m-Health for Early Detection of Oral Cancer in Low- and Middle-Income Countries

Technological aspects and recommendations for applying teledentistry in oral medicine: a scoping review

BACKGROUND

Teledentistry is applied in oral medicine to help dental practitioners and specialists manage complex oral conditions. This scoping review aims to synthesize the available evidence regarding the technical requirements and the provision of security services, as well as the recommendations on standard oral cavity photography methods for using teledentistry in oral medicine.

METHOD

The present scoping review was conducted in 2022 according to the Joanna Briggs Institute (JBI) manual. Four databases were systematically searched, including ISI Web of Science, PubMed, Scopus, and ProQuest, from January 1999 to December 2021. After finalizing the search strategy, all the original articles, reviews, editorials, letters, comments, and book chapters were included. All the dissertations uploaded in English with a full-text electronic file were also included to achieve a comprehensive picture of the available literature. Two types of analysis were applied: the quantitative descriptive analysis applying Excel 2016 and the qualitative thematic analysis using MAXQDA version 10.

RESULTS

The included papers were published during 1999-2021. Most of the included articles were from Brazil (n = 9, 21.43%), India (n = 6, 14.28%), the USA (n = 6, 14.28%), and the UK (n = 5, 11.90%). Social media usage as a teledentistry platform increased considerably between 2019 and 2021. Teledentistry platforms have been classified into four categories, including email, telephone, social network applications (WhatsApp, zoom, Google Meeting, Instagram, line Application, Viber, and Messenger), and teledentistry systems (teledentistry systems, which were designed specially to perform a teledentistry project). Teledentistry has been conducted to store and forward (n = 15, 30.71%), real-time (n = 9, 21.43%), or both (n = 12, 35.71%). According to the thematic results, basic technical requirements have been categorized into four, including teledentistry platform, type of interactions, internet connection, and photography tool. Other thematic results demonstrate seven categories of recommendations, including general factors, light, patient position, phone position, setting of a mobile phone camera, photo sending requirements, and photo visualization.

CONCLUSION

According to the results, over the past 7 years, especially during the COVID-19 pandemic, social network applications such as WhatsApp and Zoom have been used more frequently. Also, photography recommendations with a mobile phone camera depend on several factors such as general factors, light, patient position, phone position, setting of the mobile phone camera, and photo-sending requirements. Given the increased use of mobile cameras for oral photography, these recommendations can help improve the quality of images and subsequently improve the reliability of clinical decision-making in managing patients' conditions.

The association between referral by specialists in oral diagnosis on survival rates of patients with oral cancer: A retrospective cohort study

BACKGROUND

To assess the influence of diagnosis and referral provided by specialists in oral diagnosis on disease-free survival and overall survival of patients with oral cancer.

METHODS

A cohort of 282 patients with oral cancer treated at a regional cancer hospital from 1998 to 2016 was analyzed retrospectively. The referral register of the patients was analyzed and assigned to two groups: (1) those referred by oral diagnosis specialists (n = 129), or (2) those referred by nonspecialized professionals (n = 153). The cancer treatment evolution was assessed from the patients' records, and the outcome was registered concerning cancer recurrence and death. Sociodemographic and clinicopathological variables were explored as predictors of disease-free survival and overall survival.

RESULTS

Group 1 exhibited lower T stages and a reduced incidence of regional and distant metastases. Surgery was performed in 75.2% of cases in Group 1, while in Group 2, the rate was 60.8%. Advanced T stages and regional metastases reduced the feasibility of surgery. Higher TNM stages and tumor recurrence were associated with decreased disease-free survival, while surgical intervention was a protective factor. Higher TNM stage had a negative impact on the overall survival.

CONCLUSION

Specialized oral diagnosis did not directly impact disease-free survival and overall survival and did not influence the indication of surgery in oral cancer; however, it was associated with the diagnosis of early tumors and better prognosis.

