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

Comparison of virtual clinical scenario and role play in learning oral pathology among dental students

In oral pathology, virtual clinical scenario illustrating dentist-patient interactions can be utilized by both students and health professionals to deliver/gain knowledge and make clinical diagnosis of oral lesions. Role play is also an educational technique which is designed to engage and motivate students in classrooms. This study aimed to compare usefulness of virtual clinical scenario and role play in learning oral pathology among second-year dental students. The students were randomly divided to one of the two groups: virtual clinical scenario group (n = 50) and role play group (n = 50). Virtual clinical scenario group was provided with virtual clinical cases of oral lesions through Google Forms whereas role play group was exposed to virtual clinical cases of oral lesions through role playing activity. Both groups underwent assessments before and after the intervention. Students' perceptions on usefulness of both techniques in terms of diagnosis, visual parameters and impact on learning were evaluated by feedback questionnaire. Data were analyzed using Statistical Package for the Social Sciences version 27.0. Wilcoxon signed-rank test was used to compare pre-test and post-test scores. Additionally, the scores and students' responses from both groups were compared using the Mann-Whitney U test. A P-value of < 0.05 was set as statistically significant. Students in both groups showed significantly higher post-test scores compared to their pre-test scores (P < 0.001). However, the role play group outperformed the virtual clinical scenario group, with a significantly higher post-test score (P = 0.04). Furthermore, feedback concerning role play was significantly higher than that for the virtual clinical scenario across multiple aspects (P < 0.05). Our findings suggest that role play emerges as the preferred method, significantly enhancing dental students' learning experiences in oral pathology.

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

PURPOSE/OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

A Systematic Umbrella Review of the Effects of Teledentistry on Costs and Oral-Health Outcomes

Teledentistry offers possibilities for improving efficiency and quality of care and supporting cost-effective healthcare systems. This umbrella review aims to synthesize existing systematic reviews on teledentistry and provide a summary of evidence of its clinical- and cost-effectiveness. A comprehensive search strategy involving various teledentistry-related terms, across seven databases, was conducted. Articles published until 24 April 2023 were considered. Two researchers independently reviewed titles, abstracts and full-text articles. The quality of the included reviews was critically appraised with the AMSTAR-2 checklist. Out of 749 studies identified, 10 were included in this umbrella review. Two reviews focusing on oral-health outcomes revealed that, despite positive findings, there is not yet enough evidence for the long-term clinical effectiveness of teledentistry. Ten reviews reported on economic evaluations or costs, indicating that teledentistry is cost-saving. However, these conclusions were based on assumptions due to insufficient evidence on cost-effectiveness. The main limitation of our umbrella review was the critically low quality of the included reviews according to AMSTAR-2 criteria, with many of these reviews basing their conclusions on low-quality studies. This highlights the need for high-quality experimental studies (e.g., RCTs, factorial designs, stepped-wedge designs, SMARTs and MRTs) to assess teledentistry's clinical- and cost-effectiveness.

Role of teledentistry in enabling improved oral care outcomes

Nowadays, the link between oral health and general health is clearly understood and supported by many global bodies, including the World Health Organisation. Yet, oral diseases remain prevalent worldwide, necessitating a practical approach. This opinion paper seeks to clarify the role of teledentistry as an adjunct for improving oral health when access to oral care services is one of the major concerns.While prevention is the best option, many people lack regular oral care access, missing vital maintenance for mouth and body health. Limited evidence-based education further hinders effective oral hygiene routines. This holds true for remote/rural populations, low socioeconomic groups and individuals with physical/mental disabilities which could make visiting a dental practice more difficult.We examined recent teledentistry publications, highlighting outcomes and suggesting evidence-backed oral health guidance via tailored teledentistry models. Two virtual roundtables were conducted with a global working group experienced in teledentistry and dental access barriers. This panel was made up of representatives from the UK, Belgium, Vietnam, Indonesia, Bangladesh, Ghana and Tunisia.We conclude that teledentistry effectively aids dental referrals, early disease detection, treatment planning, compliance and viability, particularly in regions with limited dental access. The advantage of teledentistry lies in expanding the reach of care. Telehealth and teledentistry are value-driven, yet larger, standardised research is needed to fully harness the potential of teledentistry in bridging underserved populations with oral care experts, ultimately fostering optimal oral health. Education on the capabilities and benefits of teledentistry should become part of the curriculum of future dental professionals and broadly leveraged on continuing education platforms.

