Evaluation of telemedicine in the management of dentogenous infections.

Introduction/aim: The first written evidence of telemedicine dates back to the times of Sava Nemanjić (the end of 12th and the beginning of 13th century). Nowadays, the use of telemedicine in Serbia gains momentum, and the cause of this lies in the creation of a central telemedicine system XPA3 Online and the establishment of the Center for Telemedicine at the Faculty of Medicine, University of Pristina/Kosovska Mitrovica, Kosovska Mitrovica, Serbia. Dentogenous infections are among the most urgent conditions in dentistry, which may have even a fatal outcome. The aim of this study was to assess the possibility of using telemedicine methods in the pathology of dentogenous infections.

Methods: This experimental randomized study included 414 patients with suspected dentogenous infection. The patients were enrolled at 7 sites, with systematic photograph-taking, collection, and digitalization of the available anamnestic and laboratory data, tests, and x-rays. Together with clinical findings, the data were uploaded on the XPA3 Online central telemedicine system; after that, 10 teleconsultants reviewed the material, set the diagnosis, and gave their opinion about the treatment. The agreement was determined using the Cohen's kappa (i) coefficient, as well as diagnostic sensitivity (SE), specificity (SP), and efficacy (EFF). Statistical significance and comparisons were done using the z-test, and testing nonparametric properties using the McNemar's X2-test for the significance threshold ofp = 0.05.

Results: The results describing agreement of telemedicine diagnosis of the areas primarily involved with infection compared to clinical inspection, indicate an almost complete diagnostic agreement (kappa= 0.971). Diagnostic agreement as to the type of infection was also almost complete (kappa = 0.951), and a similar value was obtained also for the treatment agreement (kappa> =0.892).

Conclusion: The method of telemedicine provides us with a tool to make a correct clinical diagnosis of dentogenous infections equally well as in real time, as well as to get a deeper and wider insight into their nature and to suggest adequate treatments.