Mobile Health Assessment of Traumatic Dental Injuries Using Smartphone-Acquired Photographs: A Multicenter Diagnostic Accuracy Study.

Background: Mobile health (mHealth) has an emerging potential for remote assessment of traumatic dental injuries (TDI) and support of emergency care. This study aimed to determine the diagnostic accuracy of TDI detection from smartphone-acquired photographs. Methods: The upper and lower anterior teeth of 153 individuals aged ≥ 6 years were photographed using a smartphone camera app. The photos of 148 eligible participants were reviewed independently by a dental specialist, two general dentists, and two dental therapists, using predetermined TDI classification and criteria. The sensitivity, specificity, accuracy, positive predictive value, negative predictive value, and inter-rater reliability were estimated to evaluate the diagnostic performance of the photographic method relative to the reference standard established by the dental specialist. Results: Of the 1,870 teeth screened, one-third showed TDI; and one-seventh of the participants had primary or mixed dentitions. Compared between the specialist's reference standard and four dental professionals' reviews, the diagnostic sensitivity and specificity for TDI versus non-TDI were 59-95% and 47-93%, respectively, with better performance for urgent types of TDI (78-89% and 99-100%, separately). The diagnostic consistency was also better for the primary/mixed dentitions than the permanent dentition. Conclusion: This study suggested a valid mHealth practice for remote assessment of TDI. A better diagnostic performance in the detection of urgent types of TDI and examination of the primary/mixed dentition was also reported. Future directions include professional development activities involving dental photography and photographic assessment, incorporation of a machine learning technology to aid photographic reviews, and randomized controlled trials in multiple clinical settings.

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

BACKGROUND: Tele-dentistry can be useful to facilitate screening of children, especially those living in rural and remote communities, and during the COVID-19 pandemic. AIM: This study evaluated the feasibility of tele-dental screening for the identification of early childhood caries (ECC) in preschoolers using an app operated by their parents with remote review by oral-health therapists. DESIGN: This cross-sectional study was a sub-project nested in ORIGINS Project, a longitudinal birth cohort study in Western Australia. Initially, children were visually examined by a paediatric dentist (gold standard). Subsequently, dental photographs were taken by parents using a smartphone camera. Two trained oral health professionals asynchronously evaluated dental photographs. The presence of dental caries was recorded as per the International Caries Detection and Assessment System-II classification. The diagnostic accuracy and reliability of the tele-dental screening and the gold standard dental examinations were then compared. RESULTS: Forty-two children aged <4 years were enrolled in the study. Twenty-five per cent of examined children had dental caries (mean dmfs = 0.7). A total of 370 dental photographs were obtained. Parents were able to take good-quality photographs, with 90% of photographs rated as good to fair quality. Tele-dental screening demonstrated high specificity (>=95.5%) for both reviewers compared to the gold standard dental examination. However, the sensitivity scores for the two reviewers varied, ranging from 44% to 88.4%. CONCLUSION: Tele-dental screening for ECC was shown to be a feasible approach following a brief training for primary caregivers. This approach can offer a potential low-cost and sustainable alternative for visual dental examinations for young children, particularly in times of COVID-19-related restrictions.

