The efficacy of remote screening for dental caries by mid-level dental providers using a mobile teledentistry model

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.

Diagnostic accuracy of tele-dentistry in screening children for dental caries by community health workers in a lower-middle-income country

BACKGROUND

Tele-dentistry can be useful for dental caries screening of children, especially in lower-middle-income countries (LMICs).

AIM

To evaluate the diagnostic accuracy of mobile phone photographs taken by a community health worker (CHW) for caries detection in Iran.

DESIGN

Children aged 6-12 years were visually examined by a paediatric dentist. Following dental examinations, intraoral photographs were taken by a trained CHW. Two remote dentists assessed intraoral photographs for dental caries. Diagnostic accuracy of tele-dentistry for caries detection was evaluated. In addition, the questionnaire about oral health and parents' views towards tele-dentistry was prepared.

RESULTS

One hundred thirty-one children aged 8.74 ± 1.62 years participated. The caries prevalence was 30% for the whole dentition. Tele-dentistry demonstrated high accuracy, with a sensitivity exceeding 80% and specificity exceeding 90%. The inter-rater reliability for remote dentists' assessments to the gold standard dental examination ranged from substantial to almost perfect (kappa: 75%-93%). Additionally, 80% of parents whose children participated in this study had positive views towards tele-dentistry.

CONCLUSION

Tele-dentistry was shown to be an alternative approach to clinical examinations for caries detection among school children. Employing non-dental care professionals in tele-dentistry has been emerged as a reliable and cost-effective approach, especially in LMICs.

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

Objectives

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

Methods

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

Results

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

Conclusions

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

Using the Unified Theory of Acceptance and Use of Technology (UTAUT) to predict the behavioral intent of teledentistry utilization amongst United States adults

INTRODUCTION

Teledentistry is an innovative health care delivery platform that can potentially improve oral health access and outcomes. The purpose of this study was to predict teledentistry utilization intentions of U.S. adults using the Unified Theory of Acceptance and Use of Technology (UTAUT) as a framework.

METHODS

This mixed-method, cross-sectional study surveyed 899 participants from two independent samples in August and September 2021. Convenience samples of Minnesota State Fair attendees and ResearchMatch volunteers completed electronic surveys to identify the behavioral intention (BI) for teledentistry use within the next 6 months. Independent variables were the UTAUT constructs of performance expectancy (PE), effort expectancy (EE), social influence (SI), and facilitating conditions (FC). Data were analyzed using univariate analysis and multiple linear regression adjusting for age, gender and educational level. Qualitative analysis used thematic analysis using UTAUT as a coding framework.

RESULTS

Univariate analysis showed statistical significance between each construct with BI (P < 0.0001). Adjusted multiple linear regression revealed statistical significance between PE and SI with BI (P < 0.0001). Qualitative responses corroborated quantitative results and revealed a lack of teledentistry knowledge.

CONCLUSION

The majority of participants indicated an intention not to use teledentistry within the next 6 months. The lack of prior experience of telehealth or teledentistry use in addition to lack of knowledge regarding teledentistry may contribute to these results. Future interventions to improve the BI to use teledentistry may benefit from focusing on PE and SI constructs for educational and marketing strategies.

Smartphone Photography as a Teledentistry Method to Evaluate Anterior Composite Restorations

Objective

Today, teledentistry have gain more attention than past due to the advances in technology. The aim of this study was to compare the use of smartphone photography as a method in teledentistry with the face-to-face examination in the evaluation of anterior composite restorations.

Materials and Methods

In this study, photographs of 24 composite restorations in patients attended to the clinic of Ardabil Dental School were obtained using a smartphone without any additional equipment and sent by email to 10 remote observers. As a gold standard method, these restorations were evaluated by an experienced expert in restorative dentistry a face-to-face examination. In both methods FDI criteria were used to evaluate the restorations and classified them as acceptable or not. Sensitivity, specificity, positive and negative predictive values, and diagnostic accuracy of the photographic method relative to face-to-face method were calculated. Furthermore the Mann-Whitney U test was used to statistically compare the two methods in detail.

