Teledentistry in practice: literature review

The design and evaluation of gamified online role-play as a telehealth training strategy in dental education: an explanatory sequential mixed-methods study

To evaluate user perceptions and educational impact of gamified online role-play in teledentistry as well as to construct a conceptual framework highlighting how to design this interactive learning strategy, this research employed an explanatory sequential mixed-methods design. Participants were requested to complete self-perceived assessments toward confidence and awareness in teledentistry before and after participating in a gamified online role-play. They were also asked to complete a satisfaction questionnaire and participate in an in-depth interview to investigate their learning experience. The data were analyzed using descriptive statistics, paired sample t-test, one-way analysis of variance, and framework analysis. There were 18 participants who completed self-perceived assessments and satisfaction questionnaire, in which 12 of them participated in a semi-structured interview. There were statistically significant increases in self-perceived confidence and awareness after participating in the gamified online role-play (P < 0.001). In addition, the participants were likely to be satisfied with this learning strategy, where usefulness was perceived as the most positive aspect with a score of 4.44 out of 5, followed by ease of use (4.40) and enjoyment (4.03). The conceptual framework constructed from the qualitative findings has revealed five key elements in designing a gamified online role-play, including learner profile, learning settings, pedagogical components, interactive functions, and educational impact. The gamified online role-play has demonstrated its potential in improving self-perceived confidence and awareness in teledentistry. The conceptual framework developed in this research could be considered to design and implement a gamified online role-play in dental education. This research provides valuable evidence on the educational impact of gamified online role-play in teledentistry and how it could be designed and implemented in dental education. This information would be supportive for dental instructors or educators who are considering to implement teledentistry training in their practice.

Practical applications of teledentistry during the Covid-19 pandemic in ASEAN member states - a systematic review

OBJECTIVE

The objective of this review is to determine the utilisation and adoption of teledentistry based solutions and technologies during the Covid-19 Pandemic in the Asean region.

BACKGROUND

Teledentistry is a branch of telemedicine that has rapidly advanced in the last few years and has the potential to provide solutions to oral health problems of patients and locations that do not have prompt and immediate access to a dentist or dental services. The Covid-19 has increased the adaption of all digital health technologies and teledentistry is no exception.

METHODOLOGY

The study utilized online databases such as Pubmed (Medline), Scopus (Embase) and CINAHL for the purpose of document search. Newcastle Ottawa (NOS) scale was used to determine the quality of the studies included in our systematic review. PRISMA guidelines were used as the criteria for reporting items in the systematic review.

RESULTS

A total of 1297 documents were found after applying the search criteria and the keywords for the selected study. After applying the Prisma guidelines, removal of duplicates and irrelevant entries, 10 studies that were conducted during the Covid-19 pandemic were selected, fitting the inclusion criteria. All the studies included were evaluated for quality and risk of bias through the Newcastle Ottawa scale. Only high-quality studies were included for the final review.

CONCLUSION

Teledentistry is a cost-effective solution to screen, diagnose and treat dental patients from a distance. Teledentistry also has the potential to continue seamless continuation of dental education to dental students, during disruptive and non-disruptive periods. ASEAN countries should fully utilise the potential of teledentistry, however sound and effective legislation would be the key first step to achieving that potential.

Knowledge, Attitude, and Practice of Teledentistry in Periodontal Diagnosis Among Dental Interns at a College in Sebha, Libya: A Cross-Sectional Questionnaire Study

Background Teledentistry, a subspecialty of telemedicine dedicated to dentistry, has shown promise in improving access to dental care, particularly in rural and isolated areas. It integrates digital and telecommunication technology with dentistry, allowing for the remote distance exchange of relevant clinical information and digital dental imaging for dental consultation and treatment planning. Periodontal disease diagnosis is crucial for effective treatment and prevention of irreversible loss of periodontal structures. Early identification of periodontal disease can be pivotal in preventing periodontal tissue destruction and tooth loss and improving the overall quality of patients' lives. Sebha is a city located in the Fezzan region of southwestern Libya. It is the capital of the Sabha District and the Sabha Governorate. The city is situated in the Libyan part of the Sahara desert and is known for its strategic location as a gateway to the Sahara desert. However, there is a lack of information on the use of teledentistry in Libya in general and the use of teleperiodontics, especially in periodontal diagnosis. Hence, the aim of this questionnaire study was to evaluate knowledge, attitudes, and practice of teledentistry among dental interns at Sebha, Libya. Materials and methods A paper-based questionnaire consisting of 28 close‑ended Likert scale questions, including sections assessing the knowledge, attitude, and practice of teledentistry and teleperiodontics, was administered to dental interns at the Faculty of Dentistry, Sebha University, Sebha, Libya. Results The study surveyed 42 dental interns of the Faculty of Sebha, Libya, in total, with an 82.35% response rate among them. The majority of participants (59.5%) felt that teledentistry is reliable in arriving at periodontal diagnosis. The majority of participants (64.3%%) also had acceptable levels of trust in teledentistry equipment. However, over 45% percent of dental practitioners voiced their worries about patient privacy. Most of the participants suggested using teledentistry in some form in their future practice. Conclusion Teledentistry and its branch teleperiodontics are recent developments and its penetration among dental healthcare workers, and their knowledge, attitude, and practice remain to be thoroughly understood. The changing trends in attitudes and practice as a consequence of changes in Internet and technological awareness and the effects of the pandemic warrant closer observation and study.

Teledentistry content in Canadian dental and dental hygiene curricula

OBJECTIVES

To explore the extent to which teledentistry (TD) content is incorporated into Canadian dental and dental hygiene curricula.

METHODS

An anonymous survey was distributed among all 10 dental and 35 dental hygiene programs across Canada in June and July 2022. The survey focused on TD teaching (methods employed, content taught, and barriers to TD education), with descriptive (frequency, maximum, minimum, mean) and inferential (Pearson chi-square for odds ratio test) data analyses using SPSS. A ρ - value < 0.05 was considered statistically significant.

RESULTS

Thirty-four programs responsed to the survey, including all dental (n = 10) and 68% (n = 24) of dental hygiene programs; eighteen reported having TD content, including three dental programs. An average of 9.22 ± 4.86 h was reported for teaching TD, with lecture format as the most employed approach and using TD in dental practice as the most covered topic. While 53% of the dental hygiene programs employed formative and summative assessments, only one dental program reported having assessment for this content. Moreover, programs that dedicated less than 9 h to teaching this content were less likely to address more than seven topics (Odds ratio (OR) = 0.14).

CONCLUSION

The dental and dental hygiene programs in Canada differ in their offering TD education, and 30% of the dental and 62.5% of the surveyed dental hygiene programs addressed TD content. This scarcity emphasizes the necessity for incorporating such content in future curriculum planning to consequently decrease the lack of knowledge, an identified barrier to TD implementation in education and practice, as today's students will be future educators.

Telehealth technologies in care homes: a gap for dentistry?

BACKGROUND

Telehealth technologies are playing an increasing role in healthcare. This study aimed to review the literature relating to the use of telehealth technologies in care homes with a focus on teledentistry.

METHODS

Khangura et al.'s (Evidence summaries: the evolution of a rapid review approach. Syst Rev 2012;1:10) rapid review method included an electronic database search on Embase, PubMed, Web of Science and OpenGrey. Out of 1525 papers, 1108 titles and abstracts were screened, and 75 full texts assessed for eligibility. Risk of bias was assessed using the Mixed Methods Assessment Tool 2018.

RESULTS

Forty-seven papers (40 studies) from 10 countries, published 1997-2021, were included in the review, four studies related to teledentistry. Whilst some preferred in-person consultations, perceived benefits by stakeholders included reduced hospitalization rates (n = 14), cost-savings (n = 8) and high diagnostic accuracy (n = 7). Studies investigating teledentistry using intra-oral cameras reported that teleconsultations were feasible with potentially high diagnostic accuracy (n = 2), cost-savings (n = 1) and patient acceptability (n = 1).

