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AIMS: This study aims to assess the concordance between in-person clinical and virtual oral examinations among hospitalized older adults. METHODS: A single examiner performed an in-person clinical examination, recorded systemic health history and oral health indices, clinically documented the Bedside Oral Exam (BOE), and captured photographs for subsequent analysis during a virtual examination. Following a 90-day washout period, a virtual examination was repeated by the same examiner and by a second examiner. Descriptive analysis and a Kappa test were used to compare proportions and evaluate the agreement between results. RESULTS: Intra-examiners presented high percentage of agreement in all domains of BOE (80%-86%), with an exception for gingiva (78%). Kappa's intra-examiners presented moderate scores in saliva, mucous membrane, gingiva and teeth/dentures domains and a strong score in the tongue domain (0.839). Inter examiners presented moderate agreement in lips and gingiva, saliva, mucous membrane, and teeth/dentures domains. Inter examiners Kappa scores were weak for lips (0.395) and gingiva (0.498) domains; moderate for saliva (0.703), mucous membrane (0.769) and teeth/dentures (0.714) domains and strong for the tongue domain (0.872). CONCLUSION: In this study, a moderate level of agreement was observed between clinical and virtual oral examinations among older hospitalized patients. These findings are encouraging and warrant further investigation about how teledentistry can be used to enhance oral health access to this vulnerable population.

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Background: Limited attention has been given to oral health challenges faced by older Indigenous populations, especially in rural settings, where disparities exist. This study aims to assess oral health in a rural Mapuche community in southern Chile, utilizing geriatric technology support, and exploring the connection between geriatric health and oral well-being to fill a gap in this context. Methods: A cross-sectional study was conducted involving 76 independent older adults from a rural Mapuche community who required dental care. Assessments were in a remote care setting gathering extensive data including comprehensive geriatric assessments, medical and dental conditions using a geriatric teledentistry platform (TEGO®). Statistical analysis involved descriptive analysis, logistic regression, and both multiple correspondence analysis and k-means cluster analysis. Results: The sample comprised individuals with limited formal education and a high degree of vulnerability. Geriatric assessments unveiled cognitive deterioration, frailty, depression risk, and multimorbidity. A distribution of the DMFT index, number of remaining teeth, number of occluding pairs, number of teeth with restorative needs and other relevant clinical findings was conducted based on sociodemographic, and medical-geriatric-dental characteristics, and additionally, a Multinomial Logistic Regression Analysis of Dentition Variables in Relation to Geriatric Assessments was performed. The dental burden was substantial, with an average DMFT index of 25.96 (SD 4.38), high prevalence of non-functional dentition (89.3%), periodontal disease (83%), xerostomia (63.2%) and oral mucosal lesions (31.5%). Age, lower education, depression, daily medication number and sugary consumption frequency were associated with a decreased average number of teeth (p < 0.05). Multiple correspondence analysis and k-means cluster analysis identified 4 clusters, with the edentulous and functional dentition groups being the most distinct. Conclusion: This study uncovers a substantial dental burden and intricate medical-geriatric conditions interlinked among Indigenous older adults in a rural Chilean Mapuche community. The implementation of a geriatric technological ecosystem in the community enabled the resolution of less complex oral health issues and facilitated remote consultations with specialists, reducing the necessity for travel to health centers. This underscores the need for innovative dental public health initiatives to address health disparities and improve the overall well-being of older Indigenous adults.

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OBJECTIVE: Authors reported multiple definitions of e-oral health and related terms, and used several definitions interchangeably, like mhealth, teledentistry, teleoral medicine and telehealth. The International Association of Dental Research e-Oral Health Network (e-OHN) aimed to establish a consensus on terminology related to digital technologies used in oral healthcare. METHOD: The Crowdsourcing Delphi method used in this study comprised of four main stages. In the first stage, the task force created a list of terms and definitions around digital health technologies based on the literature and established a panel of experts. Inclusion criteria for the panellists were: to be actively involved in either research and/or working in e-oral health fields; and willing to participate in the consensus process. In the second stage, an email-based consultation was organized with the panel of experts to confirm an initial set of terms. In the third stage, consisted of: a) an online meeting where the list of terms was presented and refined; and b) a presentation at the 2022-IADR annual meeting. The fourth stage consisted of two rounds of feedback to solicit experts' opinion about the terminology and group discussion to reach consensus. A Delphi-questionnaire was sent online to all experts to independently assess a) the appropriateness of the terms, and b) the accompanying definitions, and vote on whether they agreed with them. In a second round, each expert received an individualised questionnaire, which presented the expert's own responses from the first round and the panellists' overall response (% agreement/disagreement) to each term. It was decided that 70% or higher agreement among experts on the terms and definitions would represent consensus. RESULTS: The study led to the identification of an initial set of 43 terms. The list of initial terms was refined to a core set of 37 terms. Initially, 34 experts took part in the consensus process about terms and definitions. From them, 27 experts completed the first rounds of consultations, and 15 the final round of consultations. All terms and definitions were confirmed via online voting (i.e., achieving above the agreed 70% threshold), which indicate their agreed recommendation for use in e-oral health research, dental public health, and clinical practice. CONCLUSION: This is the first study in oral health organised to achieve consensus in e-oral health terminology. This terminology is presented as a resource for interested parties. These terms were also conceptualised to suit with the new healthcare ecosystem and the place of e-oral health within it. The universal use of this terminology to label interventions in future research will increase the homogeneity of future studies including systematic reviews.

