Diagnostic accuracy of detecting caries and other intraoral findings using parent-obtained smartphone photographs in teledentistry.

BACKGROUND

The authors evaluated whether parent-obtained smartphone photographs can accurately assess frank caries and other intraoral findings compared with point-of-care clinical examination findings.

METHODS

Children's parents submitted intraoral photographs for a teledentistry consultation before dental rehabilitation in the operating room. Two calibrated dentists recorded hard- and soft-tissue findings from the photographs. These findings were compared with clinical findings recorded in the operating room. Sensitivity, specificity, likelihood ratios, prevalence, accuracy, and positive and negative predictive values were calculated for occlusal, frontal, and combined views. Fagan nomogram was used to predict caries risk graphically.

RESULTS

Of 138 patients, 70% were in primary dentition and 30% were in mixed dentition. All photographic views had high specificity for detecting caries (range, 97.1%-100.0%). Except for the mandibular anterior dentition, which had a sensitivity of 67.2% (95% CI, 53.5% to 79.0%), when all photographic views were combined, the maxillary occlusal and frontal images together showed high sensitivity of 94.8% through 99.1% in detecting caries in the primary dentition. Similar trends were observed for the mixed dentition. Combined photographs had an accuracy of 94.1% through 100.0%, with the positive likelihood ratio exceeding 33.3 for all photographs and sextants. Positive likelihood ratio ranged from 44.5 through 132.7 for detecting caries in primary dentition. Low sensitivity was found for detecting demineralization and soft-tissue findings.

CONCLUSIONS

Parents can reliably obtain accurate and clinically meaningful intraoral photographs using a smartphone when following a written photograph guide.

PRACTICAL IMPLICATIONS: Parent-obtained smartphone photographs can provide accurate and clinically meaningful detection of frank caries in the primary and mixed dentitions.