Journal of Dental Sciences (2021) 16, 280e286
Available online at www.sciencedirect.com
ScienceDirect
journal homepage: www.e-jds.com
Original Article
The application of teledentistry for Saudi
patients’ care: A national survey study
Soulafa A. Almazrooa a*, Ghada A. Mansour a,
Sana A. Alhamed a, Sarah A. Ali a, Sara K. Akeel a,
Nada A. Alhindi a, Osama M. Felemban b, Hani H. Mawardi a,
Nada O. Binmadi a
a
Department of Oral and Diagnostic Sciences, King Abdulaziz University, Faculty of Dentistry, Jeddah,
Saudi Arabia
b
Department of Pediatric Dentistry, King Abdulaziz University, Faculty of Dentistry, Jeddah, Saudi
Arabia
Received 6 April 2020; Final revision received 28 April 2020
Available online 19 May 2020
KEYWORDS Abstract Background/purpose: Teledentistry has emerged as a new communication tool in
ehealth; various dental disciplines around the world. The aim of this study was to investigate the appli-
mhealth; cability and reliability of teledentistry in the field of diagnostic dentistry and explore the
Telemedicine; perception of Saudi dentists of its benefits and concerns.
Telehealth Materials and methods: An electronic survey with 40 questions was developed, validated and
distributed electronically by email and social media channels to dentists from different specialty
in Saudi Arabia. Collected data were analyzed for statistical significance.
Results: A total of 148 dentists completed the survey. The current data demonstrated that 50% of
study participants have had applied teledentistry in their clinical practice. Out of all, 90% have
computers in their dental offices and 72% have been using electronic medical records in which
radiographs and clinical images are uploaded. Most participants had smart phones (91%), in which
they were used more commonly (74.3%) than conventional cameras (54.1%) to capture and share
patients’ clinical images over communication applications (74.3%) and less likely through emails
(62.2%). Overall, 83% were confident that teledentistry can improve daily dental practice, spe-
cifically in the fields of oral radiology followed by endodontics and oral medicine.
Conclusion: Teledentistry is an emerging tool with potential to improve the delivery of diagnostic
dental care for communities with limited or no access to dental specialists. As of today, teledentis-
try has not been truly implemented by the Saudi dental community. Development of national
* Corresponding author. King Abdulaziz University, Faculty of Dentistry, Al Ehtifalat St, King Abdul Aziz University, Jeddah 22252 Saudi
Arabia.
E-mail addresses: [email protected], [email protected] (S.A. Almazrooa).
https://doi.org/10.1016/j.jds.2020.04.014
1991-7902/ª 2020 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V. This is an open access article under
the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
The application of teledentistry 281
programs to educate the public and promote teledentistry among dental practitioners are war-
ranted.
ª 2020 Association for Dental Sciences of the Republic of China. Publishing services by Elsevier B.V.
This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/
licenses/by-nc-nd/4.0/).
Introduction expertise in using electronic communication devices to
evaluate their perception of incorporating teledentistry in
Telemedicine is defined as the use of advanced information their dental practices. The survey also included questions
technologies and electronic tools of communication for the about dentists’ attitude, experience, application, and ad-
exchange of medical information. It facilitates consultation vantages of teledentistry in their respective specialties.
with patients, specialists and/or health care providers at a Prior to launching the study, the survey was validated
distance in order to provide optimized medical services in through a selected sample of dental specialists at KAU-FD
the patient’s physical absence.1,2 The original concept was and was modified based on participants’ feedback. After-
developed to equip health care providers with a commu- ward, the survey was distributed electronically via email
nication method to obtain detailed history and clinical and different social media channels to study group. Par-
observations, including images for diagnosis and guidance.3 ticipants’ responses were summarized in Table 1. Chi-
This concept has evolved over the past few years and square test was used to compare responses between den-
became an essential component of health care delivery tists who reported using teledentistry and participants who
around the globe. A recent report by Fortune Business In- did not use it. Data analysis was completed using SPSS
sights predicted the telemedicine market to grow from USD version 18.0 (SPSS Inc., Chicago, IL, USA).