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BACKGROUND: This scoping review aims to systematically and critically describe the numerous legal challenges brought about by the utilization of digital oral health in the delivery of oral healthcare. METHODS: A systematic search was conducted. The following electronic databases were reviewed from inception up to March 2023: MEDLINE, Embase, Scopus, and LILACS. The search included any scientific document and paper in English, Spanish, or Portuguese on legal issues raised using digital health in oral healthcare delivery. Two reviewers conducted the selection process and data extraction. Legal issues raised concerning the adoption of digital health technology were analysed using the modified Mars' framework. RESULTS: Seventeen studies were included. Most of the documents identified and covered generic aspects of delivering digital oral healthcare (n = 11) without explicitly referring to any dental specialty. The most mentioned legal issues were data security (n = 15); liability and malpractice (n = 14); consent (n = 12); and confidentiality (n = 12). To a lower extent, patient-practitioner relationship (n = 11); and license and jurisdiction (n = 11) were also covered. These were followed by privacy of information (n = 10); adequacy of records (n = 9); and e-referrals (n = 8). On the other hand, fewer studies commented on social media use (n = 3), authentication (n = 2); or e-prescriptions (n = 2). Before implementing any digital health solution, practitioners need to be aware of the many legal issues that the introduction of these technologies involves, be clear where the responsibility lies, and apply extreme caution in following national guidelines. Current literature concentrates on a few well-known legal issues. Issues around authentication, use of social media, and e-prescriptions received less attention.

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Objective: We aimed to investigate the accuracy of remote examination by photographs compared to in-person clinical examination for detecting potentially malignant oral lesions (PMOLs). Methods: The Reporting Guide and Guidelines for Writing Systematic Reviews (Preferred Reporting Items for Systematic Reviews and Meta-Analysis [PRISMA]) guided the reporting of findings. The search was conducted by two independent reviewers in six databases with no language restriction until November 2022. The Population, Test-Index, Reference Standard, Outcome and Study Design (PIROS) strategy guided the eligibility criteria, and studies with adult patients (P) examined remotely (I) and in-person (R) to verify the detection of PMOLs (O) were considered. The methodological quality was assessed by QUADAS-2, and the certainty of the evidence was measured by the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE). Results: A total of 769 files were identified. After removing duplicates and reading titles and abstracts, 16 were read in full, from which 6 articles then comprised the qualitative synthesis. The oral clinical examination was the reference standard in four studies. Five studies presented high risk of bias in at least one assessment domain. A high probability of detection of PMOL by remote examination (97.37%) was observed for the three studies included in the meta-analysis, which presented high heterogeneity among them. The certainty of evidence for the outcome was considered very low. Conclusions: Remote tools for detecting PMOLs may be feasible and assertive, but new studies are required to incorporate them into clinical practice. Clinical Relevance: Remote examination for the detection of PMOLs has the potential to favoring the early diagnosis of malignant lesions.

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Aim: to analyze, between 2019-2021, the quantitative changes in dental emergencies (DE) in Brazil and its regions. Materials and Methods: Data collected in the Primary Care Health Information System (SISAB) from 2019 to 2021. The DE represented by dentoalveolar abscess (DAA) and toothache (TA). 2019 was the control (non-pandemic), and 2020-21 the exposure year. Durbin-Conover's Friedman and Post-Hoc tests used a significance level of 5%. The data's organization used the percentage difference to facilitate analysis. Results: For Brazil in 2021, the percentage difference with 2019 suggests that DAA (-2.16%, p=1.0) and TA (+14.94%, p=0.064) returned to values after fall of 2020. The South region, in 2020, had no decrease in DAA (-5.48%, p=0.436) and TA (+3.7%, p<0.001) in 2020, and an increase in both in 2021 (DAA: +26.86%, p<0.001; TA: +51.06%, p<0.001). Discussion: In 2021, in Brazil, limited elective access and resumption of DAA and increase in TA suggest worsening the oral health and quality of life. The DAA and TA results in the South region do not provide plausible evidence to understand the unchanged values in 2020 and the considerable increase in 2021. Conclusion: Regardless of the pandemic, elective access still struggles to offer universal acessing, equitable, and the need of investments are essentials to prevent public services from becoming just gateways for relieving pain and suffering.

Objetivo: analisar, entre 2019-2021, as alterações quantitativas nas urgências odontológicas (UO) no Brasil e suas regiões. Materiais e Métodos: Dados coletados no Sistema de Informação em Saúde da Atenção Básica (SISAB) no período de 2019 a 2021. A representação das UO foi pelo abscesso dento-alveolar (ADA) e dor de dente (DD). O ano de 2019 foi o ano de controle (não pandêmico) e 2020-21 os de exposição. Os testes Friedman e Post-Hoc de Durbin-Conover utilizaram nível de significância de 5%. Os dados foram organizados pela diferença percentual para facilitar a análise. Resultados: Para o Brasil em 2021, a diferença percentual com 2019 sugerem que o ADA (-2,16%, p=1,0) e a DD (+14,94%, p=0,064) retomaram os valores, após a queda de 2020. A região Sul, em 2020, não teve queda em ADA (-5,48%, p=0,436) e DD (+3,7%, p<0,001) em 2020, e aumento em ambos em 2021 (ADA: +26,86%, p<0,001; DD: +51,06%, p<0,001). Discussão: Em 2021, no Brasil, o limitado acesso eletivo e a retomada da ADA e aumento da DD sugerem piora na saúde bucal e na qualidade de vida. Os resultados de ADA e DD na região Sul não apresentam evidências plausíveis para compreender a inalteração de valores em 2020 e o considerável aumento em 2021. Conclusão: Independentemente a pandemia, o acesso eletivo ainda luta para ser universal, equânime e os investimentos precisam ser retomados para evitar que os serviços públicos se tornem em apenas portas de entrada de alívio dor e sofrimento.

