Non-Cochrane · DTA · PM39039499
Teledentistry accuracy for caries diagnosis: a systematic review of in-vivo studies using extra-oral photography methods.
Kargozar Sanaz, Jadidfard Mohammad-Pooyan · BMC oral health · 2024 · PubMed · doi:10.1186/s12903-024-04564-4
Full textEvery question was extracted from the full text, figures and supplements by two independent LLM extractors, disagreements adjudicated. Rows cite where in the review the value comes from.
Questions
16
current version
GRADE rated
0
No studies
0
Included studies
19
linked below
No studies 0 · 0%Ungraded 16 · 100%Very low 0 · 0%Low 0 · 0%Moderate 0 · 0%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Review question
| Element | Planned (methods) | Found (results) |
|---|---|---|
| Population | Children and adults (participants) with primary or permanent dentition, for dental caries diagnosis | 19 studies; participants aged 1 to over 65 years (children and adults); sample sizes 6 to 147 individuals |
| Intervention | Index test: dental caries diagnosis from photographs taken by DSLR or smartphone cameras (intraoral-camera and in-vitro studies excluded) | Photographic caries diagnosis: smartphone camera (12 studies), DSLR camera (remaining studies), or both (1 study); all asynchronous/store-and-forward |
| Comparison | Reference standard: visual/clinical dental examination | Visual/clinical examination (all 19 studies) |
| Outcomes | Primary: sensitivity and specificity. Additional: positive and negative predictive values, accuracy, and inter- and intra-rater reliability (kappa) | Sensitivity 48-98.3% (13 studies); specificity 83-100% (13); PPV and NPV (10); accuracy about 93-97.6% (Table 2); inter-examiner kappa 0.44-0.91 (13); intra-examiner kappa 0.52-1.00 (6). Meta-analysis not performed (heterogeneity) |
| Study designs | Original in-vivo studies: randomized clinical trials, quasi-experimental trials, longitudinal cohorts, and cross-sectional surveys | 19 studies published 2014-2022: observational cross-sectional, pilot intervention, retrospective descriptive, and one parallel-group RCT; settings included dental clinics/hospitals, schools (4), and a juvenile detention facility (1); 11 countries |
| Timing | Not specified (no date restriction on study inclusion) | Included studies published 2014-2022 |
Search date: February 2023 (electronic searches conducted February 2023; literature coverage through December 2022; no date restriction applied). Databases: PubMed, Scopus, EMBASE; gray literature via Google and Google Scholar; backward citation searching
Questions and results
Teledentistry (index test): dental caries diagnosis from photographs taken with DSLR or smartphone cameras; store-and-forward vs Visual/clinical dental examination (reference standard)
Population: Children and adults with primary or permanent dentition undergoing dental caries assessment
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Intra-examiner reliability Cross-sectional diagnostic accuracy (index test vs reference standard, in-vivo) · Overall (studies reporting intra-examiner reliability; narrative synthesis) Intra-examiner reliability ranged from kappa 0.52 to 1.00 across 6 studies; certainty not graded. Source: Results (Diagnostic outcomes); Table 2 · same question in other reviews | Intra-examiner reliability (kappa) reported in 6 studies, ranging from 0.52 to 1.00. No pooled estimate. | 6 studies | Ungraded |
Inter-examiner reliability Overall Population: Children and adults with primary or permanent dentition Inter-examiner kappa statistics ranged from 0.44 to 0.91 across 13 studies; no meta-analysis or GRADE rating was reported. Source: Results, Diagnostic outcomes; Table 2 · same question in other reviews | no estimate extracted | 13 studies | Ungraded |
Positive predictive value Cross-sectional diagnostic accuracy (index test vs reference standard, in-vivo) · Overall (studies reporting PPV; narrative synthesis) Positive predictive value was reported in 10 studies and varied widely across studies (about 42% to 99%); no pooled estimate and certainty not graded. Source: Results (Diagnostic outcomes); Table 2 · same question in other reviews | PPV 41.8% to 99% | 10 studies | Ungraded |
Positive predictive value for dental caries diagnosis Overall Population: Children and adults with primary or permanent dentition Positive predictive values were reported in 10 of the 13 studies that reported sensitivity and specificity; no meta-analysis or GRADE rating was reported. Source: Results, Diagnostic outcomes; Table 2 · same question in other reviews | no estimate extracted | 10 studies | Ungraded |