Mobile Health Assessment of Traumatic Dental Injuries Using Smartphone-Acquired Photographs: A Multicenter Diagnostic Accuracy Study

Background: Mobile health (mHealth) has an emerging potential for remote assessment of traumatic dental injuries (TDI) and support of emergency care. This study aimed to determine the diagnostic accuracy of TDI detection from smartphone-acquired photographs. Methods: The upper and lower anterior teeth of 153 individuals aged ≥ 6 years were photographed using a smartphone camera app. The photos of 148 eligible participants were reviewed independently by a dental specialist, two general dentists, and two dental therapists, using predetermined TDI classification and criteria. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and inter-rater reliability were estimated to evaluate the diagnostic performance of the photographic method relative to the reference standard established by the dental specialist. Results: Of the 1,870 teeth screened, one-third showed TDI; and one-seventh of the participants had primary or mixed dentitions. Compared between the specialist's reference standard and four dental professionals' reviews, the diagnostic sensitivity and specificity for TDI versus non-TDI were 59-95% and 47-93%, respectively, with better performance for urgent types of TDI (78-89% and 99-100%, separately). The diagnostic consistency was also better for the primary/mixed dentitions than the permanent dentition. Conclusion: This study suggested a valid mHealth practice for remote assessment of TDI. A better diagnostic performance in the detection of urgent types of TDI and examination of the primary/mixed dentition was also reported. Future directions include professional development activities involving dental photography and photographic assessment, incorporation of a machine learning technology to aid photographic reviews, and randomized controlled trials in multiple clinical settings.

Mobile Health System for Meeting Health Information Needs in Patients With Head and Neck Cancer Undergoing Radiotherapy: Development and Feasibility Study

Patients with head and neck cancer undergoing radiotherapy encounter physical and psychosocial challenges, indicating unmet needs. Mobile health technology can potentially support patients. This single-armed feasibility study included 30 patients with head and neck cancer undergoing radiotherapy. Patients were asked to use the Health Enjoy System, a mobile health support system that provides a disease-related resource for 1 week. We assessed the usability of the system and its limited efficacy in meeting patients' health information needs. The result showed that the system was well received by patients and effectively met their health information needs. They also reported free comments on the system's content, backend maintenance, and user engagement. This study supplies a foundation for further research to explore the potential benefits of the Health Enjoy System in supporting patients with head and neck cancer.

Evaluating and improving the usability of a mHealth platform to assess postoperative dental pain

Objectives

The use of interactive mobile health (mHealth) applications to monitor patient-reported postoperative pain outcomes is an emerging area in dentistry that requires further exploration. This study aimed to evaluate and improve the usability of an existing mHealth application.

Materials and methods

The usability of the application was assessed iteratively using a 3-phase approach, including a rapid cognitive walkthrough (Phase I), lab-based usability testing (Phase II), and in situ pilot testing (Phase III). The study team conducted Phase I, while providers and patients participated in Phase II and III.

Results

The rapid cognitive walkthrough identified 23 potential issues that could negatively impact user experience, with the majority classified as system issues. The lab-based usability testing yielded 141 usability issues.; 43% encountered by patients and 57% by dentists. Usability problems encountered during pilot testing included undelivered messages due to mobile phone carrier and service-related issues, errors in patients' phone number data entry, and problems in provider training.

Discussion

Through collaborative and iterative work with the vendor, usability issues were addressed before launching a trial to assess its efficacy.

Conclusion

The usability of the mHealth application for postoperative dental pain was remarkably improved by the iterative analysis and interdisciplinary collaboration.

Deep learning in oral cancer- a systematic review

BACKGROUND

Oral cancer is a life-threatening malignancy, which affects the survival rate and quality of life of patients. The aim of this systematic review was to review deep learning (DL) studies in the diagnosis and prognostic prediction of oral cancer.

METHODS

This systematic review was conducted following the PRISMA guidelines. Databases (Medline via PubMed, Google Scholar, Scopus) were searched for relevant studies, from January 2000 to June 2023.

RESULTS

Fifty-four qualified for inclusion, including diagnostic (n = 51), and prognostic prediction (n = 3). Thirteen studies showed a low risk of biases in all domains, and 40 studies low risk for concerns regarding applicability. The performance of DL models was reported of the accuracy of 85.0-100%, F1-score of 79.31 - 89.0%, Dice coefficient index of 76.0 - 96.3% and Concordance index of 0.78-0.95 for classification, object detection, segmentation, and prognostic prediction, respectively. The pooled diagnostic odds ratios were 2549.08 (95% CI 410.77-4687.39) for classification studies.

CONCLUSIONS

The number of DL studies in oral cancer is increasing, with a diverse type of architectures. The reported accuracy showed promising DL performance in studies of oral cancer and appeared to have potential utility in improving informed clinical decision-making of oral cancer.

