Could Teledentistry Be a Solution in the Diagnosis of Oral Lesions?

In recent years, teledentistry has gained visibility, especially because of the COVID-19 pandemic. Concerning oral medicine, there is great expectation, particularly about its potential to promote early diagnosis of oral lesions. In southern Brazil, two initiatives have shown a positive influence on each other and have led to greater awareness of oral cancer and more access to qualified advice on diagnosing and managing oral lesions. Although the contributions of this approach are promising, there are barriers to be overcome.

Social networking website increases efficacy and engagement in a distance learning course about oral lesions.

PURPOSE: Distance learning appears to be an attractive approach to continuing education courses, but one barrier is maintaining learner engagement throughout the course. The primary aim of this research was to evaluate the operational efficacy of a private Facebook™ group (FG) in serving as a support mechanism for distance learning courses, and its impact on three fundamental dimensions: the attrition rates of participants who did not complete the course (commonly referred to as dropout rates), the rates of course completion and approval, and the overall performance of the participants. METHODS: The participants of this quasi-experimental study comprised 159 dental students and 565 dentists enrolled in an e-learning course on oral mucosal lesion diagnosis. Prior to the initiation of the course, all participants were provided with the option to join a private FG. Within this group, moderators shared motivational messages and provided reminders concerning deadlines. Moreover, participants had the opportunity to engage in interactive discussions pertaining to topics related to the course. The course itself followed a self-guided format, employing the flipped-classroom methodology, spanning a total of 50 instructional hours. In order to assess the effectiveness of the course, participants were presented with photographs illustrating 30 oral lesions and were asked to propose diagnostic hypotheses both before and after the educational intervention (pre-tests and post-tests). RESULTS: Dentists who participated in the FG exhibited a significantly lower rate of discontinuation. As for dental students, their involvement in the group was positively associated with better performance, as determined by the percentage of accurate diagnostic hypotheses (a minimum of 70% correct responses was required for their approval in the course). CONCLUSIONS: Facebook™ demonstrates promise as a supplementary pedagogical tool in distance education courses. The interactive nature of the platform has the potential to alleviate the inherent challenges of remote learning.

EstomatoNet: A 5-year experience of an oral medicine telediagnosis service.

OBJECTIVE: EstomatoNet is an online service driven by primary health care professionals to support diagnosis and decision-making for oral lesions. This study aimed to describe the experience of the service, depicting use cases and its impact on the referral to specialised services. MATERIALS AND METHODS: Patient/applicant demographics and information related to their oral lesions and/or complaints were retrieved from the service's cloud-based platform. The differential diagnosis provided by the applicants, their level of satisfaction and the teleconsultant's opinion in terms of diagnosis and management were also reported. The teleconsultant's suggestion was cross-referenced with the data from the regulation system to verify the avoidance of referral. RESULTS: Out of 2,002 teleconsultations, most patients were women (55.1%) and 50.1% were aged between 20 and 59 years. Applicants (96.5%) generally considered the service very satisfying/satisfying. Potentially malignant disorders were reported in 19.6% of cases and 7.7% were suspected to be malignant. The referral of 37.3% of patients was avoided after the suggestion of keeping the patient in the primary health care system (k = 0.234; p < 0.001; 62.2% agreement). CONCLUSION: The use of EstomatoNet for oral mucosal lesions improves support for primary health care professionals in the management of lesions and reduces referral to specialised services.

Use of an audience response system during a continuing education action about oral lesion diagnosis.

OBJECTIVES: The present cross-sectional study aimed to evaluate the perceptions of continuing education action (CEA) participants on the use of an audience response system (ARS). Secondarily, the study assessed the association between the diagnostic abilities of participants and their self-confidence in managing oral lesions METHODS: Oral medicine specialists, dentists, hygienists, and students (n = 193) who attended the 'Maio Vermelho Project', a CEA held in a Southern Brazilian State, answered a diagnostic ability test using the ARS Socrative software during a case discussion section. The test comprised 16 simulated clinical cases based on photos of oral lesions. The questions required classification of the lesion's nature, diagnostic hypothesis, and decision making (manage the case or refer it to a specialist) for each case. A second questionnaire composed of 12 questions was also applied to evaluate satisfaction and perception of the use of ARS Socrative RESULTS: Hygienists displayed lower scores in the diagnostic abilities test, whereas the other groups' performances were quite similar. Dentists and dental students who scored higher on the diagnostic abilities test showed higher self-confidence in the management of benign lesions. All participants stated that the use of technology can improve their learning experience and should be incorporated into the classroom. Moreover, the participants' perception was highly favorable to the use of Socrative in educational activities CONCLUSION: Our findings showed good acceptance of the ARS tool in a CEA environment and suggest an association between performance on the questionnaire and self-confidence in oral lesion management.

