EFFECTIVENESS of TELEDENTISTRY VERSUS in-PERSON EXAMINATION on DENTAL CARIES EVALUATION. a SYSTEMATIC REVIEW and META ANALYSIS

Objectives: To determine the effectiveness of teledentistry versus in-person examination for dental caries diagnosis (PROSPERO # CRD42023410962).
Methods: This is a systematic review and meta-analysis study comparing the effectiveness of teledentistry versus in-person examination for dental caries diagnosis. The eligibility criteria were peer-reviewed studies published in English between January 2013 through December 2021 that reported diagnostic parameters (specificity and sensitivity) for caries detection in primary and permanent dentition. Articles were extracted using search strategies from PubMed and CINAHL databases and screened using PRISMA guidelines, following a review for quality assessment using the JBI Critical Appraisal Checklists. Meta-analysis was conducted in R using the mada package. A descriptive analysis of the sensitivity, specificity, DOR, and confidence intervals was performed with respective forest plots. Heterogeneity was assessed using Cochrane Q and Higgin’s I² tests. Univariate measures of diagnostic accuracy were performed based on the DerSimonian-Laird random effect, and the summary diagnostic odds ratio reported.
Results: Twelve studies met the inclusion criteria and were reviewed and meta-analyzed. The range of diagnostic parameters were sensitivity (45.6-88.3%), specificity (55.2-98.3%), PPV (79-92%), NPV (48-97%), accuracy (70-96%), and kappa (0.46-0.89) in teledentistry modalities. Test for equality of sensitivities and specificities were significant (p-value = <2e-16). The studies were not heterogenous with Cochran's Q: 14.502 (p = 0.206) and Higgins' I² of 24%. The multivariable analysis of the univariate measures showed a diagnostic odds ratio based on DerSimonian-Laird random effect was 35.14. This implies that the odds of caries detection via teledentistry is 35 times more true positive than false positive.
Conclusions: Diagnosis of caries via teledentistry is effective and comparable to in-person diagnosis. Remote assessments are consistent in diagnostic accuracy for caries.