Table 4 Summary of study characteristics and findings
N | Study type | Country | Participants | Teledentistry subtype | Design | Strength and weaknesses | References |
|---|---|---|---|---|---|---|---|
1 | Web interface development | Malaysia | MeMoSA® UPLOAD- 2703 images were uploaded between June 2019 to September 2020, MeMoSA® ANNOTATE − 7 specialist | Tele-diagnosis Teleconsultation | MeMoSA® UPLOAD and MeMoSA® ANNOTATE are the two components that make up the platform and all components are located on a secure cloud server, MeMoSA® Data Vault which can be accessed by authorised users by using a unique password provided to them. The function of MeMoSA® UPLOAD was for users to any images to the platform and MeMoSA® ANNOTATE allows for systemic annotations of the images. A survey was conducted to gather opinions regarding the user interface, the viability of the annotation process, and the accuracy of clinical descriptors. | Strengths - Sensitivity was high in providing the correct referral decision for cancer surveillance Weaknesses - Some images were out of focus - Some lesions were identified to be difficult to assess based on images alone - The research was only done in Asia. The researchers were not sure how it can establish a global network - Not enough comprehensive clinical information such as patient’s chief concern, medical history, oral hygiene products | Rajendran al. (21) |
2 | Cross-sectional survey study | Malaysia | 310 Malaysian Dental Practitioners | Tele-consultation Telediagnosis Tele-education Tele-monitoring | Between May and July of 2021, a prevalidated electronic questionnaire was distributed to different dental practitioners in Malaysia. The questionnaire’s first section addressed demographic data in addition to favoured techniques of communication. The questionnaire’s second section was composed of Likert-type questions, each with a maximum of five points. There were 26 questions in total which were further separated into four headings: Practitioners’ data security, advancements in dentistry through teledentistry, the advantages it offers dental patients between May and July 2021, and how beneficial teledentistry is for dental practices. | Strength - A pre-validated questionnaire was used - Randomized retrieval of subject’s e-mail from the Malaysian Dental Council (MDC) database - The study showed that Malaysian dental professionals have a positive perception of Teledentistry as a concept. Weakness Significantly high number of questions in the questionnaire - Poor response rate - The usage of a 5-point Likert scale, since numerous studies have shown that responders are more likely to choose the medium value as a safe, moderate option than any value on either extreme due to psychological obstacles. | Khokhar et al. (22) |
3 | Cross-sectional survey-based study using a non-probability sampling method | Indonesia | 652 dentists from different provinces | Teleconsultation Telediagnosis Telemonitoring | An electronic survey collecting information on demographics, the impact of teledentistry in improving dental practice for both the dentists and patients, and cyber-risks related to teledentistry was disseminated by Whatsapp from January to February 2021. This survey also explored the dentist’s preferred dental specialties to be conducted virtually | Strengths: - The first study in Indonesia that explored the perception of teledentistry implementation by dentists, as well as the elements that may affect their views - Findings will aid future policy making Weakness: - Survey is not randomised - Presence of response bias | Soegyanto et al. (23) |
4 | Observational cross-sectional study | Indonesia | Patients from outpatient Clinic of Dental Hospital, Faculty of Dentistry Universitas Trisakti, who receivied teledentistry based services during the Covid-19 pandemic were included in the study. | Teleconsultation Telediagnosis | The level of patient satisfaction on teledentistry services were gauged via a validated questionnaire | Strength: - A pre-validated questionnaire was used, increasing the reliability and accuracy of the data collected - A Cronbach’s alpha score of 0.83 and a reliability item of 0.95 with a separation of 4.49 was obtained. Weakness: - Insufficient sample size | Amtha et al. (24) |
5 | Descriptive Observational Study | Malaysia, Singapore, Indonesia | This observational study had 506 participants in total | Teleconsultation, Telediagnosis, Telemonitoring, Tele-education | Between June and July of 2021, a verified electronic questionnaire was distributed via email and several social media platforms to the dental practitioners who were chosen. The questionnaire’s first section asked about demographics, communication method preferences, and professional background. Likert-type responses on a five-point scale were used for the second section of the questionnaire. The statistical analysis was conducted using the SPSS-25. The frequency, percentage, mean, and standard deviation of the demographic characteristics, the participant’s qualification, experience, practice location, and the use of teledentistry in various specialties were all assessed using descriptive statistics. The effect of independent variables (age, gender, education, and years of experience) on dependent variables (teledentistry domains) was examined using the ANOVA test. A statistically significant result was defined as a p value of less than 0.05. | Strength - Inclusion of dentists globally Weakness - Self-reported biasness. - Dentists working in the rural areas were not included in the study (can be considered which could provide a better view of teledentistry in such localities.) | Maqsood et al. (25) |
6 | Randomized control trial | Thailand | 8 male prisoners - phase 1 309 male prisoners - phase 2 152 male prisoners for phase 3 | Tele-diagnosis | There were a total of three phases in the dental disease screening program. Phase I: (PHVs) (Prison health volunteers) were given a teledentistry training program. Phase II: Oral Health screening was conducted using teledentistry by the PHVs Phase III: Oral screening and assessment of oral health needs was conducted by trained dentist . Analysis done for diagnostic accuracy testing for sensitivity, specificity, PPV, NPV | Strengths - Without a dentist’s direct examination, other qualified healthcare workers can conduct the dental disease screening. - As a result, less time, people resources, and dental visits are required. - Teledentistry can be effectively utilized for forming a sound diagnosis and treatment planning. Weakness - Only one PHV included - Only symptomatic areas were investigated - Presence of recall bias - Teledentistry imaging is insufficient to precisely detect all dental treatment needs required for each individual because pulp and periodontal status cannot be determined by imaging alone. | Santipipat et al. (26) |
