The Potential of Teledentistry in Community Oral Health for the Pediatric Population

• Dental caries is the most prevalent chronic disease of childhood in the US. • Young children are a particularly vulnerable population because of their dependence, inability to communicate needs, and relative poverty. • Furthermore, this can be exacerbated by disparities such that an increased rates of caries are observed in children who are of low socioeconomic status and minority backgrounds. • However, community oral health screenings can play a vital role in childhood caries as a predominately preventable disease. • The current emphasis on social distance during the COVID-19 pandemic has brought attention to teledentistry, which may have a valuable role in the future of community oral health outreach

Teledentistry: New Tool to Access Dental Care

The Health sector is undergoing dramatic revolution by incorporating the utilization of computers and telecommunications. Its Implications in hospitals and among physicians have gained attention. However, its impact on dentistry is less widely reported. Teledentistry can improve access to dental care as well can be used as a tool for dental education

Potential of teledentistry in the delivery of oral health services in developing countries

In developing countries, access to qualified medical personnel especially oral health care specialists by inhabitants of rural and remote areas remain a challenge due to the fact that these personnel are mostly located in urban communities. Teledentistry is an approach that will eliminate the problem of distance between qualified oral health care personnel and potential patients in rural and remote communities. The objective of this review is to investigate the history of teledentistry and its practical application in overcoming the rural-urban oral health care problems.A scoping search of literature using keywords associated with telemedicine and teledentistry and its application was undertaken via PubMed and  Scientific electronic Library Online (SciELO). Literature published in English in the last 10 years (2008 – 2018) were selected. The review summarises the available literature related to origin and method of delivering teledentistry and its use in dental practice and education. It shows that  teledentistry has the ability to improve access to and delivery of oral health care at a relatively lower cost as well as supplementing traditional  teaching methods in dental education. However, despite the promising nature of teledentistry in improving oral health care provision, it is  associated with some attending problems and challenges. Keywords: Telemedicine, Teledentistry, Rural, Remote, Developing countrie

Remote clinical consultations in restorative dentistry: A clinical service evaluation study

Introduction Specialist consultant services in the UK NHS provide a decision-making support service to other health professionals. There is a drive to deliver this service in a more patient-centred, cost-effective and efficient manner. Remote clinical consultations (RCC), using secure, live, super-fast internet connectivity and high-resolution, multi-channel audio-visual streaming, has the potential for the delivery of this service. Aim To conduct a clinical service evaluation to assess the viability and efficiency of conducting a RCC for the management of primary care referrals in restorative dentistry, compared to an in-person consultation. Design A RCC was conducted for every participating patient and immediately followed with a 'verification' in-person consultation. Materials and method Twenty-three patients of even gender distribution participated in this study across the three specialisms of restorative dentistry. A thematic questionnaire was completed by each member of the study intervention team and the patient after each consultation. Results In all the cases, the consultant was able to conduct an effective and safe clinical consultation, not inferior to an in-person process, regardless of gender and age. The GDP, the nurse and the patient were able to participate effectively in the process and with each other. Conclusion This proof-of-concept study suggests that the RCC concept is a feasible way of delivering specialist consultations in restorative dentistry with high levels of patient acceptability and that it can be delivered in a practical and simple manner

Oral Hygiene System Design

This thesis is focused on the design of oral hygiene system. According to the research done by the author, poor oral hygiene mainly results from bad oral habits, including not brushing teeth before going to bed, failing to keep using dental floss, never going to dentists, and so on. Based on the findings, the author designed a system of oral hygiene products, an oral health database and platform for home use. As for the market, the initial targeting market is Chinese market. Then it can be promoted for universal use. These oral hygiene products include a mini camera, smart sensors, a water flosser, a toothbrush, a cell phone holder and a UV sanitizer. The oral health database and the platform have five essential functions including providing basic oral health knowledge; providing methods of self-diagnosis; providing oral health point system; sharing good dental resources; providing communication platform. All functions mentioned above are integrated in a mobile phone application. When people get high points from the point system and get a good evaluation from dentists about their oral health status, they will get lower insurance price from the medical insurance company, where the staff can get access to these data

Teleodontologia no diagnóstico de lesões de cárie e alterações da mucosa bucal em adolescentes privados de liberdade