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Aim: To evaluate the impact of online social networks (OSN) as resources for promoting behaviour changes related to the prevention and promotion of oral health. Methods: This was a systematic review with meta-analysis of randomized clinical trials identified in databases (MEDLINE/Embase/Lilacs), published up until May 2022, and prepared according to Cochrane recommendations. Studies that used OSN (WhatsApp®, Telegram®, TikTok®, Facebook®, Twitter®, YouTube®, Instagram®, Soundcloud®, Flickr®, LinkedIn®, and Webradio®) were included. The protocol was registered in the International Prospective Register of Systematic Reviews (CRD42021248045). Results: In total, 3171 studies were evaluated, of which 12 studies met the inclusion criteria for the review and contained data on 1669 participants. The most frequently investigated OSN were WhatsApp®, followed by Telegram®, and YouTube®. All studies included were at high risk of bias. Data extraction allowed the meta-analysis of gingival index (GI) and oral health knowledge (OHK) outcomes for young people. Findings revealed that young people exposed to digital interventions via OSN showed a reduction in GI when compared with traditional educational interventions. This reduction occurred in all young people (standardized mean difference, -0.48; 95% CI, -0.75 to -0.21; p = 0.0006, I2 = 0%; very low certainty), including those who were undergoing orthodontic treatment (standardized mean difference, -0.58; 95% CI, -0.92 to -0.24; p = 0.0008, I2 = 0%; very low certainty). Furthermore, young people undergoing orthodontic treatment and exposed to OSN showed an increase in OHK when compared with participation in traditional educational interventions (standardized mean difference, +0.86; 95% CI, +0.46 to +1.26; p < 0.0001, I2 = 0%; very low certainty). Conclusion: OSN could be effective tools for improving oral health outcomes in young people.

Objet: Évaluer l'incidence des réseaux sociaux comme ressources pour promouvoir les changements de comportement liés à la prévention et à la promotion de la santé buccodentaire. Méthodes: Il s'agit d'un examen systématique avec méta-analyse d'essais cliniques randomisés répertoriés dans des bases de données (MEDLINE/Embase/Lilacs) publiés jusqu'en mai 2022 et préparés selon les recommandations de Cochrane. Les études utilisant les réseaux sociaux (WhatsApp®, Telegram®, TikTok®, Facebook®, Twitter®, YouTube®, Instagram®, SoundCloud®, Flickr®, LinkedIn®, et Webradio®) ont été incluses. Le protocole a été enregistré dans le PROSPERO (International Prospective Register of Systematic Reviews, numéro CRD42021248045). Résultats: Au total, 3 171 études ont été évaluées. De celles-ci, 12 répondaient aux critères d'inclusion de l'examen et comportaient des données sur 1 669 participants. Les réseaux sociaux qui ont le plus fréquemment fait l'objet d'une enquête sont WhatsApp®, suivi de Telegram® et YouTube®. Toutes les études incluses présentaient un risque élevé de biais. L'extraction des données a permis la méta-analyse des résultats de l'indice gingival (IG) et des connaissances en santé buccodentaire chez les jeunes. Les résultats ont révélé que les jeunes exposés aux interventions numériques par l'intermédiaire des réseaux sociaux présentaient un IG réduit par rapport à ceux exposés aux interventions éducatives traditionnelles. Cette réduction était présente chez tous les jeunes (différence moyenne standardisée, ­0,48; IC à 95 %, ­0,75 à ­0,21; p = 0,0006, I2 = 0 %; certitude très faible), y compris ceux qui suivaient un traitement orthodontique (différence moyenne standardisée, ­0,58; IC à 95 %, ­0,92 à ­0,24; p = 0,0008, I2 = 0 %; certitude très faible). De plus, les jeunes recevant un traitement orthodontique exposés aux réseaux sociaux ont montré une plus grande connaissance en santé buccodentaire que ceux participant aux interventions éducatives traditionnelles (différence moyenne standardisée, +0,86; IC à 95 %, +0,46 à +1,26; p < 0,0001, I2 = 0 %; certitude très faible). Conclusion: Les réseaux sociaux pourraient être des outils efficaces pour améliorer les résultats en matière de santé buccodentaire chez les jeunes.

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The aim of this manuscript is to describe a hybrid care model to paediatricpatients on a virtual basis for dental treatment before conducting an in-person surveillance by using combined nasal/oral swabbing (NOS).This longitudinal study used a convenience sample of paediatric patients and members of the dental team from an undergraduate paediatric dentistry clinic at the University of São Paulo School of Dentistry during the COVID-19 pandemic. Firstly, parents werecontacted and teledentistry was used for screening children who need dental treatment. Appointments were scheduled once a week for two months, in which a pre-COVID-19 screening was performed. Dental team and children's parents completed a questionnaire addressing COVID-19-related symptoms. Members of the dental team and children were tested for COVID-19 before entering the dental clinic, by NOS and RT-PCR screening.Ninety-three individuals were enrolled and all of them completed the electronic questionnaire on symptoms and had NOS collected weekly, totalising 241 pairs of swabs. No participant reported COVID-19 symptomsbefore entering the clinic for treatment. Only one child tested positive in the third week of sampling. The hybrid care model associated with molecular testing for asymptomatics provided a safe clinical environment regarding the transmission of SARS-CoV-2 (AU).