CONCLUSION

There is limited published research on teledentistry, but wider telehealth research is applicable to teledentistry, with findings suggesting that telehealth technologies play a role in care homes consultations that are acceptable, cost-saving and with potential diagnostic accuracy. Further research is needed on the mode, utility and acceptability of teledentistry in care homes.

Evaluating the Impact of Teledentistry on Patient Outcomes, Diagnostic Accuracy, and Satisfaction in a Prospective Observational Analysis

Background Teledentistry, defined as the use of telecommunication technologies for dental care, has emerged as a transformative approach to oral health services. This prospective observational analysis aims to comprehensively assess the impact of teledentistry on patient outcomes and satisfaction, addressing key aspects such as diagnostic accuracy, longitudinal treatment outcomes, and economic and logistical considerations. Methods The study involved 242 participants selected from diverse dental clinics offering teledentistry services. Participants could choose between traditional in-person visits and teledentistry consultations. The teledentistry interventions included remote consultations, diagnostic evaluations, and treatment planning facilitated through virtual communication tools. Baseline assessments captured initial dental conditions, and follow-up assessments were conducted at three, six, and 12 months. Outcome measures included diagnostic accuracy, patient satisfaction, changes in dental conditions over time, and economic and logistical feedback. Results Descriptive statistics revealed baseline characteristics, with participants evenly distributed between in-person and teledentistry groups. However, the overall satisfaction with diagnoses was significantly lower in the teledentistry group as compared to the in-person group (p < 0.001). Longitudinal assessments demonstrated comparable changes in dental conditions between the two groups. Economic feedback highlighted a cost-saving advantage for teledentistry users, with 80% reporting reduced expenses. Conclusion This study highlights the transformative potential of teledentistry in expanding access to oral health services, reducing costs, and providing comparable treatment outcomes to traditional in-person care. Future efforts should focus on enhancing the teledentistry experience, addressing patient satisfaction concerns, and refining the delivery of remote dental care to maximize its benefits for both patients and healthcare systems.

Virtual counselling of tobacco cessation during the COVID-19 pandemic: A qualitative study on the experiences and perceptions of Malaysian dental undergraduates and their patients

INTRODUCTION

When dental institutions had to close down during the Movement Control Order (MCO) implementation due to the COVID-19 pandemic, dental students were faced with delays in completing their tobacco cessation schedule. An alternative was to allow students to conduct virtual counselling (VC) for smoking cessation for their patients to address their clinical requirements. This study aimed to explore Malaysian dental undergraduates' and patients' experiences undergoing smoking cessation counselling through virtual platforms.

MATERIALS AND METHODS

The study consisted of qualitative, semi-structured Focus Group Discussions (for students, n = 23) and in-depth interviews (for patients, n = 9); to phenomenologically describe the perceptions of participants involved in the VC. Each session was recorded with the participants' permission. The recorded session was transcribed verbatim and thematically analysed using the qualitative data analysis software, NVivo™.

RESULTS

The major themes that emerged were: (1) General opinions and experiences, (2) Content of VCs, (3) Remote access to counselling, (4) Patient-clinician relationships, (5) Technical issues, (6) Changes after VCs, and (7) Future application. Most students and patients were quite comfortable with VC as it is convenient, allowing students to be creative and avoid the hassle of transport and traffic. However, some of the students felt that it lacked the personal touch and guidance from lecturers who would normally be present during physical class.

CONCLUSION

Virtual counselling enables remote access to counselling, but it is also subjected to some limitations, especially regarding lack of clinical assessments, human touch and internet issues. Though participants were optimistic about adapting it in the future, multiple factors must be considered. Ultimately, the behavioural change will depend on the patient's motivation in making a difference.

Impact of COVID-19-Related Personal Protective Equipment Changes on Dental Education: A Qualitative Study to Explore Faculty and Student Perspective

Background

COVID-19 pandemic and its related personal protective equipment have impacted all aspects of dental education. The qualitative study assesses the impact of COVID-19-related changes and their effects on students' clinical learning from student and faculty perspectives.

Methods

This qualitative study involved third- and fourth-year predoctoral dental students and full-time dental clinical faculty. A semistructured interview guide was used. The interview guide consisted of seven open-ended questions about the impact of the new COVID-19-related infection control procedures on students' learning experience in the dental clinic. Interviews were recorded, transcribed verbatim, and analyzed using a basic interpretative approach by two independent researchers. Emerged themes were identified.

Results

Twelve faculty members and 21 students participated in six focus groups. Three major themes emerged from the analysis: learning challenges, learning opportunities, and long-term impact. Students identified four categories of learning challenges: communication, visualization, clinical exposure, and heat. Five learning challenges identified by faculty were: faculty burnout, service delivery challenges, material wastage, teaching difficulties, and lack of comprehensive care. The five learning opportunities students identified were autonomy, preparedness, efficiency, safety, and personalized feedback. Learning opportunities identified by faculty were time management, autonomy, and preparedness. Three categories of long-term impact on students identified were future opportunities, adaptation, and postgraduation plans. Faculty identified apathy, career re-evaluation, and adaption as the long-term impact of COVID-19-related changes.

Conclusion

Although the new COVID-19-related infection control procedures and regulations in the dental school clinical setting come with learning challenges, students and faculty also saw learning opportunities through increased autonomy, preparedness, and efficiency. The impact of COVID-19 extends beyond the current learning experiences as it may modify students' long-term plans.

Teledentistry for improving access to, and quality of oral health care: A protocol for an overview of systematic reviews and meta-analyses

Digital technologies are becoming essential to address and optimize the suboptimal performance of healthcare systems. Teledentistry involves the use of information and communication technology to improve access to oral health care and the quality of oral health care delivery. Several systematic reviews (SRs) have been conducted to synthesize evidence on the effectiveness of teledentistry but with conflicting results. The aim of this review is to comprehensively summarize available SRs and provide evidence on the impact of teledentistry on access to oral care, patients' and oral healthcare providers' outcomes, quality of oral health care and costs. This protocol has been registered with the International Prospective Register of Systematic Reviews (PROSPERO CRD42022373964). Six electronic databases including MEDLINE (Ovid), Embase (Embase.com), CINAHL (EBSCO), Web of Science, Cochrane Library and Epistemonikos will be searched for SRs of quantitative, qualitative, and mixed reviews evaluating teledentistry modalities involving both patients and/or oral health care providers (OHCPs). We will include studies published in English or French. The outcomes will include patients' outcomes (e.g., access to oral health care, patient-reported outcomes, and patient-reported experiences); patient indicators (e.g., clinical outcomes, adherence to treatment, adverse outcomes and costs); and OHCP indicators (e.g., diagnostic accuracy, barriers and enablers costs and equity). Two independent reviewers will perform data screening, data extraction and will assess the quality of included studies using AMSTAR 2 and ROBIS tools. Data will be synthesized narratively and presented by tables and graphs. We will report any overlap of primary studies in the SRs. A statement on the strength of evidence for each outcome will be provided if possible. This review will inform decision-makers, patients, OHCPs, and researchers on the potential effectiveness, benefits, and challenges of teledentistry and support them in making recommendations for its use. Results will be disseminated through peer-reviewed publications, presentations at conferences, and on social media.

Telehealth in oral medicine: A cross-sectional evaluation based on a mobile application

BACKGROUND

Teledentistry is considered a good tool in the diagnostic process. In oral medicine, there is a low number of trained professionals and dentists have difficulty in diagnosing and treating oral lesions.

OBJECTIVE

We aimed to perform a cross-sectional evaluation based on the mobile application for oral diagnosis using a mobile application in a Brazilian State.