Resumo: Objetivos: O objetivo do presente estudo foi avaliar um sistema de teleodontologia como ferramenta para o diagnóstico de lesões de cárie e alterações em mucosa bucal, em um grupo de 102 adolescentes brasileiros em conflito com a lei. Metodologia: O exame clínico foi realizado para avaliar o Índice CPO-D, de acordo com os critérios da Organização Mundial de Saúde (OMS) e a condição de saúde bucal de cada um dos adolescentes foi documentada, utilizando uma câmera fotográfica digital. A presente pesquisa contou com três avaliadores à distância, dois para o Índice CPO-D e um para as alterações em mucosa bucal. Para o telediagnóstico, foram testadas duas formas de transmissão de imagens. Na primeira delas, as imagens foram compactadas e postadas em um site para compartilhamento de arquivos (www.sendspace.com) e o link para download foi enviado por e-mail para os avaliadores. Na outra, as imagens foram salvas em um compact disc e enviadas para avaliação por meio de um serviço de orrespondência expressa. O Índice CPO-D foi calculado e as alterações em mucosa bucal foram identificadas em cada um dos casos transmitidos. Foram realizadas análises descritivas dos valores de CPO-D e das alterações em mucosa bucal. Para o CPOD, a concordância entre o exame presencial e as duas avaliações à distância foi mensurada pelo Coeficiente de Concordância Kappa. Sensibilidade e specificidade também foram calculadas, considerando o exame clínico presencial como padrãoouro. Resultados: A idade média da amostra foi de 16,84 anos (DP=0,94). De acordo com o exame clínico presencial, a prevalência de lesões de cárie foi de 93,1% e o CPO-D médio foi de 5,9. Os resultados obtidos com o Índice Kappa variaram de concordância “substancial” a “quase perfeita”. A sensibilidade variou de 48% a 73%, a especificidade de 97% a 98% e a acurácia de 93% a 95%. A prevalência de lesões bucais foi de 38,23%; 78,43% dos adolescentes apresentaram pelo menos uma variação de normalidade e 51% pelo menos uma alteração periodontal. Conclusões: Diante das dificuldades envolvidas na identificação das necessidades de tratamento de grupos vulneráveis, a aplicação da teleodontologia mostrou-se como uma alternativa ao exame clínico presencial no diagnóstico de lesões de cárie e um método adequado para auxiliar no rastreamento de alterações bucais em adolescentes que cumprem medida socioeducativa de rivação de liberdade

Predictors of Dental Students’ Behavioral Intention Use of Teledentistry: An Application of the Unified Theory of Acceptance and Use of Technology (UTAUT) Model

Shortages of dental professionals and access barriers to dental care are challenges to improving oral health and decreasing the burden of dental diseases. There are more than 57 million individuals in the U.S. who live in dental health professional shortage areas (DHPSA). The U.S. DHPSA areas need 9,951 dental practitioners to overcome the obstacles to oral care access. Due to dental care needs for these populations, it is imperative to find a new method to reach these underserved populations. Teledentistry is an innovative technology that can be used to improve access to care and oral health outcomes. Unfortunately, there is still limited utilization of teledentistry in dental practice in the U.S. Many studies have investigated factors associated with the applications of telehealth and telemedicine; however, limited investigations have addressed the barriers to the use and implementation of teledentistry. The overarching purpose of this dissertation was to explore factors associated with the future use of teledentistry among predoctoral dental students. To achieve this purpose, three interrelated projects were conducted. The first project involved a systematic review to investigate the validity of using teledentistry in dental practice. The second project examined demographics, individual characteristics, and prior experience with teledentistry associated with U.S. dental students’ intention to use teledentistry in their dental practice. The final project utilized the unified theory of acceptance and use of technology model (UTAUT) to predict the future use of teledentistry by evaluating U.S dental students’ behavioral intention to use teledentistry in practice. The systematic review confirmed that a teledentistry oral diagnosis was comparable to face-to-face diagnosis and suggests the need for methodologically designed studies with appropriate statistical tests to further investigate the validity of teledentistry. Project II results indicated that dental students with prior teledentistry experience were more likely to utilize this technology in their future practice. Project III identified that the UTAUT model significantly predicted dental students’ behavioral intention to use teledentistry. All the UTAUT constructs were significantly associated with dental students’ behavioral intention. Findings from these three projects indicate that exposure to teledentistry while in dental school increases the likelihood of use as a licensed dentist

