A Systematic Review on the Validity of Teledentistry.

Objectives: The aim of this systematic review was to evaluate the validity of using teledentistry in oral care examination and diagnosis.

Methods: In June 2016, a systematic search of the literature was conducted without time restrictions in three electronic databases (Ebscohost, Pubmed, and Scopus). Two reviewers screened the retrieved articles first by title and then by abstract to determine relevant articles for full text review. Studies included were as follows: (1) related to teledentistry, (2) available in full text and English, (3) compared teledentistry application to a gold standard, and (4) provided clear statistical tests for validity. The methodological quality of studies was determined using the "Quality Assessment of Studies of Diagnostic Accuracy (QUADAS)."

Results: Seventy-nine studies met the initial search criteria. Following removal of duplicate articles, only 58 were remaining and reviewed by title and abstract, yielding 14 full-text articles. Nine of the full-text articles met the inclusion criteria. Results of the QUADAS assessment varied from 9 to 13 out of 14 items; therefore, studies demonstrated high quality (>60%). Validity of teledentistry varied and is reported by range for the following statistics: sensitivity (n = 8, 25-100%), specificity (n = 7, 68-100%), positive predictive value (n = 5, 57-100%), and negative predictive value (n = 5, 50-100%). Kappa statistics were also reported for evaluation of reliability between gold standard and teledentistry examination (n = 6, 46-93%).

Conclusions: Teledentistry could be comparable to face-to-face for oral screening, especially in school-based programs, rural areas and areas with limited access to care, and long-term care facilities. Identification of oral diseases, referrals, and teleconsultations are possible and valid. The need for methodologically designed studies with appropriate statistical tests to determine the validity of teledentistry exists.