Results

The sensitivity, specificity, positive predictive value, and negative predictive value of the smartphone photography method was 69.35%, 48.72%, 87.34%, and 23.75%, respectively. A diagnostic accuracy of 65.97% was obtained. Statistically, in overall the photographic method rated the restorations as better than they were in reality (face-to-face examination) (p = 0.002).

Conclusions

The diagnostic accuracy of the method of evaluating anterior composite restorations by smartphone photography was moderate and the use of this method in teledentistry, although was promising, needs to be improved.

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

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

Patient perspectives on teledentistry and face-to-face doctor interaction during orthodontic treatment

INTRODUCTION

Teledentistry in orthodontics is growing, yet patient preferences for its use is unknown. This study aimed to determine the perceived value of doctor-to-patient face-to-face interaction, convenience, and attitudes toward specific uses of teledentistry among orthodontic patients.

METHODS

Private practice orthodontists emailed an electronic survey to active patients. Patients aged ≥18 years completed the survey regarding their treatment. Parents of patients aged <18 years completed a separate survey regarding their child's treatment. Responses were compared on the basis of patient characteristics (adult vs child, braces vs clear aligners, etc).

RESULTS

Three hundred and seventy-seven respondents from 8 orthodontic practices participated in the survey. Eighty-five percent of parents considered face-to-face interaction important, and 85% said that their child's treatment fit conveniently into their schedule. Adult responses were 86% and 89%, respectively. Adult preference for face-to-face was significantly higher than parents of adolescent patients (83% vs 78%; P = 0.038). Adults treated with clear aligners were less likely to strongly agree that their treatment fitted conveniently in their schedule (51% vs 76% in braces; P = 0.0490) and were more likely to be interested in using teledentistry (27% vs 18% in braces; P = 0.0429).

CONCLUSIONS

Most orthodontic patients prefer to be seen face-to-face. This is due to the high value placed on face-to-face interaction with the orthodontist. Most patients do not consider their treatment inconvenient. Patients prefer that teledentistry be used to enhance communication as opposed to replacing face-to-face interaction. Implementing teledentistry in orthodontics should be applied on a patient-to-patient basis with continued emphasis on the doctor-patient relationship.

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

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

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

BACKGROUND

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

AIM

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

DESIGN

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

RESULTS

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

CONCLUSION

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

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

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

Assessing Videoconferencing as a Method of Remote Consultation in Pediatric Dentistry

Background

The oral health condition in rural areas remains compromised due to insufficient healthcare providers. Implementation of teledentistry through videoconferencing in these areas can improve this situation when trained personnel are able to carry out real-time consultations of the patients with a pediatric dentist.

Aim

To observe the feasibility of using teledentistry for an oral examination, consultation, and education, and also to assess the participant's satisfaction regarding the use of teledentistry for a routine dental checkup.

Materials and methods

An observational study was carried out with 150 children aged 6-10 years. About 30 primary health centers (PHC)/Anganwadi (AW) workers were trained to perform the oral examination with the intraoral camera (IOC). Four self-constructed and nonstructured questionnaires were prepared to understand the knowledge, awareness, and attitude of the participants toward pediatric dentistry and their acceptance of teledentistry.

Results

A total of 83.3% of children were not scared and felt that the use of IOC was better. About 84% of the PHC/AW workers found teledentistry very convenient, easy to learn, and adapt. And around 92% thought that teledentistry is time-consuming.

Conclusion

Teledentistry is a possible way to provide pediatric oral health consultation in rural areas. It can save time, stress, and money for people in need of dental treatment.

How to cite this article

Agarwal N, Jabin Z, Waikhom N. Assessing Videoconferencing as a Method of Remote Consultation in Pediatric Dentistry. Int J Clin Pediatr Dent 2022;15(5):564-568.

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.

The evolution of the teledentistry landscape in Australia: A scoping review

INTRODUCTION

There has been a recent surge in the use of teledentistry services in Australia that has paralleled the COVID-19 pandemic. Due to the limited published literature reflecting on this transition, this article employed a systematic scoping review methodology.

OBJECTIVE

The objective was to explore the role of teledentistry in the provision of clinical dental services in Australia.

