Teledentistry within oral health care providers' training: A scoping review

INTRODUCTION

Despite teledentistry (TD) ubiquitous utilization, it has yet to be fully adopted by oral health care providers' educational training. This study aimed to explore TD incorporation in the training of oral health care providers.

METHODS

This review included studies on the TD content offered to oral health care providers. The JBI (Joanna Briggs Institute) methodology was used, and two reviewers screened the literature. Studies published between 1989 and 4 June 2022 were searched using "Teledentistry" and "Education" as initial keywords. The searched databases included MEDLINE, Cochrane Library, CINAHL, EPPI, Scopus, Epistemonikos, ERIC, MedEdPORTAL, ProQuest Dissertations and Theses Global, and Google Scholar. All of the relevant literature, regardless of their language, were added. The data were extracted using an extraction table and are presented in tabular and narrative summary formats.

RESULTS

A total of 2180 documents were found, and 1804 documents were screened by the title and abstract after deduplication; 59 were selected for full-text review; and 19 were eligible for data extraction. Of all studies, 63.15% were published after the COVID-19 pandemic. Practicing TD and TD reimbursement were some of the addressed topics. Didactic education and hands-on practice were the most employed training methods. Self/peer evaluations and surveys were among the employed assessment techniques.

CONCLUSION

TD education has been emphasized during the COVID-19 pandemic. There is a variation in the existing TD educational programmes, from addressing topics to assessment techniques. However, the number of educational programmes on this topic is sparse.

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.

Promoting Dental Health Through Teledentistry: Assessing Awareness and Attitudes in Saudi Arabia

Introduction Teledentistry has emerged as a promising solution to enhance dental healthcare accessibility and quality. Understanding public awareness and attitudes toward teledentistry is crucial for its successful implementation, especially in regions like Saudi Arabia where digital health initiatives are rapidly expanding. This study aims to assess the level of awareness, attitudes, and perceptions toward teledentistry among the Saudi Arabian population, as well as examine the demographic factors influencing its acceptance. Methods A cross-sectional survey was conducted with 474 participants, employing a structured questionnaire to collect data on demographics, awareness, knowledge, perceptions, and attitudes toward teledentistry. Statistical analyses, including correlation and chi-square tests, were performed to analyze the data. Results The majority of respondents (64%) reported awareness of teledentistry, primarily through the Internet (44.5%) and healthcare providers (36.3%). The average self-assessed knowledge score was 3.04 out of 5, indicating moderate familiarity with teledentistry concepts. Attitudes toward teledentistry were generally positive, with 54% expressing belief in its effectiveness. However, a significant portion of the sample showed reluctance toward using teledentistry for routine dental check-ups, with only 45.1% showing willingness. High technological accessibility was reported, yet 55.9% of participants preferred traditional in-person consultations. Correlation analysis revealed a moderate positive relationship between knowledge and belief in effectiveness (r = 0.21), but a negligible correlation with willingness to use teledentistry (r = 0.016). A strong positive correlation was found between belief in effectiveness and willingness for routine check-ups (r = 0.673). Educational level significantly influenced teledentistry acceptance, with higher education correlating with greater receptiveness. Conclusion While there is a moderate level of awareness and a generally positive attitude toward teledentistry among the Saudi population, hesitance remains regarding its use for routine care. The findings highlight the need for educational initiatives to improve knowledge and perceptions of teledentistry, potentially enhancing its acceptance and integration into the healthcare system.

Teledentistry content in Canadian dental and dental hygiene curricula

OBJECTIVES

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

METHODS

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

RESULTS

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

CONCLUSION

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

Telehealth Utilization in Oral Medicine and Oral and Maxillofacial Surgery

Objectives: The objectives of this retrospective study were to analyze telehealth utilization for two specialty care practices: oral medicine (OM) and oral and maxillofacial surgery (OMFS) during the first 2 years of the pandemic, its impact as a new treatment modality and on participating providers, as well as identify the type of patient visit that most readily adopted telehealth. Methods: Retrospective study of patients who sought specialty services, OM and OMFS, at an outpatient clinic in a university health system setting between March 1, 2019, and February 28, 2022. Source data were obtained from Epic, an electronic medical record application. Data were graphed using Tableau and Microsoft Excel software. Statistical analysis was performed utilizing chi-squared test and analysis of variance (ANOVA). Results: OMFS utilized telehealth 12% of the time, and OM 8% of the time. The majority (87%) of telehealth visits were for return patients (RPs). Compared with the first year of the pandemic, there was a decrease in the number of telehealth visits in the second year (p = 0.0001). As of August 2022, new patient (NP) telehealth encounters have largely returned to prepandemic levels (0-1.5%), whereas RP telehealth visits remained at an average level of 11.4% (9.4-12.4%). Surveyed providers consider telehealth as an effective complement to in-person care and will continue its use (4.2/5 Likert scale). Conclusions: Telehealth has become a viable pathway of care for OM and OMFS who previously did not utilize the remote platform to deliver healthcare. As a new treatment modality, telehealth is perceived as impactful in increasing access to specialty care by participating providers. NP visits are now almost completely in person, but telehealth continues for RPs. Ongoing demand for telehealth highlights urgency to develop appropriate standards and effective remote diagnostic/monitoring tools to maximize telehealth's capability to leverage finite health care resources and increase access to specialty care.

Assessment of Knowledge and Attitude Regarding Teledentistry Among Dental Professionals: A Cross-Sectional Study

BACKGROUND

Modern technologies have led to the development of new tools, practices, and digital techniques. However, their use in public health to provide adequate oral health facilities to the community is limited. One of the facilities that can help provide better oral health with minimal cost is teledentistry. The application of this approach will reduce inequalities in accessing oral healthcare. Knowledge of the use of teledentistry is of the utmost importance to its practice. Hence, the objective of this cross-sectional study is to assess the knowledge of and attitude regarding teledentistry among dental professionals in the Sangli district of Maharashtra.

MATERIALS AND METHODS

A 24-unit structured online validated questionnaire with six questions regarding participants' sociodemographic information and 18 questions related to their knowledge and attitude toward teledentistry and informed consent forms were circulated via email among 100 dentists, and the responses obtained were analyzed.