Diagnostic accuracy of a telediagnosis service of oral mucosal diseases: A multicentric survey.

OBJECTIVE: The aim of this multicentric study was to assess the diagnostic accuracy of a telediagnosis service for oral mucosal disorders. STUDY DESIGN: This study included 100 patients seen at the oral medicine outpatient clinic of 3 Brazilian Dental Schools (University of Campinas, Federal University of Pernambuco, and Federal University of Santa Catrina) from March 2019 to October 2019. In addition to the face-to-face assistance provided by graduate students and the final diagnosis validated by the professors of these institutions, a remote evaluation was requested for these patients through the EstomatoNet/TelessaúdeRS platform. RESULTS: The sensitivity and specificity of telediagnosis were compared with those of the face-to-face approach and found to be 100% and 97.4%, respectively. The concordance between the examiners was 95%, and case management was relatively simple in approximately 60% of cases. CONCLUSIONS: Based on the results, telediagnosis for oral diseases can be considered a reliable method, representing a promising alternative for the clinical support of health professionals, particularly in remote locations.

Oral Medicine Experience and Attitudes Toward Oral Cancer: An Evaluation of Dentists Working in Primary Health Care.

This analytical, cross-sectional, observational study aimed to evaluate the perception of dentists working at the public system of the state of Rio Grande do Sul, southern Brazil, regarding academic training to treat oral lesions, adoption of preventive measures for oral cancer, and attitude toward the need to perform oral biopsies. The sample consisted of questionnaires filled out by 192 dentists (153 women and 39 men) working in primary health care who participated in training activities on oral cancer diagnosis in July 2016. To enroll in the training activities, the professionals completed an online questionnaire to evaluate their perceptions regarding oral cancer issues. With respect to preventive measures, 96.88% of dentists reported performing full mouth examination, 87.50% reported providing tobacco cessation counseling, and 51.04% reported giving advice on excessive alcohol consumption. In addition, 72.40% and 44.79% of dentists considered, respectively, clinical training and theory instruction in oral medicine to be insufficient during undergraduate school. Only 8.33% reported performing biopsies in daily clinical routine, and almost 90% reported referring the patient to a specialist from the public system or universities. Lack of experience was the main reason not to perform a biopsy. The dentists in our sample recognize the importance of preventive measures for oral cancer, but few of them perform biopsies regularly. Therefore, there is a need for continuing education actions including practical training.

Online search interest in the use of antibiotics for dental pain: an infodemiology study / Interesse em pesquisas online sobre o uso de antibióticos para dor dentária: um estudo infodemiológico

Objective: The objective of this study was to evaluate the online search interest pertaining to queries regarding antibiotics for dental pain. Material and Methods : Google Trends™ was used to identify the online search interest. Previously, a literature search was performed on the most frequently used antibiotics in dentistry in Brazil. Accordingly, the search terms used were Amoxicillin (AM), Clindamycin (CD), Azithromycin (AZ) and Metronidazole (MD), with the phrase "for toothache" in Portuguese and English. A time-series covered the last 240 weeks (from 2015 to 2020), and the results of each term were compared to their respective annual value. Geographic regions were also evaluated. To obtain a relative search volume (RSV), the resulting Google Trends™ numbers were then scaled to a range from 0 to 100 based on the ratio of searches on a topic to searches across all topics. Results : We observed an upward trend in all antibiotics search terms over the 5 years analyzed, with a peak of greater interest in 2019. The antibiotic of most interest related to toothache was 'AM', followed by 'AZ', 'MD', and 'CD'. The annual RSV of toothache searches rose steadily from 2015 to 2020. Variations were observed between Brazilian geographic regions, and the Northeast region presented with the greatest interest in the topic. Conclusion : Although there were variations in annual and regional trends, an expressive and persistent increase in collective interest regarding the use of antibiotics related to toothache, mainly amoxicillin, was observed. Our findings provide insights for public health promotion programs. (AU)