34 billion in 2018 to 185 billion in 2026 with domination in
the North American segment.4 Results
Teledentistry, similar to telemedicine, has emerged as a
new tool with promising benefits for various dental disci- A total of 300 dentists were contacted, in which 148
plines including endodontics, orthodontics, oral surgery and participated and completed the survey (49%). All de-
pediatric dentistry.1,5 It holds the potential to improve mographic data of study participants are summarized in
access to, and delivery of oral healthcare in rural and un- Table 1. Half of the participants (50.0%) reported using
derserved areas.2,6 In addition, teledentistry has the po- teledentistry in the past.
tential to save resources and reduce the overall cost of Out of 148 dentists, there were 89 (60.1%) males; 105
healthcare.1,7 An Australian study reported potential sav- (70.9%) were within the age range of 18e35 years and 43
ings up to 40 million dollars per year if teledentistry was (29.1%) were 36 years or older. The work experience in the
implemented for screening of low caries risk children.8 In dental field differed between participants as 96 partici-
diagnostic dentistry, proper diagnosis of oral lesions, pants (64.9%) had 0e5 years of experience since they
including oral cancer, can be challenging, especially in graduated dental school while 52 (35.1%) had more than 5
underserved communities with limited access to special- years of dental experience. Dental specialists and consul-
ized dental care. Therefore, teledentistry may fill this gap tants were more likely to have used teledentistry compared
and improve standard of care. to general dentists (p Z 0.018). Accounting for type of
Considering the lack of available literature, the primary specialty, specialists and consultants were also more likely
purpose of this study was to investigate the applicability to implement teledentistry versus general dentists (p Z
and reliability of teledentistry in the field of diagnostic 0.002). In addition, dentists who reported taking clinical
dentistry and explore the perception of Saudi dentists of its images and radiographs more frequently were more likely
benefit and perceived concerns. We believe that this study to have used teledentistry in the past (p < 0.001 and p Z
will be a great addition to the teledentistry literature 0.004 respectively) (Table 1).
specifically in Saudi Arabia. When asked about having a computer or a laptop in the
dental office, 90.5% of participants reported having at least
one device which was most likely shared with other dental
Materials and methods staff. Overall, 72.4% of participating dentists have been
using electronic medical records, in which radiographs
A human research ethical approval was obtained through (82.1%) and to a lesser extent images (58.2%) get uploaded
King Abdulaziz University e Faculty of Dentistry (KAU-FD). or linked to the electronic health record system. All par-
This was a cross sectional study to include a convenient ticipants reported having an active email address, accessed
sample of dentists from all dental specialties currently regularly from a desktop, laptop, or smart phone and this
working in Saudi Arabia. finding in particular was a significant predictor for the
The survey consisted of a total of 40 questions to inquire likelihood of having used/applied teledentistry (p Z 0.047,
about dentists’ demographic information, clinical experi- p Z 0.002, p < 0.11 respectively). Most of the participants
ence, specialty, and average number of patients seen. The had a smart phone (91.2%) and those who did not were less
participants were asked about their familiarity and likely to have used teledentistry before (p Z 0.009).
282 S.A. Almazrooa et al
Table 1 Demographic data of survey participants.
Item Category n (%) Previous experience with tele- p-value
dentistry
Yes No
n Z 74 (50.0%) n Z 74 (50.0%)
How old are you? 18-35 y 105 (70.9%) 50 (47.6%) 55 (52.4%) 0.365
>36 43 (29.1%) 24 (55.8%) 19 (44.2%)
What is your gender? Male 89 (60.1%) 42 (47.2%) 47 (52.8%) 0.401
Female 59 (39.9%) 32 (54.2%) 27 (45.8%)
How many years of experience 0-5 y 96 (64.9%) 48 (50.0%) 48 (50.0%) 1.0
do you have since you More than 5 y 52 (35.1%) 26 (50.0%) 26 (50.0%)
graduated dental school?