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

BACKGROUND: Despite great improvement in child oral health, some children subgroups still suffer from higher levels of dental caries. Geographic and socioeconomic barriers and the lack of access to dental care services are among common reasons for poor oral health in children. Historically in Australia, oral health therapists or dental therapists have been responsible for providing dental care for school children through the School Dental Services (SDS). The current SDS has been unable to provide sustainable dental care to all school children due to a reduction in workforce participation and limited resources. We propose a paradigm shift in the current service through the introduction of user-friendly technology to provide a foundation for sustainable dental care for school children. METHODS/DESIGN: We describe an ongoing parallel, two-armed, non-inferiority randomised controlled trial that compares routine and teledental pathway of dental care in children aged 4-15 years (n = 250). Participating schools in Western Australia will be randomly assigned to the control or teledental group, approximately three schools in each group with a maximum of 45 children in each school. All participants will first receive a standard dental examination to identify those who require urgent referrals and then their teeth will be photographed using a smartphone camera. At the baseline, children in the control group will receive screening results and advice on the pathway of dental care based on the visual dental screening while children in the teledental group will receive screening results based on the assessment of dental images. At 9 months follow-up, all participants will undergo a final visual dental screening. The primary outcomes include decay experience and proportion of children become caries active. The secondary outcomes include the diagnostic performance of photographic dental assessment and costs comparison of two pathways of dental care. DISCUSSION: The current project seeks to take advantage of mobile technology to acquire dental images from a child's mouth at school settings and forwarding images electronically to an offsite dental practitioner to assess and prepare dental recommendations remotely. Such an approach will help to prioritise high-risk children and provide them with a quick treatment pathway and avoid unnecessary referrals or travel. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry, ACTRN12619001233112. Registered 06 September 2019.

Comparing the outcomes of gold-standard dental examinations with photographic screening by mid-level dental providers.

OBJECTIVES: To determine the detectability of the intra-oral photographic method in comparison to the baseline, comprehensive dental examination (CDE), in children when performed by different levels of dental practitioners. MATERIALS AND METHODS: As part of a quality assurance program, intra-oral photographs were obtained from 77 patients (2-18 years) as part of a CDE before undertaking dental treatment under general anaesthesia. A DSLR camera was utilised to acquire images which were subsequently uploaded to a cloud-based server. The baseline for each participant was established during the CDE, utilising both visual and radiographic examination, which was then compared to the assessment made by a mid-level dental practitioners (MLDP). The evaluation was based on utilising an odontogram where the teeth were charted either as decayed or filled. RESULTS: Specificity (95%) was higher than sensitivity (61.5%) when comparing the photographic assessment with the benchmark CDE assessment. The inter-rater reliability between the two methods of assessment was substantial, with a kappa score of 0.62. The photographic assessment method underestimated the decayed and filled teeth, as observed by the caries experience (dft/DFT scores) (CDE = 7.01 vs. photographic assessment = 5.22). There were lower levels of diagnostic detection in the posterior teeth as compared to the anterior teeth assessments. CONCLUSIONS: Although the CDE is still considered to be the gold-standard, this study found that the photographic caries assessment by MLDP produced an acceptable diagnostic level of detection particularly for the anterior teeth. CLINICAL RELEVANCE: The photographic method could offer a potential cost-saving and user-friendly screening.

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

OBJECTIVES: This study sought to evaluate the efficacy of a mobile teledentistry approach using a smartphone camera for remote screening of dental caries. MATERIALS AND METHODS: An image acquisition Android App was created to facilitate the acquisition and transmission of dental images to a store-and-forward based telemedicine server. One hundred participants who were attending routine checkups at dental clinics were enrolled in 2014. Following a face-to-face oral screening by a screener (dentist), images of patients' teeth were obtained using a smartphone camera. These images, along with patient information, were then transmitted from the Android App to the server through the Internet for later independent assessment by two charters (off-site dentists). The assessments of these charters were then compared to the benchmark face-to-face caries assessment. RESULTS: Sensitivity values for the photographic method when compared to the benchmark face-to-face caries assessment were moderate, and ranged from 60% to 63%. Weighted kappa (K) as a measure of intragrader agreement for the photographic assessment was estimated as almost perfect (K = 0.84). The intergrader agreement for the photographic method compared to the face-to-face caries assessment ranged from moderate to substantial (K = 0.54-0.66). CONCLUSIONS: Despite some limitations, the mobile teledentistry approach has shown the potential to detect occlusal caries from photographs taken by a smartphone camera with an acceptable diagnostic performance compared to traditional face-to-face screening. This study suggests that telemedicine and cellular phone technology can be combined to create an inexpensive and reliable screening tool.

Challenges in the uptake of telemedicine in dentistry.