Objetivo: O objetivo deste estudo foi avaliar o interesse da pesquisa online em consultas sobre antibióticos para dor de dente. Material e métodos : o Google Trends™ foi usado para identificar o interesse de pesquisa online. Anteriormente, foi realizada uma pesquisa bibliográfica sobre os antibióticos mais utilizados em odontologia no Brasil. A partir daí, os termos de busca utilizados foram Amoxicilina (AM), Clindamicina (CD), Azitromicina (AZ) e Metronidazol (MD) com os termos "para dor de dente" em português e inglês. Uma série histórica abrangeu as últimas 240 semanas (abril de 2015 a abril de 2020), e os resultados de cada período foram comparados com seus respectivos valores anuais. Regiões geográficas também foram avaliadas. Os números resultantes do Google Trends ™ são dimensionados para um intervalo de 0 a 100 com base na proporção de um tópico para todas as pesquisas em todos os tópicos de busca. Isso é chamado de volume relativo de pesquisa (RSV). Resultados : Foi observada uma tendência crescente para todos os termos de antibióticos ao longo dos 5 anos analisados, com um pico de maior interesse em 2019. O antibiótico de maior interesse na dor de dente foi 'AM', seguido por 'AZ', 'MD' e 'CD'. O RSV anual das buscas de dor de dente cresceu continuamente de 2015 a 2020. Variações foram observadas entre as regiões geográficas brasileiras, sendo que a Região Nordeste apresentou o maior interesse pelo tema. Conclusão : Embora tenha havido variação nas tendências anuais e regionais, observou-se um aumento expressivo e persistente do interesse coletivo pelo uso de antibióticos relacionados à dor de dente, principalmente a amoxicilina. Nossas descobertas fornecem insights para programas de promoção pública.(AU)

Synchronous Telephone-Based Consultations in Teledentistry: Preliminary Experience of the Telehealth Brazil Platform.

Background: The Brazilian National Health System (NHS) has incorporated telehealth to improve the quality of care in recent decades. Among the actions taken, teleconsultations have been offered to support diagnosis and decision-making for health professionals. Methods: This cross-sectional study aimed to summarize the preliminary experience of a telephone-first consultation for oral health issues available for dentists and physicians from primary health care (PHC). Results: The study sample was 385 teleconsultations with oral health questions requested from all Brazil sent from May 2018 to July 2019, majority by dentists 83.2% (n = 332). Oral medicine was the main reason for teleconsultation (50.9%). Resolution in PHC was considered possible in 57.1% of cases (n = 220). Conclusions: It was concluded that a telephone-first consultation may be useful to improve the resolvability and the quality of care in the PHC on oral health issues. The teledentistry allows the resolution of oral issues in PHC, avoiding the displacement of patients to more distant specialized centers. Teledentistry could be more useful in the actual coronavirus disease (Covid-19) pandemic.

Synchronous teleconsultation in the management of temporomandibular disorder

ABSTRACT Purpose: to analyze synchronous teleconsultation as a support tool in the management of temporomandibular disorders in primary health care and to identify which factors have an impact on decisions about teleconsultation. Methods: retrospective study perfomed in TelessaúdeRS, between May 2018 to May 2020. This study used primary data from synchronous teleconsultation, requested by primary health care professionals and carried out by multiprofessional teleconsultants. The data collected were the information reported by the requester, the teleconsultant's suggestions and if there was referral of the patient for specialized care after teleconsultation. The statistical association was investigated between patient characteristics and decision of teleconsultation; and teleconsultation conduct suggestions and decision of teleconsultation, using Fisher's exact test and modeling was performed using binary logistic regression considering 5% of significance (p≤0.05). Results: during the period, 56 teleconsultations had a temporomandibular diagnostic hypothesis, these 79.2% patients were female and the average age was 43.7 years. In 59.1% of teleconsultations, primary care management was suggested, with 72.4% of patients being managed. An association was found between the decision of teleconsultation and referral to specialized care (p <000.1). The trauma report (p = 0.004) was associated with a greater chance of being referred for special care and suggestions for pharmacological (p <0.001) and non-pharmacological (p = 0.007) treatments were introduced among the teleconsultation managed in primary care. Conclusion: teleconsultation helped to manage the majority of temporomandibular disorder, streamlining care and having the potential to avoid unnecessary referrals to special care.