METHODS

This is a retrospective, cross-sectional, observational study of the data of the "Telehealth in Stomatology in Paraíba" carried out between May 2021 and November 2022.

RESULTS

The app has a team of 16 consultants (Ph.D. professors, postgraduate students, residents, and dentists). In addition, there are 289 registered professionals, with a mean age of 33.7 years, predominantly female (70.2%), working in primary care (79.2%), and general practitioners (42.6%). Regarding the cases, the app has 194 cases, and reactive lesions are the most suggested hypotheses reported by dentists (24.5%) and consultants (22.3%). We had an overall concordance rate of 64.1%.

CONCLUSION

The application is easily accessible and has an assistance network that helps with early diagnosis. In addition, it has good coverage with users in more than 50% of the cities in the state. Thus, applications that provide specialized care to distant areas are important for better public health.

Patients' experience with teledentistry compared to conventional follow-up visits in TMD clinic: A pilot study

OBJECTIVES

Teledentistry has been used in many dental specialties including temporomandibular joint disorders (TMD). Studies have measured patients' experience with teledentistry visits. Thus, this study aimed to assess the experience of patients seen using teledentistry compared to the traditional Orofacial Pain (OFP) and TMD visits.

METHODS

An interventional study was conducted on 25 patients following up at the TMD clinic. The first follow-up occurred in person at the hospital clinic, where patients were given a survey at the end of the visit. A questionnaire included the following sections: socio-demographic information, patient experience of the visit, preferred online platforms, and patients' familiarity with these platforms. Patients had teledentistry visits via ZOOM Premium. After the visit, patients were given a second survey highlighting their experience towards the virtual visit and sections from the first survey. The study compares patients' satisfaction between conventional and virtual follow-up visits and compares patient experience differences based on their demographics.

RESULTS AND CONCLUSION

Twenty-five patients completed both surveys. Over half of the participants were younger than 35 years old (64 %), and the majority were female (80 %). A total of 76 % had used virtual platforms prior to the study, and 74 % of them were convenient. Regarding patients' experience, only a borderline difference existed among the age groups of the study in effectively using teledentistry in the follow-ups compared to conventional visits (p = 0.05). Other results revealed no significant differences in patients' experience between virtual and conventional visits, indicating that high-quality dental care services can be provided remotely. Therefore, teledentistry could be integrated into the OFP and TMD Clinic flow without adversely affecting patient experience or quality of care.

CLINICAL SIGNIFICANCE

Virtual follow-up visits could save patients' time, effort, and travel costs compared to conventional visits. Waiting lists are increasing in almost all dental; thus, integrating virtual follow-up visits would shorten these lists.

Teledentistry: A Comprehensive Review and Its Application in Pediatric Dental Care

In recent years, dental technology has experienced remarkable advancements, mirroring the evolution of communication and information technologies. The advent of information technology has paved the way for a new frontier in healthcare known as teledentistry. This innovative approach has revolutionized the delivery of dental care across geographical distances, enhancing accessibility and communication in the realm of oral health. This article aims to highlight the various methodologies of teledentistry, discuss its benefits for both patients and dentists, and emphasize its potential to overcome geographical barriers, enhance access to dental care, and promote oral health equity, especially among children. There are three primary teledentistry methods: real-time consultation, the store-and-forward method, and the remote monitoring method. Real-time consultation facilitates immediate interaction between dentists and patients through video conferencing, enabling the sharing of data and medical history. The store-and-forward method involves the collection and transmission of essential diagnostic materials, enhancing diagnostic accuracy. Remote monitoring allows continuous patient evaluation from a distance, improving healthcare delivery and patient safety. Teledentistry's impact on pediatric and preventive dentistry is substantial. It offers remote counseling, diagnosis, and monitoring for children, especially in areas with limited access to dental care. Additionally, mobile gaming apps play a role in behavioral management and reducing dental anxiety among children. Both patients and dentists benefit from teledentistry. Patients gain access to timely consultations, reducing the need for immediate in-person visits. Dentists can efficiently evaluate and monitor patients, collaborate with specialists, and provide expert advice, leading to improved healthcare delivery. Teledentistry is transforming dental care by overcoming geographical barriers, improving access, and enhancing communication. While facing challenges, its potential to revolutionize healthcare delivery and promote oral health equity is undeniable. With ongoing advancements and strategic measures, teledentistry is poised for a promising future in healthcare.

Patients' Readiness Towards Teledentistry in the Malaysian Urban Population Attending an Undergraduate Teaching University

Introduction: COVID-19 disease has resulted in suspension of all nonurgent routine dental treatments. In view of COVID-19 situation, social distancing, movement restriction orders, and affected health care systems, there is an urgent need to resume and deliver oral health care remotely. Hence, alternative means of dental care should be available for both patients and dentists. Therefore, this study aims to assess patients' readiness for teledentistry in Malaysian urban population attending an undergraduate teaching university. Methods: A cross-sectional study was conducted among 631 adult patients visiting the Faculty of Dentistry, SEGi University, from January 2020 to May 2021 in Selangor, Malaysia. A validated, self-administered, 5-point Likert scale online questionnaire comprising five domains was administered. (1) Patients' demographics and dental history, (2) patients' access to teledentistry, (3) patients' understanding towards teledentistry, (4) patients' willingness, and (5) barriers in using teledentistry were used to collect the required information. Results: Six hundred and thirty-one (n = 631) participants responded to the questionnaire. Ninety percent of patients were able to connect to Wi-Fi services independently and 77% participants were comfortable using online communication platforms. Seventy-one percent of the participants agreed that video and telephone clinics can reduce chances of infection rather than face-to-face consultation during the pandemic. Fifty-five percent of patients felt that virtual clinics would save time and 60% thought it could reduce travelling costs. Fifty-one percent showed their willingness to use video or telephone clinics when implemented at onsite clinics. Conclusion: Our study shows the readiness of patients to accept teledentistry as an alternative method of oral care if appropriate training and education are provided. The results of this study have prompted an increase in patients' education and shown a need to train clinicians and patients to integrate this technology at SEGi University. This might facilitate unhindered dental consultation and care in all situations.

Smartphone oral self-photography in teledentistry: Recommendations for the patient

In the current context of the coronavirus disease 2019 pandemic, the deployment of telemedicine has accelerated considerably. Like telemedicine, teledentistry involves the use of telecommunication technologies to provide medical information and services. Teledentistry can contribute to remote assessment (teletriage) and continuity of care (telemonitoring). This evaluation at a distance can be done by sending photos taken by the patient with a smartphone. Providing patients with a simple and reproducible protocol and explaining how to take a photo is important for sufficient image quality. The aim of this technical note is to help clinicians advise their patients on how to take photographs of their oral cavity simply and with sufficient quality to be reproducible.

Teledentistry: A Future Solution in the Diagnosis of Oral Lesions: Diagnostic Meta-Analysis and Systematic Review

Introduction: Teledentistry (TD) can offer a wide range of possibilities in the field of oral medicine. Oral potentially malignant disorders (OPMDs) are hard to detect, and even harder to diagnose correctly. With the help of TD, OPMDs can be detected and diagnosed by a remote specialist. Our aim was to investigate whether TD could provide a reliable diagnostic method compared with clinical oral examination (COE) in the diagnosis of OPMDs. Methods: A systematic search was conducted in three databases (Medline, EMBASE, CENTRAL) until November 2021. We included studies that compared telediagnosis and COE, both made by experts. Pooled specificity and sensitivity were calculated and visualized on a two-dimensional plot. Risk of bias was assessed using the QUADAS-2 tool, and the level of evidence is shown with the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) tool. Results: Of the 7,608 studies, 13 were included in the qualitative and 9 in the quantitative synthesis. Using TD tools in the detection of oral lesions (OLs) showed high specificity (0.92 confidence interval [95% CI] = 0.59-0.99) and sensitivity (0.93 95% CI = 0.17-1.00). In the differential diagnosis of lesions, we found high sensitivity and specificity (0.942 95% CI = 0.826-0.982 and 0.982 95% CI = 0.913-0.997), respectively. We summarized the available data on time-effectiveness, screening person, referral decision, and technical settings. Conclusion: Detecting OLs with TD tools might lead to earlier diagnosis, treatment, and stricter follow-up of OPMD. TD may offer a great substitution for COE in the diagnosis of OLs, and thus, fewer referrals could be made to special care, resulting in a greater number of treated OPMDs.

