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ORIGINAL ARTICLE
Year : 2015  |  Volume : 13  |  Issue : 4  |  Page : 434-437

Knowledge, awareness, and attitude among practicing dentists about teledentistry in Indore, Central India


1 Department of Public Health Dentistry, SAIMS, Shri Aurobindo College of Dental Sciences, Indore, Madhya Pradesh, India
2 Department of Oral Medicine and Radiology, Bhaba college of Dental Sciences, Bhopal, Madhya Pradesh, India

Date of Web Publication7-Dec-2015

Correspondence Address:
Swati V Balsaraf
B-204, Akanksha Apartment, SAIMS Staff Quarters, Behind Aurobindo Hospital, Indore-Ujjain Road, Indore - 453 555, Madya Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2319-5932.171188

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  Abstract 

Introduction: Telemedicine is a rapidly forming subset of health informatics. Until now, no studies are documented on the knowledge, awareness, and attitude of practicing dentists on teledentistry. Aim: To conduct a survey among the practicing dentist regarding knowledge, awareness and attitude among practicing dentists about teledentistry in Indore, Central India. Materials and Methods: A cross-sectional questionnaire study was conducted among the practicing dentists from April 2014 to July 2014 in Indore. The sample size of 142 dentists was selected through convenience sampling. Chi-square test was used for the association. Results: Overall 121 dentists had heard about teledentistry. Internet was recorded as the most common source of obtaining information about teledentistry. In this study, almost 20 BDS dentists said that teledentistry is useful in oral medicine and radiology. Conclusion: Most of the dentists were aware of teledentistry, and the practicing dentists are aware of working technique, uses and advantages and disadvantages of teledentistry. Until date, no teledentistry projects in India, although there are few telemedicine projects run by the Government of India. There are a lot of gray areas in teledentistry to be worked on.

Keywords: Plain old telephone system, teledentistry, tele-oral medicine, video-conferencin


How to cite this article:
Balsaraf SV, Chole RH. Knowledge, awareness, and attitude among practicing dentists about teledentistry in Indore, Central India. J Indian Assoc Public Health Dent 2015;13:434-7

How to cite this URL:
Balsaraf SV, Chole RH. Knowledge, awareness, and attitude among practicing dentists about teledentistry in Indore, Central India. J Indian Assoc Public Health Dent [serial online] 2015 [cited 2020 Jul 5];13:434-7. Available from: http://www.jiaphd.org/text.asp?2015/13/4/434/171188


  Introduction Top


Telemedicine is a rapidly forming subset of health informatics.[1] Cook in 1997 defined teledentistry as "The practice of using video-conferencing technologies to diagnose and provide advice about treatment over a distance." Dental professionals have used technology such as intraoral camera, in private practice for patient education and case acceptance, however, teledentistry has been underused as a means of diagnosis and referral in dentistry.[2] It has implications not only in an urban setup when a patient under severe distress or in a state of medical emergency wants to seek a medical physician but also in rural area where money is a great concern to people residing in remote areas as well as the distance poses a big hurdle to seek medical or dental treatment. Furthermore, the people in a rural setting have a plight of minimum or almost no treatment facilities setting up an ideal example of "inverse care law."[3] Millions of children and adults lack regular access to routine dental care, and many of them suffer needlessly with disease that inevitably results in significant decrements in their quality of life.

Telemedicine and information system has a potential to meet these needs by just logging into the system and getting treatment advice or the treatment itself immediately. The telemedicine approaches hold the potential to address many of the problems related to access, cost, efficiency, and quality of medical care.[4] Until now, no studies are documented on the awareness, knowledge and attitude of practicing dentists on teledentistry. Against this background, the study was aimed to assess the knowledge, awareness, and attitude among dentists about the practice of teledentistry.

Objectives

  1. To assess the knowledge regarding advantages and disadvantages of teledentistry practice
  2. To assess the knowledge regarding importance of practicing teledentistry and its role in changing the current scenario of practicing teledentistry
  3. To assess the awareness among practicing dentists regarding the discipline of dentistry of most use in teledentistry.



  Materials and Methods Top


A cross-sectional questionnaire study was conducted amongst the practicing dentists for 4 months from April 2014 to July 2014 in Indore. The ethical approval was taken from Institutional Ethical Committee. A list of practicing dentists of Indore was taken from the IDA, Indore office. There were 160 practicing dentists who were members of IDA. Response rate reported was 80%. The estimated variance was taken as 0.5 and precision taken was 0.05 and confidence level of 95%. Sample size was derived using the formula:



Where:

n = Sample size required; N = Number of people in the population

P = Estimated variance in population, as a decimal; A = Precision desired, expressed as a decimal

Z = Based on confidence level: R = Estimated Response rate, as a decimal.