RESULTS

Out of 100 responses, 61 showed basic knowledge and a typical attitude toward teledentistry. Urban practitioners were more familiar with teledentistry than rural ones.

CONCLUSION

This survey concludes that the branch of teledentistry still needs to be studied and publicized at a greater level to accelerate its widespread implementation in dentistry and especially to increase the outreach and time efficiency of dentistry.

Impact of COVID-19 on emergency oral health care in New Jersey

BACKGROUND

The COVID-19 pandemic led to reduced services of private dental practices. The public emergency clinic of Rutgers School of Dental Medicine (RSDM) (Newark, NJ) faced changing demands during various periods of the pandemic.

METHODS

Records of patients visiting the emergency clinic at RSDM during 3 distinct periods (prelockdown, lockdown, teledentistry) from January 10, 2020, through June 30, 2020, were retrospectively reviewed. Qualitative and quantitative attributes pertaining to patient encounters were reviewed and analyzed.

RESULTS

A total of 1,799 records were included in this study. Patient visits increased during the early lockdown but were reduced after the implementation of teledentistry. Trends were noted in patient volume, reasons for visits, treatment needs, symptoms, diagnostic methodology, prescription use, and final disposition of patients.

CONCLUSIONS

The lockdown affected emergency dental clinic services at RSDM. Teledentistry visits played a key role in screening patients and in facilitating the delivery of oral health care and timely follow-ups to patients who needed urgent in-person emergency visits.

PRACTICAL IMPLICATIONS

Data gathered will lead to a better understanding of patients seen in the emergency clinic and can help with long-term planning for both institutional and smaller outpatient clinics during public health emergencies.

Effectiveness of dental monitoring system in orthodontics: A systematic review

BACKGROUND

Dental monitoring (DM) constitutes a recent technological advance for the remote monitoring of patients undergoing an orthodontic therapy. Especially in times of health emergency crisis, the possibility of relying on remote monitoring could be particularly useful.

OBJECTIVES

To assess the effectiveness of DM in orthodontic care.

ELIGIBILITY

Studies conducted on healthy patients undergoing orthodontic care where DM was applied, assessing a change in treatment duration, emergency appointments, in-office visits, orthodontic relapse, early detection of orthodontic emergencies and improvement of oral health status.

INFORMATION SOURCES

PubMed, Web of Science and Scopus were searched for publications until November 2022.

RISK OF BIAS

Quality assessment was performed with the STROBE Checklist.

DATA EXTRACTION

Data were extracted independently by two reviewers, and discrepancies were resolved with a third reviewer.

INCLUDED STUDIES

Out of 6887 records screened, 11 studies were included.

SYNTHESIS OF RESULTS

DM implemented to the standard orthodontic care was found to significantly decrease the number of in-office visits by 1.68-3.5 visits and showed a possible trend towards improvement of aligner fit. Conversely, evidence does not support a reduction of treatment duration and emergency appointments. The assessment of the remaining variables did not allow any qualitative synthesis.

CONCLUSIONS

This review highlighted that DM implemented to standard orthodontic care can significantly decrease the number of in-office visits and may potentially result in an improved aligner fit. Due to the low quality of most of the included studies and the heterogeneity of the orthodontic system where DM was applied, studies with different investigation team and rigorous methodology are advocated.

Telehealth technologies in care homes: a gap for dentistry?

BACKGROUND

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

METHODS

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

RESULTS

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

CONCLUSION

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

Dental students' perceptions of standardized patient experiences using Zoom: Dyadic factors

PURPOSE

The COVID-19 pandemic required a rapid transition to online education, including simulations. The current study identified students' perceptions of communicating with standardized patients in a virtual setting.

METHODS

This qualitative study thematically analyzed 485 reflections submitted by 248 students between Spring 2020 and Spring 2022. Statements describing both the virtual medium and dyadic interactions between students and patients were coded for emergent themes and also coded as positive (facilitative) or negative (critical).

RESULTS

Four themes emerged from the data related to the virtual medium: impact on nonverbal communication, patient engagement/rapport, presentation aids, and listening. Within these broad themes, 13 subthemes were identified, nine of which were negative/critical. Technology problems were specifically identified as compromising both engagement and listening. Even when technology worked well, students noted that it reduced the number of message cues received from the patient and complicated the process of sending cues (e.g., by requiring students to look away from a patient's face to make "eye contact" through a camera).

CONCLUSIONS

Overall, students were critical of Zoom's impact on dyadic factors with standardized patients. However, they did acknowledge some positive aspects regarding the technology. These findings provide a foundation to consider when teaching students how to communicate effectively via teledentistry.

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.

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.

Perceptions of Schoolteachers About Teledentistry Use in Makkah City

OBJECTIVES

Teledentistry is a combination of communication technology and dentistry. Teledentistry is an alternative and useful way to remotely provide advisory, preventive, and emergency services in places with poor access to dental care. Few studies in Saudi have investigated the implementation of teledentistry at schools or assessed the perceptions of school personnel. This research aimed to evaluate teachers' perceptions about the use of teledentistry to examine schoolchildren in Makkah city.

METHODS

 The study was conducted on 20 intermediate schools randomly selected from different regions of Makkah city using a multistage cluster sampling method. Two data collectors visited the schools to administer the study questionnaire, exploring teachers' perceptions of teledentistry. The questionnaire was adapted from a validated survey based on the technology acceptance model (TAM). Descriptive statistics, analysis of variance, Mann-Whitney U test, and the Kruskal-Wallis tests were conducted to compare the mean differences in participants' perceptions of teledentistry based on their demographics.

RESULTS

 A total of 241 teachers completed the survey, 131 of whom were females (54.4%), and the mean age of participants was 42.5±7 years. Over 80% of participants taught ≥16 classes a week, and their experience ranged from less than a year to more than 31 years. Sixty participants (25%) knew teledentistry before watching the study video. The results revealed a significant difference between male and female teachers regarding perceptions of teledentistry. Female participants had higher scores in TAM dimensions than males.