Perceptions Toward the Usefulness and Benefits of Teledentistry in the Ministry of National Guard Health Affairs (MNGHA) in Saudi Arabia

Aim The present study aimed to evaluate the dentists' perceptions of the usefulness and benefits of teledentistry at the Ministry of National Guard Health Affairs (MNGHA) in Saudi Arabia. Materials and methods A cross-sectional study was carried out among 170 dentists from all the dental specialties who were recruited and trained under MNGHA in Saudi Arabia. A questionnaire was distributed using different social media channels. The questions were arranged into four distinct categories: concerns about data security held by dentists, teledentistry and the enhancement of dental practices, and the usefulness of teledentistry for dental clinics and their patients. The responses of the enrolled participants were further collected. The frequency distribution was calculated. A one-way ANOVA test was applied for comparisons. The confidence interval and p-value were set at 95% and ≤ 0.05, respectively. Results Most participants showed neutral responses to the perception of teledentistry's ability to diagnose accurately. Most of them agreed that the waiting list could be shortened with the help of teledentistry and that it would improve the interaction between peers. The mean score for the usefulness of teledentistry in dental practice was found to be significantly higher among 45-54-year-old than other age groups, among those with >16 years of work experience, among consultants, and among those with video conference as the preferred method of communication. Conclusion General knowledge, attitudes, and views of the value and advantages of teledentistry were moderate among dentists in the MNGHA. A few issues about diagnostic precision, cost, and data security were relevant.

Tele-dentistry, its trends, scope, and future framework in oral medicine; a scoping review during January 1999 to December 2021

BACKGROUND

Tele-dentistry has been increasingly used for different purposes of visit, consultation, triage, screening, and training in oral medicine. This study aims to determine the main facilitators, barriers, and participants` viewpoints of applying tele-dentistry in oral medicine and develop a framework indicating the input, process, output, and feedback.

METHOD

This was a scoping review conducted in 2022 applying Arksey and O'Malley (2005) approach. Four databases including ISI web of science, PubMed, Scopus, and ProQuest were searched from January 1999 to December 2021. Inclusion criteria consisted of all original and non-original articles (reviews, editorials, letters, comments, and book chapters), and dissertations in English with a full text electronic file. Excel₂₀₁₆ was used for descriptive quantitative analysis and MAXQDA version 10 was applied for qualitative thematic analysis. A thematic framework was developed customizing the results of the review in a virtual mini expert panel.

RESULTS

Descriptive results show that among 59 included articles, 27 (46%) have addressed the various applications of tele-dentistry during COVID-19 pandemic in the field of oral medicine. From geographical distribution perspective, most of the papers were published in Brazil (n = 13)/ 22.03%, India (n = 7)/11.86% and USA (n = 6)/10.17%. Thematic analysis shows that seven main themes of "information", "skill", "human resource", 'technical", "administrative', 'financial', and 'training and education' are explored as facilitators. 'Individual', 'environmental', 'organizational', 'regulation', 'clinical', and 'technical barriers' are also identified as main barriers of tele-dentistry in oral medicine.

CONCLUSION

According to the results for using tele-dentistry services in oral medicine, a diverse category of facilitators should be considered and at the same time, different barriers should be managed. Users` satisfaction and perceived usefulness of tele-dentistry as final outcomes can be increased considering the system`s feedback and applying facilitator incentives as well as decreasing the barriers.

Novel Approach to Improving Specialist Access in Underserved Populations with Suspicious Oral Lesions

Late detection and specialist referral result in poor oral cancer outcomes globally. High-risk LRMU populations usually do not have access to oral medicine specialists, a specialty of dentistry, whose expertise includes the identification, treatment, and management of oral cancers. To overcome this access barrier, there is an urgent need for novel, low-cost tele-health approaches to expand specialist access to low-resource, remote and underserved individuals. The goal of this study was to compare the diagnostic accuracy of remote versus in-person specialist visits using a novel, low-cost telehealth platform consisting of a smartphone-based, remote intraoral camera and custom software application. A total of 189 subjects with suspicious oral lesions requiring biopsy (per the standard of care) were recruited and consented. Each subject was examined, and risk factors were recorded twice: once by an on-site specialist, and again by an offsite specialist. A novel, low-cost, smartphone-based intraoral camera paired with a custom software application were utilized to perform synchronous remote video/still imaging and risk factor assessment by the off-site specialist. Biopsies were performed at a later date following specialist recommendations. The study's results indicated that on-site specialist diagnosis showed high sensitivity (94%) and moderate specificity (72%) when compared to histological diagnosis, which did not significantly differ from the accuracy of remote specialist telediagnosis (sensitivity: 95%; specificity: 84%). These preliminary findings suggest that remote specialist visits utilizing a novel, low-cost, smartphone-based telehealth tool may improve specialist access for low-resource, remote and underserved individuals with suspicious oral lesions.

The Efficacy of Dental Caries Telediagnosis Using Smartphone: A Diagnostic Study in Geriatric Patients

Background and aim The major barrier to oral health care for geriatrics is access to dental care. Teledentistry is the field of dentistry that uses telecommunication with digital imaging for the exchange of valid information for diagnosis, treatment, and continuing dental education, enabling some means of approach to oral health care. This study aimed to assess the accuracy of diagnosing dental caries in the older age group by examining intraoral photographs taken by smartphone camera compared with standard clinical dental examination. Methods and material A calibrated dentist examined 18 patients aged 60-75 for six variables: sound tooth, decayed tooth, filled tooth with and without caries, missing tooth, and the presence of prosthesis. Intraoral photographs of each patient were taken using a smartphone. The photographs were then sent to six different examiners through WhatsApp. The accuracy of the diagnosis was measured by applying Cohen's kappa, sensitivity, and specificity. Fleiss' kappa was used to measure the agreement index using the software R (R Foundation for Statistical Computing, Vienna, Austria) version 4.2.1. Results The overall agreement between the tele-examiners and the control was measured, with the kappa scores ranging from 0.897 to 0.921, and the mean kappa score was 0.909. There was high specificity and sensitivity in the value observed. The agreement index, measured through Fleiss' kappa for six teeth conditions, reported the perfect agreement (0.867) among six examiners. Conclusions Under the limitations of the study, teledentistry using a mobile phone has acceptable accuracy for diagnosing caries in the older age group compared to a standard clinical dental examination.

Teledentistry: A bibliometric analysis of the scientific publication's trend

Introduction

Teledentistry is a specialized area within telemedicine employs digital technology and telecommunications to remotely manage dental patients, offering care, advice, education, and treatment. The significance of teledentistry escalated during the COVID-19 pandemic.

Objective

This study presents a bibliometric analysis of teledentistry, based on a retrospective search of the Scopus database.

Materials and methods

The research utilized Bibliometrix and VOSviewer software.

Results

Publications on teledentistry have shown a recent surge, particularly since 2020, attributed to the pandemic. Out of 369 articles, just 28 (7.5%) were single-authored, while most involved collaborative efforts. These articles were dispersed across 160 journals, with the Journal Of Telemedicine And Telecare, International Journal Of Environmental Research And Public Health, and Telemedicine And E-Health each publishing over 15 articles. Remarkably, 66% of the journals featured open-access content. The University of Western Australia emerged as the most prolific institution, with 12 publications, while the United States, Chile, and Brazil led in the number of published documents.