7 | Survey | Malaysia | 23 student participants for group discussions and 6 patients participated in in-depth interviews | Tele-education | The research included semi-structured group discussions with a qualitative approach and in-depth interviews with patients to phenomenologically explain the perspectives of the participants in the virtual community. With the consent of the participants, every session was videotaped. Using qualitative data analysis, the entire transcription of the recorded session was subjected to a thematic analysis using NVivoTM software. | Strengths - The results of this study will be helpful in creating and modifying clinical training programs in the future, giving instructors and students options in the event of a lockdown or other emergency. - The study’s qualitative methodology made it possible to comprehend the patients’ and students’ experiences adjusting to these new norms on a deeper level. The subtleties of human behavior were preserved while the subjects were questioned in their natural settings, in their own language, and according to their own terms. Weakness - Only patients and students who have participated in the virtual smoking sessions were included in the study. - The participants’ voluntary bias may have an impact on the generalizability of the results. Since those who were less devoted or who relapsed would not have accepted the invitation to participate, information bias may be present in the study. | Roslan et al. (27) |
8 | Survey | Indonesia | The study recruited 301 1st-, 2nd, & 3rd-year undergrad dental students from the Faculty of Dentistry at University Indonesia. The percentage of responses was 84.3% of which 85.1% of the participants were female. | Tele-education | The purpose of the questionnaire was to gauge how the students felt about the remote learning approach. With the exception of open-ended questions about the difficulties and rewarding experiences encountered while studying remotely and questions about the best strategies for remote learning, the response possibilities for the questionnaire items correspond to Likert-type scales. There were a total of 22 statements divided into four sections: (A) general details about the student’s gender, year of study, and GPA; (B) preference; (C) effectiveness; and (D) satisfaction with the learning process. Cronbach’s alpha was used to calculate the internal consistency reliability questionnaire score. Bivariate analysis and descriptive statistics computations were done. Logistic regression analysis was used to find the variables linked to the students’ choice for online learning. There was a 0.05 level of statistical significance. | Strength - Cronbach alpha of the questionnaire was 0.880, which is deemed acceptable. Weakness - The study was limited to a single university. - The intended 90% response rate was not met by the 84.3% response rate. - The study observed mainly on preclinical students as the main respondents, the study observed that clinical students in more advanced years of undergrad courses faced major challenges in learning during the pandemic years due to the complexity of subjects and the novelty of the online learning platforms. - This study’s questionnaire only assessed students’ perceptions. - The real amount of knowledge acquired by students and their perception of their learning are not strongly correlated. | Amir et al. (28) |
9 | Comparative Study | Thailand | 37 pairs of participants participated in Study I and 34 pairs of participants participated in Study II. | Tele-education | In Study I which was conducted from October 2018 to February 2019, participants received in-person training and a 21-day chatbot course. In Study II from December 2021 to February 2022, participants received only daily chatbot programming for 30 days. The efficacy of the chatbots was evaluated in terms of knowledge gains, protection motivation theory-based attitudes of oral health care, and procedures for maintaining young children’s oral hygiene. A standardised questionnaire was utilised in both trials to collect data on socio demographic traits as well as baseline and follow-up oral health knowledge, attitudes, and practices. Questions on oral health knowledge included 11 items that addressed the following: when to start brushing, how often to brush, toothpaste with fluoride, brushing technique, and behaviour control for kids. | Strength - Cronbach alpha of the questionnaire was above 0.8 (has good internal consistency) Limitations - The data analysis has few limitations. - Both articles utilized a pre-post-methodology that might have a maturity bias. - The study might also have a vulnerability to examiner bias as the interview method and feedback period varied for both studies. - A self-administered online questionnaire was used and its validity could be prejudiced if subjects responded in a premediated manner, and a longer follow-up span could impact memory recall. | Pithpornchaiyakul et al. (29) |
10 | Cross-sectional study | Malaysia | 631 adult patients from the Dental school of SEGI University | Teledentistry in general | The validated, self-administered online questionnaire had gathered information of patients’ background and dental-related history, accessibility to teledentistry services and their understanding of such services, as well as their willingness and obstacles in using them. The responses were collected from January 2020 to May 2021 | Strength - Patient’s access to technology, acceptance and barriers in assimilating teledentistry in daily practice was explored. - The study had identified the necessity to train both patients and dentists in using teledentistry Weakness: - Results cannot be generalised as the sample size is not representative. | Zain et al. (30) |