the efficacy of mobile teledentistry in dental screening · the efficacy of mobile teledentistry in...
TRANSCRIPT
Mohamed Estai (PhD Candidate, UWA)
The Efficacy of Mobile Teledentistry in Dental
Screening
The Problem Despite progress in oral health in the past
decades, healthcare disparities do exist (1).
The majority of marginalized populations
have poorer oral health (2).
Caries is the second most costly diet-related
disease.
In 2013-14, the total expenditure on dental
care increased to $9 billion (3).
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A map of Australia with each private
dental practice (RED DOT) highlighted
Dentistry faces labour issues, particularly
maldistribution of dental labour (4).
Private sector remains the primary dental
care delivery system in Australia (4).
Regular screening can prevent or halt the
progress of caries.
Despite direct visual examination remains
the primary screening technique, this
method has limitations.
The Problem
Visual Dental Screening
DSLR camera is a better device in terms of
image quality. However, its relatively large
size and weight make it less convenient.
Intraoral camera often produces poor image
quality.
Smartphone camera is readily accessible,
provides satisfactory images and enables users
to store and share data.
Potential Solution
Intraoral Camera
Smartphone Camera
DSLR Camera
Potential Solution Mobile teledentistry refers to the
integration of cellular technology and
store-and-forward into oral care.
The introduction of smartphone into
tele-audiology and teledermatology
has proven beneficial (5,6).
However, research evidence on the
use of smartphone in dental research
is rare.
Smartphone
Cloud Storage
Reviewing
centre
Dental screening
Mobile Teledentistry
Aim & ObjectivesAim:
To evaluate the efficacy of teledentistry
approach to screen for dental caries.
Objectives:
To determine the diagnostic accuracy of
teledentistry approach to caries detection
compared to the visual examination.
To determine the diagnostic reliability of
teledentistry approach to caries detection
compared to the visual examination.
Store-and-Forward
Teledentistry
Smartphone
Screening/
DiagnosisConsultation
System Architecture A telehealth system “Remote-i”, based
on store-and-forward, was developed by
AEHRC, to work as a platform for data
storage and management.
An image acquisition android App
“Teledental” developed to facilitate
capturing photos and transmitting data to
the server (7).
A patient’s
Record
Patient records stored
in Remote-i server
1 2
3 4
Project Workflow Teledentistry approach to dental
screening involves acquiring photos from
participants’ mouths using a smartphone
camera.
Patient information and dental photos
were transmitted from the android App to
the Remote-i, for later scoring by a
screener (7).
An off-site dental practitioner access the
database from his/her desktop to assess
records and prepare treatment plan.
Participants at
the remote site
Dental expert
at the hub site
Cloud Storage “Remote-i”
One hundred regularly attending
patients at a dental clinic enrolled in this
study.
Each participant received visual
examination by a dentist to record caries
according to WHO protocol (8).
In a separate room, photos of
participant’s teeth (5 photos/patient)
were obtained using smartphone
camera.
Screening ProceduresTraditional Visual Screening
Teledental Screening
Reviewing of dental photos was conducted
by two dental practitioners (screeners).
Screeners access the database to review
dental photos and record findings on a pre-
defined chart.
These assessments form the database
which was compared to the benchmark
visual assessment.
Outcome MeasuresReviewing of records
by a dental expert
Patient’s
Record
Results Mean sensitivity for the photographic
assessment (by two screeners) as
compared to the visual screening was
61%.
Inter-examiner agreement between two
screening methods (photographic and
visual), ranging from moderate to
substantial (Kappa = 0.57 - 0.61).
Intra-examiner agreement for the
photographic assessment was almost
perfect, with Kappa = 0.89.
Benchmark = Visual dental screening
Screeners = Offsite practitioners who assess dental photographs
Benchmark Vs.
Screener 1
Benchmark Vs.
Screener 2
Sensitivity 62% 60%
Specificity 97% 98%
Kappa (95% CI) 0.57 (0.48-0.66) 0.61 (0.52-0.70)
Limitations In some cases, there was poor image quality
or unclear oral anatomy.
Up to 15% of the screened teeth were not
amenable to be scored.
Such shortcomings could contribute to the
suboptimal sensitivity and specificity.
Dark Overbright
Hazy
Perfect
An example of images with poor quality
Unclear Anatomy
Conclusions Teledentistry has the potential to detect
caries from photographs with an
acceptable diagnostic level, compared
to the direct visual screening.
Further cost-analysis research is
required to determine whether
teledentistry can reduce costs,
compared to the traditional screening.
Teledentistry
Store-and-forward
Mouth View
Teeth view
Screening tool
smartphone
Teledental Screening
Implications Perform screening to identify high-risk
groups and provide a treatment pathway for
those who require urgent intervention.
Teachers, parents or caregivers obtain
photographs from children for a dental expert
to assess at distance.
A low-cost mid-level practitioners can be
employed to perform teledental screening and
prepare treatment plan.
Remote Town
Reviewing of
records by a dentist
References1. Mejia G, Amarasena N, Ha DH, Roberts-Thomson K, Ellershaw A. Child Dental Health Survey Australia 2007: 30-year trends in child oral health.
Canbera AIHW;2012.
2. Kilpatrick N, Neumann A, Lucas N, Chapman J, Nicholson J. Oral health inequalities in a national sample of Australian children aged 2–3 and 6-7
years. Australian dental journal. 2012;57(1):38-44.
3. Australian Institute of Health and Welfare. Health expenditure Australia 2013–14. Health and welfare expenditure series no. 54. Cat. no. HWE 63.
Canberra: AIHW; 2015.
4. Australian Institute of Health and Welfare. Dental workforce 2012. National Health Workforce Series No. 7. Cat no. HWL 53. Canbera: AIHW,
2014.
5. Kroemer S, Frühauf J, Campbell T, et al. Mobile teledermatology for skin tumour screening: diagnostic accuracy of clinical and dermoscopic
image tele‐evaluation using cellular phones. British Journal of Dermatology. 2011;164(5):973-979.
6. Mahomed-Asmail F, Eikelboom RH, Myburgh HC, Hall Iii J. Clinical validity of hearScreen™ smartphone hearing screening for school children.
Ear and hearing. 2016;37(1):e11-e17.
7. Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Huang B, Kruger E, et al. A proof-of-concept evaluation of a cloud-based store-and-forward
telemedicine app for screening for oral diseases. J Telemed Telecare 2015;pii:1357633X15604554.
8. World Health Organization. Oral health surveys: basic methods, 5th ed. Geneva: World Health Organization, 2013.
Thank You