With the availability of oral care services very unevenly distributed in rural or remote areas, underserved people seek oral care from non-dental care providers. Against this backdrop, and coupled with the decreasing cost of and innovations in technology, there is a growing interest in the adoption of telemedicine services. Regardless of the lack of good-quality evidence supporting the cost-effectiveness of telemedicine, evidence already indicates that telemedicine, even with extra costs, helps in reducing the inequalities in the provision of primary health care. Telemedicine has the potential to overcome geographical barriers and contribute to closing the rural-urban healthcare gap in Australia and many other regions. Although research examining different teledentistry applications has found that this technology can be successfully integrated into different settings, there is little active teledentistry practice in Australia. The integration of telemedicine into the mainstream oral health system is a complex and collaborative process in which numerous factors at individual, infrastructure and organisational levels are involved. Addressing the barriers that delay the implementation of a teledentistry service can provide valuable insights into its lack of acceptance and establish an evidence base that can help to inform future decisions about the benefits of teledentistry.

Diagnostic accuracy of teledentistry in the detection of dental caries: a systematic review.

OBJECTIVE: This study sought to systematically review the literature for research evidence for the diagnostic accuracy of teledentistry in the detection of dental caries. METHODS: Two reviewers searched PubMed, EMBASE, and Scopus databases through January 2016 for comparative studies that examined the diagnostic accuracy of teledentistry for detecting caries compared with nontelemedicine alternatives. Retrieved studies were screened for inclusion criteria and were evaluated for methodological quality using the quality assessment of diagnostic accuracy studies (QUADAS-2) checklist. RESULTS: Of 287 citations identified, 10 met the preset inclusion criteria. Sensitivity and specificity were the most common measures of diagnostic accuracy used in 10 studies. Despite very limited published evidence on the diagnostic accuracy of teledentistry, the reviewed teledentistry studies showed comparable diagnostic performance compared with nontelemedicine alternatives. The average methodological quality of the selected articles is low, since none of the selected studies satisfied all 4 QUADAS-2 domains. Only 6 articles were scored as having a low risk of bias in 3 of 4 of QUADAS-2 domains. All the selected studies had low concerns regarding applicability. The main shortcoming was that in most of the selected studies, the methodology, in particular patient selection and index tests, was insufficiently described. CONCLUSIONS: Teledentistry has an acceptable diagnostic performance in the detection of dental caries. However, due to the heterogeneity of the reviewed studies, the generalization of results may be difficult. Further well-designed research to investigate the effectiveness of the teledentistry approach to caries detection is needed to determine the capability of this technology in epidemiologic oral surveys.

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

Objectives: Unaided visual inspection is a primary dental screening technique. Given the uneven distribution of dental services and prolonged waiting periods, an alternative screening approach is required to increase access to dental care. The purpose of this study was to evaluate the accuracy and reliability of tele-screening for detecting dental caries using mobile intra-oral photos taken by participants. Methods: Dental care seekers attending Umm Al-Qura University Teaching Dental Hospital in 2022 were invited to participate in this study. The participants were initially examined by dental interns at the hospital under the supervision of faculty dentists (reference standard) before intra-oral photos were acquired by a trained sixth-year dental student using a Samsung S10 camera. Following an introduction to the photography guide, the same participants then took intra-oral photos of their teeth at home using their mobile devices, which were all uploaded to WhatsApp for later review. Two trained dental reviewers (sixth-year dental students) independently reviewed the intra-oral photos. Sensitivity, specificity, and Kappa scores were estimated to assess the performance of the tele-screening approach relative to the reference unaided dental examination. Results: Twenty-three participants, with a mean age of 30 ± 12 years, were enrolled. The mean decayed, missing, and filled teeth (DMFT) was 13.43 ± 5.48. Patient-delivered tele-screening demonstrated a sensitivity, specificity, and inter-rater reliability kappa of 94 %, 90 %, and 0.81, respectively, when compared to unaided dental examination. Dentist-delivered tele-screening approach demonstrated a sensitivity of 88-89 %, specificity of 88-91 %, and kappa score of 0.75-0.79 relative to unaided dental examination. Conclusions: This study demonstrated that the tele-screening approach based on reviewing intra-oral photos taken by participants can be a valid and reliable alternative to unaided dental examination. This is important for ensuring sustainable access to dental care.