Conclusions

The growing interest in teledentistry, mainly fueled by the pandemic, has promising implications for dental practice. Despite the existing limitations, it holds potential. This bibliometric analysis provides a comprehensive overview of the field and offers valuable quantitative insights for shaping future research and funding strategies, especially concerning protocol development and digital risk assessment.

Challenges and Opportunities for Dental Education from COVID-19

With the ongoing COVID-19 pandemic, dental education has been profoundly affected by this crisis. First of all, COVID-19 brought physical and psychological health problems to dental students and educators. In addition, both non-clinical teaching and clinical-based training experienced challenges, ranging from fully online educational content to limited dental training, students’ research was delayed in achieving project milestones and there was hesitancy in respect of the COVID-19 vaccine. On the other hand, the COVID-19 pandemic has increased the demand for teledentistry and dental emergency treatment, and brought awareness of the advantages and high-speed development of distance education. This review aims to present these challenges and opportunities for dental education, and suggest how dental institutions should prepare for the future demand for dental education.

Telediagnosis of dental caries: Possible or impossible? A pilot cross-sectional study

OBJECTIVES

The aims of this study were to evaluate the effectiveness of teledentistry (based on a home intraoral imaging protocol) in detecting dental caries and to assess the accuracy of this method compared to clinical examination.

METHODS

Forty-three patients were recruited for the study. Using a protocol for taking intraoral photographs at home with a smartphone proposed by the Dental School of Verona, a remote diagnosis of dental caries (TD) was performed by an experienced dentist. The same caries sites were also assessed by clinical diagnosis (CD) by a second experienced dentist. Ten photos were taken at home in five different perspectives, with and without flash, and emailed to one of the authors. The best five photos were selected for telediagnosis. The International Caries Detection and Assessment System (ICDAS II) score was used for caries diagnosis. Statistical tests were performed: Sensitivity and specificity of TD, the positive and negative predictive value of TD (PPV-NPV), and Spearman correlation to evaluate the relationship between the scores of TD and CD.

RESULTS

A total of 430 photographs were submitted; TD was performed on 215 photographs and 43 patients were visited. A total of 1201 teeth were analyzed. The sensitivity of TD was 74.0, the specificity was 99.1, the PPV of TD was 91.7, and the NPV was 96.4. The Spearman correlation was 0.816, showing a very strong correlation between the values obtained with TD and CD.

CONCLUSIONS

The study showed good potential for TD, which proved to be a feasible method to combine with routine caries diagnosis in daily preventive dentistry practice.

Teledentistry as an Effective Tool for the Communication Improvement between Dentists and Patients: An Overview

Teledentistry is an online dental care service that allows patients and dentists to meet in real time, safely, without being at the same location. During the COVID-19 pandemic, real-time videoconferencing has gained popularity in the field of teledentistry, with numerous benefits for both patients and dentists. Online consultations can minimize costs, maximize time, and provide more convenient care options for both patients and dentists. When practicing teledentistry, a dentist must establish a good doctor–patient relationship. Dentists must ensure that the telecommunication solution that they choose meets their clinical requirements and complies with privacy laws. Dentists should provide adequate information to patients about the limitations, advantages, and disadvantages that may occur during online consultation. Dentists must follow guidelines and procedures regarding informed consent, patient details, personal communications, and consultancies’ privacy and confidentiality. The patient should be aware of the limitations of teledentistry, and dentists will provide the best advice possible in the absence of a face-to-face consultation. This article discusses how teledentistry could be an effective tool for dentists and patients.

National analysis of dental teleconsulting of the Brazilian Telehealth Program

This cross-sectional study nationally evaluated asynchronous dental teleconsulting services offered by the Telehealth Brazil Networks Program, using the 2019 Telehealth Results Monitoring and Evaluation System database and considering Brazilian regional differences. The following teleconsulting variables were collected: dentist's sex and specialty, date/time of question and answer, response time; dental specialty, professional satisfaction, and patient referral. Five Brazilian regions were socioeconomically characterized according to the Human Development Index, estimated population, Gini coefficient, coverage of dental specialty centers, oral health teams in Family Health Strategy, and oral health teams in primary health care (PHC). In total, 2,703 teleconsulting sessions occurred in Brazil in the analyzed period. The Southeast exhibited the highest demand (49.1%). Most dentists were female (60.6%) and were dental surgeons from the Family Health Strategy (61.3%). Most teleconsulting sessions occurred during working hours (85.5%) and questions were answered within 72 hours (66.7%). Level of satisfaction and avoidance of referral yielded rates of 90.9% and 66.8%, respectively, among dentists who answered about these topics. Semiology was the most frequently demanded area in teleconsulting (33.9%). The different demands from the regions reflected regional differences. The most frequently demanded specialties represent the Brazilian PHC scenario. Professionals incorporated teleconsulting into their work routine and most teleconsultants responded within the stipulated timeframe. Professional feedback should be encouraged.

Awareness regarding Teledentistry among Dental Professionals in Malaysia

Objective. Teledentistry is considered to be a technological advancement in providing dental care to patients while effectively addressing the time management. Furthermore, the pandemic of COVID-19 has been here for quite long now, forcing the dental practitioners to ponder upon other methods of healthcare delivery apart from the traditional in-office direct clinical examination. The aim of this study was to explore the perceptions of dental professionals of Malaysia regarding teledentistry, which can act as a future pedestal for improvements in virtual dental practice and patient care. Materials and Methods. It was a descriptive, cross-sectional study involving an electronic survey of a sample of dental professionals of Malaysia. A prevalidated, 26-item, 5-point Likert-scale questionnaire was used in assessing the perceptions of dental professionals regarding teledentistry in four domains: existing concerns about teledentistry use, the potential of teledentistry in improving practice, usefulness of teledentistry for dental practice, and its usefulness for patients. Statistical analyses involved descriptive statistics which included frequency distributions. Results. An overall response rate of 31.0% was observed with 310 dental practitioners participating in the survey. More than 60% of respondents agreed that teledentistry would benefit the dental practice through enhancement of communication with peers, guidance, and new patients’ referral. However, a substantial proportion of practitioners (70-80%) expressed uncertainty with accuracy of diagnosis, technical reliability, and privacy. Conclusion. Generally, the results of this study point towards the readiness of dental professionals of Malaysia to engage in teledentistry practice. However, further work needs to be done to assess the commercial feasibility of teledentistry, not only in Malaysia but also in other parts of the world. To start with, directed campaigns in reference to teledentistry are necessary to educate dentists and the public about the technology and its potential.

Is tele-diagnosis of dental conditions reliable during COVID-19 pandemic? Agreement between tentative diagnosis via synchronous audioconferencing and definitive clinical diagnosis

Objectives

To assess the reliability of synchronous audioconferencing teledentistry (TD) in making tentative diagnosis compared to definitive clinical face-to-face (CFTF) diagnosis; and whether agreement was influenced by dentist's experience, caller-patient relationship, and time of call.

Methods

All patients calling the TD hotline during COVID-19 pandemic, triaged as emergency/ urgent and referred for CFTF care were included (N=191). Hotline dentists triaged the calls, made tentative audio-dentistry (AD) diagnosis, while dentists at point of referral made the definitive CFTF diagnosis. Cohen's weighted kappa (κ) assessed the extent of agreement between AD vs CFTF diagnosis.