El propósito de este manuscrito es describir un modelo híbrido de atención odontológica, a través de una plataforma virtual que precede a la realización de vigilancia molecular presencial mediante hisopado nasal/oral combinado, en pacientes pediátricos. Eneste estudio longitudinal se utilizó una muestra de conveniencia de pacientes pediátricos y miembros del equipo odontológico en la clínica de pregrado de la Facultad de Odontología de la Universidade de São Paulo durante la pandemia de COVID-19. En primerlugar, se contactó con los padres y se utilizó la consulta virtual para seleccionar a los niños que requerían tratamiento odontológico. Se programaron citas una vez a la semana durante dos meses, en las que se realizó el cribado previo a COVID-19. El equipo dental y los padres de los niños rellenaron un cuestionario en el que se abordaban los síntomas relacionados con la COVID-19. A continuación, los miembros del equipo dental y los niños fueron sometidos a pruebas de detección de COVID-19 antes de entrar en la clínica para atendimiento mediante cribado con hisopo nasal/oral y RT-PCR. Se inscribieron 93 personas, todas las cuales cumplimentaron el cuestionario electrónico sobre síntomas y se les recogieron muestras semanalmente, con un total de 241 pares dehisopos. Ningún participante declaró síntomas de COVID-19 antes de entrar en la clínica para recibir tratamiento. Sólo un niño dio positivo en la tercera semana de toma de muestras. El modelo de tratamiento híbrido unido a las pruebas moleculares para asintomáticos proporcionó un entorno clínico seguro con respecto a la transmisión del SARS-CoV-2 (AU).

O objetivo deste manuscrito é descrever um modelo de atendimento odontológico híbrido, por meio de uma plataforma virtual anterior a realização de uma vigilância molecular presencial usando esfregaço combinado nasal/oral, em pacientes pediátricos. Este estudo longitudinal utilizou uma amostra de conveniência de pacientes pediátricos e membros da equipe odontológica na clínica de graduação da Faculdade de Odontologia da Universidade de São Paulo durante a pandemia COVID-19. Primeiro, os pais foram contactados e a consulta virtual foi utilizada para o rastreio de crianças que necessitavam de tratamento odontológico. Foram agendadas consultas uma vez por semana durante dois meses, nas quais foi realizado um rastreio pré-COVID-19. A equipe odontológica e os pais das crianças preencheram um questionário que abordava os sintomas relacionados com a COVID-19. Em sequência, os membros da equipe odontológica e as crianças foram testados para o COVID-19 antes de entrarem na clínica para atendimento, através do rastreio com esfregaço nasal/oral e RT-PCR. Noventa e três indivíduos foram inscritos e todos eles preencheram o questionário eletrônico sobre os sintomas e tiveram amostras coletadas semanalmente, totalizando 241 pares de cotonetes. Nenhum participante comunicou sintomas de COVID-19 antes de entrar na clínica para tratamento. Apenas uma criança testou positivo na terceira semana de amostragem. O modelo de tratamento híbrido associado a testes moleculares para assintomática proporcionou um ambiente clínico seguro no que diz respeito à transmissão da SARS-CoV-2 (AU).

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RESUMEN La teleodontología ha tenido una rápida adopción, lo que ha evidenciado una falta de consenso en su definición y uso del término. Las definiciones existentes permiten comprender sus aplicaciones, pero carecen de claridad en lo que respecta a su marco conceptual, lo que limita su implementación en el ejercicio profesional. Por ello, se realizó una búsqueda bibliográfica en la base de datos de PubMed y en el buscador web de Google para recopilar las definiciones accesibles de la teleodontología, encontrándose 63 definiciones que la incluían dentro de los dominios de la e-salud, la telesalud y la telemedicina. Aunque la mayoría incluyó a la teleodontología dentro de la telemedicina, los alcances expresados en sus definiciones reflejan que esta no se limita a la atención propiamente del paciente, por lo que es necesario delimitar los conceptos y las diferencias entre los dominios de la salud electrónica para una mejor comprensión del término.

ABSTRACT Teledentistry has experienced rapid adoption, revealing a lack of consensus in its definition and usage. Existing definitions provide insight into its applications but lack clarity regarding teledentistry's conceptual framework, which limits its implementation in professional practice. Therefore, a literature search was conducted using the PubMed database and the Google web search engine to compile the available teledentistry definitions. In total, 63 definitions were found, encompassing e-health, telehealth, and telemedicine. Although most of them included teledentistry as part of telemedicine, the scopes expressed in their definitions reflect that teledentistry goes beyond patient care. Hence, it is necessary to delineate concepts and differentiate between e-health domains for a better understanding of the term.

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Background: This will be a before-and-after study nested within a randomized clinical trial. Its objective will be to analyze the effectiveness of a teleconsultation and validate a questionnaire for performing teletriage in dental urgency/emergency situations in children aged 3 to 13, whose parents will have signed a free and informed consent form, and who have had full access to the internet. Methods: The Questionnaire for Teletriage of Emergencies and Urgencies in Pediatric Dentistry (QuesT-Odontoped)-will be validated by applying it to 140 randomized child parents/guardians. After validation, another 260 children seeking emergency dental care in the municipality of Carangola, Minas Gerais, Brazil, will receive a remote consultation, be randomized, and then allocated into two groups: G1, teleconsultation, and G2, teleconsultation and face-to-face consultation (immediately after the former) with a blinded evaluator, involving anamnesis and conventional clinical examination. The G2 sample will be used in the before-after study. Both groups will be followed-up for 7 and 14 days using pain and quality-of-life scales, applied at baseline and after each follow-up period. Clinical follow-up will be carried out after 12 and 24 months to assess the outcome of the tooth that had been indicated for treatment in the teletriage. The Mann-Whitney test will be used to assess pain; Student's t test or the Mann-Whitney test will be used to assess quality of life and the number of missing teeth after 24 months; and Poisson's regression analysis will be used to assess the influence of other variables. The significance level will be set at 5%. Conclusions: In conclusion, this study expects to confirm the hypothesis that remote urgency consultation (teletriage), through a validated questionnaire, will be able to define the planning of the clinical situation, reducing the chance of displacements and progression of infection, helping to eliminate patient pain and discomfort.

