88 (46.3)
In terms of capabilities, most participants from Pakistan (70.5%) and SA (77.5%) agreed that teledentistry would enhance guidelines and advice, improve peer-to-peer interaction (80.7% and 78.4%) and make patient's referral more efficient (73.9% and 77.5%). Only a small proportion of participants (23.7%) agree that TD would provide an accurate clinical diagnosis, but larger proportions agree that it would shorten the waiting list (75.2%), and provide a safe atmosphere for practising dentistry during the pandemic (74.2%); of which most were from Pakistan ( p < 0.05).
Regarding the usefulness, the majority of participants in Pakistan (60.2%) and Saudi Arabia (67.6%), agree that teledentistry would enhance clinical training and continuing education. Similarly, 71.6% Pakistani and 77.7% Saudi participants agreed that teledentistry can save time compared with a referral letter; however, a very low percentage of participants in both the countries (20%) agreed with the statement that teledentistry would be too expensive to set up. More Pakistani (44.3%) compared to Saudi (14.7%) participants perceived that the time spent with the patient would increase ( p < 0.05) ( Table 2 ).
Perceptions about the capability and usefulness of teledentistry to improve practice ( N = 190).
Perceptions about the capability of teledentistry to improve practice | Pakistan, (%) 88 (46.3) | SA, (%) 102 (53.7) | value | |
---|---|---|---|---|
Teledentistry would provide accurate diagnosis in a clinical setting. | Agree Disagree Neutral | 27 (30.7) 22 (25.0) 39 (44.3) | 18 (17.6) 19 (18.6) 65 (63.7) | |
Teledentistry would help shorten the waiting list | Agree Disagree Neutral | 77 (87.5) 1 (1.1) 10 (11.4) | 66 (64.7) 5 (4.9) 31 (30.4) | |
Teledentistry would enhance guidelines and advice | Agree Disagree Neutral | 62 (70.5) 10 (11.4) 16 (18.2) | 79 (77.5) 3 (2.9) 20 (19.6) | 0.072 |
Teledentistry would improve the interaction between peers | Agree Disagree Neutral | 71 (80.7) 1 (1.1) 16 (18.2) | 80 (78.4) 2 (2.0) 20 (19.6) | 0.868 |
Teledentistry would provide a safe atmosphere for practicing dentistry (e.g. COVID-19 Pandemic) | Agree Disagree Neutral | 72 (81.8) 1 (1.1) 15 (17.0) | 69 (67.6) 14 (13.7) 19 (18.6) | |
Teledentistry would make patient's referral more efficient | Agree Disagree Neutral | 65 (73.9) 0 23 (26.1) | 79 (77.5) 0 23 (22.5) | 0.565 |
Teledentistry would enhance clinical training and continuing education | Agree Disagree Neutral | 53 (60.2) 11 (12.5) 24 (27.3) | 69 (67.6) 8 (7.8) 25 (24.5) | 0.456 |
Teledentistry would reduce costs for the dental practices | Agree Disagree Neutral | 46 (52.30 12 (13.6) 30 (34.1) | 54 (52.9) 20 (19.6) 28 (27.5) | 0.430 |
Teledentistry would increase treatment time spent with the patient. | Agree Disagree Neutral | 39 (44.3) 16 (18.2) 33 (37.5) | 15 (14.7) 31 (30.4) 56 (54.9) | |
Teledentistry would save time compared with a referral letter | Agree Disagree Neutral | 63 (71.6) 3 (3.4) 22 (25.0) | 79 (77.5) 9 (8.8) 14 (13.7) | 0.061 |
Teledentistry would be too expensive to set up | Agree Disagree Neutral | 18 (20.5) 38 (43.2) 32 (36.4) | 21 (20.6) 39 (38.2) 42 (41.2) | 0.753 |
Teledentistry would provide adequate diagnostic information | Agree Disagree Neutral | 43 (48.9) 9 (10.2) 36 (40.9) | 53 (52.0) 16 (15.7) 33 (32.4) | 0.348 |
For the usefulness of teledentistry for patients, most participants in both countries agree that it is economical for the patients (61.1%), improves communication (74.7%), helps in educating the patients (86.3%), and benefits patients in remote areas (74.7%). More Pakistani participants (85.2%) compared to Saudi (69.6%) agree that teledentistry helps to avoid unnecessary travel, but a high proportion of SA (80.4%) compared to Pakistani (61.4%) participants believe that it helps in communication and monitoring of patients ( p < 0.05). Regarding the challenges in the use of teledentistry, very few participants from Pakistan (11.4%) think that it violates the patient's privacy compared to Saudi participants (32.4%); however, on the other hand more Pakistani participants (36.4%) can’t trust teledentistry equipment to work compared to Saudi participants (13.7%) ( p < 0.05). More Pakistani participants (73.9%) felt that literacy, poverty, and lack of infrastructure are the major challenges to teledentistry implementation compared to just 42.2% of Saudi participants ( p < 0.05). Similarly, slightly more Pakistani participants (67.0%) think that the barriers to the use of teledentistry among dental professionals are the lack of awareness about teledentistry benefits and applications compared to Saudi (45.1%) ( p < 0.05) ( Table 3 ). Most dental professionals felt that teledentistry would be suitable for use in community dentistry (33.7%) followed by oral medicine (24.2%) and oral radiology (10.0%) ( Figure 2 ).
