Teledentistry can be used to enhance access to dental care by reducing treatment and travel costs. It can also improve the quality of dental care by sharing patient information remotely with dental specialists and getting their advice in diagnosis and treatment planning. This systematic review is aimed to assess the diagnostic accuracy of teledentistry compared to the standard visual inspection for dental caries among children and adolescents. We developed search strategies for different databases (PubMed, CINAHL, Dentistry and oral sciences source) using MeSH terms and keywords. Two reviewers independently screened and extracted the studies against the eligibility criteria. The quality assessment for diagnostic accuracy studies-2 tool was used to assess the risk of bias of the included studies. In case of any disagreement, the third reviewer was consulted. We included seven studies that met the inclusion criteria. six studies reported on validity and one study reported on the feasibility of teledentistry in diagnosing dental caries. The pooled sensitivity of teledentistry, when compared to visual examination was 82% (95% CI: 81-84%), and specificity was 90% (95% CI: 89-92). In one study from Australia, it was reported that the total estimated cost for teledentistry and visual examination was 50 million dollars and 135 million dollars, respectively. According to the study findings, teledentistry was 2.7 times less expensive than the visual examination method. Based on the limited findings, it is concluded that teledentistry has the potential for diagnosing dental caries in children and adolecents, but further studies in varying contexts are needed to ascertain its benefits especially in low- and middle- income countries.

Search strategy and study selection

We developed search strategies for different databases (PubMed, CINAHL, Dentistry and oral sciences source) using medical subheading (MESH) terms and keywords. The references of the systematic reviews and other identified articles were also searched manually to find any relevant article that might have been missed in the database search. To manage the records of the studies imported from the electronic databases, a citation management system (Endnote X9 software) was used. The studies were later imported into Covidence (a web-based systematic review program) for screening. After the de-duplication of studies in Covidence, two reviewers (YA and MKR) carried out the title and abstract screening to identify relevant studies. The same reviewers carried out the full-text screening of the screened studies against the eligibility criteria for final inclusion of studies for data extraction. Two reviewers carried out the whole screening process, and any disagreement between the two reviewers was resolved by discussion. A third reviewer (JKD) was consulted for a final decision in case of any disagreement. We followed the Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines.

Data extraction

We used double data extraction whereby two reviewers (YA and MKR) independently extracted data from the included studies on a designed data extraction form on Microsoft Excel. Discrepancies were resolved through discussion. The data extraction sheet included information about the study (first author, year of publication, journal, study title, country, income region of the country according to the world bank, aim of the study, study design, study setting, sample size, the participants (age range), the index test, the reference standard, the results (sensitivity and specificity), study limitations, funding source of the study, conflict of interest, and the comments by the reviewer).