Mobile-Based Application Interventions to Enhance Cancer Control and Care in Low- and Middle-Income Countries: A Systematic Review

Objective: To identify and appraise mobile-based application (mAPP) interventions that have been used to support cancer control and care in low- and middle-income countries (LMICs). Methods: Four electronic databases were systematically searched for studies that reported primary research findings related to mAPP interventions applied in oncology settings in LMICs. A narrative synthesis was performed using the Mhealth Index and Navigation Database as an analytical framework. Results: Twenty studies reporting 18 cancer control and care mAPPs were included in this review. Among these mAPPs, ten focused on prevention, screening and early detection of cancer, five provided information to optimise supportive and palliative care, two provided support to assist treatment-shared decision-making and one covered information for follow-up and survivorship care. Conclusion: Cancer mAPP interventions are gradually gaining attention in LMICs as they provide unique resources for empowering and strengthening the role of people with cancer in their own care. To enhance cancer control, a focus on prevention and early detection is important; however, more mAPP interventions related to cancer treatment, follow-up and survivorship are also needed to enable more cost-effective cancer care.

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.

Potential implications of mobile applications in oral cancer

ABSTRACT

The modern era has observed vast technological advancements with a definite impact on the health sector. There has been an upsurge in mobile applications (mApps) used for varied purposes. Many mApps are available that target different arenas in dentistry including a range of oral health issues, the most important being oral cancer. These mApps with specific algorithms have been used for risk assessment, screening and diagnosis of oral potentially malignant and malignant disorders. Other benefits include remote consultation, timely referral, treatment of the disease, self monitoring and adherence to medications. Therefore, this review is designed to appraise the utility of mobile apps in oral cancer. The systematic research of the literature was done to find relevant articles regarding the development and applications of mApps in oral cancer by using specific research engines. PubMed, Cochrane and Clinical Key databases were searched electronically, irrespective of date of publication, with an assortment of several independent terms. A total of 423 articles were accessed, and screened. After applying the definite inclusion and exclusion criteria, 9 articles were finally selected which highlighted the impact of mApps in oral cancer. It was concluded that the potential of mobile applications could be harnessed judiciously to improve the screening, diagnosis and treatment of oral cancer.

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.

Impact of digital economic development and environmental pollution on residents' health: an empirical analysis based on 279 prefecture-level cities in China

BACKGROUND

The digital economy based on the internet and IT is developing rapidly in China, which makes a profound impact on urban environmental quality and residents' health activities. Thus, this study introduces environmental pollution as a mediating variable based on Grossman's health production function to explore the impact of digital economic development on the health of the population and its influence path.

METHODS

Based on the panel data of 279 prefecture-level cities in China from 2011 to 2017, this paper investigates the acting mechanism of digital economic development on residents' health by employing a combination of mediating effects model and spatial Durbin model.

RESULTS

The development of digital economy makes direct improvement on residents' health condition, which is also obtained indirectly by means of environmental pollution mitigation. Besides, from the perspective of spatial spillover effect, the development of digital economy also has a significant promoting effect on the health of adjacent urban residents, and further analysis reveals that the promoting effect in the central and western regions of China is more pronounced than that in the eastern region.

CONCLUSIONS

Digital economy can have a direct promoting effect on the health of residents, and environmental pollution has an intermediary effect between digital economy and residents' health; At the same time, there is also a regional heterogeneity among the three relationships. Therefore, this paper believes that the government should continue to formulate and implement scientific digital economy development policies at the macro and micro levels to narrow the regional digital divide, improve environmental quality and enhance the health level of residents.

A Current Review of Machine Learning and Deep Learning Models in Oral Cancer Diagnosis: Recent Technologies, Open Challenges, and Future Research Directions