DESIGN

Two independent reviewers searched PubMed, Embase, Scopus, Web of Science and grey literature sources to identify literature eligible for inclusion. The search was restricted to Australia and service delivery. Data were categorically synthesised by modalities and reported benefits and limitations; findings were cross-referenced with the COVID-19 pandemic timeline.

FINDINGS

The systematic search identified 758 articles, of which 25 met the inclusion criteria. Results highlight a range of service providers and definitions of teledentistry. A shift in modality from asynchronous towards synchronous teledentistry pre- and post-COVID-19 pandemic is detailed.

DISCUSSION

Whilst highly useful during the COVID-19 pandemic, teledentistry provides a unique opportunity to continue to increase the accessibility of dental services, especially for patients in rural areas or those who are immunocompromised.

CONCLUSION

Clinicians and researchers must consider opportunities to merge existing research with the recent clinical uptake of teledentistry for patients that would benefit from teledental services beyond the COVID-19 pandemic.

Indonesian Dentists' Perception of the Use of Teledentistry

Introduction

Teledentistry is the use of information and communication technology to provide dental services from distant locations. The use of teledentistry is highly beneficial in the COVID-19 pandemic era.

Objective

This study aimed to explore Indonesian dentists’ perceptions of the use of teledentistry in their daily practice and the benefits for patients.

Methods

This was a descriptive cross-sectional study comprising an electronic survey of Indonesian dentists. We used a cross-cultural, adapted questionnaire that consisted of 26 items and 5-point Likert scale questions that evaluated dentist perception in the following 4 domains: usefulness of teledentistry for dental practice, usefulness of teledentistry to improve practices, usefulness of teledentistry for patients, and dentists who had concerns about the use of teledentistry.

Results

A total of 652 dentists from 34 provinces in Indonesia participated in this study. The majority of respondents agreed about the usefulness of teledentistry in dental practice, especially for saving time, compared to referral letters (87%). Most respondents recognised the utility of teledentistry for improving dental practice and its benefits for patients. Nevertheless, most of the dentists had concerns about teledentistry in terms of digital forgery concern (74.2%) and technical incompatibility (71.8%).

Conclusions

Indonesian dentists reported their positive perception of the usefulness of teledentistry for improving dental practice and benefits for patients, although some concerns were still present. Further studies on the application of teledentistry in Indonesia are still needed.

Smartphone use for tomographic evaluation: application in endodontic diagnosis

INTRODUCTION

Portable equipment that allows quick exchanges of information, such as smartphones, is increasingly important in Dentistry. Thus, they have become frequently used, with the potential to contribute to the tomographic evaluation. This study aimed to evaluate the accuracy of smartphone applications for diagnosing the root canal system (RCS) and measuring the root canal length.

METHODS

DICOM files of 92 lower incisor teeth were evaluated by two trained and calibrated examiners using the CS 3D Imaging software and two smartphone applications (DroidRender and Horos Mobile). The RCS was assessed according to Vertucci's classification, and the tooth length was measured using linear cusp-apex measurements. The diagnostic reference standard was obtained by the mode and the mean of the evaluations made by three experienced examiners using the CS 3D Imaging software. The diagnostic performance of RCS was evaluated using sensitivity (Se), specificity (Sp), and overall accuracy (Ac). The Bland-Altman analysis was used to assess the agreement of linear measurements.

RESULTS

The diagnostic tests showed similar performance between the smartphone applications (DroidRender: Se = 1.00; Sp = 0.95; Ac = 0.97; Horos: Se = 0.95; Sp = 0.94; Ac = 0.95) and the computer software (Se = 0.97 - 0.95; Sp = 0.93 - 0.96; Ac = 0.95 - 0.96). The smartphone applications showed discrepancies greater than 1.0 mm for the dental lengths, which may signal relevant differences in some clinical situations.

CONCLUSION

Smartphone applications offered similar diagnostic performance in comparison to the computer software for the RCS evaluation.

The accuracy of teledentistry in caries detection in children – A diagnostic study

Introduction

: The increasing burden of dental caries and the lack of effective dental caries screening protocols in non-dental settings, such as schools, demand an innovative and cost-effective approach. Teledentistry is the field of dentistry that combines telecommunication with health records and digital imaging to improve access to dental care and help in epidemiological surveys. This study aimed to assess the accuracy of non-dentist teledentistry in caries detection compared with the clinical dental examination of a sample of 5–10-year-old schoolchildren.