Results

There was significantly very good pair-wise agreement (κ = 0.853, P < 0.0001) between AD and CFTF diagnosis. AD diagnosis of pulpitis and periodontitis exhibited the most frequent disagreements. Tele-dentists with ≥ 20 years’ experience exhibited the highest level of agreement (κ =0.872, P < 0.0001). There was perfect agreement when mothers mediated the call (κ = 1, P < 0.0001), and very good agreement for calls received between 7 am-2 pm (κ = 0.880, P < 0.0001) compared to calls received between 2-10 pm (κ = 0.793, P < 0.0001).

Conclusions

Remote tentative diagnosis using AD is safe and reliable. Reliability was generally very good but varied by dentist's experience, caller-patient relationship, and time of call.

Clinical significance

The findings suggest that using AD in the home environment is safe and reliable, deploying providers with variable years of experience. The findings have generalizability potential to a variety of similar circumstances, healthcare settings and epi/pandemic situations.

Role of Newly Introduced Teledentistry Service in the Management of Dental Emergencies During COVID-19 Pandemic in Qatar: A Cross-Sectional Analysis

Introduction: The lockdown imposed by the COVID-19 pandemic rendered teledentistry (TD) necessary to maintain the continuity of oral health services and avoid missing emergency dental conditions, while minimizing face-to-face visits. Our objective was to evaluate the ability of a newly introduced triage-based TD service to deliver its goals, by evaluating its processes and outcomes and assessing the demand for TD. Methods: This cross-sectional report assessed the triage processes and outcomes (triage category, referral to emergency/dental facility undertaken, remote medications prescribed, and procedures performed at the point of referral); and evaluated the demand for the newly introduced TD service during 5 months of the first wave of the pandemic. Results: Of 850 calls, about 70.6% of the samples were managed remotely; 29.4% were categorized as emergency/urgent and referred to the emergency/dental facility. Compared with other complaints, orofacial dental pain was the most common reason for the calls (41.6%, p < 0.0001). About 14.71% of callers received prescription for medications remotely. The most demanded disciplines were general dentistry, orthodontics, and oral surgery, respectively (p < 0.0001). Of those referred to a dental facility, 31.84% required no clinical intervention, 28.7% received orthodontic appliance repair, and 14.3% and 11.2% had urgent dental extractions or root canal treatments. Demand on the service fluctuated through various distinct stages of the lockdown. Conclusions: There has been continuous demand for the newly introduced TD service throughout the period of the current report despite the fluctuations, with most complaints managed remotely. TD was effective and suitable for triage, service delivery, and care during the pandemic.

Orthodontists' perceptions of and adaptations to nonspecialist and direct-to-consumer orthodontic service providers

OBJECTIVES

To evaluate orthodontists' perceived impacts on their practices as a result of general practitioners (GPs) and direct-to-consumer (DTC) orthodontic care providers and the adaptational changes implemented in the past 10 years.

MATERIALS AND METHODS

An electronic survey was administered to 270 orthodontists in Canada and the United States to determine demographic background, perception of perceived impact, and specific changes implemented to improve practice competitiveness.

RESULTS

More experienced orthodontists (P = .0001) and males (P = .027) were more likely to indicate a perceived impact from GP orthodontics. American orthodontists were significantly more likely than Canadian orthodontists to perceive an impact from DTC providers (P = .017). There was a positive association with orthodontists' years of experience and having implemented adaptational changes to their practice for a period greater than 10 years across multiple categories. Female orthodontists were more likely to have implemented adaptational changes for a period of less than 10 years across multiple categories.

CONCLUSIONS

The perceived impact of GPs providing orthodontic care was greater than that of DTC providers. American orthodontists were significantly more likely to perceive an impact from DTC providers. Orthodontists have experienced a reduction in referrals from GPs and an increase in referred case difficulty. Less experienced and female orthodontists have made the most adaptive changes to their practices in the past 10 years.

Teledentistry as a Supportive Tool for Dentists in Diagnosing MRONJ in Northern Cyprus

Objective

This web-based survey, as a tool of teledentistry, is aimed at assessing the level of knowledge, attitudes, and awareness regarding MRONJ among dental professionals in Northern Cyprus.

Methods

An online self-administered questionnaire about MRONJ was sent to all dentists in Northern Cyprus through Google Forms. The first part of the questionnaire consists of demographic and professional information, and the second part included questions about knowledge and awareness questions about MRONJ. The SPSS software was used for statistical data analysis. A Chi-square test was performed to compare between the groups. The significance level was set at p < 0.05.

Results

A total of 112 dentists participated in this survey. The participants showed an insufficient level of knowledge regarding MRONJ, as only 56.6% of the participants stated that they had general knowledge about MRONJ. Regarding the practical questions of the survey, the participants showed poor knowledge about implant and tooth extraction procedures while a patient is using antiresorptive or antiangiogenic drugs, particularly the usage of oral antiresorptive or antiangiogenic drugs for less than 3 years. Participants showed adequate knowledge in terms of usage area of medications and administration of them.

Conclusion

Teledentistry can be used as a supportive tool for dentists in diagnosing MRONJ. Similar to previous studies, the knowledge and awareness of MRONJ of dentists in Northern Cyprus were found to be inadequate. There is a significant need to provide more professional information as part of undergraduate programs so that the next generation of dentists can practice more confidently.

Teledentistry awareness, its usefulness, and challenges among dental professionals in Pakistan and Saudi Arabia

Objectives

This study aims to describe the perception of dental professionals in Pakistan and Saudi Arabia (SA) towards the practice of teledentistry, its usefulness and challenges.

Methods

A cross-sectional study was carried out among 190 dentists from January 2021 to April 2021. The participants were included in the study using snowball sampling method. A 26-item adopted questionnaire was distributed using different social media channels. Chi-square test was used for analysis.

Results

Out of 190 participants, 46.3% were from Pakistan and 53.7% were from SA. The majority of participants in both countries agreed that teledentistry would enhance guidelines and advice (74.2%), improve peer-to-peer interaction (79.5%) and make patient's referrals more efficient (75.8%). For the usefulness, most participants agree that it is economical for the patients (61.1%), improves communication (74.7%), helps in educating the patients (86.3%), avoid unnecessary travel (76.8%), helps monitoring (71.6%), and benefits patients in remote areas (74.7%); however, more Pakistani participants perceived that time spent with the patient would increase compared to SA participants (p < 0.001) and a higher proportion of SA participants believe that it helps in communication and monitoring of patients (p < 0.001) than Pakistani participants. Regarding the challenges in the use of teledentistry, few participants think that it violates the patient's privacy (22.6%) or is difficult to use (14.7%) or have distrust towards the teledentistry equipment (24.2%).

Conclusion

The results indicated a high awareness and a positive attitude towards teledentistry, and its adaptation in their dental practice in both countries. However, limited infrastructure, set-up cost, and information technology (IT) literacy are the main challenges in integrating teledentistry which can be overcome by strategic government initiatives, policies, and programs.

Accuracy and perceptions of teledentistry in KSA during the COVID-19 pandemic: A single-centre randomised controlled trial

Objective

Methods

Results

Conclusion

The Teledentistry, Impact, Current Trends, and Application in Dentistry: A Global Study

Objective

The present study was aimed at assessing the impact of teledentistry, its application, and trends in uplifting dental practice and clinical care around the world. Material and Methods. The present observational study comprised of an electronic survey distributed among dental professionals around the globe. The validated survey form consisted of a total 26 questions with 5-point Likert scale response. The questionnaire used was divided into four domains: usefulness of teledentistry for patients, its usefulness in dental practice, its capacity to improve the existing practice, and the concerns attached to its use. The statistical analysis was performed using SPSS-25. ANOVA test was used to assess the effect of independent variables on dependent variables. A p value of ≤0.05 was taken as statistically significant.