A Deep Learning-Based System for the Assessment of Dental Caries Using Colour Dental Photographs.

D1ental caries remains the most common chronic disease in childhood, affecting almost half of all children globally. Dental care and examination of children living in remote and rural areas is an ongoing challenge that has been compounded by COVID. The development of a validated system with the capacity to screen large numbers of children with some degree of automation has the potential to facilitate remote dental screening at low costs. In this study, we aim to develop and validate a deep learning system for the assessment of dental caries using color dental photos. Three state-of-the-art deep learning networks namely VGG16, ResNet-50 and Inception-v3 were adopted in the context. A total of 1020 child dental photos were used to train and validate the system. We achieved an accuracy of 79% with precision and recall respectively 95% and 75% in classifying 'caries' versus 'sound' with inception-v3.

Experience of primary caregivers in utilising an mHealth application for remote dental screening in preschool children.

Objectives This study aimed to address the acceptance of mHealth applications for a dental screening app that facilitates patient information entry and captures dental photos remotely to assist in caries diagnosis in preschool children in Australia. Methods All participants were recruited through the ORIGINS Project, a community-based interventional birth cohort study in Western Australia. Forty-two primary caregivers, who were the users of a teledental screening app, were given a questionnaire with 17 questions; these were constructed based on the theme of the Technology Acceptance Model: perceived ease of use (PE), perceived usefulness (PU), behavioural intention to adopt (BI), anxiety (ANX), attitude toward a behaviour (ATB), and self-efficacy (SE). Cronbach's alpha was estimated to determine internal consistency. Path analysis was employed to quantify the relationship between each theme. Results The mean values for most themes indicated high satisfaction with the intervention among caregivers (scores out of 5): PE (4.54 ± 0.55), PU (4.65 ± 0.49), BI (4.40 ± 0.65), ATB (4.23 ± 0.70), SE (4.36 ± 0.64). Results indicated high consistency in response in the PE, PU, ATB, and SE (α = 0.74-0.84) and moderate consistency was observed in ANX and BI (α = 0.50-0.62). The overall intention of using the dental screening app was significantly related to both PU and ATB (P Conclusion The perceived usefulness and attitude toward behaviours influenced the overall behavioural intention of the participants to use the telehealth model in dental screening. Recognising these relationships indicates community readiness for implementing the telehealth application in the dental program and enables identification of areas for improving its diffusion.

Deep learning for automated detection and numbering of permanent teeth on panoramic images.

OBJECTIVE: This study aimed to evaluate an automated detection system to detect and classify permanent teeth on orthopantomogram (OPG) images using convolutional neural networks (CNNs). METHODS: In total, 591 digital OPGs were collected from patients older than 18 years. Three qualified dentists performed individual teeth labelling on images to generate the ground truth annotations. A three-step procedure, relying upon CNNs, was proposed for automated detection and classification of teeth. Firstly, U-Net, a type of CNN, performed preliminary segmentation of tooth regions or detecting regions of interest (ROIs) on panoramic images. Secondly, the Faster R-CNN, an advanced object detection architecture, identified each tooth within the ROI determined by the U-Net. Thirdly, VGG-16 architecture classified each tooth into 32 categories, and a tooth number was assigned. A total of 17,135 teeth cropped from 591 radiographs were used to train and validate the tooth detection and tooth numbering modules. 90% of OPG images were used for training, and the remaining 10% were used for validation. 10-folds cross-validation was performed for measuring the performance. The intersection over union (IoU), F1 score, precision, and recall (i.e. sensitivity) were used as metrics to evaluate the performance of resultant CNNs. RESULTS: The ROI detection module had an IoU of 0.70. The tooth detection module achieved a recall of 0.99 and a precision of 0.99. The tooth numbering module had a recall, precision and F1 score of 0.98. CONCLUSION: The resultant automated method achieved high performance for automated tooth detection and numbering from OPG images. Deep learning can be helpful in the automatic filing of dental charts in general dentistry and forensic medicine.

