title: Accuracy of Teledentistry for Diagnosing Dental Pathology Using Direct Examination as a Gold Standard: Results of the Tel-e-dent Study of Older Adults Living in Nursing Homes.
abstract: OBJECTIVE
  Dental neglect and high levels of unmet dental needs are becoming increasingly prevalent among elderly residents of long-term care facilities, although frail, elderly, and dependent populations are the most in need of professional dental care. Little is known about the validity of teledentistry for diagnosing dental pathology in nursing home residents.
  
  
  OBJECTIVE
  To evaluate the accuracy of teledentistry for diagnosing dental pathology, assessing the rehabilitation status of dental prostheses, and evaluating the chewing ability of older adults living in nursing homes (using direct examination as a gold standard).
  
  
  METHODS
  Multicenter diagnostic accuracy study performed in France and Germany.
  
  
  METHODS
  Eight nursing homes in France and Germany.
  
  
  METHODS
  Nursing home residents with oral or dental complaints, self-reported or reported by caregivers, willing to receive oral or dental preventive care. In total, 235 patients were examined. The mean age was 84.4 ± 8.3 years, and 59.1% of the subjects were female.
  
  
  METHODS
  The patients were examined twice. Each patient was his or her own control. First, the dental surgeon established a diagnosis by reviewing a video recorded in the nursing home and accessed remotely. Second, within a maximum of 7 days, patients were examined conventionally (face-to-face) by the same surgeon who established the initial diagnosis.
  
  
  METHODS
  All residents received a comprehensive clinical examination in their home by a trained geriatrician and underwent a dental hygiene evaluation that used the Silness-Loe and Greene-Vermillion dental hygiene assessment indices. The diagnoses established via the video recording and in the face-to-face setting were compared. The main outcome measure was number of dental pathologies.
  
  
  RESULTS
  In total, 128 (55.4%) patients had a dental pathology. The sensitivity of teledentistry for diagnosing dental pathology was 93.8% (95% confidence interval [CI] 90.7-96.9), and the specificity was 94.2% (95% CI 91.2-97.2). Among the 128 cases of dental pathology identified by teledentistry, 6 (4.8%) were false positives. The teledentistry assessments were quicker than the face-to-to-face examinations (12 and 20 minutes, respectively).
  
  
  CONCLUSIONS
  Teledentistry showed excellent accuracy for diagnosing dental pathology in older adults living in nursing homes; its use may allow more regular checkups to be carried out by dental professionals.
authors.affiliation: ENT, Head and Neck Surgery Department, Guéret Hospital, Guéret, France.
authors.forename: Alain
authors.initials: A
authors.lastname: Queyroux
authors.affiliation: Odontology-Dental Medicine Department, Guéret Hospital, Guéret, France.
authors.forename: Bernard
authors.initials: B
authors.lastname: Saricassapian
authors.affiliation: Dental Care Clinic, Kassel District, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Herzog
authors.affiliation: Department of Health, Kassel District, Germany.
authors.forename: Karin
authors.initials: K
authors.lastname: Müller
authors.affiliation: CHU Limoges, Accompagnement de la Recherche Clinique Hospitalière (ARCH); INSERM U1435 Centre Investigation Clinique (CIC), Limoges, France.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Herafa
authors.affiliation: CHU Limoges, Accompagnement de la Recherche Clinique Hospitalière (ARCH); INSERM U1435 Centre Investigation Clinique (CIC), Limoges, France.
authors.forename: Dorothée
authors.initials: D
authors.lastname: Ducoux
authors.affiliation: Université de Limoges, INSERM, CHU, UMR_S 1094, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, 87000 Limoges, France; CHU Limoges, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France.
authors.forename: Benoît
authors.initials: B
authors.lastname: Marin
authors.affiliation: Université de Limoges, CHU Limoges; EA 6310 HAVAE (Handicap Activité Vieillissement Autonomie et Environnement), IFR 145 GEIST; 87000 Limoges, France; CHU Limoges, Pôle Clinique Médicale et Gérontologie Clinique, Service de Médecine Interne Gériatrique, Limoges, France.
authors.forename: Thierry
authors.initials: T
authors.lastname: Dantoine
authors.affiliation: Université de Limoges, INSERM, CHU, UMR_S 1094, Institut d'Epidémiologie Neurologique et de Neurologie Tropicale, CNRS FR 3503 GEIST, 87000 Limoges, France; CHU Limoges, Centre d'Epidémiologie de Biostatistique et de Méthodologie de la Recherche, Limoges, France.
authors.forename: Pierre-Marie
authors.initials: PM
authors.lastname: Preux
authors.affiliation: Université de Limoges, CHU Limoges; EA 6310 HAVAE (Handicap Activité Vieillissement Autonomie et Environnement), IFR 145 GEIST; 87000 Limoges, France; CHU Limoges, Pôle Clinique Médicale et Gérontologie Clinique, Service de Médecine Interne Gériatrique, Limoges, France. Electronic address: Achille.tchalla@unilim.fr.
authors.forename: Achille
authors.initials: A
authors.lastname: Tchalla
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D003729:Dental Care; D003945:Diagnosis, Oral; D005260:Female; D005602:France; D005858:Germany; D006801:Humans; D008297:Male; D009735:Nursing Homes; D009909:Oral Health; D009910:Oral Hygiene; D017216:Telemedicine
keywords: Validity; nursing home; older adults; oral health; teledentistry