Cancer is a problematic global health issue with an extremely high fatality rate throughout the world. The application of various machine learning techniques that have appeared in the field of cancer diagnosis in recent years has provided meaningful insights into efficient and precise treatment decision-making. Due to rapid advancements in sequencing technologies, the detection of cancer based on gene expression data has improved over the years. Different types of cancer affect different parts of the body in different ways. Cancer that affects the mouth, lip, and upper throat is known as oral cancer, which is the sixth most prevalent form of cancer worldwide. India, Bangladesh, China, the United States, and Pakistan are the top five countries with the highest rates of oral cavity disease and lip cancer. The major causes of oral cancer are excessive use of tobacco and cigarette smoking. Many people’s lives can be saved if oral cancer (OC) can be detected early. Early identification and diagnosis could assist doctors in providing better patient care and effective treatment. OC screening may advance with the implementation of artificial intelligence (AI) techniques. AI can provide assistance to the oncology sector by accurately analyzing a large dataset from several imaging modalities. This review deals with the implementation of AI during the early stages of cancer for the proper detection and treatment of OC. Furthermore, performance evaluations of several DL and ML models have been carried out to show that the DL model can overcome the difficult challenges associated with early cancerous lesions in the mouth. For this review, we have followed the rules recommended for the extension of scoping reviews and meta-analyses (PRISMA-ScR). Examining the reference lists for the chosen articles helped us gather more details on the subject. Additionally, we discussed AI’s drawbacks and its potential use in research on oral cancer. There are methods for reducing risk factors, such as reducing the use of tobacco and alcohol, as well as immunization against HPV infection to avoid oral cancer, or to lessen the burden of the disease. Additionally, officious methods for preventing oral diseases include training programs for doctors and patients as well as facilitating early diagnosis via screening high-risk populations for the disease.

High referral accuracy for oral cancers and oral potentially malignant disorders using telemedicine

OBJECTIVE

To evaluate the accuracy of MeMoSA®, a mobile phone application to review images of oral lesions in identifying oral cancers and oral potentially malignant disorders requiring referral.

SUBJECTS AND METHODS

A prospective study of 355 participants, including 280 with oral lesions/variants was conducted. Adults aged ≥18 treated at tertiary referral centres were included. Images of the oral cavity were taken using MeMoSA®. The identification of the presence of lesion/variant and referral decision made using MeMoSA® were compared to clinical oral examination, using kappa statistics for intra-rater agreement. Sensitivity, specificity, concordance and F1 score were computed. Images were reviewed by an off-site specialist and inter-rater agreement was evaluated. Images from sequential clinical visits were compared to evaluate observable changes in the lesions.

RESULTS

Kappa values comparing MeMoSA® with clinical oral examination in detecting a lesion and referral decision was 0.604 and 0.892, respectively. Sensitivity and specificity for referral decision were 94.0% and 95.5%. Concordance and F1 score were 94.9% and 93.3%, respectively. Inter-rater agreement for a referral decision was 0.825. Progression or regression of lesions were systematically documented using MeMoSA®.

CONCLUSION

Referral decisions made through MeMoSA® is highly comparable to clinical examination demonstrating it is a reliable telemedicine tool to facilitate the identification of high-risk lesions for early management.

COVID-19 Related Information on Pediatric Dental Care including the Use of Teledentistry: A Narrative Review

In addition to the direct impact of the SARS-CoV-2 infection, the COVID-19 pandemic reports multiple effects on people's health and psycho-physical well-being. In the dental field, oral hygiene sessions, regular dental check-ups, and aerosol-generating procedures were commonly postponed, thus resulting in repercussions on oral health also favored by the changing eating and oral hygiene habits during the multiple lockdowns. Furthermore, dental settings and practices were generally perceived as at high risk for SARS-CoV-2 transmission, thus unsafe, and by general and pediatric dentists themselves. Last, the consequences of stress related to deprivation of social life and playful activities should not be underestimated in children, exposing them to the deleterious effects of bad oral habits, with repercussions on the balanced growth and development of the stomatognathic system. The present work intends to analyze the medium-term and long-term impact of COVID-19 on pediatric oral and dental care provision, reviewing pediatric dentistry practice and oral and dental needs of pedodontics patients during the first peak and the various waves of the COVID-19 pandemic, and lessons learned.

Human Monkeypox: Oral Implications and Recommendations for Oral Screening and Infection Control in Dental Practice

The World Health Organization declared the spread of the human monkeypox virus (MPXV) an "emerging threat of moderate health concern" on 23 June 2022. Although about 20,000 cases of Monkeypox (MPX) were recorded in Europe and more than 28,000 in the United States from May to October 2022, their number is still small compared to the number of dental patients treated annually. Therefore, the likelihood of oral healthcare workers encountering an MPX case is relatively low in not endemic regions. In addition, MPX-positive individuals are considered contagious only during the prodromal or acute phase. However, the exact shedding and transmission routes of MPX and the associated risk of transmission in the dental setting remain unclear. Moreover, infected subjects whose disease is confined to the head and neck may require oral and dental care because they complain of lymphadenopathy involving the cervical lymph nodes. Furthermore, MPX lesions may first appear in the oral cavity or perioral area. Therefore, given the recent spread of MPXV in non-endemic areas where dentists are not used to considering this disease in the differential diagnosis and taking appropriate preventive measures, all oral healthcare providers nowadays should be aware of the oral presentation of MPX for adequate oral screening and appropriate preventive measures for infection control in the dental practice.