The sample size thus derived was 142 dentists.

Indore city is divided into four zones North, East, West, and South. From each zone 36 dentists were selected through convenient sampling to reach a total sample size of 142 dentists. The informed consent was taken from dentists and was asked to fill the questionnaire.

A pilot study was conducted on 50 practicing dentists to check the validity of the questionnaire. To check the reliability test-retest reliability was applied. Few questions were modified for ease of understanding. Information regarding practicing area, gender, age and qualification were also recorded. The questionnaire was close-ended. There were nine questions in total on knowledge and awareness and attitude. The dentists were met in person, and the questionnaire was submitted and collected after 2–3 days. The data were subjected to statistical analysis by means of Statistical package for social sciences version 17. Bar diagrams, pie charts and frequency distribution tables were used to present the data. Chi-square test was applied. P value was set at 0.05%.


  Results Top


Total dentists contacted were 142. Gender distribution of the sample was 70 males and 72 females. Among the practicing dentists 70 were MDS and 72 were BDS. Age and gender distribution of dentists is shown in [Figure 1]. Overall 121 (85%) dentists have heard about teledentistry. Internet was recorded as the most common source of obtaining information about teledentistry. The practicing BDS dentists responded correctly, that is, there are no teledentistry projects in India (31%) and the results were statistically significant (P < 0.000). Few of them quoted in the answer Sanjeevani telemedicine project that was incorrect. Majority of the MDS knew (32%) that teledentistry is practiced through the internet, IT networks, telecommunication services, data security, videoconferencing, and the results were statistically significant (P < 0.000) [Table 1]. When asked about future of teledentistry in India most of them (66%) answered that it will be useful in all fields of dentistry. The responses to advantages of teledentistry are recorded in [Table 2]. Overall response for the question on the utmost use of teledentistry in dentistry field was useful in oral medicine and radiology [Table 3]. When asked about the uses of teledentistry 73% of the dentists said it is useful in all diagnosis, consultation, treatment, and training. In this study, 20% of BDS dentists said it is useful in oral medicine and radiology (P < 0.099). In this study, almost 43% of dentists said that it is useful in tele-orthodontics.
Figure 1: Age and gender distribution of dentists

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Table 1: Response to the question how is teledentistry practiced

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Table 2: Advantages of teledentistry

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Table 3: Uses of teledentistry in various branches of dentistry

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{Inline 2}


  Discussion Top


The US Army's Total Dental Access Project began in 1994, this project initially used a traditional plain old telephone system (POTS), with two different communication methods: Real-time and store- and -forward. POTS still is used frequently in teledentistry because of its low maintenance and technical support costs.[5]

In our study, most of them answered yes when asked if they heard about teledentistry. Apart from its uses in consultation and referral guide for the general dental practitioners in various disciplines the teledentistry system also can provide a unique way to deliver long-distance clinical training and continuing education. Video-conferencing and Internet technologies allow low-cost, real-time interactive, two-way communication between instructors and trainees, making long-distance education more virtual and affordable.[6],[7] When asked about the uses of teledentistry 73 dentists said it is useful in all diagnosis, consultation treatment, and training. Tyndall et al.[8] reported that although there has been considerable research on the use of tele-radiology in medicine, there has been little effort to evaluate its use in dentistry. Farman and Farag [9] reported that telemedicine should be an alternative to a second opinion in dental practice and that this system could provide economic benefit by allowing patients in remote areas access to specialized medical care without the difficulty and cost of travel to distant medical centres. In this study, almost 20 BDS dentists said that teledentistry is useful in oral medicine and radiology (P < 0.099).

Mandall et al.[10] suggested that teledentistry is a good way of positively identifying patients who should be referred to a consultant orthodontist. Stephens et al.[11] supported the dentists' opinions that teledentistry enabled them to offer a better service for their patients and use specialist services more appropriately. Cook et al.[12] established a prototype teledentistry service that incorporated a PC-based expert system designed to assist in orthodontic cases. It guided the general dental practitioner through the assessment of a patient's malocclusion and helped ensure that all relevant clinical observations were made and details recorded. In our study almost 43% of dentists said that it is useful in tele-orthodontics.

Nuttall et al. have confirmed the view that dental practices in rural areas do not have equality of access to secondary referral services. Over half of the dentists on the Scottish islands said they considered themselves to have no consultant service for restorative dental care. In our study, only 2% said that teledentistry is useful in restorative dentistry.[13]

The future of teledentistry is exciting. Any physician or dentist who has a modern desktop computer, one of several software programs to facilitate teleconsulting, a modem connection to the internet, a digital camera, a radiograph/text scanner, and a minimum amount of training will be able to access a teleconsultant. This individual can send appropriate patient history and examination findings and high-quality images to the expert teleconsultant. It is anticipated that complete patient records can be transmitted in just minutes. The addition of high-resolution digital photos; audio and video clips; and magnetic resonance imaging, computed tomography or standard radiographs that have been digitized will require some additional transmission time, depending on the size and number of images to be sent (however, the transmission time is not always critical since most teleconsults are not real-time events). For the largest imaging files (e.g., magnetic resonance imaging), regular telephone service will not be adequate because transmission time is far too long. In these instances, cable and satellite transmission methodologies have to be used.[14],[15]

Limitations

The sampling technique chosen was convenient sampling.