Methods

A calibrated dentist examined schoolchildren aged 5–10 years old. The dentist and two teachers took intraoral photographs for each child, using a smartphone. The photographs were concealed; therefore, the dentist assessed the three sets of photographs blindly two weeks after the clinical examination. Accuracy was measured to compare the teledentistry examination with the clinical dental examination.

Results

The mean DMFT of primary teeth was 3.38, 3.42, and 3.17 upon clinical examination, dental-teledentistry examination (findings of photographs taken by a dentist), and non-dental teledentistry (findings of photographs taken by teachers), respectively. The mean DMFT of permanent teeth was 0.75, 0.69, and 0.65 upon clinical examination, dental-teledentistry examination, and non-dental teledentistry examination, respectively. In primary teeth, dental teledentistry and non-dental teledentistry examinations showed 95 and 98.3 sensitivity and 94.3 and 91.4 specificity, respectively. In permanent teeth, dental teledentistry and non-dental teledentistry examinations showed 80.8 and 88.5 sensitivity and 94.1 and 96.1 specificity, respectively.

Conclusions

Teledentistry has acceptable accuracy for caries detection in schoolchildren compared to a clinical dental examination.

Detection of dental caries in oral photographs taken by mobile phones based on the YOLOv3 algorithm

Background

The aim of this study was to explore the value of using the YOLOv3 algorithm for detection and diagnosis of dental caries in oral photographs taken with mobile phones.

Methods

Oral photographs taken with the mobile phones of 570 patients were used as 3 datasets: the augmented images (n=3,990), the enhanced images (n=3,990), and the combined augmented and enhanced images (n=7,980). Oral photographs taken by mobile phones from another 70 patients were used as an independent test set. We used the YOLOv3 network for migration learning for modelling. Diagnostic precision, recall, F1-score, and mean average precision (mAP) were calculated to obtain the detection and diagnostic performance of the YOLOv3 algorithm.

Results

After 3 independent training, the mAP value of the original group YOLOv3 algorithm was 56.20%, in which the precision for primary caries recognition was 76.92%, recall was 49.59%, and F1-score was 0.60; the precision for secondary caries recognition was 91.67%, recall was 52.38%, and F1-score was 0.67. The mAP value of the enhance group algorithm was 66.69%, in which the precision for primary caries identification was 81.82%, recall was 52.07%, and F1-score was 0.64, and the precision for secondary caries identification was 100%, recall was 33.33%, and F1-score was 0.50. The mAP value of the comprehensive group algorithm was 85.48%, in which the precision for primary caries identification was 93.33%, recall was 69.42%, F1-score was 0.80, and the F1-score for secondary caries identification was 0.50; precision was 100%, recall was 52.38%, and F1-score was 0.69.

Conclusions

The caries detection capability based on the YOLOv3 algorithm highlights the potential utility of deep learning in caries detection and diagnosis. Comparing the 3 experiments, the detection of the model trained after using image augmented and enhancement techniques was significantly improved.

Validity and Reliability of Intraoral Camera with Fluorescent Aids for Oral Potentially Malignant Disorders Screening in Teledentistry

There is limited documentation of using fluorescence images in oral potentially malignant disorders (OPMDs) and oral cancer screening through the field of teledentistry. This study aims to develop and evaluate the validity and reliability of the intraoral camera with the combination method of autofluorescence and LED white light used for OPMDs and oral cancer screening in teledentistry. The intraoral camera with fluorescent aids, which uses a combined method of both autofluorescence and LED white light, was developed before the device was evaluated for validity and reliability as a OPMDs screening tool for teledentistry. All lesions of thirty-four OPMD patients underwent biopsy for definitive diagnosis and were examined by an oral medicine specialist. Both images under autofluorescent and LED white light mode captured from the device were sent online and interpreted for the initial diagnosis and dysplastic features in addition to being compared to the direct clinical examination and histopathological findings. The combination method was also compared with autofluorescence method alone. The device provided good image quality, which was enough for initial diagnosis. Using the combination method, sensitivity, specificity, PPV, and NPV of the device via teledentistry were 87.5%, 84.6%, 63.6%, and 95.7%, respectively, which were higher than autofluorescence method alone in every parameter. The concordance of dysplastic lesion was 85.29% and 79.41% for category of lesion. The validity and reliability results of the combination method for the screening of dysplasia in OPMDs were higher than autofluorescent method alone. The intraoral camera with fluorescent aids for the OPMDs screening can be utilized for screening via teledentistry.