What is your clinical rank? General Dentist 80 (54.1%) 32 (40.0%) 48 (60.0%) 0.018
Specialist 37 (25.0%) 25 (67.6%) 12 (32.4%)
Consultant 31 (20.9%) 17 (54.8%) 14 (45.2%)
In which sector do you work? Government 103 (69.6%) 48 (46.6%) 55 (53.4%) 0.211
Private 45 (30.4%) 26 (57.8%) 19 (42.2%)
What is your specialty? General dentist 71 (48.0%) 27 (38.0%) 44 (62.0%) 0.002
Oral medicine 13 (8.9%) 5 (6.9%) 8 (10.8%)
Oral pathology 3 (2.1%) 1 (1.4%) 2 (2.7%)
Oral radiology 3 (2.1%) 2 (2.8%) 1 (1.4%)
Oral surgery 14 (9.6%) 10 (13.9%) 4 (5.4%)
Prosthodontics 13 (8.9%) 7 (9.7%) 6 (8.1%)
Endodontics 4 (2.7%) 0 4 (5.4%)
Periodontics 7 (4.8%) 7 (9.7%) 0
Pedodontics 3 (2.1%) 1 (1.4%) 2 (2.7%)
Orthodontic 7 (4.8%) 6 (8.3%) 1 (1.4%)
Dental public Health 5 (3.4%) 4 (5.6%) 1 (1.4%)
Advanced general dentistry 2 (1.4%) 1 (1.4%) 1 (1.4%)
Restorative dentistry 2 (1.4%) 2 (2.8%) 0
In the past 12 months, in an 1e24 h 67 (45.3%) 31 (46.3%) 36 (53.7%) 0.409
average week, how many >25 h 81 (54.7%) 43 (53.1%) 38 (46.9%)
hours per week do you
practice dentistry?
In the past year, in an average 1-10 patients 52 (35.1%) 26 (50.0%) 26 (50.0%) 0.587
week, how many patients 11-20 patients 41 (27.7%) 23 (56.1%) 18 (43.9%)
do you see per week? 21 patients or more 55 (37.2%) 25 (45.5%) 30 (54.5%)
How many patients per week, None 42 (28.4%) 8 (19.0%) 34 (81.0%) <0.001
do you take photos for? Some patients 77 (52.0%) 43 (55.8%) 34 (44.2%)
Most or all patients 29 (19.6%) 23 (79.3%) 6 (20.7%)
How many patients per week None 29 (19.6%) 19 (65.5%) 10 (34.5%) 0.004
do you take dental Some patients 55 (37.2%) 18 (32.7%) 37 (67.3%)
radiographs for? Most or all patients 64 (43.2%) 37 (57.8%) 27 (42.2%)
Interestingly, less than a third of the participants were peers, improves case diagnosis, and helps with new pa-
familiar with the term teledentistry (28.4%). However, tients’ referrals (Table 3).
after reading the definition, 30.2% of those who were not With regards to participants’ previous experience with
familiar with term reported having applied teledentistry at teledentistry, 64.9% of all subjects have implement it for
some point in the past (Table 2). diagnosis and 73.0% to obtain a second opinion from those
A question on participants’ impression for which dental who have used it before. Further analysis demonstrated
specialty to best implement and benefit from teledentistry radiographs as most commonly shared among clinicians
indicated oral radiology to come first (53.4%), followed by (68.9%), followed by images of oral mucosal lesions
endodontics (47.3%), and oral medicine (45.3%). At the (52.7%), and root canal related cases (43.2%). Patient’s
same time, periodontics came last (25.7%) to benefit from images were more commonly captured using smart phone
teledentistry. The majority of participants (83.8%) were (74.3%) than regular cameras (54.1%) and transferred over
confident that teledentistry has the potential to improve (62.2%). Teledentistry users who reported confirming
daily dental practice, saves time, and reduces overall cost initial diagnosis via teledentistry portals (59.5%), less than
but not as effective in enhancing communication with half of them confirmed the diagnosis with a clinic visit
The application of teledentistry 283
Table 2 Participants attitude toward application of teledentistry.
