Comparison of the Accuracy of Non-Clinical Dental Examination Using Mobile Phone Photography and Clinical Examination in Assessing DMFT Index and Occlusion
Document Type : Original Articles
Authors
1 Dentist, School of Dentistry, Department of Oral Medicine, Isf.c, Islamic Azad University, Isfahan, Iran
2 Assistant Professor, Department of Oral Diseases, School of Dentistry, Isf.c, Islamic Azad University, Isfahan, Iran
3 Assistant Professor, Department of Community Dentistry, School of Dentistry, Isf.c, Islamic Azad University, Isfahan, Iran
4 Postgraduate Student, Department of Operative Dentistry, Isf.c, Islamic Azad University, Isfahan, Iran
10.22122/jids.2025.45364.1009
Abstract
Introduction: This study aimed to compare the accuracy of non-clinical dental examination using mobile phone photography and in-person clinical examination in determining the DMFT index and assessing occlusion.
Materials and Methods: In this experimental in vitro study, 39 individuals with dental caries or restorations, as determined by the DMFT index, were selected. Intraoral photographs of each participant were first taken using a smartphone and evaluated by a dentist. Subsequently, the same individuals underwent direct clinical examination. In both methods, the DMFT index and occlusion status—including dental class, crowding, bite type, and crossbite—were assessed. Data were analyzed using a paired t-test and Bowker's McNemar test.
Results: The mean DMFT index was significantly higher in the clinical examination compared to the non-clinical evaluation (P = 0.003). The greatest differences were related to decayed teeth, followed by filled teeth, while missing teeth showed minimal differences. In the assessment of occlusion status, no significant difference was observed between the two methods (P > 0.05).
Conclusion: Non-clinical examination using smartphone photography appears to be a reliable method for evaluating certain oral health parameters, such as occlusal status and missing teeth. However, it has lower accuracy in detecting caries and restorations, particularly in early or secondary cases. Therefore, teledentistry is recommended as a complementary tool for initial screening, while in-person clinical examination remains essential for definitive diagnoses.
Materials and Methods: In this experimental in vitro study, 39 individuals with dental caries or restorations, as determined by the DMFT index, were selected. Intraoral photographs of each participant were first taken using a smartphone and evaluated by a dentist. Subsequently, the same individuals underwent direct clinical examination. In both methods, the DMFT index and occlusion status—including dental class, crowding, bite type, and crossbite—were assessed. Data were analyzed using a paired t-test and Bowker's McNemar test.
Results: The mean DMFT index was significantly higher in the clinical examination compared to the non-clinical evaluation (P = 0.003). The greatest differences were related to decayed teeth, followed by filled teeth, while missing teeth showed minimal differences. In the assessment of occlusion status, no significant difference was observed between the two methods (P > 0.05).
Conclusion: Non-clinical examination using smartphone photography appears to be a reliable method for evaluating certain oral health parameters, such as occlusal status and missing teeth. However, it has lower accuracy in detecting caries and restorations, particularly in early or secondary cases. Therefore, teledentistry is recommended as a complementary tool for initial screening, while in-person clinical examination remains essential for definitive diagnoses.
Keywords
- Petersen PE. The World Oral Health Report 2003: continuous improvement of oral health in the 21st Community Dent Oral Epidemiol 2003; 31(Suppl 1): 3–23.
- Graber LW, Vig KWL, Vanarsdall RL, Huang GJ. Orthodontics: current principles and techniques. 6th ed. Mosby: St. Louis; 2016.
- Proffit WR, Fields HW, Larson BE, Sarver DM. Contemporary Orthodontics. 6th ed. Philadelphia: Elsevier; 2019.
- Fejerskov O, Kidd EAM. Dental caries: the disease and its clinical management. 2nd ed. Oxford: Blackwell Munksgaard; 2008.
- World Health Organization. Oral health surveys: basic methods. 5th ed. Geneva: WHO Press; 2013.
- Pitts NB, Baez RJ, Diaz-Guallory C, Donly KJ, Feldens CA, McGrath C, et al. Early childhood caries: IAPD Bangkok declaration. J Dent Child (Chic) 2019; 86(2): 72.
- Daniel SJ, Kumar S. Teledentistry: a key component in access to care. J Evid Based Dent Pract 2014; 14(Suppl): 201–8.
- Estai M, Kruger E, Tennant M, Bunt S. Challenges in the uptake of telemedicine in dentistry. Rural Remote Health 2016; 16(4): 3915.