Social Media and Health Care, Part I: Literature Review of Social Media Use by Health Care Providers

BACKGROUND

As the world continues to advance technologically, social media (SM) is becoming an essential part of billions of people's lives worldwide and is affecting almost every industry imaginable. As the world is becoming more digitally oriented, the health care industry is increasingly visualizing SM as an important channel for health care promotion, employment, recruiting new patients, marketing for health care providers (HCPs), building a better brand name, etc. HCPs are bound to ethical principles toward their colleagues, patients, and the public in the digital world as much as in the real world.

OBJECTIVE

This review aims to shed light on SM use worldwide and to discuss how it has been used as an essential tool in the health care industry from the perspective of HCPs.

METHODS

A literature review was conducted between March and April 2020 using MEDLINE, PubMed, Google Scholar, and Web of Science for all English-language medical studies that were published since 2007 and discussed SM use in any form for health care. Studies that were not in English, whose full text was not accessible, or that investigated patients' perspectives were excluded from this part, as were reviews pertaining to ethical and legal considerations in SM use.

RESULTS

The initial search yielded 83 studies. More studies were included from article references, and a total of 158 studies were reviewed. SM uses were best categorized as health promotion, career development or practice promotion, recruitment, professional networking or destressing, medical education, telemedicine, scientific research, influencing health behavior, and public health care issues.

CONCLUSIONS

Multidimensional health care, including the pairing of health care with SM and other forms of communication, has been shown to be very successful. Striking the right balance between digital and traditional health care is important.

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

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Accuracy of remote diagnoses using intraoral scans captured in approximate true color: a pilot and validation study in teledentistry

BACKGROUND

Intraoral scans (IOS) provide three-dimensional images with approximate true colors representing a possible tool in teledentistry for remote examination. The aim of the present cross-sectional validation study was, therefore, to evaluate the levels of agreement between remote diagnoses derived from IOS and diagnoses based on clinical examinations for assessing dental and periodontal conditions.

METHODS

The test sample comprised 10 patients representing different clinical conditions. Following the acquisition of IOS (Trios, 3Shape), a full-mouth dental and periodontal examination was done and periapical radiographs were taken. Ten dentists were asked to perform dental and periodontal scorings for each of the ten patients on a tablet computer presenting the IOS. Scores included diagnosis of gingivitis/periodontitis, and evaluated presence as well as amount of plaque and calculus, and presence of teeth exhibiting gingival recession, furcation involvement, erosion, tooth wear, stain, and non-carious cervical lesion, as well as presence of decayed, filled, and crowned teeth and implants. In a second round of assessments, the periapical radiographs were provided and the dentists were able to change the scores. The time for the remote assessment was recorded. The agreement between remote and clinical scorings (reference) was then analyzed descriptively.

RESULTS

The mean time for the tele assessment was 3.17 min and the additional consultation of the radiographs accounted for another 1.48 min. The sensitivity and specificity values were 0.61 and 0.39 for gingivitis and 0.67 and 0.33 for periodontitis, with no relevant changes when radiographs were provided for the diagnosis of periodontitis (0.72 and 0.28). The agreement for dichotomized dental and periodontal indices ranged between 78 and 95%. With the provision of radiographs, the remote examiners were able to detect existing filled teeth, crowned teeth, and implants, whereas the detection of decayed teeth (70%) was not improved.

CONCLUSIONS

The remote examination using IOS was effective in detecting dental findings, whereas periodontal conditions could not be assessed with the same accuracy. Still, remote assessment of IOS would allow a time-efficient screening and triage of patients. Improvement of the image quality of IOS may further allow to increase the accuracy of remote assessments in dentistry. According to the Swiss Regulation this investigation is not a clinical trial and therefore no registration in a WHO-registry is needed.

