title: A proof-of-concept evaluation of a cloud-based store-and-forward telemedicine app for screening for oral diseases.
abstract: OBJECTIVE
  It is widely considered that telemedicine can make positive contributions to dental practice. This study aimed to evaluate a cloud-based telemedicine application for screening for oral diseases.
  
  
  METHODS
  A telemedicine system, based on a store-and-forward method, was developed to work as a platform for data storage. An Android application was developed to facilitate entering demographic details and capturing oral photos. As a proof-of-concept, six volunteers were enrolled in a trial to obtain oral images using smartphone cameras. Following an onsite oral examination, images of participants' teeth were obtained by a trained dental assistant. Oral images were directly uploaded from the smartphone to a cloud-based server via broadband network. The assessments of oral images by offsite dentists were compared with those carried out via face-to-face oral examinations.
  
  
  RESULTS
  A complete set of 30 oral images was obtained from all six participants. Out of 192 teeth reviewed, the proportion of ungradable teeth was 8%. Sensitivity and specificity of teledental screening were 57% and 100% respectively. The inter-grader agreement estimated for two examination modalities and between two teledental graders was 70% and 62% respectively. Findings indicate that the proposed system for screening of oral diseases can be implemented to provide a valid and reliable alternative to traditional oral screening.
  
  
  CONCLUSIONS
  This study provided evidence that a robust system for store-and-forward screening for dental problems can be developed, and leads to the need for further testing of its robustness to confirm the accuracy and reliability of the teledentistry system.
authors.affiliation: International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Australia.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Estai
authors.affiliation: Australian e-Health Research Centre, CSIRO, Australia.
authors.forename: Yogesan
authors.initials: Y
authors.lastname: Kanagasingam
authors.affiliation: Australian e-Health Research Centre, CSIRO, Australia.
authors.forename: Di
authors.initials: D
authors.lastname: Xiao
authors.affiliation: Australian e-Health Research Centre, CSIRO, Australia.
authors.forename: Janardhan
authors.initials: J
authors.lastname: Vignarajan
authors.affiliation: School of Dentistry and Health Sciences, Charles Sturt University, Australia.
authors.forename: Boyan
authors.initials: B
authors.lastname: Huang
authors.affiliation: International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Australia estie.kruger@uwa.edu.au.
authors.forename: Estie
authors.initials: E
authors.lastname: Kruger
authors.affiliation: International Research Collaborative, Oral Health and Equity, Department of Anatomy, Physiology and Human Biology, University of Western Australia, Australia.
authors.forename: Marc
authors.initials: M
authors.lastname: Tennant
mesh_terms: D000328:Adult; D000067917:Cloud Computing; D003726:Dental Assistants; D003731:Dental Caries / Q000175:diagnosis*; D003770:Dental Offices; D003815:Dentists; D005260:Female; D006801:Humans; D020407:Internet; D008297:Male; D008875:Middle Aged; D009059:Mouth Diseases / Q000175:diagnosis; D010781:Photography; D012680:Sensitivity and Specificity; D000068997:Smartphone; D012984:Software; D017216:Telemedicine / Q000379:methods*; D014904:Western Australia; D055815:Young Adult
keywords: Telemedicine; caries; cloud; dental; digital imaging; remote; smartphone; teledentistry