Recommendations

Teledentistry approaches may hold the potential to address many of the problems related to access, cost, efficiency, and the general quality of dental care in India and the world. Practitioners choosing to include teledentistry as part of their practices should educate themselves as to the legal, technological, and ethical issues that are a part of this new practice medium. Practitioners are encouraged to remain aware of the legal requirements in their states of practice and to remain vigilant regarding the legislative changes in this rapidly developing field.


  Conclusion Top


The present study exhibited a fair knowledge about the way teledentistry is practiced and the advantages and disadvantages of teledentistry amongst practicing dentists of Indore. The majority of dentists in our study reported awareness about teledentistry and obtained the information from the internet. The study was able to assess the knowledge awareness and attitude of the practicing dentists regarding teledentistry, its uses advantages, and disadvantages.

Acknowledgments

The authors thank Sri Aurobindo College of Dentistry, Indore, Madhya Pradesh for providing necessary material for completion of this work.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

 
  References Top

1.
Association of American Medical Colleges. Medical School Objectives Project: Medical Informatics Objectives. Special Reports. Washington: Association of American Medical Colleges Publication; 1998. p. 3-15s.  Back to cited text no. 1
    
2.
Folke LE. Teledentistry. An overview. Tex Dent J 2001;118:10-8.  Back to cited text no. 2
    
3.
Bhambal A, Saxena S, Balsaraf S. Teledentistry: Potentials unexplored. J Int Oral Health 2010;2:1-7.  Back to cited text no. 3
    
4.
Fricton J, Chen H. Using teledentistry to improve access to dental care for the underserved. Dent Clin North Am 2009;53:537-48.  Back to cited text no. 4
    
5.
Rocca MA, Kudryk VL, Pajak JC, Morris T. The evolution of a teledentistry system within the Department of Defense. Proc AMIA Symp 1999;921-4.  Back to cited text no. 5
    
6.
Johnson LA, Wohlgemuth B, Cameron CA, Caughman F, Koertge T, Barna J, et al. Dental interactive simulations corporation (DISC): simulations for education, continuing education, and assessment. J Dent Educ 1998;62:919-28.  Back to cited text no. 6
    
7.
Johnson LA, Schleyer T. Development of standards for the design of educational software. Standards committee for dental informatics. Quintessence Int 1999;30:763-8.  Back to cited text no. 7
    
8.
Tyndall DA, Boyd KS, Matteson SR, Dove SB. Video-based teleradiology for intraosseous lesions. A receiver operating characteristic analysis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1995;80:599-603.  Back to cited text no. 8
    
9.
Farman AG, Farag AA. Teleradiology for dentistry. Dent Clin North Am 1993;37:669-81.  Back to cited text no. 9
    
10.
Mandall NA, O'Brien KD, Brady J, Worthington HV, Harvey L. Teledentistry for screening new patient orthodontic referrals. Part 1: A randomised controlled trial. Br Dent J 2005;199:659-62.  Back to cited text no. 10
    
11.
Stephens C, Cook J, Mullings C. Orthodontic referrals via TeleDent Southwest. Dent Clin North Am 2002;46:507-20.  Back to cited text no. 11
    
12.
Cook J, Mullings C, Vowles R, Ireland R, Stephens C. Online orthodontic advice: a protocol for a pilot teledentistry system. J Telemed Telecare 2001;7:324-33.  Back to cited text no. 12
    
13.
Nuttall NM, Steed MS, Donachie MA. Referral for secondary restorative dental care in rural and urban areas of Scotland: findings from the Highlands Et Islands Teledentistry Project. Br Dent J 2002;192:224-8.  Back to cited text no. 13
    
14.
Clark GT. Teledentistry: what is it now, and what will it be tomorrow? J Calif Dent Assoc 2000;28:121-7.  Back to cited text no. 14
    
15.
Eraso FE, Scarfe WC, Hayakawa Y, Goldsmith J, Farman AG. Teledentistry: protocols for the transmission of digitized radiographs of the temporomandibular joint. J Telemed Telecare 1996;2:217-23.  Back to cited text no. 15
    


    Figures

  [Figure 1]
 
 
    Tables

  [Table 1], [Table 2], [Table 3]



 

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