Among 898 studies, 16 studies were included in the review. In most studies reporting patient satisfaction, all patients had shown willingness for teleconsultation for a dental problem and they were mostly satisfied due to saved travel time, saved working days, and prompt treatment onset. Most of the studies acknowledged teledentistry as a cost-effective and cost-saving method. Moreover, the teledentistry consultations showed diagnostic reliability and validity values comparable to conventional dental consultations. The majority of studies were considered level 4 and 3b, due to limited sample populations, analysis based on limited alternatives or costs, non-consistent sensitivity analysis, failure to appropriately control known confounders, and/or failure to carry out an appropriate follow-up of patients.
The majority of the studies were conducted between 2010 and 2019 [31,32,33,34,35,36,37,38,39,40,41,42,43,44], with only two prior studies carried out in 1998 and 2002 [29, 30]. In total, five studies were from Australia [35, 40,41,42,43], three from India [34, 39, 44], two studies were conducted in the USA [36, 37], two in Spain [32, 33], one in Canada , one in the UK , one in Italy , and one in Finland . The types of studies comprised non-randomized clinical trials [30, 33], observational studies [31, 34, 36, 37, 39, 42,43,44], pilot intervention studies [29, 32, 38], and cost analysis [35, 40, 41]. Most studies used teledentistry consultations, either live or store and forward [29, 30, 32, 33, 35, 37, 40,41,42,43], and other studies used smartphone-based applications like WhatsApp [38, 44], the Oncogrid application for oral cancer surveillance , and videographic examination .
In several studies, teledentistry-based general dental examination and screening were done using intraoral cameras [29,30,31, 39, 42, 43]. In other studies, specialized dental services were provided such as oral and maxillofacial surgery for impacted third molar pathology, cleft lip and palate patient management, temporomandibular joint disorders [32, 33, 36, 37, 41], oral pathology for preventive screening of oral potentially malignant disorders , oral medicine and diagnosis for oral cancer surveillance [34, 38], and prosthodontics for dental prosthetics and oral rehabilitation . All of these specialized dental services primarily used the teledentistry model for specialist teleconsultations, disease screening, diagnosis and surveillance, treatment planning, preoperative assessment and management of patients requiring operative procedures, as well as referrals [31,32,33,34, 36,37,38, 41, 44].
Moreover, Ignatius et al. reported that dental professionals were satisfied with the performance of teledentistry devices . Furthermore, in a study conducted by Wood et al. , general dental practitioners moderately agreed with benefits of teledentistry and expressed a desire to refer more patients through telemedicine consultations. While oral and maxillofacial surgeons were mostly neutral, they acknowledged that more referrals would influence their decision to provide telemedicine consultations and implement teledentistry in their practice .
Petruzzi et al., Patterson et al., Vinayagamoorthy et al., and Purohit BM et al. reported significant agreement between teledentistry consultation and clinicopathologic examination [29, 38, 39, 44]. According to Vinayagamoorthy et al., substantial agreement was found when the lesions were dichotomized as normal and abnormal (examiner 1 and 2, K reliability: 0.68 and 0.67, sensitivity: 98.5% and 99.04%, specificity: 72% and 64%), but slightly reduced when assessed for the exact diagnostic match (examiner 1 and 2, K reliability: 0.59 and 0.55, sensitivity: 98.1% and 98.7%, specificity: 64% and 52%) . Birur et al. reported 45% and 100% concordance with the specialists in the targeted cohort and opportunistic cohort respectively . In a study by Purohit BM et al., the sensitivity and specificity were 0.86 and 0.58 for videography-based teledentistry assessment .
As per Ignatius et al.  and Scuffman and Steed , the additional training of the general dental practitioners and familiarity with equipment and procedures were associated with better teledentistry related outcomes. Training may have higher initial cost but it can be cost-effective in the long run . Birur et al. also reported better concordance in the presence of trained onsite health workers such as in the diagnosis and surveillance of oral cancer .