Dentists’ Self-perception on Teledentistry: The Changing Landscape Driven by Technological Booming in the 21stCentury

Aim:

Teledentistry has gained popularity worldwide because it is cost-effective and increase accessibility to dental healthcare. This study assessed the self-perceptions of teledentistry among dental practitioners in Saudi Arabia and examinedany gender-related differences.

Methods:

This cross-sectional study was conducted between January and December 2017 and recruited a convenience sample of dental practitioners, whose self-perceptions of the practice-related use of teledentistry were assessed viaateledentistry survey (TDS). The TDS consisted off our sections:efficiency in patient care, cost reduction,capabilities forimproving practice, and security and confidentiality.Data analyseswere conducted throughdescriptive statistics,internalreliability tests(Cronbach’s alpha), andchi-squaredtests of the TDS.

Results:

The response rate was 620/800(78%). Most respondents were female (62%), and 58% of themworked in the public sector. The internal reliability of the TDS was 0.85 for the whole sampleand 0.85 and 0.90 for males and females, respectively. Among the entire sample, 51% agreed that teledentistry reduced potential cost, and 65% reported shortened waitlists. More females (42%, p<0.001) than males (22%) agreed that teledentistry could help monitor a patient’s condition.More females (35%) than males (13%, p<0.001) considered that teledentistry would require additional appointments for imaging. More females(29%, p=0.0001) than males (22%) expressed great concern aboutpotential violations of confidentiality.

Conclusion:

These findings suggest thatteledentistry in dental practiceis well perceived by practitioners in Saudi Arabia. Gender differences in perceptions are linked to certain aspects of teledentistry.

Digital photography vs. clinical assessment of resin composite restorations

PURPOSE

To compare direct clinical and indirect digital photographic assessment of resin composite restorations. Ninety-two posterior resin composite restorations were classified using World Dental Federation (FDI) criteria by two different clinical examiners (C1 and C2). In the same appointment of clinical assessment, intraoral high-quality digital photographs were taken and posteriorly two different digital examiners (D1 and D2) classified the images of each restoration. Restorations of each patient were assessed once by C1 and C2 independently. D1 and D2 assessed the digital images from different locations and in different time. Data were analyzed using the Cohen's kappa coefficient, Kruskal-Wallis non-parametric test and Dunn's multiple shared test, with 95% confidence. Agreement levels varied from very good (0.81-1.00) to fair (0.21-0.40). Statistically significant differences (p < 0.05) between assessments were found for surface lustre, staining, color match and translucency, esthetic anatomical form, fracture of material and retention and marginal adaptation. The classification of the resin composite restorations varied significantly according to clinical or high-quality digital photographic assessments. Overall, clinical assessment detected more demand for repair or replacement.

Teledentistry as a novel pathway to improve dental health in school children: a research protocol for a randomised controlled trial

Background

Despite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries. Geographic and socioeconomic barriers and the lack of access to dental care services are among common reasons for poor oral health in children. Historically in Australia, oral health therapists or dental therapists have been responsible for providing dental care for school children through the School Dental Services (SDS). The current SDS has been unable to provide sustainable dental care to all school children due to a reduction in workforce participation and limited resources. We propose a paradigm shift in the current service through the introduction of user-friendly technology to provide a foundation for sustainable dental care for school children.

Methods/design

We describe an ongoing parallel, two-armed, non-inferiority randomised controlled trial that compares routine and teledental pathway of dental care in children aged 4–15 years (n = 250). Participating schools in Western Australia will be randomly assigned to the control or teledental group, approximately three schools in each group with a maximum of 45 children in each school. All participants will first receive a standard dental examination to identify those who require urgent referrals and then their teeth will be photographed using a smartphone camera. At the baseline, children in the control group will receive screening results and advice on the pathway of dental care based on the visual dental screening while children in the teledental group will receive screening results based on the assessment of dental images. At 9 months follow-up, all participants will undergo a final visual dental screening. The primary outcomes include decay experience and proportion of children become caries active. The secondary outcomes include the diagnostic performance of photographic dental assessment and costs comparison of two pathways of dental care.

