20%), neither consultant made the correct diagnosis. Therefore, in 80% of cases, at least one consultant provided the correct diagnosis. The agreement between the first consultant and the gold standard was substantial (κ=0.669), and the agreement between the second consultant and the gold standard was fair (κ=0.574).

CONCLUSIONS

The use of information technology can increase the accuracy of consultations in oral medicine. As expected, the participation of two remote experts increased the possibility of correct diagnosis.

Teleortodontia: ferramenta de auxílio à prática clínica e à educação continuada

INTRODUÇÃO: a Tecnologia da Informação (TI) está revolucionando os relacionamentos interpessoais. Esse novo contexto tornou possível exercer à distância as profissões da área da saúde, um conceito denominado telessaúde. A essência dessa área é a oferta, à distância, de serviços e informação sobre saúde. Nesse contexto, a Ortodontia como especialidade não pode ficar alheia a esses avanços. OBJETIVO: esse artigo se propôs a investigar - através de revisão não sistemática da literatura - quais dentre as tecnologias disponíveis são passíveis de ser utilizadas no desenvolvimento de serviços de teleortodontia, como ferramentas de auxílio à prática clínica e à educação continuada. O uso de tecnologias já acessíveis no mercado pode viabilizar os serviços de teleortodontia no país. Apesar desse artigo ter analisado as condições técnicas e as tecnologias relacionadas ao objeto de estudo, concentra-se no campo das questões éticas/morais, legais e econômicas do processo.

Effectiveness of Tele-guided Interceptive Prosthodontic treatment in rural India: A comparative pilot study

Loss of teeth and resultant resorption of the residual ridges is a major oral health problem in India. The resorption leads to irreversible loss of bone volume of the jaws and seriously undermines retention and stability of future dentures. Loss of masticatory efficiency causes nutritional deficiencies and affects quality of life. However, construction of over-dentures (dentures anchored to modified teeth or roots), a sophisticated procedure requiring skills of several dental specialists, can arrest the resorption and provide retentive dentures. Dental specialists in India are, however, concentrated in urban areas leaving the rural populace under-serviced. The aim of our study was to find out whether newly graduated dentists, under remote guidance from specialists, can fabricate over-dentures that are functional and improve the oral health related quality of life.

Two groups of subjects were treated with over-dentures. Group 1 consisted of subjects attending a rural dental health clinic (site1) and group 2 at a university teaching hospital (site 2). Two dental graduates at each site carried out treatments. Operators at site 1 were guided remotely over a telemedicine link, cell phones, and emails while those at site 2 were guided directly. Functional assessment of dentures was carried out at the end of the treatment period to determine the technical quality of dentures. Subjective evaluation was carried out by subjects completing the Oral Health Impact Profile (OHIP-EDENT) questionnaire for edentulous subjects before and after treatment.

No statistically significant difference was seen between the functional assessment scores of dentures from the two sites (p=0.08) at 95% confidence interval. Both groups also experienced significant improvement in all domains of OHIP - EDENT.

Remotely supervised newly graduated general dentists can provide over-dentures of sufficient quality to rural population. This strategy has the potential to improve access to care and elevate the level of dentistry available to rural population when referral to specialists in not feasible. The results of the study provide pointers for dental public health policy makers and administrators in developing nations on how to leverage Information and Communication Technology infrastructure to enhance access to care in rural areas.