Diagnóstico de lesões bucais à distância com fotografias de smarthphones

Orientador: Prof. Dr. Cassius Carvalho Torres-PereiraDissertação (mestrado) - Universidade Federal do Paraná, Setor de Ciências da Saúde, Programa de Pós-Graduação em Odontologia. Defesa: Curitiba, 29/07/2015Inclui referências : f. 68-77Resumo: A "telessaúde" pode ser definida como uma forma de promover saúde com o uso das tecnologias de informação e comunicação para a troca de dados, e para melhorar a qualidade e a eficiência do acesso à saúde, atravessando distâncias geográficas. É considerada uma prática com potencial de reduzir custos e com a vantagem de ampliar o acesso para populações em áreas remotas ou onde não houver a presença de especialistas. O objetivo do presente estudo foi avaliar o diagnóstico à distância de lesões bucais com o uso de uma amostra de fotografias obtidas com um smartphone. O estudo teve desenho observacional transversal com uma amostra de conveniência. Os dados foram coletados no ambulatório de estomatologia da Universidade Federal do Paraná, e foram obtidos a partir de exame físico, história da doença atual e registro fotográfico de lesões orais realizado com câmera de um smartphone. Participaram da amostra todos os pacientes que apresentaram lesões bucais visíveis à inspeção. As informações clínicas e as fotografias das lesões foram enviadas para três avaliadores, os quais foram solicitados a formular um mínimo de uma e o máximo de duas hipóteses diagnósticas para cada caso. Além disso, os especialistas responderam algumas questões referentes à decisão de encaminhamento, solicitação de exames complementares, dificuldade diagnóstica de cada caso e qualidade das fotos. As hipóteses diagnósticas formuladas à distância foram comparadas com o padrão-ouro em cada caso clínico proposto e medidas pelo coeficiente kappa. Nos casos com exclusivo diagnóstico clínico, o padrão-ouro foi considerado o diagnóstico presencial de consenso entre três especialistas. Nos demais casos, passíveis de biópsia, o padrão-ouro foi considerado o resultado de exame histopatológico. O estudo avaliou uma amostra de 235 fotografias de lesões bucais obtidas de 113 casos clínicos de pacientes. Em 76% dos casos os avaliadores à distância realizaram o diagnóstico correto quando comparado ao padrão-ouro. Os avaliadores 1 e 3 fizeram o diagnóstico correto em 103 casos (91,2%), enquanto o avaliador 2 em 94 casos (83,2%). A concordância obtida entre as hipóteses diagnósticas e o padrão-ouro foi considerada "quase perfeita" de acordo com os valores do índice de kappa (k = 0,817 - 0,903). Para os avaliadores à distância, os encaminhamentos para a média complexidade poderiam ter sido evitados em uma média de aproximadamente 35% dos casos. O diagnóstico de lesões bucais por meio de imagens obtidas com um smartphone mostrou boa concordância e acerto diagnóstico comparável com aquele obtido presencialmente e pode ser sugerido como uma ferramenta auxiliar na referência de casos entre a atenção primária e a média complexidade em estomatologia. Palavras-chave: Telemedicina. Telessaúde. Diagnóstico. Estomatologia. Smartphone.Abstract: "Telehealth" can be defined as a way to promote health through the use of information and communication technologies to exchange data and to increase the quality and efficiency of health access, crossing geographical distances. It is considered a practice with the potential of reducing costs and with the advantage of expanding access for populations in remote areas or where there are not specialists. The aim of this study was to evaluate the diagnosis at distance of oral lesions with the use of a sample of photographs obtained with a smartphone. The study had a cross-sectional observational design with a convenience sample. The data were collected on the Stomatology ambulatory of Federal University of Paraná. They were obtained from clinical examination, current history of the illness and photographic record of oral lesions taken with a smartphone camera. The participants of the sample were all the patients with oral lesions visible to inspection. The clinical information and the photographs of the lesions were sent to three consultants, who were solicited to formulate a minimum of one and a maximum of two diagnostic hypotheses for each case. Moreover, the specialists answered some questions related to the forwarding decision, solicitation of complementary exams, diagnostic difficulty of each case and quality of the photographs. The diagnostic hypotheses formulated at distance were compared to the gold standard in each clinical case proposed and measured by the kappa coefficient. In cases with exclusive clinical diagnosis, the gold standard was considered the presence diagnostic consensus of three specialists. In all other cases, subject to biopsy, the gold standard was considered the result of histopathological examination. The study evaluated a sample of 235 photographs of oral lesions obtained from 113 clinical cases of patients. In 76% of the cases the consultants at distance made the correct diagnosis when compared to the gold standard. Consultants 1 and 3 made the correct diagnosis in 103 cases (91,2%), while consultant 2 in 94 cases (83,2%). The concordance obtained between the diagnostic hypotheses and the gold standard was considered "nearly perfect", according to the values of kappa index (k = 0.817 - 0.903). For the consultants at distance, the referrals to medium complexity could have been avoided by in average of approximately 35% of cases. The diagnostic of oral lesions through images taken with a smartphone showed good concordance and diagnostic accuracy comparable to that obtained in person and it can be suggested as an auxiliary tool in reference cases between primary care and medium complexity in stomatology. Key words: Telemedicine. Telehealth. Diagnosis. Oral medicine. Cell Phone