key: cord-0853244-ilrnj0uy authors: Ghai, Suhani title: Teledentistry during COVID-19 pandemic date: 2020-06-16 journal: Diabetes Metab Syndr DOI: 10.1016/j.dsx.2020.06.029 sha: 4c7e7a0e265c36727a2c0220334326fb5ac804d4 doc_id: 853244 cord_uid: ilrnj0uy BACKGROUND AND AIMS: Dentistry involve close face-to-face interaction with patients, hence during the COVID-19 pandemic, it has mostly been suspended. Teledentistry can offer an innovative solution to resume dental practice during this pandemic. In this review, we provide a brief overview of applications of teledentistry. METHODS: Articles on teledentistry, relevant to this review, were searched and consulted from PubMed, Google Scholar, and Cochrane database. RESULTS: Teledentistry is the remote facilitating of treatment, guidance, and education via the use of information technology instead of direct face-to-face contact with patients. Teleconsultation, telediagnosis, teletriage, and telemonitoring are subunits of teledentistry that have important functions relevant to dental patients. There are many challenges for acceptance of teledentistry by the dentists as well as patients, which need to be addressed urgently. CONCLUSION: Teledentistry can offer a novel solution to resume dental practice during the current pandemic, hence, the need of the hour is to incorporate teledentistry into routine dental practice. If not fully replace, at least teledentistry can complement the existing compromised dental system during the current pandemic. The COVID-19 pandemic has challenged the existing healthcare systems across the globe. As it spreads by droplet, fomite and contact transmission, face-to-face interaction of healthcare professional with the patient carries a risk of its transmission. As dental treatment invariably involves close inspection, examination, diagnostic and therapeutic interventions of the naso-oropharyngeal region, dental professionals are most susceptible to get infected with coronavirus [1] . As a result, during the current pandemic, most routine dental procedures all around the world, have been suspended, and only emergency dental procedures and surgeries are being performed. However, looking at the current increasing trend of COVID-19 cases, it does not appear that this pandemic will end anytime soon. In fact, even the WHO has recently feared that this virus may become just another endemic virus in our communities and may never go away [2] . If these speculations are true and COVID-19 indeed becomes endemic, dental practice will need to reorganize and innovate to continue dental care with minimal risk of cross-infection. Teledentistry can provide an innovative solution to continue dental practice during the current pandemic as well as beyond. Teledentistry (a subunit of telehealth along with telemedicine) is the remote facilitating of dental care, guidance, education or treatment via the use of information technology rather than through direct face-to-face contact with any patient [3] . Teledentistry is not a new concept and one of the earliest teledentistry projects was started by US military in 1994 to serve the troops all around the world [4] . Over the years teledentistry has proved to be beneficial for remote dental screening, making diagnosis, providing consultation, and proposing treatment plan. It is found to be comparable to real-time consultations in areas with limited access to facilities, in school children, and in long-term healthcare facilities [5, 6] . In today's circumstances of ongoing COVID-19 pandemic, with increasing likelihood of it becoming endemic, the main aim is to avoid person-to-person contact. The word 'tele' means 'distant', and therefore teledentistry satisfies the need for social distancing as has been advocated by the authorities all over the globe to contain the spread of SARS-COV-2. Teledentistry can be incorporated into routine dental practice as it offers a wide range of applications such as remote triaging of the suspected COVID-19 patients for dental treatment and decreasing the unnecessary exposure of healthy or uninfected patients by decreasing their visits to already burdened dental offices and hospitals. Teledentistry can be subdivided into various units: The most common form of teledentistry is teleconsultation in which patients or local healthcare provider seeks consultation from dental specialists using telecommunication [7] . It has been valuable for the consultation of patients who are physically and intellectually challenged, and patients from aged care facilities and prisons [8] [9] [10] .Teleconsultation has beenshown to reduce the number of referrals from primary health centers to higher centers by >45% [11] . In the current COVID-19 pandemic it may aid the patients in continuing their therapy during quarantine and lockdown. Telediagnosis makes use of technology to exchange images and data to make a diagnosis of an oral lesion [12, 13] . With the use of a telediagnosis program EstomatoNet, patient referral to specialists reduced from 96.9% to 35.1% [14] .While the use of smartphones for detection of dental caries is well advocated [15, 16] ; it has also served as a reliable adjunct for screening of oral potentially malignant lesions [17] . An addition to telediagnosis is telecytology, a system for early detection of oral potentially malignant or malignant lesions [18] . Haron [20] . During the current COVID-19 pandemic investigators from Brazil recently illustrated the use of WhatsApp and telemedicine in making a differential diagnosis of oral lesions [21] . As most of the oral lesion are often directly evident telediagnosis can be made by dental photography thus reducing the need of close clinical examination [22] . Teletriage involves the safe, appropriate and timely disposition of patient symptoms via smartphone by specialists. It has been used for remote assessment of school children and prioritize those requiring dental care without unnecessary travel regardless of socioeconomic and geographical difficulties in many places [23, 24] . Brucoli et al suggested use of teleradiology as a useful tool in triaging of maxillofacial trauma patients from peripheral centers to their main trauma center [25] . Monitoring of dental patients require frequent visits of patients to their dentist to monitor the progress of treatment. The use of telemonitoring can replace the frequent physical visits by virtual visits for regular monitoring of treatment outcomes and disease progression [7] . In a recent pilot study during this pandemic, telemonitoring appeared to be a promising tool in the remote monitoring of surgicaland non-surgical dental patients, especially reducing costs and waiting times [26] . The lack of acceptance of teledentistry by the dentists can be attributed to the fact that they may find it complex and maybe resistant to new skills [27, 28] . They may be technologically challenged, be afraid of making an inaccurate diagnosis, and concerned about increased costs and expenses.There may be constraints related to infrastructure, such as, poor internet access, shortage of hardware, lack of training, lack of technical support and expertise. Organizational incompatibility of teledentistry with the healthcare system, insufficient financial reimbursement, inadequate guidelines, incoordination between remote and core center, and high cost of setup are other challenges in its acceptance by dentists [28] .Two-dimensional representation of lesions and inability to perform tests like palpation and auscultation are other limitations [3] . To overcome these challenges, dentists must be trained adequately and educated about this technology, which will increase the acceptance of teledentistry. During the current pandemic, the dental school curriculum not only needs to be updated regarding infection control measures [29] , teledentistry should also be routinely taught as a solution for prevention of infection transmission. In addition, adequate funding, payment and authenticating teledentistry within the healthcare systems will be required. Patient acceptance is the key to success of any module. Lack of face-to-face communication may lead to apprehension of patients of inadequacy of proper communication of their problems to their dentists. These challenges will take time to overcome. Acceptability of teledentistry by the patients will increase in parallel with the acceptability of telemedicine in general, which is increasing day-by-day. Many surveys have found that teledentistry is gradually gaining acceptance by patients as well as healthcare providers [30, 31] . Dentistry forms an important part of our healthcare system, which has become severely compromised during the current pandemic of COVID-19. The need of the hour is to incorporate teledentistry into routine dental practice. If not fully replace, at least teledentistry can complement the existing compromised dental system during the current pandemic. 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A Descriptive Pilot Study Telehealth for global emergencies: Implications for coronavirus disease 2019 (COVID-19) Challenges in the uptake of telemedicine in dentistry Are dental schools adequately preparing dental students to face outbreaks of infectious diseases such as COVID-19? End-user acceptance of a cloud-based teledentistry system and Android phone app for remote screening for oral diseases Author has no Conflict of Interest Author has no Conflict of Interest Author has not received any funding