Accuracy of Remote Examination for Detecting Potentially Malignant Oral Lesions: A Systematic Review and Meta-Analysis

Objective: We aimed to investigate the accuracy of remote examination by photographs compared to in-person clinical examination for detecting potentially malignant oral lesions (PMOLs). Methods: The Reporting Guide and Guidelines for Writing Systematic Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analysis [PRISMA]) guided the reporting of findings. The search was conducted by two independent reviewers in six databases with no language restriction until November 2022. The Population, Test-Index, Reference Standard, Outcome and Study Design (PIROS) strategy guided the eligibility criteria, and studies with adult patients (P) examined remotely (I) and in-person (R) to verify the detection of PMOLs (O) were considered. The methodological quality was assessed by QUADAS-2, and the certainty of the evidence was measured by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: A total of 769 files were identified. After removing duplicates and reading titles and abstracts, 16 were read in full, from which 6 articles then comprised the qualitative synthesis. The oral clinical examination was the reference standard in four studies. Five studies presented high risk of bias in at least one assessment domain. A high probability of detection of PMOL by remote examination (97.37%) was observed for the three studies included in the meta-analysis, which presented high heterogeneity among them. The certainty of evidence for the outcome was considered very low. Conclusions: Remote tools for detecting PMOLs may be feasible and assertive, but new studies are required to incorporate them into clinical practice. Clinical Relevance: Remote examination for the detection of PMOLs has the potential to favoring the early diagnosis of malignant lesions.

Legal issues in digital oral health: a scoping review

BACKGROUND

This scoping review aims to systematically and critically describe the numerous legal challenges brought about by the utilization of digital oral health in the delivery of oral healthcare.

METHODS

A systematic search was conducted. The following electronic databases were reviewed from inception up to March 2023: MEDLINE, Embase, Scopus, and LILACS. The search included any scientific document and paper in English, Spanish, or Portuguese on legal issues raised using digital health in oral healthcare delivery. Two reviewers conducted the selection process and data extraction. Legal issues raised concerning the adoption of digital health technology were analysed using the modified Mars' framework.

RESULTS

Seventeen studies were included. Most of the documents identified and covered generic aspects of delivering digital oral healthcare (n = 11) without explicitly referring to any dental specialty. The most mentioned legal issues were data security (n = 15); liability and malpractice (n = 14); consent (n = 12); and confidentiality (n = 12). To a lower extent, patient-practitioner relationship (n = 11); and license and jurisdiction (n = 11) were also covered. These were followed by privacy of information (n = 10); adequacy of records (n = 9); and e-referrals (n = 8). On the other hand, fewer studies commented on social media use (n = 3), authentication (n = 2); or e-prescriptions (n = 2). Before implementing any digital health solution, practitioners need to be aware of the many legal issues that the introduction of these technologies involves, be clear where the responsibility lies, and apply extreme caution in following national guidelines. Current literature concentrates on a few well-known legal issues. Issues around authentication, use of social media, and e-prescriptions received less attention.

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.

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.

Parent perceptions regarding virtual pediatric dental clinics during COVID-19 pandemic: a cross-sectional study

Objective

To assess the attitudes and responses of parents of pediatric patients towards virtual dental clinics during COVID-19.