Negative predictive value for dental caries diagnosis Overall Population: Children and adults with primary or permanent dentition Negative predictive values were reported in 10 of the 13 studies that reported sensitivity and specificity; no meta-analysis or GRADE rating was reported. Source: Results, Diagnostic outcomes; Table 2 · same question in other reviews | no estimate extracted | 10 studies | Ungraded |
Specificity Cross-sectional diagnostic accuracy (index test vs reference standard, in-vivo) · Overall (studies reporting specificity; narrative synthesis) Across 13 studies, the specificity of teledentistry caries diagnosis ranged from 83% to 100%; no pooled estimate and certainty not graded. Source: Abstract; Results (Diagnostic outcomes); Table 2 · same question in other reviews | Specificity ranged from 83% to 100% across studies (reported in 13 of 19 studies). No pooled estimate; meta-analysis not performed. | 13 studies | Ungraded |
Overall diagnostic accuracy (agreement) Cross-sectional diagnostic accuracy (index test vs reference standard, in-vivo) · Overall (studies reporting accuracy; narrative synthesis) Where reported (about 5 studies, Table 2), overall diagnostic accuracy was high (about 93% to 97.6%); no pooled estimate and certainty not graded. Source: Table 2 · same question in other reviews | Accuracy 92.9% to 97.6% | 5 studies | Ungraded |
Sensitivity Cross-sectional diagnostic accuracy (index test vs reference standard, in-vivo) · Overall (studies reporting sensitivity; narrative synthesis) Across 13 studies, the sensitivity of teledentistry (photographic) caries diagnosis versus visual examination ranged from 48% to 98.3%; the review pooled no estimate and did not grade certainty. Source: Abstract; Results (Diagnostic outcomes); Table 2 · same question in other reviews | Sensitivity Overall 48% to 98.3% across 13 studies; sensitivity is lesion-stage dependent: Kohara reported <40% for initial/moderate caries (75-100% for extensive) and early enamel lesions were less sensitive | 13 studies | Ungraded |
Intra-examiner reliability Overall Population: Children and adults with primary or permanent dentition Intra-examiner kappa statistics ranged from 0.52 to 1.00 across 6 studies; no meta-analysis or GRADE rating was reported. Source: Results, Diagnostic outcomes; Table 2 · same question in other reviews | no estimate extracted | 6 studies | Ungraded |
Inter-examiner reliability Cross-sectional diagnostic accuracy (index test vs reference standard, in-vivo) · Overall (studies reporting inter-examiner reliability; narrative synthesis) Inter-examiner reliability ranged from kappa 0.44 to 0.91 across 13 studies (moderate to almost perfect agreement); certainty not graded. Source: Results (Diagnostic outcomes); Table 2; Discussion · same question in other reviews | Inter-examiner reliability (kappa) reported in 13 studies, ranging from 0.44 to 0.91. No pooled estimate. | 13 studies | Ungraded |
Negative predictive value Cross-sectional diagnostic accuracy (index test vs reference standard, in-vivo) · Overall (studies reporting NPV; narrative synthesis) Negative predictive value was reported in 10 studies and ranged widely across studies (about 31% to 99.5%); no pooled estimate and certainty not graded. Source: Results (Diagnostic outcomes); Table 2 · same question in other reviews | Negative predictive value reported in 10 of 19 studies; per-study values ranged from about 31% to 99.5% (Table 2). No pooled estimate. | 10 studies | Ungraded |
Sensitivity for dental caries diagnosis Overall Population: Children and adults with primary or permanent dentition Sensitivity ranged from 48% to 98.3% across 13 studies; no meta-analysis or GRADE rating was reported. Source: Results, Diagnostic outcomes; Table 2 · same question in other reviews | Sensitivity Overall 48% to 98.3% across 13 studies; sensitivity is lesion-stage dependent: Kohara reported <40% for initial/moderate caries (75-100% for extensive) and early enamel lesions were less sensitive | 13 studies | Ungraded |
d/D dft/DFT or dmft/DMFT score differences Overall Population: Children and adults with primary or permanent dentition Eight studies calculated caries-score differences; six reported no significant difference, one underestimation, and one overestimation with teledentistry. Source: Results, Diagnostic outcomes; Table 2 · same question in other reviews | no estimate extracted | 8 studies | Ungraded |
Specificity for dental caries diagnosis Overall Population: Children and adults with primary or permanent dentition Specificity ranged from 83% to 100% across 13 studies; no meta-analysis or GRADE rating was reported. Source: Results, Diagnostic outcomes; Table 2 · same question in other reviews | no estimate extracted | 13 studies | Ungraded |