- Hosseininejad F, Rashidi Meybod F, Mahabadi M, Emamzadeh K. The knowledge and attitude of general dentists regarding teledentistry, Isfahan 2022. Contemporary Orofacial Sciences 2023; 1(3): 14-9.
- Dela Cruz GG, Chi DL, Koerber A. Tele-dentistry for caries detection and management. Dent Clin North Am 2020; 64(3): 509–18.
- Moynihan P, et al. Tele-dentistry applications in oral health: Evidence and future directions. Community Dent Oral Epidemiol. 2022; 50(1): 1–9.
- Subbalekshmi TP, Anandan V, Ramesh A. Validity of mobile phone photographic method in screening for dental caries. Indian J Public Health Res Dev. 2017;8(2):203–7.
- Ghai S. Teledentistry during COVID-19 pandemic. Diabetes Metab Syndr 2020; 14(5): 933–5.
- Bissessur D, Naidoo S, Smit D. The reliability of teledentistry in caries diagnosis using photographic images. SADJ. 2021;76(1):23–27.
- AlShaya MS, Assery MK, Pani SC. Reliability of mobile phone teledentistry in dental diagnosis and treatment planning in mixed dentition. J Telemed Telecare 2020; 26(1-2): 45–52.
- Lima M, Ribeiro CC, Mello-Moura ACV, et al. Use of smartphone for telediagnosis in oral health: a systematic review. J Telemed Telecare 2021; 27(10): 641–50
- Lima CP, Mendes SR, Dufour T, Nielsen B. Comparison of the reliability and accuracy of mobile photography in remote dentistry with in-person examination in diagnosing dental caries in school children. BMC Oral Health. 2025; 25: 58.
- Mendes SR, Alves LG, Souza NL, Lima CP. Comparison of mobile photography with in-person examination in evaluating anterior composite restorations. J Dent Res 2022; 101(9): 1025–31.
- Dufour T, Tran K, Samawi H, et al. Diagnostic accuracy of intraoral mobile photography for oral health screening in children: A pilot study. Res Dent Sci. 2023.
- Steinmeier S, Wiedemeier D, Hämmerle CHF, Mühlemann S. Accuracy of remote diagnoses using intraoral scans captured in approximate true color: a pilot and validation study in teledentistry. BMC Oral Health 2020; 20(1): 266.
- Bissessur S, Naidoo S. A comparative analysis of traditional dental screening versus teledentistry screening. S Afr Dent J 2019; 74(1): 19–23.
- Subbalekshmi T, Anandan V, Apathsakayan R. Use of a teledentistry-based program for screening of early childhood caries in a school setting. Cureus 2017; 9(7): e1416.
- Estai M, Kanagasingam Y, Xiao D, Vignarajan J, Huang B, Kruger E, Tennant M. A proof-of-concept evaluation of a cloud-based store-and-forward telemedicine app for screening for oral diseases. J Telemed Telecare 2016; 22(6): 319-25.
- Mehdipoor A, Karimi A, Vahedian M, Eshagh Hosseini S, Hossein Zadeh H. Diagnostic value of tele-dentistry in decay detection by DMFT method [in Persian]. Qom Univ Med Sci J 2021; 15(1): 58–65.
- Kopycka-Kedzierawski DT, Billings RJ, McConnochie KM. Dental screening of preschool children using teledentistry: a feasibility study. Pediatr Dent 2007; 29(3): 209–13.
- Pentapati KC, Mishra P, Damania M, Narayanan S, Sachdeva G, Bhalla G. Reliability of intra-oral camera using teledentistry in screening of oral diseases - pilot study. Saudi Dent J 2017; 29(2): 74–7.
- Kohara EK, Abdala CG, Novaes TF, Braga MM, Haddad AE, Mendes FM. Is it feasible to use smartphone images to perform telediagnosis of different stages of occlusal caries lesions? PLoS One 2018; 13(9): e0202116.
- Saccomanno S, Quinzi V, Sarhan S, Laganà D, Marzo G. Perspectives of tele-orthodontics in the COVID-19 emergency and as a future tool in daily practice. Eur J Paediatr Dent 2020; 21(2): 157-62.
- Qari AH, Hadi M, Alaidarous A, Aboalreesh A, Alqahtani M, Bamaga IK, Patel J, Estai M. The accuracy of asynchronous tele-screening for detecting dental caries in patient-captured mobile photos: A pilot study. Saudi Dent J 2024; 36(1): 105-11.
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