Item Category n (%) Used tele-dentistry p-value
Yes No
n Z 74 (50.0%) n Z 74 (50.0%)
Do you have a computer/laptop Yes 134 (90.5%) 66 (49.3%) 68 (50.7%) 0.574
in your dental office/ No 14 (9.5%) 8 (57.1%) 6 (42.9%)
practice?
Are you the main computer Yes 55 (41.0%) 31 (56.4%) 24 (43.6%) 0.170
user? No 79 (59.0%) 35 (44.3%) 44 (55.7%)
Do you use as an electronic Yes 97 (72.4%) 50 (51.5%) 47 (48.5%) 0.390
medical record? No 37 (27.6%) 16 (43.2%) 21 (56.8%)
Do patient’s radiographs get Yes 110 (82.1%) 57 (51.8%) 53 (48.2%) 0.204
uploaded/linked to the No 24 (17.9%) 9 (37.5%) 15 (62.5%)
electronic record you use?
Do patient’s clinical image get Yes 78 (58.2%) 40 (51.3%) 38 (48.7%) 0.579
uploaded/linked to the No 56 (41.8%) 26 (46.4%) 30 (53.6%)
electronic record?
Do you have an email? Yes, personal 44 (29.7%) 22 (50.0%) 22 (50.0%) 0.014
Yes, professional 17 (11.5%) 3 (17.6%) 14 (82.4%)
Yes, personal and professional 87 (58.8%) 49 (56.3%) 38 (43.7%)
How do you access the email? Desktop 66 (44.6%) 39 (59.1%) 27 (40.9%) 0.047
check all that applies Laptop 90 (60.8%) 54 (60.0%) 36 (40.0%) 0.002
Tablet 22 (14.9%) 13 (59.1%) 9 (40.9%) 0.355
Smart phone 116 (78.4%) 67 (57.8%) 49 (42.2%) <0.001
How often do you use your Daily 114 (77.0%) 65 (57.0%) 49 (43.0%) 0.002
email? Weekly 34 (23.0%) 9 (26.5%) 25 (73.5%)
In a typical day, about how 0e10 132 (89.5%) 70 (53.0%) 62 (47.0%) 0.034
many emails do you send? >10 16 (10.8%) 4 (25.0%) 12 (75.0%)
Do you send clinical images of Yes 41 (27.7%) 21 (51.2%) 20 (48.8%) 0.854
patients by email? No 107 (72.3%) 53 (49.5%) 54 (50.5%)
Do you have a smart phone Yes 135 (91.2%) 72 (53.3%) 63 (46.7%) 0.009
No 13 (8.8%) 2 (15.4%) 11 (84.6%)
Do you use your smart phone in Yes 107 (79.3%) 64 (59.8%) 43 (40.2%) 0.003
patient related matters? No 28 (20.7%) 8 (28.6%) 20 (71.4%)
Do you take patients clinical Yes 84 (62.2%) 49 (58.3%) 35 (41.7%) 0.135
images with your smart No 51 (37.8%) 23 (45.1%) 28 (54.9%)
phone?
Do you send clinical images Yes 97 (71.9%) 60 (61.9%) 37 (38.1%) 0.002
through smart phone No 38 (28.1%) 12 (31.6%) 26 (68.4%)
applications to colleagues
for consultations?