Material and Method

A total of 102 parents of pediatric patients who were scheduled for virtual (video or telephonic) clinic appointments for new patient consultations and follow-up clinics were included in the study. Parents and patients could attend the virtual clinic from a personal computer, tablet, or smartphone. An electronic self-administered questionnaire was sent to the parents through email after consultation (video or telephonic) which consisted of demographic data and a ten-item, five-point Likert-scale assessing: (i) parent satisfaction; (ii) ease of use; (iii) the effectiveness including increasing access to clinical services; (iv) reliability of the teledentistry system and (v) usefulness for patients. Statistical analyses used were t-test, one-way ANOVA test, Shapiro-Wilk and histogram.

Result

Out of 102 parents, 52 attended video clinics and 50 attended the telephonic clinic. The majority of the parents were between 30-39 years of age, and about 73% had no previous experience with either virtual or telephonic consultation. Ninety-four percent of parents were satisfied with vide clinic consultation, and most of them agreed that accessing clinical services through a video clinic was easy to understand, comfortable, and time-saving. The majority of the parents (94%) agreed and strongly agreed that they will use video clinics again in the future for consultation.

Conclusion

Parents' response to the use of virtual clinics for pediatric dentistry during COVID was positive. The majority of the parents stated that they would consider using teledentistry for future consultation.

Barriers and Enablers to Implementing Teledentistry From the Perspective of Dental Health Care Professionals: Protocol for a Systematic Quantitative, Qualitative, and Mixed Studies Review

BACKGROUND

There is growing literature on the potential of digital technologies for improving access to, ensuring continuity and quality of health care, and to strengthen health systems. Some studies have reported the cost-effectiveness of teledentistry, its reliability for remote dental screening, diagnosis, consultation, and treatment planning. Nonetheless, current evidence suggests that teledentistry implementation faces many challenges and is not yet adopted by dental health care providers (DHCPs). Developing strategies to improve teledentistry adoption requires an understanding of the factors that promote or hinder its successful implementation.

OBJECTIVE

This systematic review aims to identify and synthetize barriers and enablers to implementing teledentistry as perceived by DHCPs in their clinical practices, using the Theoretical Domains Framework (TDF) and the Capacity, Opportunity, and Motivation Behavior (COM-B) model.

METHODS

This protocol follows the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols) checklist. Literature will be searched in the following databases: PubMed, Cochrane Library, Web of Science, CINAHL, Embase, and PsycINFO. We will perform additional searches on Google, Google Scholar, and ProQuest Dissertations & Theses Global, screen the references of the included studies to capture additional relevant studies, and contact the authors of studies if we need more details. We will consider studies using qualitative, quantitative, and mixed methods. There will be no restrictions on the publication date and dental setting. We will include studies published in French, English, and Portuguese. Two independent reviewers will select the study, extract data, and assess methodological quality using the Mixed Methods Appraisal Tool's checklist. Data analysis will include a descriptive and a thematic content analysis. We will synthetize and categorize the barriers and enablers using the TDF and COM-B model and present a narrative synthesis of our results using tables, figures, and quotes.

RESULTS

By March 2023, the literature search has retrieved 7355 publications. We will identify the range of barriers and enablers to implementing teledentistry through DHCPs' perspectives. Considering the critical need for theory-based implementation interventions to improve the use of evidence-informed practices, we will synthesize the factors influencing the adoption of teledentistry based on the TDF domains and the 3 essential conditions predicting behavior change in accordance with the COM-B model. As needed, we will include additional determinants if not included in the TDF. We will conduct some subgroups analyses if studies are sufficient. We expect to complete the review by July 2024.

CONCLUSIONS

This review will provide some insights on the determinants of teledentistry implementation as perceived by DHCPs in dental settings. These findings will cater to patients, families, DHCPs, researchers, academic and professional decision-makers, and policy makers. The results of the systematic review could be used to develop theory-led interventions in improving teledentistry implementation.

TRIAL REGISTRATION

PROSPERO CRD42021293376; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=293376.

INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID)

PRR1-10.2196/44218.