CONCLUSION

 This survey revealed a generally favorable attitude toward teledentistry utilization in schools. Including non-dental employees, such as teachers to provide such a service will assist in alleviating the shortage or unavailability of dentists at schools. This goes in line with the government's plans to promote telehealth as part of the Saudi Vision 2030.

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

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

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

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

Dental clinicians' perceptions on the use of tele-dentistry consultations during COVID-19 within public dental clinics in Sydney, Australia

BACKGROUND

Although well accepted by clinicians and patients, teledentistry is not currently a widely used model of care within Australian public oral health services. This qualitative study aimed to review and evaluate dental clinicians' perceptions, by determining the acceptability and appropriateness of teledentistry as a model of care.

METHODS

A purposive sample of 12 public dental practitioners employed by a Local Health District in Sydney, and who had participated in teledentistry consultations, were recruited to participate in focus groups. Focus group discussions were transcribed verbatim and subjected to thematic analysis.

RESULTS

Teledentistry was a novel concept for most participants and was well accepted. Participants valued the use of a standardized consultation template as well as effective communication with other dental clinicians to support the practice of teledentistry. However, many found attempting contact with patients over the telephone difficult as well as the perceived patient frustration with the administration process and technological difficulties experienced.

CONCLUSION

Teledentistry has the potential for growth and expansion in the public health system. From the opinions in this study, the authors propose further research is needed into the efficacy of teledentistry to assist with the development of a model of care that would be beneficial for dental clinicians and their patients. © 2023 Australian Dental Association.

Attitudes and opinions of telehealth in the dental school environment: A survey study

PURPOSE

The objective of this study was to assess provider attitudes and opinions regarding telehealth in the dental school environment.

METHOD

A survey was developed and validated and was sent to 849 predoctoral students, postdoctoral students (residents), and faculty at a single dental school. It consisted of 13 questions regarding the participants' professional backgrounds, opinions, and attitudes toward telehealth. The survey opened on November 16, 2021, and remained open for 6 weeks.

RESULTS

Of 849 survey recipients, 163 (19%) responded. Among 161 usable surveys, 90 (56%) were predoctoral students, 42 (26%) were postdoctoral students, and 29 (18%) were faculty. Fifty-four percent reported having completed at least one telehealth visit. Among this subset, 80% strongly agreed or agreed that telehealth is a good adjunct in providing care; 74% strongly agreed or agreed that telehealth has improved communication with patients.

CONCLUSION

Most dental providers reported positive opinions and attitudes regarding telehealth's ability to improve communication and serve as an adjunct to providing care.

PRACTICAL IMPLICATIONS

In the right circumstances, telehealth offers an alternative to traditional oral healthcare delivery methods. Based on the perceptions of dental providers, the use of telehealth may also be beneficial in combination with traditional approaches in the dental school environment.

Telemedicine in the diagnosis and management of temporomandibular disorders: A systematic review conducted according to PRISMA guidelines and the Cochrane Handbook for Systematic Reviews of Interventions

BACKGROUND

Telemedicine (T-Med) has always been an important tool in the arsenal of clinicians worldwide. This technique has become increasingly popular in recent years, especially in light of the COVID-19 pandemic, which has made it difficult for some people to access traditional dental care. The current review aimed to analyse the usage of telemedicine in the diagnosis and management of temporomandibular disorders (TMDs) and its impact on general health.

METHODS

An extensive search of databases was conducted using keywords such as, "telemedicine," "teledentistry," "TMJ" and "temporomandibular disorders," resulting in a total of 482 papers to be available from which eligible studies were selected. The Risk of Bias in Observational Studies of Exposures (ROBINS-E) tool was used to evaluate methodological quality of included studies.

RESULTS

Two studies were selected which fulfilled the eligibility criteria. All assessed studies indicated varying degrees of positive outcomes for patients who were intervened for TMDs using T-Med.

CONCLUSION

T-Med shows promising results for the diagnosis and management of TMDs, especially since the advent of the COVID-19 pandemic and thereafter. Long-term clinical trials with larger samples are needed to further ascertain validity in this regard.

Evaluation of knowledge and awareness about teledentistry among dentists and patients living in Turkey

BACKGROUND

Teledentistry is a field of telemedicine that combines digital technology and clinical dentistry, enabling remote communication between dentists and patients.

OBJECTIVES

The aim of the present study was to evaluate the knowledge and awareness of dentists and patients about teledentistry in Turkey.

MATERIAL AND METHODS

This cross-sectional study was conducted among general and specialist dentists in Turkey, and dental patients in Edirne, Turkey. A questionnaire prepared in Google Docs was shared virtually among Turkish dentists, as well as administered to the patients referred to the university dental clinic in Edirne.

RESULTS

Among the 336 dentists participating in the study, 69.9% were female, 39.6% were working in the profession for 1-5 years, and 48.5% were specialist dentists. A total of 86.9% of dentists stated they would like to use teledentistry for radiological examinations, some follow-up examinations, and for follow-up during holidays. There were 21.1% of dentists who thought that teledentistry practices could be the new standard of oral healthcare, and only 34.0% were willing to try such practices. Among the 447 patients in the study, 49.9% were female, 79.0% were aged 20-44 years, and 54.4% had middle income. There were 74.5% of patients who stated that it would be easier to communicate with the dentist via a teledentistry application, 80.3% of patients in the underserved regions stated it would facilitate access to the dentist, 76.3% of patients stated that it would reduce costs, and 88.8% of patients thought that this method could help overcome the problem of isolation during the coronavirus disease 2019 (COVID-2019) pandemic period.

CONCLUSIONS

Based on the results, it can be said that the teledentistry approach would provide convenience for both dentists and patients in terms of dentist-patient communication, cost and efficiency of dental care.