Preferred dental speciality for application of teledentistry.
Perceptions about the usefulness of teledentistry for patients and challenges to the use of teledentistry ( N = 190).
Perceptions about the usefulness of teledentistry for patients | Pakistan, (%) 88 (46.3) | SA, (%) 102 (53.7) | value | |
---|---|---|---|---|
Teledentistry would save money for patients | Agree Disagree Neutral | 57 (64.8) 7 (8.0) 24 (27.3) | 59 (57.8) 10 (9.8) 33 (32.4) | 0.619 |
Teledentistry would improve communication with patients | Agree Disagree Neutral | 63 (71.6) 17 (19.3) 8 (9.1) | 79 (77.5) 0 23 (22.5) | |
Teledentistry would be helpful patient education | Agree Disagree Neutral | 76 (86.4) 3 (3.4) 9 (10.2) | 88 (86.3) 0 14 (13.7) | 0.138 |
Teledentistry would help in avoiding unnecessary travel to Dental clinic | Agree Disagree Neutral | 75 (85.2) 4 (4.5) 9 (10.2) | 71 (69.6) 3 (2.9) 28 (27.5) | |
Teledentistry would help in monitoring patient's condition | Agree Disagree Neutral | 54 (61.4) 16 (18.2) 18 (20.5) | 82 (80.4) 3 (2.9) 17 (16.7) | |
Teledentistry would be convenient and well received by patients | Agree Disagree Neutral | 47 (53.4) 11 (12.5) 30 (34.1) | 56 (54.9) 12 (11.8) 34 (33.3) | 0.976 |
Teledentistry would be useful for patients in remote areas | Agree Disagree Neutral | 65 (73.9) 10 (11.4) 13 (14.8) | 77 (75.5) 6 (5.9) 19 (18.6) | 0.347 |
I think teledentistry can violate the patient's privacy. | Agree Disagree Neutral | 10 (11.4) 37 (42.0) 41 (46.6) | 33 (32.4) 38 (37.3) 31 (30.4) | 0.002 |
I am worried about data entry mistakes. | Agree Disagree Neutral | 46 (52.3) 15 (17.0) 27 (30.7) | 48 (47.1) 16 (15.7) 38 (37.3) | 0.635 |
I can’t trust teledentistry equipment to work. | Agree Disagree Neutral | 32 (36.4) 18 (20.5) 38 (43.2) | 14 (13.7) 31 (30.4) 57 (55.9) | |
I think the equipment used in teledentistry is difficult to use. | Agree Disagree Neutral | 15 (17.0) 25 (28.40 48 (54.5) | 13 (12.7) 44 (43.1) 45 (44.1) | 0.107 |
In Pakistan/ Saudia Arabia, major challenges in teledentistry are illiterates, population below the poverty line and lack of infrastructure. | Agree Disagree Neutral | 65 (73.9) 0 23 (26.1) | 43 (42.2) 20 (19.6) 39 (38.2) | |
I think the barriers to the use of TD among dental professionals is the lack of awareness about teledentistry benefits and applications. | Agree Disagree Neutral | 59 (67.0) 3 (3.4) 26 (29.5) | 46 (45.1) 4 (3.9) 52 (51.0) |
This study had investigated the perception of Saudi Arabian and Pakistani dental practitioners about the usefulness and challenges in adopting teledentistry. Overall, the majority of the participants in both countries agreed and are positive about adopting teletechnology in dentistry. Teledentistry is a relatively new field and is slowly adopted by dental professionals around the world. It has begun to change and transform the way oral health care services are provided to patients, owing to advancing technologies. 17
From the perspective of clinical practice, teledentistry could help shorten the waiting time and time elapse between appointments. Compare to the traditional paper referral which takes a longer time, the online referrals process between clinics or dental professionals is faster as patients’ status and needs are shared earlier and patients will be assigned to a dental specialty clinic based on an early informed decision and need. 2 , 17 Teledentistry also allows for multi-participants conferencing to discuss a case, hence the interaction between health professional helps improve the quality of service that benefit the patients. 3 Consequently, a discussion between a referring general practitioner and a specialist also enhances clinical training and continuing education.