Do you know what teledentistry Yes 42 (28.4%) 42 (100%) 0 (0%) <0.001
means? No 106 (71.6%) 32 (30.2%) 74 (69.8%)
(45.5%) and 45.5% patients of all had an accurate diag- dental services delivered to soldiers. Nowadays, tele-
nosis. More than two thirds of teledentistry users (68.9%) dentistry is widely accepted in the fields of dental educa-
were confident of teledentistry to be sufficient to tion, public awareness, and research activities within
generate an accurate diagnosis and start treatment (Table several dental disciplines. Using teledentistry, dental con-
4). The current data reported 44 doctors to confirm the sultations may take several formats including “Real-time
oral lesion diagnosis with either a clinical visit (30/44), Consultation” and “Store-and-forward”.1 Real-time
treatment or biopsy and false diagnosis in 4 out 44 pa- Consultation necessitate a dentistepatient interaction,
tients (9%) which takes place over a videoconference. In this portal,
dental professionals and their patients are able to
communicate effectively while being physically present at
Discussion different locations.1 On the other hand, the exchange of
static images and clinical information between dental
The concept of teledentistry was initially proposed by the practitioners, known as Store-and-forward, is more likely
American Army as part of the Total Dental Access Project in aimed at interpretation and treatment planning of dental
1994.9 The main goal was to improve the efficiency of patients.1 Typically, store-and-forward format uses e-mails
284 S.A. Almazrooa et al
Table 3 The dentists’ perception on the best specialties Table 4 Teledentistry experience among dentists.
served by teledentistry and its advantages. Item Response n (%)
Item Responses n (%) out of 74
out of 148 Have you used Yes 48 (64.9%)
In your opinion, which Oral radiology 78 (53.4%) teledentistry for No 26 (35.1%)
specialty is to best Endodontics 70 (47.3%) dental diagnosis?
benefit Oral medicine 67 (45.3%) Have you used Yes 54 (73.0%)
teledentistry? Oral pathology 57 (38.5%) teledentistry for No 20 (27.0%)
check all that Oral surgery 48 (32.4%) second opinion?
applies Prosthodontics 47 (31.8%) What are the cases Radiographs 51 (68.9%)
Orthodontics 47 (31.8%) you used Oral medicine 39 (52.7%)
Periodontics 38 (25.7%) teledentistry for? conditions
If you needed a Yes 131 (88.5%) check all that Endodontics-related 32 (43.2%)
consultation in an No 17 (11.5%) applies Prosthodontics- 23 (31.1%)
oral lesion, do you related
think the oral Orthodontics-related 20 (27.0%)
medicine Periodontics-related 18 (24.3%)
specialist needs to What did you use to Conventional camera 40 (54.1%)
see the patient? get the clinical Smart phone 55 (74.3%)
Will teledentistry Yes 124 (83.8%) images with?
improve dental No 24 (16.2%) check all that
practice? applies
Do you think it saves Yes 116 (87.4%) What did you use to WhatsApp 55 (74.3%)
time? No 32 (21.6%) send it? check all Email 46 (62.2%)
Do you think it is cost- Yes 90 (60.8%) that applies
effective? No 58 (39.2%) Did you confirm the Yes 44 (59.5%)
What are the Enhancing 81 (54.7%) diagnosis that you No 30 (40.5%)
advantages of communication with got through the
teledentistry? peers tele-dentistry
choose all that Help with guidance 75 (50.7%) process
applies and referral of new How did you confirm The patient went to 20 (45.5%)
patients the diagnosis? see the doctor
Improve patient 67 (45.3%) Check all that directly
management applies. (n Z 44) The suggested 14 (31.8%)
Increase patient 44 (29.7%) treatment was
satisfaction effective
Increase practice 61 (41.2%) The biopsy proved the 10 (22.7%)
efficiency and diagnosis was correct
production Relatively speaking, Very accurate 20 (45.5%)
Improve case 78 (52.7%) how accurate was Not accurate but 15 (34.1%)
diagnosis the diagnosis? close enough
Decrease 53 (35.8%) (n Z 44) Not correct 4 (9.1%)
appointment time Not sure 5 (11.4%)
Improve record 44 (29.7%) Do you think Yes 51 (68.9%)
quality teledentistry is No 23 (31.1%)
enough for the
diagnosis to be
able to start
and smart phones which have been on the rise among
treatment?
dental practitioners.9
In general, dentists around the globe have supported the
application of teledentistry and its potential advantages of
time and cost effectiveness, enhancing communication demonstrated only 7.23% of responding dentists to know
with treating doctors in addition to increasing the quality of the concept of teledentistry and 98% having never prac-
diagnosis and treatment planning as well as patient satis- ticed it.11 One explanation could be related to the younger
faction.10 In the current study, 70.9% of participants aged population of included participants who are more familiar
between 18 and 35 years and 28.4% were familiar with the with dental technology advancements.