Teledentistry and Forensic Odontology: Qualitative Study on the Capacity of Implementation

The postmortem identification of people without an identity is performed either by using DNA, dental charts, or fingerprints (until advanced decomposition prevents their study). The lack of forensic dentists who can conduct identifications lead us to reflect on the use of digital technology in this area. The aim of this study was to validate the organizational capacity of using teledentistry for the identification of bodies in a forensic medicine department. A mixed observational study was conducted on 55 cases between July 2020 and February 2021 in the Forensic Medicine and Thanatology Department of Montpellier University Hospital. The protocol was structured in five steps: an initial interview with the agent (a forensic autopsy technician/caregiver specialized in forensic medicine), regarding the idea they had in terms of using telemedicine in their daily practice; agent training in the telemedicine system; realization of a clinical examination using an intra-oral camera by the agent; data analysis by a dental surgeon; final interview with the agent. The study was conducted on 55 subjects. The average age was 54 years old, with more than two-thirds of the patients being male (69%). The videos had an average duration of 29 min. There was an increase in visit duration when rigidity was high; this was also the case when there were many dental specificities in the oral cavity. The quality of the videos was either good or excellent. This study showed that remote identification could be considered as a new non-invasive identification tool. Many features were analyzed to create a training guide for forensic institutes.

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

INTRODUCTION

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

OBJECTIVE

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

MATERIAL AND METHODS

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

RESULTS

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

CONCLUSION

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

Factors Affecting the Adoption of Teledentistry Based on the Unified Theory of Acceptance and Use of Technology Model

OBJECTIVES

The rise of teledentistry initiatives within the healthcare system is being recognized as healthcare institutions strive to decrease costs and enhance operational effectiveness. While previous research endeavors have examined various variables influencing the adoption of teledentistry, there exists a dearth of empirical studies that comprehensively investigate the success factors facilitating the acceptance of teledentistry. This research aimed to examine the factors that influence the behavioral intention of undergraduate dental students and interns to utilize teledentistry using the unified theory of acceptance and use of technology (UTAUT) as a theoretical framework.

METHODS

A cross-sectional survey study was conducted in early 2023. An online survey was emailed to Bachelor of Dental Surgery (BDS) students from the fourth to sixth years and interns (N = 199) at a dental school in Saudi Arabia. A total of 187 students have responded (response rate: 93.9%). The survey comprised questions and scales that measured the UTAUT constructs of performance expectancy (PE), effort expectancy (EE), social influence (SI), facilitating conditions (FC), and behavioral intentions (BI). The data were analyzed using SPSS version 28 (IBM Corp., Armonk, NY).

RESULTS

The findings of the study revealed that all UTAUT constructs had strong predictive power in relation to the BI in the decision to adopt teledentistry. Nevertheless, PE and EE were the salient factors. There was a statistically significant relationship between the UTAUT model and the BI, with the model explaining 60% of the variance in the BI (R2 = 0.606, P < 0.001).

CONCLUSION

The findings revealed that dental students' openness to teledentistry is influenced by their expectations for potential success, the level of work required, and the level of social pressure exerted on them. Thus, a number of different forms of support are required to boost teledentistry's uptake.

Acceptance and Usability of an Innovative mDentistry eHygiene Model Amid the COVID-19 Pandemic Within the US National Dental Practice-Based Research Network: Mixed Methods Study

BACKGROUND

Amid the COVID-19 pandemic and other possible future infectious disease pandemics, dentistry needs to consider modified dental examination regimens that render quality care and ensure the safety of patients and dental health care personnel (DHCP).

OBJECTIVE

This study aims to assess the acceptance and usability of an innovative mDentistry eHygiene model amid the COVID-19 pandemic.

METHODS

This pilot study used a 2-stage implementation design to assess 2 critical components of an innovative mDentistry eHygiene model: virtual hygiene examination (eHygiene) and patient self-taken intraoral images (SELFIE), within the National Dental Practice-Based Research Network. Mixed methods (quantitative and qualitative) were used to assess the acceptance and usability of the eHygiene model.

RESULTS

A total of 85 patients and 18 DHCP participated in the study. Overall, the eHygiene model was well accepted by patients (System Usability Scale [SUS] score: mean 70.0, SD 23.7) and moderately accepted by dentists (SUS score: mean 51.3, SD 15.9) and hygienists (SUS score: mean 57.1, SD 23.8). Dentists and patients had good communication during the eHygiene examination, as assessed using the Dentist-Patient Communication scale. In the SELFIE session, patients completed tasks with minimum challenges and obtained diagnostic intraoral photos. Patients and DHCP suggested that although eHygiene has the potential to improve oral health care services, it should be used selectively depending on patients' conditions.

CONCLUSIONS

The study results showed promise for the 2 components of the eHygiene model. eHygiene offers a complementary modality for oral health data collection and examination in dental offices, which would be particularly useful during an infectious disease outbreak. In addition, patients being able to capture critical oral health data in their home could facilitate dental treatment triage and oral health self-monitoring and potentially trigger oral health-promoting behaviors.

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

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

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.

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.

Teledentistry from research to practice: a tale of nineteen countries

Aim

The COVID-19 pandemic has accelerated teledentistry research with great interest reflected in the increasing number of publications. In many countries, teledentistry programs were established although not much is known about the extent of incorporating teledentistry into practice and healthcare systems. This study aimed to report on policies and strategies related to teledentistry practice as well as barriers and facilitators for this implementation in 19 countries.

Methods

Data were presented per country about information and communication technology (ICT) infrastructure, income level, policies for health information system (HIS), eHealth and telemedicine. Researchers were selected based on their previous publications in teledentistry and were invited to report on the situation in their respective countries including Bosnia and Herzegovina, Canada, Chile, China, Egypt, Finland, France, Hong Kong SAR, Iran, Italy, Libya, Mexico, New Zealand, Nigeria, Qatar, Saudi Arabia, South Africa, United Kingdom, Zimbabwe.

Results

Ten (52.6%) countries were high income, 11 (57.9%) had eHealth policies, 7 (36.8%) had HIS policies and 5 (26.3%) had telehealth policies. Six (31.6%) countries had policies or strategies for teledentistry and no teledentistry programs were reported in two countries. Teledentistry programs were incorporated into the healthcare systems at national (n = 5), intermediate (provincial) (n = 4) and local (n = 8) levels. These programs were established in three countries, piloted in 5 countries and informal in 9 countries.