There is, however, a concern among most participants regarding the accuracy of clinical diagnosis made during teledentistry consultation, particularly among those with higher qualifications. A systematic review on the accuracy of diagnosis to detect dental caries using teledentistry showed it is reliable and almost equivalent to the non-telemedicine alternatives. 18 Nevertheless, the interpretation and accuracy of oral diagnostic in teledentistry likely depends upon the quality of the equipment, images, and training. 19 , 20
Many participants agreed that teledentistry would provide a safe atmosphere for practicing dentistry during an infectious epidemic such as the COVID-19 pandemic; many dental practitioners shifted to teledentistry as an additional effort to minimise contact and risk of infection while continuing to provide care to patients. 21 – , 23
Studies in Turkey and Rwanda show that the majority of the participants irrespective of qualification and experience (83% and 79%) think that teledentistry would save time and reduce the time spend with patients. 6 , 24 That contrasts to the current study (28%) and more Pakistani than SA participants viewed that teledentistry would increase the time spent with the patient. Many specialists and postgraduate residents in this study do not think that teledentistry will increase treatment time compared to general practitioners. The general dentists have been reported to demonstrate some resistance toward new technology because of lack of experience or misunderstanding of the concept; they are also still in the process of navigating their way into building their career and might be resistant to the technology not to lose their patients pool. 7 , 25
Teledentistry can benefit patients in several ways. Most current study participants believe that it is more economical for the patients; because consultations can be done online it avoids unnecessary travel and this would be advantageous especially for patients in remote areas. The cost of patient assessments using teledentistry was reported to be lower compared to conventional methods but in India, only 21% of dental professionals believe that it reduces the cost of dental practices. 26 Correspondingly, it is time-efficient; there is less time spent on traveling, waiting for the appointment, and waiting at the clinic. In India, only 33.3% of respondents think that teledentistry saves time but other studies have shown that efficient time management and cost-saving are influential in gaining the trust of patients and encouraging them to use teledentistry, hence the main driver to implementation of telehealth in dental practice. 24 , 26 Another benefit of teledentistry for the patients is improvement in patient–dentist communication. One aspect of communication is monitoring the progress patient's condition through constantly sharing information and materials by the patient to the dentist. 24 This finding of this study is similar to another study in Turkey whereby 81% of participants are happily monitored the patients’ conditions using teledentistry but only 44% of dental professionals in India feel that they can monitor patients effectively using teledentistry. 24 , 26
Lack of infrastructure, lower socioeconomic conditions, and low literacy rate is a major challenge to implementing teledentistry; these are more likely the case in Pakistan compared to Saudi Arabia. Similar challenges have been reported in other developing countries like Rwanda. 6 Advanced telecommunication infrastructure that provides fast and reliable internet is a determinant of the success of teledentistry and it is available to the majority of dental professionals who are located in the urban area, but the services can be limited in rural areas which are inhabited by the less affluent with low literacy rate. The type and affordability of internet prices and IT gadgets such as computers or smartphones determine the quality of internet connection and communication and interaction between patients and dental professionals; these can limit the type of consultation that can be done. 6 , 27 In addition, the issue of information technology literacy rate can be higher among the older generation in the rural area although the younger population quickly adapts to changing trends. 28 These challenges are also reflected through the choice of communication methods, more Pakistani dental professionals still preferred in-person communication and half of the participants (50%) use less than one hour of internet daily for practice-related use.