The use of teledentistry in clinical oral and maxillofacial pathology practice: an institutional experience

Background

Although there has been a slight increase in dental professionals since 2011, 98 of North Carolina's 100 counties are designated as Dental Health Professional Shortage Areas by the Heath Resources and Service Administration. This shortage significantly increases disparities and access to primary and specialized oral health care. Also, dental professionals in these remote locations may feel the access and referrals to oral and maxillofacial pathologists cumbersome. In 2020, the COVID-19 pandemic prompted an inevitable surge in the use of digital technology due to the social distancing norms and lockdowns, which forced dental education institutions and practitioners to adjust to new ways of meeting, teaching, and providing dental care. In the present manuscript, we report our institutional experience delivering specialized dental care in rural areas.

Materials and methods

We conducted a retrospective case series of diagnosis, management, and outcomes of patients who underwent synchronous or asynchronous virtual and remote examination of oral lesions at ECU School of Dental Medicine and one satellite clinic over seven years. For those cases that concluded on surgical sampling, the clinical impressions, differential diagnoses, and the final diagnosis were compared to assess the accuracy of the clinical exam through teledentistry.

Results

The total study population consisted of 71 patients. Most of the remote consultations were done asynchronously. Also, most virtual clinical consultations were initiated due to clinical suspicion of malignancy and infectious/reactive conditions, accounting for 42% and 25.3% of all encounters.

Conclusions

The presented data suggest how teledentistry can support clinical practice in rural areas to achieve optimal care for the patient in rural or remote communities. Also, it significantly decreases the travel required, the number of appointments, and increases the speed of diagnosis. Teledentistry is an excellent tool available to all clinicians and can dramatically aid in diagnosing oral mucosa lesions.

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.

Establishment of Neural Series Transmission Keys (NSTKs) and Security in the Field of COVID-19 Telepediatric Oral Health

In this exceptional COVID-19 crisis, telemedicine had arisen as a substitute technique for medicines. Even more unequivocally, pediatric children were at high risk to outside homes. The spread of COVID-19 has suddenly ascended. Because of lockdown conventions and isolation protocols, kids were confined to live inside their homes. Non-emergency youngsters ought to be managed remotely through the telepediatric health. An establishment of Neural Series Transmission Keys (NSTKs) has been created and security had been planned on the intraoral data. Oral cavity is a kind of dental disease occurring in children. It is for the most cases caused due to drawn out bacterial invasions. Bacterial attacks are more because of sticky chocolates, desserts, sugar, and so forth. Homeopathy medicines are the best prescribed to fix such dental diseases in this current unprecedented COVID-19. Since, it needs no dental medical procedure for the non-invasive kids, which is the reason that the homeopathy medicines are most appropriate in this COVID-19 lockdown stages. The doctor can gather symptoms of the kids from their parents through online interfaces. Some of the normal homeopathy drugs are: Kreasotum, Mercurius, Mezereum, etc. Moreover, in this pandemic situation online telepediatric homeopathy medicines were better alternatives to investigate from home disengages. Additionally it bears no voyaging consumptions and costs. Secure online transmission of clinical pediatric information has been the most challenging issue in COVID-19 telepediatric oral wellbeing. Data mystery factor is protected with tendency in this proposed cryptographic technique. Neural Series Transmission Keys (NSTKs) were established based on neural network based hamming codes. It has been diffused inside the intraoral pediatric data. The proposed key was so particularly amazing that it gives assorted blend after each bit of evolving. Beginning seeds were kept at the dentists and the patients, in order to go against external attacks inside the public channel, especially during this hyper digitized COVID-19 times. Standard graphs were drawn with accuracy using the proposed cryptographic method. The absolute cryptographic time in this strategy was 2.88 ms which was significantly important. By applying Chi Square test, we have noted χ 2 = 17.012, under 5% level of significance.