Results

A total of 506 dental professionals participated in the study with the response rate of 89.39%. More than half of the participants (50-75%) endorsed that teledentistry is a useful tool for improving clinical practice as well as patient care. Two-thirds of the participants (69.96%) considered that teledentistry would reduce cost for the dental practices. On the other hand, about 50-70% of dental professionals expressed their concerns regarding the security of the data and consent of patients. The most preferred communication tool for teledentistry was reported to be videoconference followed by phone. The majority of participants recommended the use of teledentistry in the specialty of oral medicine, operative dentistry, and periodontics. There was a significant difference between the age, experience of dentists, and their qualifications with domains of teledentistry.

Conclusions

The overall impact of dental professionals towards teledentistry was positive with adequate willingness to incorporate this modality in their clinical practice. However, the perceived concerns pertaining to teledentistry are significant impediments towards its integration within the oral health system. An in-depth study of its business model and cost-benefit needs of time, especially in the context of developing countries, in order to avail the optimum benefits of teledentistry.

Impact of covid-19 pandemic on characteristics of dental emergencies and treatment services at tertiary care centre

To categorize and compare the dental emergencies along with status of health services received in the tertiary dental health care centre during the pre covid- 19 periods and period of the complete lockdown in COVID 19 pandemic. Methods: A retrospective cross-sectional observational survey was conducted. Four different groups period were studied on patients who visited for dental emergencies at tertiary care centre. April 14 to 13 May 2020 assigned and analyzed as a test period group or group IV. The control period group i.e. group III was 14 February 2020 to 17 March, pre lockdown COVID 19 month when there was no consideration of epidemic in India. Same as periods of group II and IV, group I and II from last year 2019 were also assigned and analyzed. The tertiary care centre provision of health services during this pandemic was also inquired and evaluated. The information was recorded regarding availability of health services like non-emergency dental treatments, emergency dental services, and online professional consultation. To compare four different time period of obtained data, Analysis of variance (ANOVA) and Chi square test were used. Results: The overall proportion and percentage of dental emergencies were raised. The reason for emergency visits to dental clinic were the main problem related with pulpal (46.0%) followed by abscess (16.6%), periapical lesions (15.0%), cellulitis (4.1%) or trauma (0.3%). In lockdown most of the dental emergencies 228(2 6 5) were endodontic related (86.1%) which managed mostly through '3A" approach (advise, analgesics and antibiotics) (60.1%) and remaining (26.0%) through extraction.

Communication, Veterinary-Client-Patient Relationship, and Teledentistry

Communication is the basis of any relationship. Communication can help strengthen the relationship between veterinarians, their clients, and their colleagues throughout the profession. Different models of communication have been demonstrated including the directive model, consumerism model, and relationship-centered model. When veterinarians refer to a specialist, they view the referral as an extension of the care they provide. Therefore, developing a relationship with the specialist is an important facet of patient care. Creating an appropriate veterinary-client-patient relationship (VCPR) helps the patient receive the best care possible. This needs to be considered when offering telemedicine or teledentistry to clients or referring veterinarians.

Telemedicine for healthcare: Capabilities, features, barriers, and applications

Regular hospital visits can be expensive, particularly in rural areas, due to travel costs. In the era of the Covid-19 Pandemic, where physical interaction becomes risky, people prefer telemedicine. Fortunately, medical visits can be reduced when telemedicine services are used through video conferencing or other virtual technologies. Thus, telemedicine saves both the patient's and the health care provider time and the cost of the treatment. Furthermore, due to its fast and advantageous characteristics, it can streamline the workflow of hospitals and clinics. This disruptive technology would make it easier to monitor discharged patients and manage their recovery. As a result, it is sufficient to state that telemedicine can create a win-win situation. This paper aims to explore the significant capabilities, features with treatment workflow, and barriers to the adoption of telemedicine in Healthcare. The paper identifies seventeen significant applications of telemedicine in Healthcare. Telemedicine is described as a medical practitioner to diagnose and treat patients in a remote area. Using health apps for scheduled follow-up visits makes doctors and patients more effective and improves the probability of follow-up, reducing missing appointments and optimising patient outcomes. Patients should have an accurate medical history and show the doctor any prominent rashes, bruises, or other signs that need attention through the excellent quality audio-video system. Further, practitioners need file management and a payment gateway system. Telemedicine technologies allow patients and doctors both to review the treatment process. However, this technology supplements physical consultation and is in no way a substitute for a physical consultation. Today this technology is a safe choice for patients who cannot go to the doctor or sit at home, especially during a pandemic.

Knowledge, Perception, and Experience of Dentists About Teledentistry

OBJECTIVES

This study aimed to evaluate the level of knowledge, perception, and experience of teledentistry amongst Brazilian dentists with the ongoing COVID-19 pandemic.

METHODS

Between June and July 2020, an online questionnaire was used to collect information on the demographic and professional profiles of dentists and their levels of knowledge, perception, and attitudes towards teledentistry. Descriptive statistics were reported as percentages, and Chi-squared test was used to compare responses amongst general practitioners, specialists, and those with varying levels of professional experience.

RESULTS

This study included 575 dentists, the majority of whom were from the southeast region of Brazil (73.4%) and had a specialist degree (70.4%). Approximately 42.4% of the study sample had graduated more than 10 years ago, 39.3% between 2 and 10 years ago, and 18.3% up to 2 years ago. In general, the majority of dentists exhibited only a superficial awareness of the resolution that regulates teledentistry in Brazil. A greater number of specialists were aware of the resolution (P = .007) and felt confident performing teledentistry (P = .000) compared to general practitioners, whilst those with more experience (graduated more than 10 years ago) exhibited greater knowledge (P = .012) and preparation (P = .000). More than 60% of the dentists, regardless of dental specialty and clinical experience, had no knowledge of providing prescriptions via teledentistry. The majority of general practitioners (89.5%) and specialists (81.4%) had no previous experience using teledentistry.

CONCLUSIONS

The findings of this study suggest that Brazilian dentists are inadequately prepared for the implementation of teledentistry.

Scoping review: Facilitators and barriers in the adoption of teledentistry among older adults

OBJECTIVE/BACKGROUND

Access to oral health care among older adults is a key issue in society, which has been exacerbated by social distancing measures and lockdowns during the COVID-19 pandemic. Older adults would greatly benefit from teledentistry, yet little information exists on the enablers and challenges of adopting this technology for use with this group. The aim of this scoping review is to summarise the applications and key factors associated with the adoption of teledentistry among older adults.

MATERIALS AND METHODS

This scoping review was developed in accordance with Arksey and O'Malley's five-stage framework and the Joanna Briggs Institute scoping review protocol guidelines. Publications on teledentistry involving direct clinical services for older adults aged 60 and above were included. Publications that focused solely on teleeducation were excluded. A systematic search was carried out on major electronic databases until 25 August 2020. Out of 1084 articles screened, 25 articles were included. Facilitators and barriers were categorised using the socio-ecological model.

RESULTS/DISCUSSION

Teleconsultation and telediagnosis were the most reported applications of teledentistry among older adults. Reported policy-level factors were data privacy issues (n = 7) and regulations (n = 17). Community-level facilitators and barriers included the availability of resources (n = 15) and support (n = 3). Familiar care settings (n = 2) and effective administration (n = 20) were key organisational-level factors. Staff attitudes and education (n = 23) and individual patient knowledge, attitudes and practices (n = 10) can influence teledentistry adoption while complex medical conditions (n = 8) may pose a challenge.

CONCLUSION

Key factors in the uptake of teledentistry among older adults span across policy, community, organisational, interpersonal and individual factors. Commonly reported barriers included technical issues, lack of funding, consent issues and cognitive impairments.

The use of teledentistry in facilitating oral health for older adults: A scoping review

BACKGROUND

Teledentistry is used in many countries to provide oral health care services. However, using teledentistry to provide oral health care services for older adults is not well documented. This knowledge gap needs to be addressed, especially when accessing a dental clinic is not possible and teledentistry might be the only way for many older adults to receive oral health care services.