Conclusion

Despite the growth in teledentistry research during the COVID-19 pandemic, the use of teledentistry in daily clinical practice is still limited in most countries. Few countries have instituted teledentistry programs at national level. Laws, funding schemes and training are needed to support the incorporation of teledentistry into healthcare systems to institutionalize the practice of teledentistry. Mapping teledentistry practices in other countries and extending services to under-covered populations increases the benefit of teledentistry.

Online social networks for prevention and promotion of oral health: a systematic review

Aim

To evaluate the impact of online social networks (OSN) as resources for promoting behaviour changes related to the prevention and promotion of oral health.

Methods

This was a systematic review with meta-analysis of randomized clinical trials identified in databases (MEDLINE/Embase/Lilacs), published up until May 2022, and prepared according to Cochrane recommendations. Studies that used OSN (WhatsApp^®, Telegram^®, TikTok^®, Facebook^®, Twitter^®, YouTube^®, Instagram^®, Soundcloud^®, Flickr^®, LinkedIn^®, and Webradio^®) were included. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42021248045).

Results

In total, 3171 studies were evaluated, of which 12 studies met the inclusion criteria for the review and contained data on 1669 participants. The most frequently investigated OSN were WhatsApp^®, followed by Telegram^®, and YouTube^®. All studies included were at high risk of bias. Data extraction allowed the meta-analysis of gingival index (GI) and oral health knowledge (OHK) outcomes for young people. Findings revealed that young people exposed to digital interventions via OSN showed a reduction in GI when compared with traditional educational interventions. This reduction occurred in all young people (standardized mean difference, -0.48; 95% CI, -0.75 to -0.21; p = 0.0006, I² = 0%; very low certainty), including those who were undergoing orthodontic treatment (standardized mean difference, -0.58; 95% CI, -0.92 to -0.24; p = 0.0008, I² = 0%; very low certainty). Furthermore, young people undergoing orthodontic treatment and exposed to OSN showed an increase in OHK when compared with participation in traditional educational interventions (standardized mean difference, +0.86; 95% CI, +0.46 to +1.26; p < 0.0001, I² = 0%; very low certainty).

Conclusion

OSN could be effective tools for improving oral health outcomes in young people.

The Impact of Pandemic Concerns on Consumers' Teledentistry Use During the First Months of the COVID-19 Pandemic

OBJECTIVES

The COVID-19 pandemic affected consumers' access to oral health care. This study evaluated factors associated with teledentistry use among US adults from June 2019 through June 2020.

METHODS

We used data from a nationally representative survey of 3500 consumers. We estimated teledentistry use and adjusted associations with respondents' concerns about the impacts of the pandemic on health and welfare and with their sociodemographic characteristics using Poisson regression models. We also analyzed teledentistry use across 5 teledentistry modalities (email, telephone, text, video conferencing, and mobile application).

RESULTS

Overall, 29% of respondents used teledentistry, and 68% of teledentistry users reported doing so for the first time because of the COVID-19 pandemic. First-time teledentistry use was positively associated with a high level of pandemic concerns (relative risk [RR] = 5.02; 95% CI, 3.49-7.20), age 35-44 years (RR = 4.22; 95% CI, 2.89-6.17), and annual household income $100 000-$124 999 (RR = 2.10; 95% CI, 1.55-2.84) and negatively associated with rural residence (RR = 0.68; 95% CI, 0.50-0.94). Having a high level of pandemic concerns (RR = 3.42; 95% CI, 2.30-5.08), young age (age 25-34 years: RR = 5.05; 95% CI, 3.23-7.90), and higher level of education (some college: RR = 1.59; 95% CI, 1.22-2.07) were strongly associated with teledentistry use for all "other" users (ie, existing or first-time use because of reasons unrelated to the pandemic). Most first-time teledentistry users used email (74.2%) and mobile applications (73.9%), whereas "other" teledentistry users used telephone communication (41.3%).

CONCLUSIONS

Teledentistry use during the pandemic was higher in the general population than among those for whom teledentistry programs were originally designed (eg, low-income, rural populations). Favorable regulatory changes to teledentistry should be expanded to meet patient needs beyond the pandemic.

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

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

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.

Knowledge, attitude, and practice of teledentistry in periodontal diagnosis: Is it the required upgrade to conventional periodontics?

Background

Teledentistry which is similar to telemedicine has emerged as a new tool for various dental disciplines. Teleperiodontics is a branch of telehealth which focuses on the application of digital communication technology into the field of periodontics without demanding a specialist presence. An early detection and diagnosis of periodontal conditions can not only treat the disease in its early stage but also prolong the health of the periodontium, thereby improving the overall quality of life of an individual. However, teledentistry has not penetrated into the field of periodontics to a level it has to in providing periodontal care. Hence, the aim of this questionnaire study was to assess the knowledge, attitude, and application of teleperiodontics into everyday practice among the dental surgeons at various levels.

Materials and Methods

An electronic questionnaire consisting of 29 close-ended questions including sections assessing the knowledge, attitude, and practice of teledentistry and teleperiodontics was sent to dental colleges present in East and West Godavari districts of Andhra Pradesh.

Results

A total of 350 responses were received and 80.57% dental surgeons were aware about teledentistry, and a total of 74% dental surgeons were likely to prescribe oral hygiene aids and medication for temporary management of periodontal conditions.

Conclusion

Teleperiodontics is an emerging science whose knowledge, attitude, and application are yet to be explored.

Dental innovations which will influence the oral health care of baby boomers

From the widespread use of smartphones and tablets to the multitude of applications available, older adults are showing an interest in utilizing technology to maintain their independence and to improve their quality of life. As technology continues to advance and be incorporated into many day-to-day activities, the baby boom generation will see these changes affecting the way they access and utilize dental services. Innovative toothbrushes and chemotherapeutics are continuing to be developed and utilized by many older adults. Within the dental office, older adults are seeing greater application of technology in every day dental procedures. These include the use of teledentistry, artificial intelligence (AI), innovative restorative materials, digitization of fixed and removable prosthodontics, cone beam computed tomography (CBCT) scans to guide dental implant placement and endodontic procedures. There is also new technology to aid in cancer detection and shielding during cancer treatment. Improved communication between the medical and dental fields has become increasingly necessary to facilitate effective patient care and a few innovative healthcare systems have begun to consolidate these services. Overall, the baby boom generation will continue to see dental innovations that will change the way they experience everyday life and dental services.