Virtual Oral Health across Canada: A Critical Comparative Analysis of Clinical Practice Guidances during the COVID-19 Pandemic

During the COVID-19 pandemic, teledentistry was suggested as a cost-effective and promising approach to improve access to oral health care. In response, Canadian provincial and territorial dental regulatory authorities (DRAs) published teledentistry-related clinical practice guidances (TCPGs). However, an in-depth comparison between them is needed to understand their gaps and commonalities so as to inform research, practice, and policy. This review aimed to provide a comprehensive analysis of TCPGs published by Canadian DRAs during the pandemic. A critical comparative analysis of these TCPGs published between March 2020 and September 2022 was conducted. Two members of the review team screened the official websites of dental regulatory authorities (DRAs) to identify TCPGs and performed data extraction. Among Canada's 13 provinces and territories, only four TCPGs were published during the relevant time period. There were some similarities and differences in these TCPGs, and we identified gaps pertaining to communication tools and platforms, and measures to safeguard patients' privacy and confidentiality. The insights from this critical comparative analysis and the unified workflow on teledentistry can aid DRAs in their development of new or an improvement to existing TCPGs or the development of nationwide TCP guidelines on teledentistry.

Exploring challenges and mitigation strategies towards practicing Teledentistry

BACKGROUND

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

METHODS

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

FINDINGS

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

CONCLUSION

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

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.

Dentistry website analysis: An overview of the content of formulated questions and answers

Aim

This study aimed to analyze the content of questions and answers posted on dentistry websites.

Subject and methods

A mixed-method study was conducted in 2020. A total of 1354 related questions were included, of which 1182 were answered by dentists. The data was analyzed quantitatively according to the classification of the questions, main complaints of the subjects and length of the questions and answers using Excel₂₀₁₃. A qualitative content analysis was carried out also for data robustness and triangulation.

Results

Of the 1354 questions, 866 of them were categorized into 11 categories according to the main sub-classes of the International Classification of Diseases to Dentistry and Stomatology. Furthermore, the inquiries were allocated to 3 communication styles to present the users' main complaints that included contextual (52.33%), emotional (6.79%) and focal (40.89%) strategies. Results of the qualitative content analysis have led to 6 main themes: seeking the related recommendations of any actions, treatment seeking, information seeking, seeking for causes and reasons, seeking for oral and dental health recommendations and seeking for the dentists' diagnosis or comments.

Conclusions

The present study can be used for designing specific customized websites of dentistry and help the website managers for better optimization of the websites. All these interventions can pave the way for developing teleconsulting in dentistry for middle-income countries.

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

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

Is Teledentistry a Method for Optimizing Dental Practice, Even in the Post-Pandemic Period? An Integrative Review

Background: For the past two and half years, dentists all across the world, along with their patients, have faced numerous challenges. In this context, the aim of this integrative review was to assess if dentists’ and patients’ attitudes regarding teledentistry (TD) have changed since the COVID-19 outbreak, and if the use of TD will continue to rise, even in the post-pandemic period; (2) Methods: A literature search was performed between August 2021 and January 2022. The PubMed, Scopus, and Science Direct databases were searched for articles published between 2012 and 2022 using a combination of the following Mesh terms: “COVID-19”, “pandemic”, “oral telemedicine”, “teledentistry”; (3) Results: Among the 52 included papers, nine papers were published between 2011 and 2019, and 43 articles were published after 2020 (12 were published in 2020, 29 papers were published in 2021, and two in 2022). Among the articles published before 2020, seven out of nine included papers were reviews, and two were original research. Among the 43 papers published after 2020, 18 were reviews and 25 original research. (4) Conclusions: Based on the results of this integrative review, there is clear evidence that the interest in teledentistry and teleassistance in the dental field has increased rapidly, especially in the context of the COVID-19 pandemic. Therefore, while dental practitioners should be encouraged to keep themselves updated about new technologies, patients should also be constantly informed about their options for receiving special oral health care.