TYPES OF STUDIES REVIEWED

Nine databases were searched and 3,396 studies were screened using established eligibility criteria. Included studies were original research or review articles in which the intervention of interest was delivered to an older adult population (≥ 60 years) via teledentistry. The authors followed the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Review criteria.

RESULTS

Nineteen studies were identified that met the criteria for inclusion. Only 1 study was from the United States. Seven studies had results focusing on older adult participants only, with most of those conducted in elder care facilities. The remainder consisted of studies with mixed-age populations reporting distinct results or information for older adults. The included studies used teledentistry, in both synchronous and asynchronous modes, to provide services such as diagnosis, oral hygiene promotion, assessment and referral of oral emergencies, and postintervention follow-up.

CONCLUSIONS AND PRACTICAL IMPLICATIONS

Teledentistry comprises a variety of promising apps. The authors identified and described uses, promising possibilities, and limitations of teledentistry to improve the oral health of older adults.

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.

Attitude towards Telemonitoring in Orthodontists and Orthodontic Patients

The purpose of this study was to analyze the attitude of dentists and patients towards the use of Dental Monitoring^TM (DM), an orthodontic telemonitoring software. Thus, two different specially prepared specific questionnaires were administered to 80 dentists (40 were general dentists and 40 orthodontists) and 80 orthodontic patients. All dentists judged positively telemonitoring, as 96.25% of them considered telemonitoring indicative of high tech and high-quality treatment; 100% considered it a way to reduce the number of in-office visits; 17.5% agreed on a weekly telemonitoring frequency, 40% on a biweekly, and 42.5% on a lower frequency. Further, 97.5% of patients judged positively telemonitoring; 81.25% of them considered telemonitoring indicative of high-tech treatment; 81.25% declared to be interested in reducing the number of in-office visits through telemonitoring; 27.5% agreed on taking self-picture every week, 57.5% every two weeks, and 15% on a lower frequency. Both patients and dentists positively judged telemonitoring, considering it a technologically advanced tool increasing the perception of quality and accuracy of the treatment. Both groups were interested in reducing the number of in-office visits, although not all of them revealed to be ready to invest more money and time in it.

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.

Is It Time to Consider Implementation of Telemedicine in Current Oral Health Care Services?

Telemedicine offers an excellent opportunity to provide continuing health care for those in need during local/global pandemics and disasters. It provides a safe and effective communication tool between health professionals and can be used as "forward triage" to manage medical/dental emergencies and to minimize the contact between the patients and clinicians during the coronavirus disease (COVID-19) pandemic. Patients with noncommunicable diseases, like cancer, diabetes, cardiovascular, or chronic respiratory diseases, may present with critical health problems due to less access to health care systems during global disasters; opportunities for screening oral mucosa might be significantly disrupted, leading to delayed diagnosis of malignant/potentially malignant lesions. Telemedicine and oral health care associated mobile applications should be implemented to provide equal access to care, to eliminate unnecessary visits to health centers, and to improve practical coordination between professionals and health facilities.

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.

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.

The Modern and Digital Transformation of Oral Health Care: A Mini Review

Dentistry is a part of the field of medicine which is advocated in this digital revolution. The increasing trend in dentistry digitalization has led to the advancement in computer-derived data processing and manufacturing. This progress has been exponentially supported by the Internet of medical things (IoMT), big data and analytical algorithm, internet and communication technologies (ICT) including digital social media, augmented and virtual reality (AR and VR), and artificial intelligence (AI). The interplay between these sophisticated digital aspects has dramatically changed the healthcare and biomedical sectors, especially for dentistry. This myriad of applications of technologies will not only be able to streamline oral health care, facilitate workflow, increase oral health at a fraction of the current conventional cost, relieve dentist and dental auxiliary staff from routine and laborious tasks, but also ignite participatory in personalized oral health care. This narrative article review highlights recent dentistry digitalization encompassing technological advancement, limitations, challenges, and conceptual theoretical modern approaches in oral health prevention and care, particularly in ensuring the quality, efficiency, and strategic dental care in the modern era of dentistry.

The application of teledentistry for Saudi patients' care: A national survey study

BACKGROUND/PURPOSE

Teledentistry has emerged as a new communication tool in various dental disciplines around the world. The aim of this study was to investigate the applicability and reliability of teledentistry in the field of diagnostic dentistry and explore the perception of Saudi dentists of its benefits and concerns.

MATERIALS AND METHODS

An electronic survey with 40 questions was developed, validated and distributed electronically by email and social media channels to dentists from different specialty in Saudi Arabia. Collected data were analyzed for statistical significance.

RESULTS

A total of 148 dentists completed the survey. The current data demonstrated that 50% of study participants have had applied teledentistry in their clinical practice. Out of all, 90% have computers in their dental offices and 72% have been using electronic medical records in which radiographs and clinical images are uploaded. Most participants had smart phones (91%), in which they were used more commonly (74.3%) than conventional cameras (54.1%) to capture and share patients' clinical images over communication applications (74.3%) and less likely through emails (62.2%). Overall, 83% were confident that teledentistry can improve daily dental practice, specifically in the fields of oral radiology followed by endodontics and oral medicine.

CONCLUSION

Teledentistry is an emerging tool with potential to improve the delivery of diagnostic dental care for communities with limited or no access to dental specialists. As of today, teledentistry has not been truly implemented by the Saudi dental community. Development of national programs to educate the public and promote teledentistry among dental practitioners are warranted.

Disruptive Innovation in Dentistry: What It Is and What Could Be Next

Dentistry is a technically oriented profession, and the health care sector is significantly influenced by the ubiquitous trend of digitalization. Some of these digital developments have the potential to result in disruptive changes for dental practice, while others may turn out to be just a pipedream. This Discovery! essay focuses on innovations built on artificial intelligence (AI) as the center-technology influencing 1) dental eHealth data management, 2) clinical and technical health care applications, and 3) services and operations. AI systems enable personalized dental medicine workflows by analyzing all eHealth data gathered from an individual patient. Besides dental-specific data, this also includes genomic, proteomic, and metabolomic information and therefore facilitates optimized and personalized treatment strategies and risk management. Based on the power of AI, the triangular frame of "data"/"health care"/"service" is supplemented by technological advancements in the field of social media, Internet of things, augmented and virtual reality, rapid prototyping, and intraoral optical scanning as well as teledentistry. Innovation continues to be critical to tackle dental problems until its routine implementation based on sound scientific evidence. Novel technologies must be viewed critically in relation to the cost-benefit ratio and the ethical implications of a misleading diagnosis or treatment produced by AI algorithms. Highly sensitive eHealth data must be handled responsibly to enable the immense benefits of these technologies to be realized for society. The focus on patient-centered research and the development of personalized dental medicine have the potential to improve individual and public health, as well as clarify the interconnectivity of disease in a more cost-effective way.

Post COVID-19 lockdown: measures and practices for dental institutes

Resuming regular clinical activities at dental premises after the COVID-19 lockdown period or post COVID-19 is likely to be a challenge for all dental institutes. When returning to the dental practice or training, staff and students alike should abide by the new rules and regulations. In the process of controlling viral spread, clinical dental facilities face a higher risk of disease transmission among patients as well as clinical and non-clinical staff. Aerosols formation and diffusion into the surrounding air can be a real concern of viral transmission, if no protective measures are established. We aim in this review to present the currently implemented measures and propose changes in clinical dental facilities to minimize the risk of transmission. Dental professionals should be prepared to treat every patient as a suspected COVID-19 carrier and be ready to receive and manage an overwhelming number of patients. We suggest that dental practices establish a sensible workforce shift schedule, improve ventilation levels, reduce dental aerosol generating procedures, and develop a comprehensive guidance to Healthcare Workers to reduce the risk of COVID-19 transmission.

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.