Teledentistry Beyond the Screen: Intraoral Scanners and the Future of Diagnosis

In contrast to general medicine, teledentistry has not been organically adopted in many countries, with only a few exceptions. Barriers include lack of rationale, political restrictions, and limited access to appropriate technologies. A key factor underlying skepticism is that radiographs remain the gold standard for diagnosing most oral diseases, while alternative tools such as cell phone images, intraoral cameras, or endoscopes capture only small sections of the oral cavity and cannot substitute for essential clinical tests like tooth percussion or pulp vitality⁸. Emerging technologies, such as intraoral scanners, may help address these diagnostic challenges¹. Teledentistry has demonstrated potential to increase access to care, particularly in remote consultations and pediatric emergency care, where visual examinations can support caries detection¹,⁸. However, insufficient regulation creates legal and ethical risks. Dentists providing online consultations—whether to colleagues or patients—must clarify that the interaction occurs via teledentistry and obtain explicit, digitally signed consent to mitigate malpractice risks⁹. Among older adults, photographic documentation supports monitoring of oral care, while intraoral scanners provide three-dimensional visualization to enhance diagnostic accuracy². Steinnmeier et al. (2020) further validated this concept by demonstrating high concordance between remote intraoral scans and clinical examinations, supporting teledentistry use¹⁰. Clinical examinations in nursing homes highlight the feasibility of applying teledentistry outside traditional dental units, though risks remain due to poor lighting, lack of suction, and reflections on wet tooth surfaces². Integration with nursing staff or geriatric physicians may enhance early diagnosis and promote medical–dental collaboration, with the understanding that radiology remains indispensable as the diagnostic gold standard². To partially bridge this gap, intraoral cameras and smartphones have been explored as surrogates for radiographs. While realistic in their depiction of oral structures, they are constrained by two-dimensionality and recording perspective². In pediatric dentistry, teledentistry facilitates interdisciplinary collaboration between pediatricians and dentists, enhancing treatment planning and holistic care. With appropriate training, pediatricians can reliably evaluate oral health, contribute to triage and referral, and coordinate care, while dentists provide more detailed diagnostic expertise¹⁵. This integration holds promise for reducing waiting lists, improving outcomes for vulnerable children, and preventing progression of oral disease². In one study, intraoral scanners showed high accuracy for detecting missing teeth and restorations¹. Similarly, incorporating dental data into electronic health records (EHRs) can equip family physicians with a more comprehensive view of patient health, supporting continuity of care and interdisciplinary management⁵. Artificial intelligence (AI) further strengthens teledentistry by enabling automated image analysis, disease modeling, and personalized treatment recommendations. AI-powered chatbots and virtual assistants also facilitate patient education and engagement³. Caries, periodontal diseases, and lesions can be detected with higher precision in remote contexts, and AI-integrated scanning software has improved data analysis, diagnosis, and patient management efficiency³⁴. Photogrammetry represents another cost-effective solution, capable of capturing accurate dental geometries and facilitating workflows in low-resource environments, with accuracy comparable to digital scanners⁶. The COVID-19 pandemic accelerated adoption, particularly among oral surgeons, where teledentistry enabled remote guidance of surgical procedures. Its use has also expanded in geriatric populations due to cost-effectiveness and convenience⁷. As in traditional clinics, explicit informed consent is essential before sharing patient information with remote practitioners⁷. Current practice includes four modalities: 1. Store-and-forward consultations (asynchronous) 2. Synchronous real-time consultations 3. Remote patient monitoring 4. Mobile health (mHealth) services leveraging portable devices for monitoring and promoting oral health⁸. Future directions for teledentistry include integration with medical specialties, enhanced interdisciplinary workflows, and widespread adoption of advanced digital tools. However, a critical question remains: while intraoral scanners and complementary technologies hold promise, are they sufficient to overcome current diagnostic barriers, or will entirely new modalities be required to achieve the level of accuracy and reliability offered by radiographs?

References

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