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ABSTRACT Introduction: With the advent of COVID-19, teledentistry and remote monitoring have become an imminent reality that allows orthodontists to monitor orthodontic treatment through virtual checkups, which complement in-office appointments. Objective: To evaluate the effectiveness of using teledentistry in monitoring the evolution of orthodontic treatment. Material and Methods: Searches were performed in on-line databases. PECO strategy focused on comparing orthodontic patients exposed and not exposed to teledentistry. Searches and data extraction followed PRISMA guidelines. The assessment of the risk of bias and the certainty of the evidence was performed using the ROBINS-I and GRADE tools, respectively. A meta-analysis was also performed. Results: Out of 1,178 records found, 4 met the criteria and were included in the qualitative analysis. The risk of bias for follow-up assesment in aligner treatment was low to moderate; while for interceptive treatment, it was high. Studies are favorable to the use of teledentistry. The meta-analysis was performed with aligners studies only, due to heterogeneity. The certainty of the evidence was considered very low. Conclusion: With very low certainty of evidence, teledentistry using Dental Monitoring® software is effective as an aid in monitoring the evolution of interceptive orthodontic treatment (high risk of bias) and, especially, treatment performed with aligners (low to moderate risk of bias). The meta-analysis evidenced a reduction in the number of face-to-face appointments (mean difference = −2.75[−3.95, -1.55]; I2=41%; p<0.00001) and the time for starting refinement (mean difference = −1.21[−2.35, -0.08]; I2=49%; p=0.04). Additional randomized studies evaluating corrective orthodontic treatment with brackets and wires are welcome.

RESUMO Introdução: Com o advento da COVID-19, a teleodontologia e o monitoramento remoto tornaram-se uma realidade iminente, permitindo ao ortodontista acompanhar o tratamento ortodôntico por meio de checkups virtuais, que complementam as consultas presenciais. Objetivo: Avaliar a eficácia do uso da teleodontologia no acompanhamento da evolução do tratamento ortodôntico. Material e Métodos: Buscas foram realizadas em bases de dados on-line. A estratégia PECO focou na comparação de pacientes ortodônticos expostos e não expostos à teleodontologia. As buscas e a extração dos dados seguiram a metodologia PRISMA. A avaliação do risco de viés e da certeza da evidência foi realizada com as ferramentas ROBINS-I e GRADE, respectivamente. Uma metanálise também foi realizada. Resultados: Dos 1.178 estudos encontrados, 4 atenderam aos critérios e foram incluídos na análise qualitativa. O risco de viés para a avaliação do acompanhamento de tratamentos com alinhadores foi baixo a moderado; enquanto para o tratamento interceptativo, foi alto. Os estudos são favoráveis ao uso da teleodontologia. A meta-análise foi realizada apenas com estudos de alinhadores, devido à heterogeneidade. A certeza da evidência foi considerada muito baixa. Conclusão: Com muito baixo nível de certeza da evidência, a teleodontologia utilizando o software Dental Monitoring® é eficaz para auxiliar no acompanhamento da evolução do tratamento ortodôntico interceptativo (alto risco de viés) e, principalmente, do tratamento realizado com alinhadores (risco de viés baixo a moderado). A metanálise evidenciou redução no número de atendimentos presenciais (diferença média = −2,75[−3,95, -1,55]; I2=41%; p<0,00001) e no tempo para início do refinamento (diferença média = −1,21[−2,35, -0,08]; I2=49%; p=0,04). Estudos randomizados adicionais avaliando o tratamento ortodôntico corretivo com braquetes e fios são bem-vindos.

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ABSTRACT Adolescence comprises a life cycle with high contact to information and communication technological tools. For this reason, it was decided to incorporate these tools into the oral health work process aimed at this public. The COVID-19 pandemic contextualized the use of digital technological tools in several productive sectors, including oral health care in the Unified Health System. Objective: The objective was to stimulate the use of teledentistry in the oral health care of adolescents in Primary Health Care in the Ceará interior. Methods: The participants were adolescents between 12 and 15 years old from two micro areas of the territory, in total there are 25 participants. The intervention was divided into three stages: application of an electronic form, creation of an instant messaging application group and creation and expansion of a flow for access to the service. Results: The reasons for the dropout in dental consultations by adolescents were the lack of vacancies, long wait and the low number of educational actions aimed at health. In the messaging application group, remote educational activities were carried out, as well as restructuring of the dental care flow with the possibility of scheduling a first appointment through the group. Conclusion: The interaction obtained in the intervention favored the improvement of access to dental appointments.