A Comparison of Innovative App-Based Prescriptions With Conventional Prescriptions for Children by General Dentists: A Mixed Methods Study

Introduction Writing drug prescriptions for children with accurate drug dosages and clear instructions is a must for general dentists. A digital tool in the form of a software application (app) to write, save and share prescriptions can potentially overcome the possible limitations of handwritten prescriptions such as handwriting illegibility, errors in calculations, and incomplete descriptions. However, it is also important to assess the satisfaction of dentists with making prescriptions using a digital tool such as an android application. A mixed methods study comparing an innovative "app-based" and handwritten prescriptions in dental settings is presented. Methodology An indigenously developed and piloted app "PREscribing children made EASY (PREASY)" was used in this study. Based on the preliminary study, a sample size of 20 was found to be adequate. Twenty-two dentists participated in the study. The conventional handwritten and an Android app PREASY-based prescriptions were compared in terms of the time taken, precision of writing, and satisfaction of the dentists. Qualitative feedback regarding the PREASY app was obtained in Google Forms (Google, Inc., Mountain View, CA, USA). Results A study sample of 20 subjects was calculated based on a pilot study, and 22 dentists were recruited. The mean time taken in seconds for handwritten prescriptions (199.14 (+ 59.18)) was almost four times higher than that for app-based prescriptions (52.05 (+ 23.89)) (t-test, P < 0.00001). The accuracy of handwritten prescriptions versus app-based prescriptions was compared by two examiners independently using analysis of variance (ANOVA) in three domains: dosage accuracy, legible handwriting, and completeness of instructions, the differences (Domain 1 mean + SD: 1.04 + 0.89, Domain 2 mean + SD: 1.38 + 0.40, Domain 3 mean + SD: 0.88 + 0.58) being statistically significant (P < 0.05). The differences in the percentages of the three domains (dosage accuracy: 40.9%, legibility of handwriting: 63.6%, completeness of instructions: 18.1%) were found to be statistically significant (P < 0.05; chi-squared statistic, 9.4017). Of the participants, 59% were very satisfied, 36.3% were satisfied, and 4.5% were neutral (chi-squared test, P < 0.00001). Participants' feedback/comments were categorized under technical suggestions, dosage suggestions, criticism, and positive remarks and were thematically analyzed. Conclusion App-based prescriptions proved to be more instantaneous and detailed than handwritten ones with the majority of dentists satisfied. Valuable feedback pertaining to the limitations of the tool was obtained for improving the app. PREASY-based prescriptions could be recommended for prescribing to pediatric dental patients.

Teledentistry in pediatric dentistry: Postgraduate dental students' knowledge, practice, and attitudes

Objective

This study aimed to investigate postgraduate pediatric dental students' knowledge, practice, and attitudes toward teledentistry and identify potential applications of this technology in pediatric dentistry.

Methods

An online questionnaire was sent to all students through Google Forms. The questionnaire included questions about socio-demographic information, knowledge, practice, and attitudes regarding teledentistry and the use of teledentistry during coronavirus disease 2019.

Results

Before the coronavirus disease 2019 pandemic, only 8.2% of students knew teledentistry. However, this increased to 45% after the pandemic, with differences depending on the student's clinical experience. Teledentistry was reported as useful for medicine taking, follow-up consultations, and diagnosing soft tissue problems.

Conclusions

Integrating teledentistry topics into the dental curriculum can increase awareness and adoption of this technology in pediatric dentistry. Dental students need to be aware of its potential applications.

Assessment of Self-Care Methods for Acute Dental Pain Among Adults During COVID-19 Dissemination and the Implementation of Teledentistry in Makkah, Saudi Arabia: A Cross-Sectional Study

AIM

This cross-sectional study aims to explore the prevalence of acute dental pain, different self-care methods done by adults to manage this pain, and the utilization of teledental platforms during the COVID-19 pandemic lockdown period. The study was conducted in Makkah, Saudi Arabia.

METHODS

A total of 727 participants answered the study questionnaire, which was distributed as an online survey on different social media platforms. The modified dental pain screening questionnaire (M-DePaQ) was used to obtain dental pain-related characteristics of subjects. Also, self-care and formal-care strategies for pain relief questionnaire for most recent toothache and additional questions developed by the authors related to virtual clinics were used to determine the need for implementation of teledentistry and remote dental consultations. Data was entered in SPSS (IBM Corp., Armonk, NY) and analyzed using descriptive statistics, chi-square test, and binary logistic regression.

RESULTS

Around 39% out of 727 participants experienced dental pain during the COVID-19 Makkah city lockdown; 58% of them reported that the pain was related to a tooth. The majority reported that it was exaggerated with cold beverages and foods [67.1%]. A chi-square association test showed that the age group between 20-30 significantly used the Sehaty (Lean, Riyadh, Saudi Arabia) application more than other age groups. Additionally, women were notably found to use home remedies more frequently than men. Furthermore, individuals with a bachelor's degree believed more in the importance of having a virtual dental clinic during the periods of lockdown.

CONCLUSION

During the COVID-19 pandemic, acute dental pain and self-medication were found common among this study population. The practice of self-medication was also documented frequently, therefore, it is important to educate the general population on the proper way to manage dental pain. However, The use of teledentistry services was found uncommon, so to improve patient care especially when accessibility to professional treatment is difficult, the implementation of teledental services need to be considered.

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

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

Teledentistry: Evaluation of Instagram posts related to bruxism

BACKGROUND

Instagram statistic has attracted roughly one billion, monthly active users. In 2021, Instagram belonged to the most popular social networks worldwide. It has been considered an effective tool that contributes to the contemporary sharing of information for raising public awareness while providing educational information. The growing presence of Instagram and frequent user engagement has made it a potentially effective platform for patient communication, seeking educational information, product information for consumers, and advertisements in the form of images and videos.

