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

Objectives: This study aimed to determine whether intraoral photographic assessment by mid-level dental providers (MLDPs) offers a valid and reliable means of dental caries screening. Methods: A mobile teledentistry model was developed to facilitate the acquisition of dental images, and transmission and reviewing of data. One hundred regularly attending patients at a dental clinic participated in the study. Following an on-site clinical examination by a senior dentist, photographs of participants' teeth were taken by a teledental assistant, using a smartphone camera. These intraoral photographs were directly uploaded from an Android App to a cloud-based server, ‘Remote-i’, using an encrypted store-and-forward telemedicine technology. The photographic assessment carried out by two independent screeners (MLDPs), was compared to the visual oral examination scores of a benchmark examiner. Results: The sensitivity and specificity values for the photographic assessment method (assessed by screeners) as compared to the direct visual examination ranged from 60% to 68%, and 97% to 98%, respectively. The intra-rater reliability for the photographic assessment was almost perfect, with a kappa score of 0.89. The inter-rater reliability between the photographic and visual oral assessments ranged from moderate to substantial agreement, with kappa scores ranging from 0.57 to 0.61. Conclusion: A new smartphone-based mobile teledentistry model used by mid-level dental providers shows potential for remote screening of dental caries.