Dental Hygienists' and Dentists' Clinical and Teledentistry Screenings for Dental Caries in Urban School Chldren

Dental caries is an infectious disease that affects people of all ages. Young children often suffer with pain due to carious lesions in primary and permanent teeth and are frequently absent from school. Dental caries is also associated with reduced growth in children. For many children in the United States, access to dental care has been challenging whether in rural or urban areas. Prevention, early detection, and treatment can alleviate the consequences of diseases.;The Department of Dental Hygiene at the University of Tennessee Health Science Center in Memphis has operated an Urban Smiles dental program for school children in Memphis since 2004. Prior to delivery of preventive services, children are screened by a licensed dentist, and then preventive and educational services are provided by dental hygiene students under the supervision of licensed dental hygienists. Providing greater access to preventive services such as dental sealants and fluoride varnish could be accomplished if teledentistry screening for dental caries were implemented.;This study was undertaken to determine whether or not there was a difference in dental hygienists' and dentists' screening for dental caries with either clinical or teledentistry methods. A convenience sample of 82 children 4-7 years of age was selected for the study. Of the 82 participants, 78 met inclusion criteria. There were four examiners in the study: two clinical examiners (i.e., dental hygienist and dentist) and two teledentistry examiners (i.e., dental hygienist and dentist). The UTHSC Investigative Review Board for use of human subjects provided approval for the study. Consent was obtained for participants and examiners.;Participants received an oral screening from the clinical examiners, a first visit from the dentist, and a second visit from the dental hygienist. Findings were charted on separate forms for each screening. Photographic images were obtained on all children to capture occlusal surfaces of posterior teeth and facial aspects of anterior teeth with the teeth occluded. Cheek retractors and intraoral mirrors were used to see the surfaces to be photographed. Photographic images were screened by the two teledentistry examiners. Carious lesions and restorations were charted separately. Charts from all four examiners were scored for decayed and filled surfaces (DFS).;Sixty-three percent of participants were female, 72% of were African American, and 23% were Hispanic. By age, 41% of participants were 7 years old, 24% were 5 years old, 17% were 4 years old, and 18% were 6 years old. More 5-year-olds were girls (n = 15), and more 6-year-olds were boys (n = 10). Ethnicity was not significantly related to gender; however, ethnicity was significantly related to age: More younger children were Hispanic, and more older children were African American.;At least one permanent molar was present in 63% of the participants. African American participants were more likely to have a first molar than were Hispanic participants (p < .05). The relationship between a first permanent molar and caries was marginally significant ( p = .098). Children with a greater number of carious lesions had poor oral hygiene status (p < .05). Oral hygiene status and presence of a first permanent molar were also significant (p < .05). Although age was related to presence of a first molar, age was not related to caries status. A greater proportion of participants who were 5 years old had excellent oral hygiene than did participants of other ages (p < .05).;Among the examiners, the teledentistry dentist recorded the highest number of caries or restorations, which resulted in the highest DFS scores. Spearman's correlation between the two clinical examiners was .99. Spearman's correlations in other group relationships were between .75 and .81. There were no differences among examiners for demographics variables.;There were no significant differences among the DFS scores for all four examiners. The clinical dentist had marginally higher DFS scores than did the clinical hygienist. The teledentistry dentist had significantly higher scores than did the teledentistry dental hygienist, clinical dentist, and clinical dental hygienist. Perhaps most important is that there was no difference between the teledentistry dental hygienist and the clinical dentist.;Continued investigation of the use of teledentistry for screening of dental caries and other oral diseases is encouraged based on the literature and the findings from this study that there is no significant difference in screenings of the teledentistry dental hygienist and clinical dentist using DFS scores as the outcome measure. Teledentistry has been demonstrated as an effective and efficient means of increasing access to care for screening, referral, and treatment.