Mobile Health (mHealth) Technology in Early Detection and Diagnosis of Oral Cancer-A Scoping Review of the Current Scenario and Feasibility

Objective

Oral cancer is one of the most common types of cancer with dreadful consequences. But it can be detected early without much expensive equipment. Screening and early detection of oral cancer using Mobile health (mHealth) technology are reported due to the availability of the extensive network of mobile phones across populations. Therefore, we aimed to explore the existing literature regarding mHealth feasibility in the early detection of oral cancer. Materials and Method. An extensive search was conducted to explore the literature on the feasibility of mobile health for early oral cancer. Clinical studies reporting kappa agreement between on-site dentists and offsite health care workers/dentists in the early detection of oral cancer were included in this review. Studies describing the development of a diagnostic device, app development, and qualitative interviews among practitioners trained in using mobile health were also included in this review for a broader perspective on mHealth.

Results

While most of the studies described various diagnostic accuracies using mHealth for oral cancer early detection, few studies reported the development of mobile applications, novel device designs for mHealth applications, and the feasibility of a few mHealth programs for early oral cancer detection. Community health workers equipped with a mobile phone-based app could identify “abnormal” oral lesions. Overall, many studies reported high sensitivity, specificity, and Kappa value of agreement. Effectiveness, advantages, and barriers in oral cancer screening using mHealth are also described.

Conclusion

The overall results show that remote diagnosis for early detection of oral cancer using mHealth was found useful in remote settings.

Machine learning in point-of-care automated classification of oral potentially malignant and malignant disorders: a systematic review and meta-analysis

Machine learning (ML) algorithms are becoming increasingly pervasive in the domains of medical diagnostics and prognostication, afforded by complex deep learning architectures that overcome the limitations of manual feature extraction. In this systematic review and meta-analysis, we provide an update on current progress of ML algorithms in point-of-care (POC) automated diagnostic classification systems for lesions of the oral cavity. Studies reporting performance metrics on ML algorithms used in automatic classification of oral regions of interest were identified and screened by 2 independent reviewers from 4 databases. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed. 35 studies were suitable for qualitative synthesis, and 31 for quantitative analysis. Outcomes were assessed using a bivariate random-effects model following an assessment of bias and heterogeneity. 4 distinct methodologies were identified for POC diagnosis: (1) clinical photography; (2) optical imaging; (3) thermal imaging; (4) analysis of volatile organic compounds. Estimated AUROC across all studies was 0.935, and no difference in performance was identified between methodologies. We discuss the various classical and modern approaches to ML employed within identified studies, and highlight issues that will need to be addressed for implementation of automated classification systems in screening and early detection.

Dentist perceptions about the value of teledentistry

Background

Teledentistry has expanded access to oral health care by allowing patients and providers the option to receive care using technology and telecommunications. This study used a cross-sectional, mixed-methods design to evaluate dentists’ perceptions in the United States and understanding of the value and scope of teledentistry in their practices and to adopt virtual encounters as a care delivery methodology.

Methods

This study used a cross-sectional, mixed-methods design. The DentaQuest Partnership for Oral Health Advancement (now CareQuest Institute for Oral Health) conducted an electronic survey of providers in the DentaQuest Network that assessed the impact of COVID-19 on dental practices' patient volume, staffing, dental insurance carriers, treatment protocols, and the office's pre-and post-COVID finances. A total of 2767 dental providers completed the survey with a response rate of 13%. Qualitative interviews were then conducted with ten providers to get more in-depth information on teledentistry. Descriptive statistics summarize the survey population. Thematic analysis, which allows both deductive and inductive approaches, were used to analyze the interviews.