Evaluation of a deep learning system for automatic detection of proximal surface dental caries on bitewing radiographs.

OBJECTIVE: This study aimed to evaluate a deep learning (DL) system using convolutional neural networks (CNNs) for automatic detection of caries on bitewing radiographs. STUDY DESIGN: In total, 2468 bitewings were labeled by 3 dentists to create the reference standard. Of these images, 1257 had caries and 1211 were sound. The Faster region-based CNN was applied to detect the regions of interest (ROIs) with potential lesions. A total of 13,246 ROIs were generated from all 'sound' images, and 50% of 'caries' images (selected randomly) were used to train the ROI detection module. The remaining 50% of 'caries' images were used to validate the ROI detection module. Caries detection was then performed using Inception-ResNet-v2. A set of 3297 'caries' and 5321 'sound' ROIs cropped from the 2468 images was used to train and validate the caries detection module. Data sets were randomly divided into training (90%) and validation (10%) data sets. Recall, precision, specificity, accuracy, and F1 score were used as metrics to assess performance. RESULTS: The caries detection module achieved recall, precision, specificity, accuracy, and F1 scores of 0.89, 0.86, 0.86, 0.87, and 0.87, respectively. CONCLUSIONS: The proposed DL system demonstrated promising performance for detecting proximal surface caries on bitewings.

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

OBJECTIVES: This study was conducted to compare the use of intraoral photographs with the unaided visual dental examination as a means of dental caries detection in children. METHODS: Children aged 4- to 14-year-olds were visually examined at their schools. Following dental examinations, children had five photographs of their teeth taken using a smartphone camera. Four dental reviewers, who are different from those who visually examined the children, assessed intraoral photographs for dental caries. Sensitivity, specificity, and inter-rater reliability agreement were estimated to assess the diagnostic performance of the photographic method relative to the benchmark visual dental assessments. Caries prevalence was measured using dft/DFT (decayed and filled teeth) index. RESULTS: One hundred thirty-eight children (67 male and 71 female) were enrolled and had a mean age of 7.8 ± 2.1 years. The caries prevalence (dft/DFT > 0) using photographic dental assessments ranged from 30 percent to 39 percent but was not significantly different from the prevalence (42 percent) estimated with the visual dental examination (P ≥ 0.07). The sensitivity and specificity of the photographic method for detection of dental caries compared to visual dental assessments were 58-80 percent and 99.7-99.9 percent, respectively. The sensitivity for the photographic assessments was high in the primary dentition (63-82 percent) and children ≤7-year-olds (67-78 percent). The inter-rater reliability for the photographic assessment versus the benchmark ranged from substantial to almost perfect agreement (Kappa = 0.72-0.87). CONCLUSIONS: The photographic approach to dental screening, used within the framework of its limitations, yielded an acceptable diagnostic level of caries detection, particularly in younger children with primary dentition.

A systematic review of the research evidence for the benefits of teledentistry.