Perceived usability of a store and forward telehealth platform for diagnosis and management of oral mucosal lesions: A cross-sectional study.

EstomatoNet was created in the south of Brazil to provides specialist support over a web-based platform to primary care dentists for diagnosis of oral lesions. To evaluate the usability of EstomatoNet and to identify user perceptions regarding their expectations and difficulties with the system; and to compare the perceptions of regular users of the service to those of first-time users. Sixteen dentists were selected for the study: 8 were frequent users of EstomatoNet and 8 were residents who had never used the Platform. To assess usability, participants were required to request telediagnosis support for a fictional case provided by the research team. During the process of uploading the information and sending the request, users were asked to "think out loud," expressing their perceptions. The session was observed by an examiner with remote access to the user's screen (via Skype). After the simulation, users completed the System Usability Scale (SyUS), a validated tool with scores ranging from 0 to 100. The mean SyUS score assigned by frequent users was 84.7±6.6, vs. 82.2±9.3 for residents (satisfactory usability: score above 68). The difference between the groups was not statistically significant (Student t test, P = .55). The residents group took longer (347.1±101.1s) to complete the task than frequent users (252.8±80.3s); however, the difference between the groups was not statistically significant (Student t test, P = .06). In their subjective evaluation, users suggested the inclusion of a field to add further information on outcomes and resolution of the case and changes in the position of the "Send" button to improve workflow. The present results indicate satisfactory usability of EstomatoNet. The Platform seems to meet the needs of users regardless of how experienced they are; nevertheless, a few minor changes in some steps would improve the tool.

Teledentistry: A Tool to Promote Continuing Education Actions on Oral Medicine for Primary Healthcare Professionals.

BACKGROUND: Difficulties in diagnosis of oral mucosal lesions are a significant cause of delayed oral cancer diagnosis, and this difficulty may be due to gaps in knowledge. This study evaluated the diagnostic skills of primary healthcare professionals regarding oral cancer and presented them with an e-learning course. MATERIALS AND METHODS: Forty-seven primary healthcare professionals (32 dentists and 15 nondentists) enrolled in a 24-h course on oral medicine delivered through an e-learning platform. A test, based on 33 clinical images of oral lesions, was used to evaluate the diagnostic skills of participants. The participants were requested to classify each lesion as benign, potentially malignant, or malignant as well as to inform their clinical impression. Three specialists also took the test as the gold standard. RESULTS: Twenty-seven participants completed the test. Nondentists and dentists showed a comparable sensitivity of 68.8 ± 11.1 and 63.7 ± 15.8, respectively. Specialists performed somewhat better; however, the difference was not statistically significant (81.0% ± 4.1%, p = 0.16). Dentists and specialists (70.0% ± 16.6% and 95.5% ± 3.1%, respectively) showed higher specificity than nondentists (39.3 ± 20.6, p < 0.01). Nondentists had a higher number of unanswered questions (p < 0.01) for classification and clinical impression (50.0% ±45.1% and 72.0% ± 25.0%, respectively) than dentists (5.7% ±11.9% and 19.8% ± 20%, respectively). Both dentists and nondentists had low attendance in the course (44.57% ± 37.38% and 26.53% ± 26.53%, respectively, p = 0.26). To the best of our knowledge, this is the first study to assess the diagnostic skills of public health workers belonging to different professional categories. CONCLUSION: Both dentists and nondentists have a fairly good capacity for discriminating the nature of oral lesions. Early squamous cell carcinoma is the most challenging situation and remains an issue to be addressed.