Results

About 23% of the dentists used teledentistry or virtual platforms. Findings illustrate that early adopter dentists were more likely to perceive the benefits of teledentistry as being more significant than its drawbacks. Late/resistant adopters to teledentistry were less aware of its benefits and were more focused on the drawbacks, such as upfront cost. Late adopters were also concerned about the level of care delivered through teledentistry.

Conclusions

This study explored dentists’ perceptions of teledentistry. Expanding access to care was recognized as one of the greater values of teledentistry.

Image collection and annotation platforms to establish a multi-source database of oral lesions

OBJECTIVE

To describe the development of a platform for image collection and annotation that resulted in a multi-sourced international image dataset of oral lesions to facilitate the development of automated lesion classification algorithms.

MATERIALS AND METHODS

We developed a web-interface, hosted on a web server to collect oral lesions images from international partners. Further, we developed a customised annotation tool, also a web-interface for systematic annotation of images to build a rich clinically labelled dataset. We evaluated the sensitivities comparing referral decisions through the annotation process with the clinical diagnosis of the lesions.

RESULTS

The image repository hosts 2474 images of oral lesions consisting of oral cancer, oral potentially malignant disorders and other oral lesions that were collected through MeMoSA^® UPLOAD. Eight-hundred images were annotated by seven oral medicine specialists on MeMoSA^® ANNOTATE, to mark the lesion and to collect clinical labels. The sensitivity in referral decision for all lesions that required a referral for cancer management/surveillance was moderate to high depending on the type of lesion (64.3%-100%).

CONCLUSION

This is the first description of a database with clinically labelled oral lesions. This database could accelerate the improvement of AI algorithms that can promote the early detection of high-risk oral lesions.

Barriers to early detection and management of oral cancer in the Asia Pacific region

Objective

Oral cancer is amenable to early detection but remains a prominent cause of mortality in the Asia Pacific region. This study aimed to identify barriers to early detection and management of oral cancer in the Asia Pacific region.

Methods

A mixed-methods approach was employed triangulating findings from a survey and focus groups. The survey was conducted among seven representative members of the Asia Pacific Oral Cancer Network (APOCNET) across six countries. Focus groups were conducted to gain deeper insights into the findings of the survey.

Results

The identified barriers were a lack of national cancer control strategies and cancer registries and the limited availability of trained health care professionals. Overcoming these challenges in the Asia Pacific region where resources are scarce will require collaborative partnerships in data collection and novel approaches for continuous professional training including eLearning. Further, to overcome the lack of trained health care professionals, innovative approaches to the management of oral potentially malignant lesions and oral cancer including telemedicine were suggested.

Conclusion

The findings of this study should be taken into account when charting national cancer control plans for oral cancer and will form the basis for future collaborative studies in evaluating effective measures to improve oral cancer detection and management in low- and middle-income countries.

Potential of Internet of Medical Things (IoMT) applications in building a smart healthcare system: A systematic review

Sudden spurting of Corona virus disease (COVID-19) has put the whole healthcare system on high alert. Internet of Medical Things (IoMT) has eased the situation to a great extent, also COVID-19 has motivated scientists to make new ‘Smart’ healthcare system focusing towards early diagnosis, prevention of spread, education and treatment and facilitate living in the new normal. This review aims to identify the role of IoMT applications in improving healthcare system and to analyze the status of research demonstrating effectiveness of IoMT benefits to the patient and healthcare system along with a brief insight into technologies supplementing IoMT and challenges faced in developing a smart healthcare system.

An internet-based search in PUBMED, Google Scholar and IEEE Library for english language publications using relevant terms resulted in 987 articles. After screening title, abstract, and content related to IoMT in healthcare and excluding duplicate articles, 135 articles published in journal with impact factor ≥1 were eligible for inclusion. Also relevant articles from the references of the selected articles were considered.

The habituation of IoMT and related technology has resolved several difficulties using remote monitoring, telemedicine, robotics, sensors etc. However mass adoption seems challenging due to factors like privacy and security of data, management of large amount of data, scalability and upgradation etc. Although ample knowledge has been compiled and exchanged, this structured systematic review will help the healthcare practitioners, policymakers/decision makers, scientists and researchers to gauge the applicability of IoMT in healthcare more efficiently.

