The feasibility of a digital health approach to facilitate remote dental screening among preschool children during COVID-19 and social restrictions

Abstract

Background: Tele-dentistry can be useful to facilitate screening of children, especially those living in rural and remote communities, and during the COVID-19 pandemic.

Aim: This study evaluated the feasibility of tele-dental screening for the identification of early childhood caries (ECC) in preschoolers using an app operated by their parents with remote review by oral-health therapists.

Design: This cross-sectional study was a sub-project nested in ORIGINS Project, a longitudinal birth cohort study in Western Australia. Initially, children were visually examined by a paediatric dentist (gold standard). Subsequently, dental photographs were taken by parents using a smartphone camera. Two trained oral health professionals asynchronously evaluated dental photographs. The presence of dental caries was recorded as per the International Caries Detection and Assessment System-II classification. The diagnostic accuracy and reliability of the tele-dental screening and the gold standard dental examinations were then compared.

Results: Forty-two children aged <4 years were enrolled in the study. Twenty-five per cent of examined children had dental caries (mean dmfs = 0.7). A total of 370 dental photographs were obtained. Parents were able to take good-quality photographs, with 90% of photographs rated as good to fair quality. Tele-dental screening demonstrated high specificity (>=95.5%) for both reviewers compared to the gold standard dental examination. However, the sensitivity scores for the two reviewers varied, ranging from 44% to 88.4%.

Conclusion: Tele-dental screening for ECC was shown to be a feasible approach following a brief training for primary caregivers. This approach can offer a potential low-cost and sustainable alternative for visual dental examinations for young children, particularly in times of COVID-19-related restrictions.

Keywords: ORIGINS; dental photography; early childhood caries; early diagnosis; mHealth; paediatric screening.