Comparison
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
Correlation between teledentistry and clinical caries assessment Studies reporting Spearman correlation (Almosa 2014, Daniel 2017, Zotti 2022) | Spearman correlation coefficient 0.76 to 0.99 (Almosa 0.76; Zotti 0.816; Daniel 0.99) | 3 studies | Ungraded |
Comparable diagnostic accuracy (photographic vs visual examination) Overall narrative conclusion across included studies | Study conclusion (narrative) 17 of 19 studies concluded photographic diagnostic accuracy comparable to visual caries assessment | 19 studies | Ungraded |
Included primary studies 19
Open as a trial list| Study | Also included by | Outcomes it informs here | Trial PICO | Results |
|---|---|---|---|---|
| Aboalshamat 2022 Accuracy and perceptions of teledentistry in KSA during the COVID-19 pandemic: A single-centre randomised controlled trial. PMID:35079243 | this review only | not stated | not extracted yet | not extracted yet |
| Almosa 2014 Diagnosing the severity of buccal caries lesions in orthodontic patients at de-bonding using digital photographs. PMID:24320004 | this review only | not stated | not extracted yet | not extracted yet |
| Alshaya 2020 Reliability of mobile phone teledentistry in dental diagnosis and treatment planning in mixed dentition. PMID:30134778 | this review only | not stated | not extracted yet | not extracted yet |
| Alshaya 2022 The accuracy of teledentistry in caries detection in children - A diagnostic study. PMID:35774249 | this review only | not stated | not extracted yet | not extracted yet |
| Ciardo 2022 Remote assessment of DMFT and number of implants with intraoral digital photography in an elderly patient population - a comparative study. PMID:35580131 | this review only | not stated | not extracted yet | not extracted yet |
| Daniel 2017 Comparison of dental hygienists and dentists: clinical and teledentistry identification of dental caries in children. PMID:27256722 | this review only | not stated | not extracted yet | not extracted yet |
| Estai 2015 A proof-of-concept evaluation of a cloud-based store-and-forward telemedicine app for screening for oral diseases. PMID:26377126 | this review only | not stated | not extracted yet | not extracted yet |
| Estai 2016 The efficacy of remote screening for dental caries by mid-level dental providers using a mobile teledentistry model. PMID:27111291 | this review only | not stated | not extracted yet | not extracted yet |
| Estai 2017 Comparison of a Smartphone-Based Photographic Method with Face-to-Face Caries Assessment: A Mobile Teledentistry Model. PMID:27854186 | this review only | not stated | not extracted yet | not extracted yet |
| Estai 2021 Mobile photographic screening for dental caries in children: Diagnostic performance compared to unaided visual dental examination. PMID:33495989 | this review only | not stated | not extracted yet | not extracted yet |
| Golsanamloo 2022 Accuracy of Teledentistry for Diagnosis and Treatment Planning of Pediatric Patients during COVID-19 Pandemic. PMID:36444215 | this review only | not stated | not extracted yet | not extracted yet |
| Guo 2021 Feasibility of oral health evaluation by intraoral digital photography: a pilot study. PMID:33530811 | this review only | not stated | not extracted yet | not extracted yet |
| Hu 2016 Are Carious Lesions in Previously Sealed Occlusal Surfaces Detected as well on Colour Photographs as by Visual Clinical Examination? PMID:26870847 | this review only | not stated | not extracted yet | not extracted yet |
| Kale 2019 Assessment of mother's ability in caries diagnosis, utilizing the smartphone photographic method. PMID:31710010 | this review only | not stated | not extracted yet | not extracted yet |
| Kohara 2018 Is it feasible to use smartphone images to perform telediagnosis of different stages of occlusal caries lesions? PMID:30188900 | this review only | not stated | not extracted yet | not extracted yet |
| Mehdipour 2021 matched by author and year (probable) | this review only | not stated | not extracted yet | not extracted yet |
| Morosini 2014 Performance of distant diagnosis of dental caries by teledentistry in juvenile offenders. PMID:24693859 | this review only | not stated | not extracted yet | not extracted yet |
| Park 2018 Comparing the outcomes of gold-standard dental examinations with photographic screening by mid-level dental providers. PMID:30302610 | this review only | not stated | not extracted yet | not extracted yet |
| Zotti 2022 Telediagnosis of dental caries: Possible or impossible? A pilot cross-sectional study. PMID:36134446 | this review only | not stated | not extracted yet | not extracted yet |