Practical Applicability of Teledentistry in Pediatric Patients Amidst Pandemic : A Narrative Review

The coronavirus disease-2019 (COVID-19) pandemic has imposed a situation where all healthcare facilities except emergency services remain suspended. These times generated the necessity for the implementation of a healthcare delivery system that can be accessed digitally and, thus, benefit the majority of children as well as healthcare professionals. This review aims to propose a sound model of less technique sensitive, safe and handy strategies for dental traumatic injuries, endodontic and restorative concerns, and orthodontic urgencies until complete clinical help can be sought. Five hundred thirty articles were obtained from the PubMed, Google Scholar, Embase, Lilacs, and Cochrane databases published from 2011 to 2021. Nineteen articles that described teledentistry in the COVID-19 era were included. Teledentistry can serve as a vital patient management strategy that can aid in triaging urgent and elective patient treatment needs, ultimately easing the burden of clinics and at the same time providing a safer means of consultation.

Telediagnosis of oral lesions using smartphone photography

OBJECTIVE

The objective of this observational study was to evaluate telediagnosis of oral lesions using smartphone photography.

MATERIALS AND METHODS

Individuals with visible oral lesions composed a convenience sample. The lesions were photographed using a smartphone camera and emailed along with clinical information to three evaluators, who formulated up to two diagnostic hypotheses for each case. A total of 235 photographs from 113 clinical cases were obtained. The evaluators answered questions regarding referral decisions, requests for additional tests, diagnostic difficulties, and image quality. The diagnostic hypotheses were compared to the gold standard by means of percent agreement and kappa coefficient. Consensual face-to-face diagnoses of three specialists-when only a clinical diagnosis was necessary-or histopathological results-when a biopsy was necessary-were considered the gold standard.

RESULTS

The telediagnosis was similar to the gold standard in 76% of the cases, and kappa coefficients showed almost perfect agreement (k = 0.817-0.903). The evaluators considered that referrals could have been avoided on an average of 35,4% of the cases.

CONCLUSION

Diagnosis of oral lesions using images taken with a smartphone showed almost perfect agreement and diagnostic accuracy comparable to face-to-face diagnosis.

Healthcare providers' acceptance of telemedicine and preference of modalities during COVID-19 pandemics in a low-resource setting: An extended UTAUT model

Background

In almost all lower and lower middle-income countries, the healthcare system is structured in the customary model of in-person or face to face model of care. With the current global COVID-19 pandemics, the usual health care service has been significantly altered in many aspects. Given the fragile health system and high number of immunocompromised populations in lower and lower-middle income countries, the economic impacts of COVID-19 are anticipated to be worse. In such scenarios, technological solutions like, Telemedicine which is defined as the delivery of healthcare service remotely using telecommunication technologies for exchange of medical information, diagnosis, consultation and treatment is critical. The aim of this study was to assess healthcare providers’ acceptance and preferred modality of telemedicine and factors thereof among health professionals working in Ethiopia.

Methods

A multi-centric online survey was conducted via social media platforms such as telegram channels, Facebook groups/pages and email during Jul 1- Sep 21, 2020. The questionnaire was adopted from previously validated model in low income setting. Internal consistency of items was assessed using Cronbach alpha (α), composite reliability (CR) and average variance extracted (AVE) to evaluate both discriminant and convergent validity of constructs. The extent of relationship among variables were evaluated by Structural equation modeling (SEM) using SPSS Amos version 23.

Results

From the expected 423 responses, 319 (75.4%) participants responded to the survey questionnaire during the data collection period. The majority of participants were male (78.1%), age <30 (76.8%) and had less than five years of work experience (78.1%). The structural model result confirmed the hypothesis “self-efficacy has a significant positive effect on effort expectancy” with a standardized coefficient estimate (β) of 0.76 and p-value <0.001. The result also indicated that self-efficacy, effort expectancy, performance expectancy, facilitating conditions and social influence have a significant direct effect on user’s attitude toward using telemedicine. User’s behavioral intention to use telemedicine was also influenced by effort expectancy and attitude. The model also ruled out that performance expectancy, facilitating conditions and social influence does not directly influence user’s intention to use telemedicine. The squared multiple correlations (r²) value indicated that 57.1% of the variance in attitude toward using telemedicine and 63.6% of the variance in behavioral intention to use telemedicine is explained by the current structural model.

Conclusion

This study found that effort expectancy and attitude were significantly predictors of healthcare professionals’ acceptance of telemedicine. Attitude toward using telemedicine systems was also highly influenced by performance expectancy, self-efficacy and facilitating conditions. effort expectancy and attitude were also significant mediators in predicting users’ acceptance of telemedicine. In addition, mHealth approach was the most preferred modality of telemedicine and this opens an opportunity to integrate telemedicine systems in the health system during and post pandemic health services in low-income countries.