RESUMO A adolescência compreende um ciclo de vida com alto contato com ferramentas tecnológicas de informação e comunicação. Por este motivo optou-se pela incorporação dessas ferramentas no processo de trabalho em saúde bucal voltado a este público. A pandemia de COVID-19 contextualizou a utilização de ferramentas tecnológicas digitais em diversos setores produtivos, incluindo a assistência à saúde bucal no Sistema Único de Saúde. Objetivos: Objetivou-se estimular o uso da teleodontologia na atenção à saúde bucal de adolescentes na Atenção Primária à Saúde do interior do Ceará. Métodos: Os participantes foram adolescentes entre 12 e 15 anos de duas microáreas do território, totalizando 25 participantes. A intervenção foi dividida em três etapas: a aplicação de um formulário eletrônico, criação de um grupo de aplicativo de mensagens instantâneas e criação com ampliação de um fluxo para acesso ao serviço. Resultados: Os motivos da evasão em consultas odontológicas pelos adolescentes foram a falta de vagas, o longo tempo de espera e o baixo número de ações educativas voltadas à saúde. No grupo do aplicativo de mensagens, foram realizadas atividades educativas remotas, assim como restruturação do fluxo de atendimento com a possibilidade de marcação de primeira consulta através do grupo. Conclusão: A interação obtida na intervenção favoreceu a melhoria do acesso às consultas odontológicas.

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Objetivo: Analisar, por meio de uma revisão de literatura, a utilização da teleodontologia no cuidado em saúde bucal durante o período da pandemia de COVID-19 no Brasil. Materiais e Métodos: Trata-se de estudo de revisão integrativa, realizado de janeiro de 2020 até junho de 2021. Foram utilizados descritores controlados e combinados, em português e inglês. As bases consultadas foram a Biblioteca Regional de Medicina (BIREME), National Library of Medicine (MEDLINE/PubMed) e o Google Acadêmico. Excluíram-se produções não relacionadas ao escopo do estudo e produções duplicadas. Revisão de literatura: 28 publicações foram analisadas. Os resultados mostraram que a teleodontologia, no Brasil, ampliou sua utilização a partir da pandemia, sendo utilizada em ações preventivas-educativas de promoção da saúde bucal, em diagnósticos e apoio ao diagnóstico, na prescrição de medicamentos, na facilitação das marcações de consultas, no acompanhamento de tratamentos que já ocorriam de forma presencial e nas clínicas radiológicas, com envio de resultados de maneira digital. Discussão: Apesar dos estudos relatarem benefícios da utilização da teleodontologia relacionados ao cuidado e à formação em saúde, desafios relacionados ao acesso à tecnologia e à internet, a não familiarização com as ferramentas tecnológicas e a limitação para saber, após as teleconsultas, quais ações os profissionais tomaram em relação ao que foi orientado, foram relatados. Conclusão: A teleodontologia no período pandêmico analisado foi caracterizada como um dispositivo de cuidado que qualificou as práticas de saúde às pessoas-famílias-comunidade. Estudos que acompanhem a utilização da teleodontologia no Brasil, incluindo a participação de cirurgiões-dentistas e usuários, são recomendados.

Aim: To analyze, through a literature review, the emer-ging use of teledentistry in oral health care during the period of the COVID-19 pandemic in Brazil. Materials and Methods: This is an integrative review study, carried out from January 2020 to June 2021. Controlled and combined descriptors were used, in Portuguese and English. The databases consulted were the Regional Library of Medi-cine (BIREME), National Library of Medicine (MEDLINE/PubMed) and Google Scholar. Productions not related to the scope of the study and duplicate productions were excluded. Literature review: 28 publications were analyzed. The results showed that teledentistry, in Brazil, expanded its use from the COVID-19 pandemic, being applied in preventive-educational actions to promote oral health, in diagnoses and support for diagnosis, in pres-cribing medications, facilitating appointment bookings, monitoring treatments that were already taking place in person and at radiological clinics, with results being sent digitally. Discussion: Despite the studies reporting benefits of using teledentistry related to health care and training, challenges related to access to technology and the internet, lack of familiarity with technological tools and the limitation to know, after teleconsultations, what actions professionals took in relation to what was oriented, were reported. Conclusion: Teledentistry in the analyzed pandemic period was characterized as a health care device, qualifying health practices for people-families-community. It is recommended to carry out studies that monitor the use of teledentistry in Brazil, including the participation of dentists and users.

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A Organização Mundial da Saúde (OMS) decretou, em março de 2020, o estado de pandemia decorrente do novo Coronavírus (SARS-CoV-2). Nesse cenário, a teleodontologia se destacou como mecanismo de promoção da assistência odontológica durante o período mais crítico da pandemia. O presente estudo tem como objetivo apresentar, por meio de uma revisão de literatura, os aspectos éticos e legais pertinentes ao uso da teleodontologia no Brasil. A teleodontologia já era utilizada no Brasil antes da pandemia de COVID-19, porém não era regulamentada pelo Conselho Federal de Odontologia (CFO). Em 4 de junho de 2020 foi promulgada a Resolução CFO-226/2020, regulamentando o exercício da teleodontologia no país. A Resolução apresenta impasses e discussões quanto aos meios de assistência e suas vedações referentes a atuação dos profissionais. Conclui-se que a Resolução CFO-226/2020 reafirmou princípios éticos e legais quanto a prática odontológica descrita nas principais normas da classe e que, apesar das vedações apresentadas, a mesma se configura como um guia específico para realização das atividades laborais odontológicas referentes à teleodontologia