Objective This review is designed to inform future decisions about the benefits of integrating teledentistry into routine health services, by presenting an overview of the evidence for the effectiveness and economic impact of teledentistry. Methods Two reviewers searched PubMed, EMBASE and CINAHL databases through November 2016 to identify published peer-reviewed studies in English. Teledentistry studies were included if they were; (a) controlled (randomised or non-randomised) assessment studies; and (b) compared outcomes of a teledentistry intervention in terms of clinical or economic evaluation with the outcomes of traditional clinical alternatives. The quality of the studies was evaluated using a quality appraisal tool that considered study performance and design. Results This review identified 385 publications, of which 217 full-text articles were retrieved for further inspection. Of these, only 11 articles met the inclusion criteria. Nine of the included articles showed some clinical outcomes; the other two were primarily economic analyses. The balance of these studies assesed the efficacy of teledentistry interventions rather than their effectiveness. Four studies (36%) achieved higher quality scores and have greater potential to influence health-care decision-making. To date, the most convincing published evidence regarding the efficacy of teledentistry was provided by studies on paediatric dentistry, orthodontics and oral medicine. The economic analysis referred only to cost-minimisation, suggesting that the use of teleconsultation in dentistry can be cost-saving when compared to a conventional consultation. However, high-quality economic studies on teledentistry are rare. Conclusion There is emerging evidence supporting the efficacy of teledentistry. However, there is not yet enough conclusive evidence, particularly for its effectiveness, cost-effectiveness and long-term use, to make evidence-based policy decisions on teledentistry.

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

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

A resource reallocation model for school dental screening: taking advantage of teledentistry in low-risk areas.

OBJECTIVE: To estimate the scale of resource transfer that could be achieved by screening low-risk schoolchildren using teledentistry rather than using traditional visual dental examination. METHODS: This study was based on a previous cost-minimisation study that compared the costs of two dental-screening approaches (visual and teledentistry). The data for the population of children 5-14 years of age was obtained from the Australian Bureau of Statistics and was divided across Australia according to statistical local area (SA2). The cost models (for teledentistry and visual screening) for each SA2 relative to the state, Remoteness Area (RA) and Socio-Economic Index for Area (SEIFA) indexes were estimated. The geographical information system was used to superimpose modelled cost data on the geographical map to provide a visual presentation of the data. Resource transfer scenarios, based on risk minimisation, were then developed and analysed. RESULTS: This study demonstrated a suboptimal allocation of dental-care resources, such that children living in high socio-economic areas (major cities) with low disease burdens consuming half of the estimated resources of a universal visual dental screening system. The findings suggest that utilising teledentistry screening for low-risk children has the potential to free up $40 million per annum. Such resources can be reallocated to increase care access and improve the quality of dental services for vulnerable children. CONCLUSION: To reduce inequalities in dental health within a community, scarce health-care resources should be targeted at the population at most risk. These findings can be used to inform policymakers, guide the appropriate distribution of scarce resources and target dental services to benefit high-need children.

End-user acceptance of a cloud-based teledentistry system and Android phone app for remote screening for oral diseases.

Objective This study aimed to evaluate users' acceptance of a teledentistry model utilizing a smartphone camera used for dental caries screening and to identify a number of areas for improvement of the system. Methods A store-and-forward telemedicine platform "Remote-I" was developed to assist in the screening of oral diseases using an image acquisition Android app operated by 17 teledental assistants. A total of 485 images (five images per case) were directly transmitted from the Android app to the server. A panel of five dental practitioners (graders) assessed the images and reported their diagnosis. A user acceptance survey was sent to the graders and smartphone users following completion of the screening program. Results Of the 22 surveys sent out, 20 (91%) were completed. Generally, users showed optimism towards the use of the teledentistry system, and strongly positively assessed items on content and service quality. The majority of graders took less than 15 min to read the images while phone users took 5-10 min to complete the dental photography using the Android app. This study identified a number of factors that are essential for improving the current system, such as optimization of smartphone camera features, the format of the server, and the orientation of images and using oral retractors during photography. Conclusions Users appear to be generally satisfied with the proposed teledentistry model. However, they have specific concerns to address, many of which could be resolved through more effective training, coordination between sites and upgrading the current system.

Best teaching practices in anatomy education: A critical review.