Discussion

The current project seeks to take advantage of mobile technology to acquire dental images from a child’s mouth at school settings and forwarding images electronically to an offsite dental practitioner to assess and prepare dental recommendations remotely. Such an approach will help to prioritise high-risk children and provide them with a quick treatment pathway and avoid unnecessary referrals or travel.

Trial registration

Australian New Zealand Clinical Trials Registry, ACTRN12619001233112. Registered 06 September 2019.

Assessment of mother's ability in caries diagnosis, utilizing the smartphone photographic method

BACKGROUND

Smartphone is proved to be reliable in teledentistry model. The aim of the study was to assess the mother's ability in caries diagnosis, utilizing the smartphone-based photographic method.

HYPOTHESIS

Mothers have the ability for caries diagnosis utilizing the smartphone photographic method.

METHODS

A cohort of 100 mothers was given health education regarding dental caries diagnosis. Then, their children from the preschools were screened by the dentist for dental caries using visual examination, followed by clicking intraoral photographs using Motorola 3G phone. The photographs were sent through WhatsApp to respective mothers, and they were asked to diagnose their child's dental status. Accuracy and reliability measures of mother's diagnosis were estimated by calculating the sensitivity, specificity, predictive values, and kappa value.

RESULTS

The calculated value for sensitivity was 88.3%, specificity was 98.3%, positive predictive value was 92%, negative predictive value was 97%, and accuracy was 96%. There was a strong agreement between mother's and dentist's diagnosis (kappa value of 0.87).

CONCLUSION

Following the dental health education, it can be concluded that mothers are in a better position to diagnose their child's dental status through smartphone-based photographs.

Reliability of mobile phone teledentistry in dental diagnosis and treatment planning in mixed dentition

INTRODUCTION

The aim of the study was to test the reliability of mobile phone teledentistry in the diagnosis and treatment planning of dental caries of children in mixed dentition.

METHODS

A total of 57 cases, aged 6-12 years, among six examiners were used yielding 342 comparisons. The patients were examined by a dentist who was calibrated in the recording of oral findings in children using the World Health Organization (WHO) oral health assessment form for children (version 2013), which served as the gold standard for diagnosis. Six paediatric dentists calibrated using the same WHO form served as the teledentistry group and made their diagnoses using only the images sent to them without the use of radiographs. The pictures obtained were stored on an online cloud platform (Google Drive). The sharing links for these pictures were forwarded to participating dentists using a social media application (WhatsApp Messenger, Facebook Corp., Mountain View, CA).

RESULTS

This study showed greater sensitivity than specificity, and though both sensitivity and specificity were constantly above 80%, it can be stated that the current model has a higher chance of false positive results than false negative results. The reliability of teledentistry in this study is greater in primary teeth than in permanent teeth.

DISCUSSION

Although the use of teledentistry without radiographs is not as accurate as clinical examination, mobile phone teledentistry offers acceptable reliability for the initial diagnosis of caries in children.

Validity and reliability of remote dental screening by different oral health professionals using a store-and-forward telehealth model

Objective This study was conducted to evaluate the validity and reliability of intraoral photographic assessments by different members of a dental team as a means for dental screening in children.Methods The intraoral photographic records of 126 children (2 to 18 years old) were obtained from routine clinical records taken before dental treatment. Intraoral photographs were obtained using a DSLR camera and then uploaded to a cloud-based server using store-and-forward telehealth technology. Images were reviewed by an expert panel to formulate a benchmark screening baseline, to which the screeners' data were compared. The photographic assessments conducted by a mid-level dental practitioner (MLDP) and dentist, were compared to the benchmark expert panel assessment.Results The screeners' assessments by means of intraoral photography, when compared to the expert panel assessment had a sensitivity value of 82-89% and specificity value of 97%. The inter-examiner agreement between the expert panel assessment and photographic method (assessed by a dentist and MLDP), was almost perfect, with a kappa score ranging from 0.82 to 0.88. The mean DFT/dft score for the children as determined by the expert panel's review and photographic assessment ranging from 5.41 to 5.79, with mean scores between the two assessment methods not significantly different (P = 0.746).Conclusion Our results suggested that oral health professionals (other than dentists) have the potential to screen for caries from intraoral photographs with the same diagnostic accuracy and reliability as dentists. This strategy has implications for supporting the use of MLDPs such as dental therapists or hygienists to screen for oral disease using telehealth.

