Performance of Distant Diagnosis of Dental Caries by Teledentistry in Juvenile Offenders

Background: Telehealth has been considered a practical and potentially cost-effective method of providing healthcare to the underprivileged population. The aim of this study was to determine whether a teledentistry system is a valid tool to screen for the presence of dental caries in a cohort of 102 Brazilian juvenile offenders. Materials and Methods: Clinical examinations were performed to evaluate the decayed, missing, and filled teeth (DMFT) index and oral conditions of each adolescent, documented using a digital camera. For distant diagnosis, two methods of image transmission were tested. In the first, images were uploaded on a file-sharing service, and the link was sent via e-mail to one distant consultant. The other consultant received the images recorded on a compact disc. Both assessed the files and calculated the DMFT index for each case. The degree of agreement between the traditional examination and distant consultant assessments was measured by the kappa coefficient of agreement. Sensitivity and specificity were also calculated. Results: According to the traditional clinical examination, 93.1% of the adolescents had at least one instance of dental caries with a mean DMFT index of 5.9. Kappa statistics ranged from strong'' to almost perfect.'' Sensitivity ranged from 48% to 73%, and specificity was either 97% or 98%. Conclusions: Adolescent inmates could benefit from oral health screening using digital photography. Teledentistry appears to be a reliable alternative to the traditional oral examination for dental caries assessment.