Rationale for Study

Teledentistry is an effective and efficient means of increasing access to care for screening, referral and treatment. Practice restrictions and the undocumented concern that dental hygienists do not have the skill or knowledge to identify or diagnose a carious lesion impede access to care.


This study compared the identification of dental caries by both dental hygienists and dentists and by both clinical and teledentistry methods.


A sample of 82 children 4–7 years of age attending an elementary school in Memphis, Tennessee, was selected for the study. Two clinical examiners, a dental hygienist and dentist, independently examined and charted dental caries and existing restorations separately on the children. Two teledentistry examiners, a dental hygienist and dentist, independently reviewed and charted dental caries and restorations from photographs obtained with the iPhone 4S. Dental charts for each child were converted to a decayed filled surface (DFS) score resulting in four scores for analyses.


Seventy-eight children met the inclusion criteria. The clinical dentist’s and clinical dental hygienist’s DFS scores resulted in Spearman’s correlation of r = 0.99. Friedman’s analysis of the four examiners’ DFS scores found no significant difference (P > 0.10) between the teledentistry dental hygienist’s and the clinical dentist’s scores.


A dental hygienist can identify dental caries in children 4–7 years of age from photographs as accurately as a dentist in the clinical setting.

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