A Systematic Review on the Validity of Teledentistry

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSIONS

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

Cost savings from a teledentistry model for school dental screening: an Australian health system perspective

Objective The aim of the present study was to compare the costs of teledentistry and traditional dental screening approaches in Australian school children. Methods A cost-minimisation analysis was performed from the perspective of the oral health system, comparing the cost of dental screening in school children using a traditional visual examination approach with the cost of mid-level dental practitioners (MLDPs), such as dental therapists, screening the same cohort of children remotely using teledentistry. A model was developed to simulate the costs (over a 12-month period) of the two models of dental screening for all school children (2.7 million children) aged 5–14 years across all Australian states and territories. The fixed costs and the variable costs, including staff salary, travel and accommodation costs, and cost of supply were calculated. All costs are given in Australian dollars. Results The total estimated cost of the teledentistry model was $50 million. The fixed cost of teledentistry was $1 million and that of staff salaries (tele-assistants, charters and their supervisors, as well as information technology support was estimated to be $49 million. The estimated staff salary saved with the teledentistry model was $56 million, and the estimated travel allowance and supply expenses avoided were $16 million and $14 million respectively; an annual reduction of $85 million in total. Conclusions The present study shows that the teledentistry model of dental screening can minimise costs. The estimated savings were due primarily to the low salaries of dental therapists and the avoidance of travel and accommodation costs. Such savings could be redistributed to improve infrastructure and oral health services in rural or other underserved areas. What is known about the topic? Caries is a preventable disease, which, if it remains untreated, can cause significant morbidity requiring costly treatment. Regular dental screening and oral health education have the great potential to improve oral health and save significant resources. The use of role substitution, such as using MLDPs to provide oral care has been well acknowledged worldwide because of their ability to provide safe and effective care. The teledentistry approach for dental screening offers a comparable diagnostic performance to the traditional visual approach. What does this paper add? The results of the present study suggest that teledentistry is a practical and economically viable approach for mass dental screening not only for isolated communities, but also for underserved urban communities. The costs of the teledentistry model were substantially lower than the costs associated with a conventional, face-to-face approach to dental screening in both remote and urban areas. The primary driver of net savings is the low salary of MLDPs and avoidance of travel and overnight accommodation by MLDPs. What are the implications for practitioners? The use of lower-cost MLDPs and a teledentistry model for dental screening has the potential to save significant economic and human resources that can be redirected to improve infrastructure and oral care services in underserved regions. In the absence of evidence of the economic usefulness of teledentistry, studies such as the present one can increase the acceptance of this technology among dental care providers and guide future decisions on whether or not to implement teledentistry services.

Comparison of a Smartphone-Based Photographic Method with Face-to-Face Caries Assessment: A Mobile Teledentistry Model

OBJECTIVES

This study sought to evaluate the efficacy of a mobile teledentistry approach using a smartphone camera for remote screening of dental caries.

MATERIALS AND METHODS

An image acquisition Android App was created to facilitate the acquisition and transmission of dental images to a store-and-forward based telemedicine server. One hundred participants who were attending routine checkups at dental clinics were enrolled in 2014. Following a face-to-face oral screening by a screener (dentist), images of patients' teeth were obtained using a smartphone camera. These images, along with patient information, were then transmitted from the Android App to the server through the Internet for later independent assessment by two charters (off-site dentists). The assessments of these charters were then compared to the benchmark face-to-face caries assessment.

RESULTS

Sensitivity values for the photographic method when compared to the benchmark face-to-face caries assessment were moderate, and ranged from 60% to 63%. Weighted kappa (K) as a measure of intragrader agreement for the photographic assessment was estimated as almost perfect (K = 0.84). The intergrader agreement for the photographic method compared to the face-to-face caries assessment ranged from moderate to substantial (K = 0.54-0.66).

CONCLUSIONS

Despite some limitations, the mobile teledentistry approach has shown the potential to detect occlusal caries from photographs taken by a smartphone camera with an acceptable diagnostic performance compared to traditional face-to-face screening. This study suggests that telemedicine and cellular phone technology can be combined to create an inexpensive and reliable screening tool.