Impact of the COVID-19 pandemic on Public University Laboratories of oral and maxillofacial pathology - a Brazilian multicenter study

OBJECTIVE

To evaluate the impact of the COVID-19 pandemic on the number of diagnoses of oral and maxillofacial lesions in public laboratories after one year of COVID-19 outbreak in Brazil.

MATERIAL AND METHODS

This is a cross-sectional study. Biopsies submitted to histopathologic examination from March 2019 to February 2020 (pre-pandemic period) and from April 2020 to March 2021 (pandemic period) in nine Brazilian public oral pathology laboratories were retrieved and the number of diagnoses, types of lesion, and percentage changes during both periods were analyzed.

RESULTS

There were 7,389 diagnoses in the pre-pandemic period and 2,728 in the pandemic era, indicating a reduction of 63.08%. The reduction was 64.23% for benign lesions and 49.48% for malignant lesions, with a 50.64% reduction in squamous cell carcinoma. The largest decreases were observed in April 2020 and January 2021.

CONCLUSION

An important reduction in the diagnoses of benign and malignant lesions was noted in the Brazilian public oral pathology laboratories during the first year of the COVID-19 pandemic.

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-Knowledge, Practice, and Attitudes of Dental Practitioners in Saudi Arabia: A Nationwide Web-Based Survey

The present survey assessed the knowledge, attitudes, and practice of teledentistry (TD) among dental practitioners in Saudi Arabia. This questionnaire-based cross-sectional study was conducted with dental interns and practicing dentists in Saudi Arabia. An online questionnaire was sent to all potential respondents. Questions related to knowledge, practice, attitudes, and training regarding TD were presented. A total of 603 (227 dental interns, 376 practicing dentists) completed the questionnaire. Generally, the participants revealed poor knowledge and practice of TD, with only 38% having heard about TD and only one-quarter of the sample (23.2%) reporting practicing TD at their current workplace. However, most of the participants expressed positive attitudes and a willingness to practice TD in the future. Specialists and those in practice for >5 years showed significantly better knowledge and practice of TD than general dentists and those with lesser clinical experience (p < 0.01). While only one-fifth of the participants (20.2%) reported having attended a workshop/lecture about TD, the majority (69.7%) felt that they needed training on TD. The results revealed poor knowledge, practice, and training with regard to TD among practicing dentists in Saudi Arabia. However, the positive attitude expressed by most of the participants towards practicing TD in the future is an encouraging sign for dental educators and planners of oral health care. Continuous education through periodic workshops and training courses on TD is crucial to improve dentists’ knowledge, practice, and attitudes towards TD. Integration of TD topics into undergraduate/postgraduate curricula is highly recommended. Special attention should be directed to training general dental practitioners and junior dentists.

Role of Artificial Intelligence in the Early Diagnosis of Oral Cancer. A Scoping Review

The early diagnosis of cancer can facilitate subsequent clinical patient management. Artificial intelligence (AI) has been found to be promising for improving the diagnostic process. The aim of the present study is to increase the evidence on the application of AI to the early diagnosis of oral cancer through a scoping review. A search was performed in the PubMed, Web of Science, Embase and Google Scholar databases during the period from January 2000 to December 2020, referring to the early non-invasive diagnosis of oral cancer based on AI applied to screening. Only accessible full-text articles were considered. Thirty-six studies were included on the early detection of oral cancer based on images (photographs (optical imaging and enhancement technology) and cytology) with the application of AI models. These studies were characterized by their heterogeneous nature. Each publication involved a different algorithm with potential training data bias and few comparative data for AI interpretation. Artificial intelligence may play an important role in precisely predicting the development of oral cancer, though several methodological issues need to be addressed in parallel to the advances in AI techniques, in order to allow large-scale transfer of the latter to population-based detection protocols.

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.

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.

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

OBJECTIVES

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

MATERIALS AND METHODS

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

STATISTICAL ANALYSIS

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

RESULTS

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

CONCLUSION

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