Studies have shown that dental professionals working in the private sector are more accepting of teledentistry as it has better and reduces the workload. 29 , 30 However, in this study, a higher number of participants from SA (84.3%) were working in the public sector having fewer working hours (<34 h) but still more willing to adopt teledentistry compared to Pakistani dentists. teledentistry may also have the same effect on government services, thus, initiatives to improve and facilitate the adoption rate of teledentistry should be encouraged. This may include the provision of infrastructures such as computers and servers, applications, training, and incentivize the adaptation of teledentistry.
This study has some limitations. Data collection during the COVID-19 pandemic whereby there are restrictions and precautionary measures still in place in both countries which can influence the thinking of the dental professionals and maybe they are more inclined towards adopting teledentistry. Generalization and external validity are limited because the samples are not representative of the population. There is no information on whether a participant practices teledentistry or had any experience using it, hence, there is possible bias from participants who do not know its potential. Future studies should explore the issue and expectations of a dental professional regarding the implementation. Studies should also explore patients’ perspectives and expectations of the use of teledentistry and evaluate the effectiveness of the current usage.
The results of this study indicated a high awareness and a positive attitude towards teledentistry, and its adaptation in their dental practice in both countries; however, there is further need to improve the knowledge and promote teledentistry in these countries. There are main challenges in integrating teledentistry into the current dental practice are limited infrastructure, set-up cost, and IT literacy which can be overcome by strategic government initiatives, incentives, policies, and programs.
Authors’ Note: The raw data used to support the findings of this study are included in this published article and its supplementary information files.
Conflict of interest: The authors no conflicts of interest to declare.
Contributorship: FAC and BA researched literature and conceived the study. MQJ, AAS.AF, and MMJ were involved in protocol development, gaining ethical approval, patient recruitment and data analysis. FAC and MKL wrote the first draft of the manuscript. BA and SM reviewed and edited the final version. All authors approved the final version of the manuscript.
Ethical approval: The ethical review board of the School of Dentistry, Shaheed Zulfiqar Ali Bhutto Medical University approved this study (Reference no. F.105/21/SOD/ERB).
Funding: The authors received no financial support for the research, authorship, and/or publication of this article.
Guarantor: FAC.
ORCID iDs: Farooq Ahmad Chaudhary https://orcid.org/0000-0002-1748-0413
Basaruddin Ahmad https://orcid.org/0000-0003-3088-0558
Muhammad Qasim Javed https://orcid.org/0000-0002-7586-4319
IMAGES
COMMENTS
Abstract. Teledentistry is a combination of telecommunications and dentistry involving the exchange of clinical information and images over remote distances for dental consultation and treatment planning. Teledentistry has the ability to improve access to oral healthcare, improve the delivery of oral healthcare, and lower its costs.
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 ...
The origin, rationale, scope, basis, and requirements for teledentistry, along with the current evidence that exists in the literature are reviewed. Teledentistry is a combination of telecommunications and dentistry involving the exchange of clinical information and images over remote distances for dental consultation and treatment planning. Teledentistry has the ability to improve access to ...
A total of 506 dental professionals participated in the study with the response rate of 89.39%. More than half of the participants (50-75%) endorsed that teledentistry is a useful tool for improving clinical practice as well as patient care. Two-thirds of the participants (69.96%) considered that teledentistry would reduce cost for the dental ...
Teledentistry in practice: literature review Telemed J E Health. 2013 Jul;19(7):565-7. doi: 10.1089/tmj.2012.0200 . ... teleconsultations, and telediagnosis. All the applications used in teledentistry aim to bring about efficiency, provide access to underserved population, improve quality of care, and reduce oral disease burden. ...
It can be used as a service modality in three primary ways [].These include the following: (i) consultations among dentists—for example, a general dentist and a specialist dentist can exchange patient photos and records, followed by a review and treatment planning discussion; (ii) a real-time face-to-face video conference consultation between a general dentist or specialist and a patient or ...