In March 2020, the World Health Organization (WHO) declared the state of pandemic caused by the new Coronavirus (SARS-CoV-2). In this scenario, teledentistry stood out as a mechanism for promoting dental care during the most critical period of the pandemic. This study aims to present, through a literature review, the ethical and legal aspects relevant to its use in Brazil. Teledentistry was already available in Brazil before the COVID-19 pandemic, but the Federal Council of Dentistry (CFO) did not regulate it. On June 4th, 2020, the Resolution CFO-226/2020 was drafted, which regulated the exercise of teledentistry in the Brazilian territory. The resolution presents impasses and discussions regarding the means of assistance and its prohibitions referring the performance of professionals. It is concluded that the resolution CFO-226/2020 reaffirmed ethical and legal principles respected by the dental practice described in the main norms of the class. Moreover, despite the prohibitions presented in Resolution CFO-226/2020, it is configured as a specific guide for carrying out dental work activities related to teledentistry

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Abstract The COVID-19 pandemic has highlighted the economic, social, and oral care health inequities in societies, especially in the developing world. Severe restrictions have been imposed on dental practices, limiting prophylactic and routine oral care health, allowing treatment only for emergencies. Since dental care includes procedures that generate aerosols, the risk of infection for dental personnel has increased significantly. In this review, a comprehensive and updated source of information about SARS-CoV-2/COVID-19 and the impacts it is having on oral health care is presented. The ongoing repercussions in dental practice and in dental education, including the opportunities for practice innovation that are evolving, are also indicated. Also, a discussion of the psychosocial factors that affect health and the quality of life of an individual, such as stress, depression, and anxiety, is provided. This pandemic may be an opportunity to promote the inclusion of well-established prevention measures, together with the use of teledentistry in academic dental curricula, encourage the implementation of new perspectives for the effective instruction and interactions with students, and foster the transition toward e-learning strategies in dental education.

Resumo A pandemia COVID-19 destacou as desigualdades econômicas, sociais e de saúde bucal, especialmente no mundo em desenvolvimento. Severas restrições têm sido impostas para a prática odontológica, limitando a rotina de saúde bucal, permitindo o tratamento apenas em emergências. Como o atendimento odontológico inclui procedimentos que geram aerossóis, o risco de infecção para a equipe odontológica aumentou significativamente. Nesta revisão, é abordada uma fonte abrangente e atualizada de informações sobre o SARS-CoV-2/COVID-19 e os impactos que têm nos cuidados de saúde bucal. As repercussões contínuas na profissão odontológica e na educação odontológica, incluindo as oportunidades de inovação da prática. Além disso, é fornecido o efeito de fatores psicossociais que afetam a saúde e a qualidade de vida, como estresse, depressão e ansiedade. Esta pandemia pode ser uma oportunidade para promover a inclusão de medidas de prevenção bem estabelecidas, juntamente com o uso da teledontologia nos currículos acadêmicos de odontologia, trazendo novas perspectivas sobre a forma de ensinar e interagir com os alunos, com a transição para estratégias de e-learning na educação odontológica.

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En junio 2020, en un escenario de confinamiento por cuarentenas y con restricción de la atención odontológica por la pandemia del COVID-19, comienza la implementación en Chile de una herramienta basada en la generación de interconsultas electrónicas asincrónicas a un especialista en patología oral y maxilofacial geográficamente distante, bajo la dirección de Hospital Digital de Ministerio de Salud. Esta nueva herramienta de teleodontología, denominada "Célula de Patología Oral", tiene como objetivo fortalecer la Red Asistencial de salud con un modelo de atención a distancia enfocado en la persona, permitiendo mejorar el acceso y oportunidad en la atención de salud en la especialidad de Patología Oral y Maxilofacial a través Tecnología de Información y Comunicaciones. La Célula de Patología Oral ha demostrado contribuir a la accesibilidad y reducir las desigualdades en la atención de la salud bucal, en una de las especialidades odontológicas implicadas en el diagnóstico de lesiones graves como son el cáncer oral y otras lesiones orales de alta prioridad durante la pandemia por la enfermedad debido a SARS-CoV2.

In June 2020, in a confinement scenario and with restriction of dental care due to the COVID-19 pandemic in Chile, a tool based on the generation of asynchronous electronic consultations by a geographically distant specialist in oral and maxillofacial pathology was implemented under the direction of the Digital Hospital of the Ministry of Health. This new dentistry tool, called " Célula de Patología Oral", aims to strengthen the Health Assistance Network with a remote care model focused on the patient, allowing the improvement of health care access and opportunity in the specialty of Oral and Maxillofacial Pathology, through Information and Communication Technology. The "Célula de Patología Oral" has proven to contribute to accessibility and to reduce inequalities in oral health care, in a dental specialty involved in the diagnosis of serious disease such as oral cancer and other high-priority oral diseases during the SARS-CoV2 pandemic.

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BACKGROUND: With the COVID-19 pandemic, thousands of children had their dental care interrupted or postponed, generating a pent-up demand for primary care. To minimize the impact of this outage, information and communication technologies (ICT) could be an alternative. The aim of this study is to elucidate the impact of implementing the ICTs in primary dental care for children on resolving the pent-up demand for primary dental care to children in the national health system service (SUS) due to the COVID-19 pandemic. METHODS: Different research strategies are being proposed to demonstrate such effect and extrapolating findings to a real-world context to guide further research, practice and policies: two clinical trials (one randomized controlled by the waiting list trial (RCT) and a before-and-after study), one simulation study to prospect trial results to a broader population and three economic evaluations using different effects. Children enrolled in a reference dental unit will be invited to participate in the before-and-after study for trials. The first 368 families will be randomized for the RCT to the intervention vs waiting list. All participants will receive the intervention, but the waiting list group will be assessed before the intervention is available for them. The intervention comprises standardized non-face-to-face primary dental care using the V4H platform. The problem-solving and the family's perception will be the primary outcomes set for the before-and-after study and RCT, respectively. They will be measured 2 weeks after randomization. Based on trial findings, we will develop theoretical models to estimate how the intervention could benefit the population included in the national health system.  Three economic evaluations will be carried out considering different trial effects (cost-effectiveness analyses). A societal perspective and the pandemic time horizon will be considered. Possible social impact (inequalities) will also be explored. DISCUSSION: This ongoing trial may be an essential contribution to clarify positive and negative aspects related to the use of technologies for non-face-to-face dental care for children. Trial products may bring relevant contributions to the pandemic context and the post-pandemic period. Potential benefits may be feasible to implement and preserve in the health system even in the post-pandemic period. Trial registration Clinicaltrials.gov registration NCT04798599 (registered March 2021).