Seven studies acknowledged teledentistry as a cost-effective and cost-saving method. A study by Estai et al.  compared traditional dental screening at school with teledentistry using a cost-minimization analysis. This study demonstrated the ability of teledentistry in minimizing the cost; for instance, the total estimated cost and fixed cost of the teledentistry model was $50 million and the estimated annual reduction with the teledentistry model was $85 million, which included staff salary savings, travel allowance avoided, and supply expenses avoided . Similarly, cost analysis by Marino et al.  showed that asynchronous teleconsultation was the lowest cost service model with AU$32.35 cost per resident compared to traditional face-to-face (average cost: AU$36.59 per resident) and real-time (average cost: AU$41.28 per resident) consultations.
According to Wood et al., consultation by telemedicine for 255 patients and eliminating in-office consultation saved a significant amount equivalent to $134,640 . In a model-based analysis, in Teoh et al.  the expected cost per consultation for conventional care was AU$431.29 and that for teledentistry was AU$294.35, saving an average AU$136.94 in societal costs per consultation. They also mentioned that teledentistry would save AU$50,258.92 in total costs per year, and that costs to the patient were reduced by 69% . Comparing the conventional care in hospital to teledentistry, the largest difference in cost savings was the costs to the patient including their transportation, accommodation, and lost productivity costs, amounting to AU$70,719.19 . The sensitivity analysis after adjustment of potential variables showed that teledentistry is a cost-saving option to society with the saving of $3,160.81 for every timely cleft lip and palate consultation compared to hospital consultation . Salazar-Fernandez et al.  reported the mean cost of lost working hours per patient was significantly less (50%) in teleconsultation (16.8 h) compared to the standard system (32.24 h).
Tynan et al. , on the other hand, compared three cost scenarios: screening by an oral health therapist in a residential aged care facility, teledentistry in a residential aged care facility, and resident attendance at an oral health clinic. Screening by an oral health therapist was deemed the lowest cost scenario when compared to the other two since the teledentistry setup in scenario 2 and dentist time in scenario 3 increased total costs . In a cost-minimization analysis by Scuffham and Steed , the cost of teledentistry was compared with two modes, outreach visits (specialist regularly visiting the two remote communities) and hospital visits. In both the communities, teleconsultation was associated with additional costs to the health organization and society compared with outreach visits . However, the cost savings for teleconsultation varied between the communities compared to hospital visits. In one community, cost savings were higher due to more travel time and travel cost . Nonetheless, the researchers concluded that teledentistry would be a cost-effective tool for the health organization in the long run .
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How to cite this article: Dhopte AN, Kahar AR, Joshi J, Radke U. Assessment of knowledge and attitude towards teledentistry during COVID pandemic among undergraduate dentistry students and interns of a private dental institute of Nagpur city. J Adv Dental Pract Res 2022;1:7-12.
The objective of the study were to assess the knowledge and evaluate the attitude toward teledentistry during COVID pandemic among undergraduate dental students and interns of a private dental institute of Nagpur-MS.
A total of 307 students and interns were surveyed in this study. Out of them, 175 (57%) said that they were aware of the term teledentistry. Two hundred and twenty-seven (74%) participants felt that teledentistry can improve the reach of oral health care to rural areas and during pandemic and 256 (83%) said that they want to practice teledentistry.
The knowledge of interns regarding teledentistry was good. Their attitude toward applying it in the profession was satisfactory. More than 80% of students were willing to practice teledentistry and 60% thought that it is the future of dentistry. The future perspective will be assessing more students and interns for more insight on topic.
Methods We designed a ten-item, five-point Likert-scale questionnaire assessing: 1) patient satisfaction; 2) ease of use; 3) the effectiveness including increasing access to clinical services; 4) reliability of the teledentistry system; and 5) usefulness for patients. Fifty-two patients completed the survey and data was analysed.
Results We had a 100% response rate with 52 surveys completed over seven clinics. Patients that used the virtual clinic and telephone consultation had 97% and 94% satisfa