In this report we review the range of teaching resources and strategies used in anatomy education with the aim of coming up with suggestions about the best teaching practices in this area. There is much debate about suitable methods of delivering anatomical knowledge. Competent clinicians, particularly surgeons, need a deep understanding of anatomy for safe clinical procedures. However, because students have had very limited exposure to anatomy during clinical training, there is a concern that medical students are ill-prepared in anatomy when entering clerkships and residency programs. Therefore, developing effective modalities for teaching anatomy is essential to safe medical practice. Cadaver-based instruction has survived as the main instructional tool for hundreds of years, however, there are differing views on whether full cadaver dissection is still appropriate for a modern undergraduate training. The limitations on curricular time, trained anatomy faculty and resources for gross anatomy courses in integrated or/and system-based curricula, have led many medical schools to abandon costly and time-consuming dissection-based instruction in favour of alternative methods of instruction including prosection, medical imaging, living anatomy and multimedia resources. To date, no single teaching tool has been found to meet curriculum requirements. The best way to teach modern anatomy is by combining multiple pedagogical resources to complement one another, students appear to learn more effectively when multimodal and system-based approaches are integrated. Our review suggests that certain professions would have more benefit from certain educational methods or strategies than others. Full body dissection would be best reserved for medical students, especially those with surgical career intentions, while teaching based on prosections and plastination is more suitable for dental, pharmacy and allied health science students. There is a need to direct future research towards evaluation of the suitability of the new teaching methodologies in new curricula and student perceptions of integrated and multimodal teaching paradigms, and the ability of these to satisfy learning outcomes.

Role of telemedicine and mid-level dental providers in expanding dental-care access: potential application in rural Australia.

Despite great progress in oral health over the past three decades, the rates of caries remain high in Australia, particularly among underserved populations. The reasons for poor oral health amongst underserved populations are multiple, but rests with socio-economic determinants of health. The present review considers international workforce models that have been created to enhance the recruitment and retention of dental providers in rural areas. Several strategies have been developed to address care access problems in rural areas, including the use of telemedicine and mid-level dental providers (MLDPs). Despite ongoing opposition from dentistry organisations, the Alaska and Minnesota workforce models have proven that developing and deploying dental therapists from rural communities has the potential to address the unmet needs of underserved populations. It is more efficient and cost-effective for MLDPs to perform triage and treat simple cases and for dentists to treat complicated cases. The use of MLDPs is intended to increase the capacity of the dental workforce in areas that are too isolated to entice dentists. Telemedicine has emerged as one solution to address limited access to health care, particularly in locations where there is a lack of providers. Telemedicine not only provides access to care, but also offers support, consultations and access to continuing education for practicing dental providers in rural areas. This strategy has the potential to free up resources to increase care access and reduce oral health disparities, thereby contributing to closing the rural-urban oral health gap.

A proof-of-concept evaluation of a cloud-based store-and-forward telemedicine app for screening for oral diseases.

OBJECTIVE: It is widely considered that telemedicine can make positive contributions to dental practice. This study aimed to evaluate a cloud-based telemedicine application for screening for oral diseases. METHODS: A telemedicine system, based on a store-and-forward method, was developed to work as a platform for data storage. An Android application was developed to facilitate entering demographic details and capturing oral photos. As a proof-of-concept, six volunteers were enrolled in a trial to obtain oral images using smartphone cameras. Following an onsite oral examination, images of participants' teeth were obtained by a trained dental assistant. Oral images were directly uploaded from the smartphone to a cloud-based server via broadband network. The assessments of oral images by offsite dentists were compared with those carried out via face-to-face oral examinations. RESULTS: A complete set of 30 oral images was obtained from all six participants. Out of 192 teeth reviewed, the proportion of ungradable teeth was 8%. Sensitivity and specificity of teledental screening were 57% and 100% respectively. The inter-grader agreement estimated for two examination modalities and between two teledental graders was 70% and 62% respectively. Findings indicate that the proposed system for screening of oral diseases can be implemented to provide a valid and reliable alternative to traditional oral screening. CONCLUSION: This study provided evidence that a robust system for store-and-forward screening for dental problems can be developed, and leads to the need for further testing of its robustness to confirm the accuracy and reliability of the teledentistry system.