[Emergency dental care for adults and children with a new coronavirus infection caused by SARS-Cov-2 at an out-patients dental clinic in a megapolis]

BACKGROUND

In the article presented data about organization of the medical care over a period of 10 months at the Municipal Public Dental clinic in the metropolitan city such as Saint-Petersburg to the patients diagnosed with new coronavirus infection.

AIM

Organization of the medical ambulatory care to the patients diagnosed with new coronavirus infection.

MATERIALS AND METHODS

Layout decisions were utilized that enabled to organize the reception of patients infected with SARS-CoV-2 without disrupting the scheduled mode of treatment of the dental patients. Saint Petersburg Budgetary Healthcare Facility «Municipal Dental Clinic N 33» provided dental service to 191 patients with COVID-19.

RESULTS

Whereas 159 patients were admitted for treatment at the contagious isolation ward, 89 patients were consulted via the use of telehealth technology and among them 39 received telemedical assistance service. Mean age of the patients treated in the isolated ward: children 8.6±3.6, adults 39.1±13.8 years. People of active working age comprised 72% of all adult patients. Males filed for dental assistance more than females (54%). ICD K04.5 was established diagnosis in 52% of cases.

CONCLUSIONS

We managed to demonstrate high efficiency in utilizing telehealth technology. An issue of organizing medical dental care at the II level healthcare institution for adult population and for children diagnosed with new coronavirus infection COVID-19 in the heavy populated metropolis was solved.

Healthcare Professional in the Loop (HPIL): Classification of Standard and Oral Cancer-Causing Anomalous Regions of Oral Cavity Using Textural Analysis Technique in Autofluorescence Imaging

Oral mucosal lesions (OML) and oral potentially malignant disorders (OPMDs) have been identified as having the potential to transform into oral squamous cell carcinoma (OSCC). This research focuses on the human-in-the-loop-system named Healthcare Professionals in the Loop (HPIL) to support diagnosis through an advanced machine learning procedure. HPIL is a novel system approach based on the textural pattern of OML and OPMDs (anomalous regions) to differentiate them from standard regions of the oral cavity by using autofluorescence imaging. An innovative method based on pre-processing, e.g., the Deriche-Canny edge detector and circular Hough transform (CHT); a post-processing textural analysis approach using the gray-level co-occurrence matrix (GLCM); and a feature selection algorithm (linear discriminant analysis (LDA)), followed by k-nearest neighbor (KNN) to classify OPMDs and the standard region, is proposed in this paper. The accuracy, sensitivity, and specificity in differentiating between standard and anomalous regions of the oral cavity are 83%, 85%, and 84%, respectively. The performance evaluation was plotted through the receiver operating characteristics of periodontist diagnosis with the HPIL system and without the system. This method of classifying OML and OPMD areas may help the dental specialist to identify anomalous regions for performing their biopsies more efficiently to predict the histological diagnosis of epithelial dysplasia.

Teledentistry during COVID-19 pandemic

BACKGROUND AND AIMS

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

METHODS

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

RESULTS

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

CONCLUSION

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

The establishment of the Asia-Pacific Oral Cancer Network-Inaugural stakeholders' Meeting

The majority of oral cancer cases occur in Asia and the incidence is expected to continue to rise. Oral cancer is amenable to early detection through visual oral examination yet in many Asian countries, the disease presents at a late stage. The barriers to early detection are similar across the Asia-Pacific countries therefore, strategies to address these could be more effective if there were concerted efforts and joint resources amongst the countries. To facilitate better engagement and collaboration between stakeholders in oral cancer detection and management, the Asia-Pacific Oral Cancer Network (APOCNET) was established and the inaugural meeting was held in Kuala Lumpur on the 13th to 15th of September 2019. In this meeting, we identified the challenges faced in the early detection and management of oral cancer amongst the stakeholder countries, showcased the successful oral cancer programs in the region and identified strategic areas for collaboration. For this, notable international speakers and those from local universities and the Ministry of Health Malaysia were invited to share their experiences. The lessons learned from our neighbouring countries could lead to the implementation of similar programs that could help reduce the oral cancer burden in the region.