term teledentistry; however, around half of dentists were The importance of teledentistry among various dental
aware of its components and have applied it previously in disciplines may vary. Our data have demonstrated spe-
their daily practice. These results are relatively higher cialties such as prosthodontics, and endodontics to more
compared to averages in an Indian study which likely implement teledentistry compared to oral medicine,
The application of teledentistry 285
oral pathology, and oral radiology. One explanation could for clinical diagnosis of impacted or semi-impacted third
be the difference in the total number of registered dentists molars has been investigated.23 Using this system, oral
for each specialty which would reflect on the participants’ surgeons have been able to view radiographs along with
responses.12 Development and implementation of educa- intraoral and extraoral images over a web server and made
tional campaigns to increase awareness and encourage- remote diagnoses accordingly which were similar to real-
ment of teledentistry among dentists including young time assessment obtained by clinical diagnoses.
general dentists with limited clinical experience may help A multiple series of studies addressed the role of tele-
in improving standard of care delivered to patients in need. dentistry in preventive and pediatric dentistry and its
Electronic medical records have been on a mission to feasibility in the diagnosis and detection of early childhood
replace conventional charts in almost all medical and caries. The results reported no significant difference be-
dental centers in the last decade around the globe.13 In the tween teledentistry and visual/tactile screening for dental
current study, 90% of participants reported having a com- caries in young children.24 As a result, intraoral cameras
puter/laptop in their workplace and 82% have used elec- have been proposed as a feasible and potentially cost-
tronic medical records before. Although 18% of participants effective alternative to visual oral examination for caries
have been relying on paper-based medical records, this screening, especially early lesions in preschool children.25
carries the potential of consuming space and increasing risk Additionally, teledentistry via cellular smart phones was
of loss of patients’ data and/or breach of confidentiality. It proven reliable in diagnosis and treatment planning for
may also hinder the use of teledentistry especially in younger patients.26
remote counties in which teledentistry has significant po- Similar to other dental disciplines, multiple studies were
tential to improve the quality of care delivered local conducted to investigate the role of teledentistry in oral
communities.14 medicine. Access to oral medicine specialists has been
Based on the current data, smart phones were the challenging historically due to the limited number of
preferred method for sharing patients’ images and radio- practicing specialists resulting in longer waiting time.
graphs among dentists. The main reason for this practice is Therefore, screening for oral lesions using static images
accessibility and the user-friendly nature of smart phones may reduce patients’ suffering and decreases financial
nowadays. However, this practice may risk patients’ pri- costs.9 As such, the feasibility of distant diagnosis of oral
vacy compared to encrypted emails which should be lesions using emails as a primary source of image trans-
emphasized all times during the exchange of information.15 mission has been investigated before.27 In this study, im-
On the other hand, several communication applications ages of 25 oral lesions obtained from patients in a primary
(e.g. WhatsAppª and Telegramª) have recently become care public health clinic in Brazil were forwarded to two
encrypted to dissipate the public privacy concerns.15,16 Yet, oral medicine consultants.27 At the end of the study, both
all health care providers are expected to consider the consultants agreed on 60% of included cases diagnoses.