An illustration of a computer application window Wayback Machine. An illustration of an open book. Books. An illustration of two cells of a film strip. Video. An illustration of an audio speaker. Audio. An illustration of a 3.5" floppy disk. Software. An illustration of two photographs. ...
Teledentistry is a combination of telecommunications and dentistry involving the exchange of clinical information and images over remote distances for dental consultation and treatment planning. Teledentistry has the ability to improve access to oral healthcare, improve the delivery of oral healthcare, and lower its costs.
Flores A P da C, Lazaro S A, Molina-Bastos C G et al. Teledentistry in the diagnosis of oral lesions: A systematic review of the literature. J Am Med Inform Assoc 2020; 27: 1166-1172.
Abstract. Teledentistry is a combination of telecommunications and dentistry involving the exchange of clinical information and images over remote distances for dental consultation and treatment planning. Teledentistry has the ability to improve access to oral healthcare, improve the delivery of oral healthcare, and lower its costs.
Abstract. We conducted a systematic review of teledentistry applications. We searched the MEDLINE/PubMed, Embase and Cochrane Library databases for relevant articles published from 1992 to 2012. The reference lists of all retrieved articles were hand-searched. Studies were included after assessing the eligibility of the full-text article.
DOI: 10.4103/2231-0762.97695 Corpus ID: 38479617; Applications of teledentistry: A literature review and update @article{Nutalapati2011ApplicationsOT, title={Applications of teledentistry: A literature review and update}, author={Rajasekhar Nutalapati and Ramanarayana Boyapati and Nd Jampani and Bala Sunil Kumar Dontula}, journal={Journal of International Society of Preventive \& Community ...
This study aimed to determine the impact of teledentistry applications on clinical practice in different specialties based on the current evidence in the literature. Methods: two reviewers conducted a literature search in PubMed, EMBASE, EBSCO, ScienceDirect and LILACS databases until August 2019, to identify studies published in English ...
Jampani N D, Nutalapati R, Dontula B S, Boyapati R. Applications of teledentistry: A literature review and update. J Int Soc Prev Community Dent 2011; 1: 37-44.
Jampani N D, Nutalapati R, Dontula B S K, Boyapati R. Applications of teledentistry: A literature review and update. J Int Soc Prev Community Dent 2011; 1: 37-44.
Applications of teledentistry: A literature review and update JISPCD_42_11 Review Article ... Jampani, : Applications of teledentistry information that might help a patient. To others, it is
Teledentistry is a combination of telecommunications and dentistry involving the exchange of clinical information and images over remote distances for dental consultation and treatment planning. Teledentistry has the ability to improve access to oral healthcare, improve the delivery of oral healthcare, and lower its costs. It also has the potential to eliminate the disparities in oral health ...
This article aims to review the literature and information available on the provision and utilization of teledentistry as a method to address oral health needs of paediatric patients. Results Teledentistry has been utilised in paediatric population for the purpose of oral health education and promotion, remote diagnosis and monitoring, and ...
Introduction: access to dental services in rural and remote areas is a problem still to be solved; for this purpose, a new alternative known as teledentistry has emerged. Through the application of information and communications technologies (ICTs), teledentistry promotes prevention, diagnosis, and treatment. This study aimed to determine the impact of teledentistry applications on clinical ...
Jampani N D, Nutalapati R, Dontula B S K, Boyapati R. Applications of teledentistry: a literature review and update. J Int Soc Prev Community Dent 2011; 1: 37-44.. FGDP(UK).
DOI: 10.4103/2231-0762.97695 Corpus ID: 38479617; Applications of teledentistry: A literature review and update @article{Jampani2011ApplicationsOT, title={Applications of teledentistry: A literature review and update}, author={N. D. Jampani and Rajasekhar Nutalapati and Bala Sunil Kumar Dontula and Ramanarayana Boyapati}, journal={Journal of International Society of Preventive \& Community ...
A systematic review on the accuracy of diagnosis to detect dental caries using teledentistry showed it is reliable and almost equivalent to the non-telemedicine alternatives. 18 Nevertheless, the interpretation and accuracy of oral diagnostic in teledentistry likely depends upon the quality of the equipment, images, and training. 19,20