OBJECTIVE

To assess and compare the contents of Instagram posts by healthcare professionals (HP) and non-professional healthcare workers (NPHW) on bruxism and to assess public engagement with this content.

METHODS

Twelve "hashtag" terms linked to bruxism were searched. HP and NPHW analyzed the content of relevant posts for the presence of domains. Discourse analysis assessed the post quality for themes. We conducted the descriptive and univariate statistical analysis, whereas inter-rater reliability was tested using Cohen's kappa.

RESULTS

A total of 1184 posts were retrieved, with the majority uploaded by NPHW (622 posts). The posts by HPs were in text and image(s) format (53%) with the range of 25-1100 Instagram post "Likes." "Mouthguard" (90) % was the most frequently included domain posted by HP, followed by "treatment plan/pain management", and complaints of clicking or locking of TMJ" (84%). Greater number of domains (p= 0.03) were seen in the posts by NPHWs, compared to HP's having more bruxism-related content. The inter-rater reliability method (0.89) was used for the presence of domains.

CONCLUSION

NPHW uses Instagram more frequently to post bruxism-related information than HP. HPs must ascertain that the content posted by NPHW is relevant and the concerns addressed in posts are to the purpose.

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

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

The development of digital dentistry in the UK: An overview

The COVID-19 pandemic has highlighted the benefits which digital technology offers to all aspects of dental practice and education. This paper provides an overview of how digital technology has enhanced clinical and administrative procedures within dental practice, including computer-aided design/computer-aided manufacture (CAD/CAM), digital radiography, 3D printing, patient records, electronic patient referrals and electronic communications from dental practices. It then considers the development of teledentistry (mHealth) and its benefits in enabling distant consultations with patients, who for one reason or another are unable to visit dental practices easily. It then goes on to consider how and why digital dental distance learning materials were provided to general dental practitioners in England by the Department of Health (DoH) (England) and how they evolved. Finally, this paper considers the use of digital technology in dental education by dental schools.

Two Teledentistry Models for the Provision of Essential Oral Health Care Services in Rural School Settings

Purpose: Access to adequate dental services is limited for children in rural communities in the United States.The purpose of this paper was to describe how two school-based teledentistry programs increased access to oral health services for children and adolescents living in rural areas.Methods: The School-Based Telehealth Network Grant Program (SB TNGP) was designed to expand access to, and improve the quality of health care services in schools through telehealth. Data were collected from July 1 to December 31, 2019 on 164 students at 7 preschool sites by Marshfield Clinic Health System (MCHS) and on 1,467 students at 57 school sites by Children's Dental Services (CDS).Results: Both MCHS and CDS reported that over 99 percent of encounters were successfully completed using telehealth technology. Both grantees reported that 99.4 percent of students received an oral health evaluation/screening, primarily through a dental hygienist traveling to the school site connected to a dentist or advanced dental therapist through telehealth. One half of the students had dental caries (50.6 % MCHS; 48.6% CDS). Both grantees referred all students with dental caries for oral health follow-up care.Conclusions: By utilizing dental hygienists traveling to school sites and connecting with centrally located dental professionals through telehealth, both grantees increased access to needed oral health care services for rural children. Oral health screening in school settings using dental hygienists with teledentistry can provide an efficient way to identify students at high risk for dental caries and offer a valuable strategy for oral disease prevention and control.

Effectiveness of Telemedicine and Teledentistry after the COVID-19 Pandemic

Telemedicine has become increasingly important worldwide over the last two decades. As a new field, it became known especially during the COVID-19 pandemic; this review presents fields of activity with special attention to opportunities and risks. Numerous areas of application offer the possibility for broad use in the medical and dental care landscape in diagnostics, therapy, rehabilitation, and decision advice across a spatial distance. Technical and semantic standards are required, and profiles and guidelines are increasingly defined and organized. Medical/dental consultations have been established in various regions around the world as a response to pandemic challenges and have made video and online emergency consultations possible. Telemedicine applications are already regularly used in medical/dental emergencies, regardless of the pandemic situation, both for transport by train and by plane, from which patients benefit. However, legal hurdles are often still unresolved, but infrastructure challenges both for provider, user hard- and software also complicate deployment. Problems are particularly prevalent in the absence of necessary internet coverage or among socially disadvantaged and vulnerable groups who cannot afford expensive equipment or do not know how to use the technology. Broad access must be enabled, and hardware and software interfaces and updates must be regularly checked and updated. Telemedicine might also improve access to and delivery of oral and general health care support both for rural and urban areas with low costs. Even though dentistry and many medical specialties are still performed clinically by means of practical/manual examination, there are areas of diagnostics where telemedicine applications can provide good support. Therefore, as conclusions, access, and delivery of telemedicine applications in dentistry and medicine should be expanded and improved to provide access to all population groups.

The Forefront of Dentistry-Promising Tech-Innovations and New Treatments

KNOWLEDGE TRANSFER STATEMENT

This article discusses innovations in technology and treatments that have enormous potential to revolutionize our dental care, including novel concepts in electronic health records, communication between dentists and patients, biologics around diagnosis and treatment, digital dentistry, and, finally, the real-time optimization of information technology. The early implementation and validation of these innovations can drive down their costs and provide better dental and medical services to all members of our society.

The Changing Face of Dentistry: Perspectives on Trends in Practice Structure and Organization

KNOWLEDGE TRANSFER STATEMENT

This perspective is intended to stimulate thoughts by clinicians, researchers, and educators about needed trends to the dental profession. With consideration of changes needed within the dental profession, improvements and implementation of diagnostic coding and value-based care could result in improved oral health for numerous Americans.