importance of data privacy when using smart phones for However, there was disagreement in 28% of cases and the
sharing patients’ related materials. diagnosis was inaccurate for 12% of cases.27 Another study
Overall, dentists in Saudi Arabia were more supportive in India reported high reliability in diagnosis of “normal”
for the application of teledentistry in oral radiology, end- from “abnormal” oral findings through sharing of intraoral
odontics and oral medicine specialties compared to other images over smart phone messaging application. However,
disciplines. In addition, teledentistry has been successfully the reported reliability was lower for actual diagnosis.28 In
integrated in various dental disciplines around the world Belfast, researchers were able to support teledentistry use
without reported advantage of one specialty over another. as an alternative approach to manage referrals in oral
In endodontics, no statistical difference was reported be- medicine and help treatment prioritization to decrease the
tween interpretations of periapical bone lesions via video- waiting time for appointments.29 Comparing these data
conference or view-box conventional methods.17 Another with the current study, 68.9% of Saudi dentists who had
study assessing images of root canal orifices in endodonti- previously applied teledentistry reported acceptable diag-
cally accessed teeth obtained with an intraoral camera has nosis reliability confirmed by clinical visits (45.5%),
reported 87% of root canal orifices to be correctly marked response to treatment (31.8%), and/or biopsy report
by image observers.18 Other dental specialties have (22.7%) which may justify starting needed treatment. In
benefited from teledentistry such as orthodontics which conclusion, Teledentistry is an important communication
was explored in several studies. A cross-sectional study of method with a significant potential to improve patients’
orthodontic consultants’ attitude in United Kingdom toward dental care. In addition to time and cost effectiveness, it
teleconsultation was conducted.19 In this study, more than has the potential to be implemented in all branches of
50% of participants were confident in offering diagnostic dentistry mainly in oral radiology, endodontics as well as
advice to dental practitioners and their patients from a oral medicine. Therefore, promotion of teledentistry
geographic distance. A study by Moylan et al. reported high application in patient care is advised for both private and
accuracy in assessing linear tooth movement, intercanine government sector particularly in remote areas. In addi-
and intermolar width measurements calculated using tele- tion, national programs are needed to educate the public
dentistry and a software for orthodontic treatment moni- and facilitate implementation.
toring purposes compared to real time.20 Other studies by One limitation of this study is the overall low response
Mandall demonstrated that teledentistry has been used as a rate. Even with reaching out to 300 practicing dentists in
frequent screening tool for patients’ referrals to ortho- Saudi Arabia and following up with frequent reminders,
dontist and reducing inappropriate referral rates.21,22 In only 49% of participants have completed the survey. One
the field of oral surgery, application of teledental systems explanation could be the length of the survey (average
286 S.A. Almazrooa et al
5e12 min to complete) as our records have shown several Arabia: a descriptive cross-sectional study. Saudi Pharmaceut J
attempts to access the survey without responding to all 2017;25:1208e16.
questions. Although this study sample may not represent 13. Schleyer TK, Thyvalikakath TP, Spallek H, Dziabiak MP,
the whole Saudi dental community, it provides a valuable Johnson LA. From information technology to informatics: the
information revolution in dental education. J Dent Educ 2012;
data to better understand the perception toward tele-
76:142e53.
dentistry in this group of dentists. 14. Carter JT. Electronic medical records and quality improve-
ment. Neurosurg Clin 2015;26:245e51 [ix].
15. Silva BM, Rodrigues JJ, de la Torre Diez I, Lopez-Coronado M,
Declaration of Competing Interest Saleem K. Mobile-health: a review of current state in 2015. J
Biomed Inf 2015;56:265e72.
The authors have no conflicts of interest relevant to this 16. Hassinen M, Laitinen P. End-to-end encryption for SMS mes-
article. sages in the health care domain. Stud Health Technol Inf 2005;
116:316e21.
17. Baker WP, Loushine RJ, West LA, Kudryk LV, Zadinsky JR.
Acknowledgements Interpretation of artificial and in vivo periapical bone lesions
comparing conventional viewing versus a video conferencing
system. J Endod 2000;26:39e41.
We Acknowledge the Scientific Endowment, King Abdulaziz
18. Brullmann D, Schmidtmann I, Warzecha K, d’Hoedt B. Recog-
University, Jeddah, Saudi Arabia for funding this study. nition of root canal orifices at a distance - a preliminary study
of teledentistry. J Telemed Telecare 2011;17:154e7.
19. Stephens CD, Cook J. Attitudes of UK consultants to tele-
References
dentistry as a means of providing orthodontic advice to
dental practitioners and their patients. J Orthod 2002;29:
1. Jampani ND, Nutalapati R, Dontula BS, Boyapati R. Applications 137e42.
of teledentistry: a literature review and update. J Int Soc Prev 20. Moylan HB, Carrico CK, Lindauer SJ, Tufekci E. Accuracy of a
Community Dent 2011;1:37e44. smartphone-based orthodontic treatment-monitoring applica-
2. Fricton J, Chen H. Using teledentistry to improve access to tion: a pilot study. Angle Orthod 2019;89:727e33.
dental care for the underserved. Dent Clin North Am 2009;53: 21. Mandall NA, Qureshi U, Harvey L. Teledentistry for screening
537e48. new patient orthodontic referrals. part 2: GDP perception of
3. Dolan B. The American dentists: ethics, technology and edu- the referral system. Br Dent J 2005;199:727e9.
cation for the twenty-first century. J Hist Dent 2009;57:100e8. 22. Mandall NA, O’Brien KD, Brady J, Worthington HV, Harvey L. Tel-
4. Telemedicine market size, share and industry analysis and edentistry for screening new patient orthodontic referrals. Part 1:
regional forcast 2019e2026. Fortune Business Insights. For- a randomised controlled trial. Br Dent J 2005;199:659e62.
tune Business Insights, 2019. 23. Duka M, Mihailovic B, Miladinovic M, Jankovic A, Vujicic B.
5. Khan SA, Omar H. Teledentistry in practice: literature review. Evaluation of telemedicine systems for impacted third molars
Telemed J e Health 2013;19:565e7. diagnosis. Vojnosanit Pregl 2009;66:985e91.
6. Irving M, Stewart R, Spallek H, Blinkhorn A. Using teledentistry 24. Kopycka-Kedzierawski DT, Billings RJ, McConnochie KM. Dental
in clinical practice as an enabler to improve access to clinical screening of preschool children using teledentistry: a feasi-
care: a qualitative systematic review. J Telemed Telecare bility study. Pediatr Dent 2007;29:209e13.
2018;24:129e46. 25. Kopycka-Kedzierawski DT, Billings RJ. Teledentistry in inner-
7. Marino R, Tonmukayakul U, Manton D, Stranieri A, Clarke K. city child-care centres. J Telemed Telecare 2006;12:
Cost-analysis of teledentistry in residential aged care facilities. 176e81.
J Telemed Telecare 2016;22:326e32. 26. AlShaya MS, Assery MK, Pani SC. Reliability of mobile phone
8. Estai M, Bunt SM, Kanagasingam Y, Kruger E, Tennant M. A teledentistry in dental diagnosis and treatment planning in
resource reallocation model for school dental screening: taking mixed dentition. J Telemed Telecare 2020;26:45e52.
advantage of teledentistry in low-risk areas. Int Dent J 2018; 27. Torres-Pereira C, Possebon RS, Simoes A, et al. Email for dis-
68:262e8. tance diagnosis of oral diseases: a preliminary study of tele-
9. Daniel SJ, Kumar S. Teledentistry: a key component in access dentistry. J Telemed Telecare 2008;14:435e8.
to care. J Evid Base Dent Pract 2014;14:201e8. 28. Vinayagamoorthy K, Acharya S, Kumar M, Pentapati KC,
10. Estai M, Kruger E, Tennant M. Perceptions of Australian dental Acharya S. Efficacy of a remote screening model for oral
practitioners about using telemedicine in dental practice. Br potentially malignant disorders using a free messaging appli-
Dent J 2016;220:25e9. cation: a diagnostic test for accuracy study. Aust J Rural
11. Boringi M, Waghray S, Lavanya R, et al. Knowledge and Health 2019;27:170e6.
awareness of teledentistry among dental professionals - a cross 29. Bradley M, Black P, Noble S, Thompson R, Lamey PJ. Applica-
sectional study. J Clin Diagn Res 2015;9:ZC41e4. tion of teledentistry in oral medicine in a community dental
12. AlBaker AA, Al-Ruthia YSH, AlShehri M, Alshuwairikh S. The service, N. Ireland. Br Dent J 2010;209:399e404.
characteristics and distribution of dentist workforce in Saudi