Artificial Intelligence in Teledentistry

Artificial intelligence (AI) has grown tremendously in the past decade. The application of AI in teledentistry can reform the way dental care, dental education, research, and subsequent innovations can happen remotely. Machine learning including deep learning-based algorithms can be developed to create predictive models of risk assessment for oral health related conditions, consequent complications, and patient stratification. Patients can be empowered to self-diagnose and apply preventive measures or self-manage some early stages of dental diseases. Applications of AI in teledentistry can be beneficial for both, the dental surgeon and the patient. AI enables better remote screening, diagnosis, record keeping, triaging, and monitoring of dental patients based on smart devices. This will take away rudimentary cases requiring run-of-the-mill treatments from dentists and enable them to concentrate on highly complex cases. This would also enable the dentists to serve a larger and deprived population in inaccessible areas. Its usage in teledentistry can bring a paradigm shift from curative to preventive personalised approach in dentistry. A strong asset to teledentistry could be a robust and comprehensive feedback mechanism routed through various channels proposed in this paper. This paper discusses the application of AI in teledentistry and proposes a feedback mechanism to enhance performance in teledentistry.

Teledentistry Implementation During the COVID-19 Pandemic: Scoping Review

Background

COVID-19 spreads via aerosol droplets. The dental profession is at high risk of contracting the virus since their work includes treatment procedures that produce aerosols. Teledentistry offers an opportunity to mitigate the risk to dental personnel by allowing dentists to provide care without direct patient contact.

Objective

The purpose of this scoping review was to examine the implementation, challenges, strategies, and innovations related to teledentistry during the COVID-19 pandemic lockdown.

Methods

This scoping review evaluated teledentistry use during the pandemic by searching for articles in PubMed and Google Scholar using the search terms teledentistry, tele-dentistry, covid-19, coronavirus, telehealth, telemedicine, and dentistry. Inclusion criteria consisted of articles published in English from March 1, 2020, to April 1, 2022, that were relevant to dentistry and its specialties, and that included some discussion of teledentistry and COVID-19. Specifically, the review sought to explore teledentistry implementation, challenges, strategies to overcome challenges, and innovative ideas that emerged during the pandemic. It followed the 2020 Preferred Reporting Items for Systematic reviews and Meta-Analyses for Scoping Reviews (PRISMA-ScR). This approach is organized into 5 distinct steps: formulating a defined question, using the question to develop inclusion criteria to identify relevant studies, an approach to appraise the studies, summarizing the evidence using an explicit methodology, and interpreting the findings of the review.

Results

A total of 32 articles was included in this scoping review and summarized by article type, methodology and population, and key points about the aims; 9 articles were narrative review articles, 10 were opinion pieces, 4 were descriptive studies, 3 were surveys, 2 were integrative literature reviews, and there was 1 each of the following: observational study, systematic review, case report, and practice brief. Teledentistry was used both synchronously and asynchronously for virtual consultations, often employing commercial applications such as WhatsApp, Skype, and Zoom. Dental professionals most commonly used teledentistry for triage, to reduce in-person visits, and for scheduling and providing consultations remotely. Identified challenges included patient and clinician acceptance of teledentistry, having adequate infrastructure, reimbursement, and security concerns. Strategies to address these concerns included clinician and patient training and utilizing Health Insurance Portability and Accountability Act-compliant applications. Benefits from teledentistry included providing care for patients during the pandemic and extending care to areas lacking access to dental care.

Conclusions

Pandemic lockdowns led to new teledentistry implementations, most commonly for triage but also for follow-up and nonprocedural care. Teledentistry reduced in-person visits and improved access to remote areas. Challenges such as technology infrastructure, provider skill level, billing issues, and privacy concerns remain.

Assessment of attitudes and practices regarding oral healthcare during the COVID-19 pandemic among the parents of children aged 4-7 years

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has brought about radical changes in our habits and lifestyles. The suspension of schools has led children to spend long hours at home, with reduced socialization, and changes in dietary patterns, oral hygiene practices and sleep routines. During a pandemic, appropriate oral health management and disease prevention are very important for the child's oral and general health.

OBJECTIVES

The aim of this study was to assess the attitudes and practices of parents with regard to their children's oral healthcare, dietary habits and dental care during the COVID-19 pandemic.

MATERIAL AND METHODS

This cross-sectional study included 381 Indian parents of children aged 4-7 years. A self-instructed questionnaire was designed in English using the Google Forms platform. The questionnaire consisted of 4 parts: sociodemographic data; dietary habits of the child; oral hygiene measures; and dental information. The collected data was analyzed using descriptive and analytical statistics (the χ2 test).

RESULTS

Among the children included in the study, 48% of those who experienced dental problems during the pandemic consumed more snacks and packaged foods between meals. Among the parents, 80% reported that their children used electronic devices at mealtimes, and 60% reported the food pouching habit in their children. A total of 71% of parents assisted their child at tooth brushing, while only 28% of the parents would take their child to the dental clinic for treatment.

CONCLUSIONS

This study highlights the shortfalls in attitudes and practices among parents in relation to dietary habits, oral hygiene measures and the use of dental services during the COVID-19 pandemic regarding their children. This could be attributed to a lack of awareness, the fear of exposure and the inconveniences faced by parents.

Dental Care and Education Facing Highly Transmissible SARS-CoV-2 Variants: Prospective Biosafety Setting: Prospective, Single-Arm, Single-Center Study

With the arrival of the highly transmissible Omicron variants (BA.4 and BA.5), dentistry faces another seasonal challenge to preserve the biosafety of dental care and education. With the aim of protecting patients, students, teachers and healthcare professionals, this paper introduces a prospective sustainable biosafety setting for everyday dental care and education. The setting developed by dental clinicians, epidemiologists, and teachers of dentistry consists of a combination of modern technologies focused on the air-borne part of the viral pathway. The introduced biosafety setting has been clinically evaluated after 18 months of application in the real clinical environment. The protocol has three fundamental pillars: (1) UVC air disinfection; (2) air saturation with certified virucidal essences with nebulizing diffusers; (3) complementary solutions including telehealth and 3D printing. A pseudonymous online smart form was used as the evaluation method. The protocol operates on the premise that everybody is a hypothetical asymptomatic carrier. The results of a clinical evaluation of 115 patient feedbacks imply that no virus transmission from patient to patient or from doctor to nurse was observed or reported using this protocol, and vice versa, although nine patients retrospectively admitted that the clinic visit is likely to be infectious. Despite these promising results, a larger clinical sample and exposition to the current mutated strains are needed for reliable conclusions about protocol virucidal efficiency in current dental environments.

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.