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Objective: To develop a new concept of teledentistry for the elderly through a web platform and associated mobile application in the context of the COVID-19 pandemic. Material and Methods: A new concept for attention via teledentistry of the elderly supported by the web platform/app TEGO (Acronym for Tele-platform of Geriatric and Dental Specialties in Spanish) was developed. Priority and urgent dental care for elderly patients in the context of the COVID-19 pandemic was provided onboard a mobile dental clinic equipped with all the necessary conventional dental care facilities as well as state-of-the-art digital technology. Dental care was carried out in five cities of Chile. For the study, 135 elderly patients were treated. The tele-dental care model includes visit-appointment and remote interconsultation with a staff of specialists. To evaluate patient satisfaction aspects, regarding the service / care provided, a user satisfaction survey was applied. Results: A total of 68 questionnaires were completed by patients. The results showed high levels of patients' satisfaction after the priority or urgent dental care, which reached above 75% in all dimensions of the questionnaire (Access to dental care, user treatment, platform, recommendation). Conclusion: The generation of a technological ecosystem for teledentistry can provide a series of important advantages in the attention of elderly patients, by optimizing the dental care coverage by different specialists who can provide attention to a population that has limited or no access to them.

Objetivo: Desarrollar un nuevo concepto de teleodon-tología para adultos mayores a través de una plataforma web y aplicación móvil asociada en el contexto de la pandemia de COVID-19. Material y Métodos: Se desarrolló un nuevo concepto de atención vía teleodontología del adulto mayor apoyado en la plataforma/app web TEGO (Teleplataforma de Especialidades Geriatricas y Odontológicas). La atención dental prioritaria y urgente para pacientes de edad avanzada en el contexto de la pandemia de COVID-19 se brindó a bordo de una clínica dental móvil equipada con todas las instalaciones de atención dental convencional necesarias, así como con tecnología digital de última generación. La atención odontológica se realizó en cinco ciudades de Chile. Para el estudio, 135 pacientes de edad avanzada fueron atendidos. El modelo de atención teledental incluye visita-cita e inter-consulta remota con un staff de especialistas. Para evaluar los aspectos de satisfacción del paciente, respecto al servicio/atención brindada, se aplicó una encuesta de satisfacción del usuario. Resultados: Los pacientes completaron un total de 68 cuestionarios. Los resultados mostraron altos niveles de satisfacción de los pacientes tras la atención odontológica prioritaria o urgente, que superó el 75% en todas las dimensiones del cuestionario (Acceso a la atención odontológica, trato al usuario, plataforma, recomendación). Conclusión: La generación de un ecosistema tecnológico para la teleodontología puede brindar una serie de ventajas importantes en la atención de pacientes adultos mayores, al optimizar la cobertura de atención odontológica por parte de diferentes especialistas que pueden brindar atención a una población que tiene acceso limitado o nulo.

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Objective: To recognize the usefulness of incorporating Three-Dimensional models of standardized humans in electronic health records, in the context of the development of a teledentistry web platform designed for the attention of the elderly population in COVID-19 pandemic context. Material and Methods: A teledentistry web platform designed with different modules for clinical records. Through a new user-computer interface with a standardized virtual 3D phantom, an extraoral physical examination, an intraoral examination section was modeled. A label-associated marker is allowed to record descriptive aspects of the findings. A 3D odontogram represents multiple patient's conditions for each of the 32 dental positions. Results: From a total of 135 patients registered on the platform, 51 markers and 33 photographs associated with the surface of the virtual 3D phantoms were recorded. For the Location parameter: Hard palate 27.6%, inserted gingiva 15.7%, tongue 15.6%. For the Type of lesion parameter (according to the information entered in the pathology selector): unidentified 35.3%, sub-prosthetic stomatitis 23.5%, irritative fibroma 9.8%. Through the registration of the exact location of the finding in the virtual phantom by a 3D marker, the 3D modeling of the oral pathologies contributed to a better diagnosis, improving the remote communication between the attending dentist and specialists. Conclusion: The combination of the 3D modeling and anatomical-referencing in a teledentistry platform can become a powerful tool for the dental practice, due to their utility and specificity.

Objetivo: Reconocer la utilidad de incorporar modelos tridimensionales de humanos estandarizados en registros electrónicos de salud, en el contexto del desarrollo de una plataforma web de teleodontología diseñada para la atención de la población adulta mayor en contexto de pandemia por COVID-19. Material y Métodos: Una plataforma web de teleodontología diseñada con diferentes módulos para historias clínicas. A través de una nueva interfaz usuario-computadora con un fantoma 3D virtual estandarizado, se modeló un examen físico extraoral, una sección de examen intraoral. Se permite un marcador asociado a la etiqueta para registrar aspectos descriptivos de los hallazgos. Un odontograma 3D representa múltiples condiciones del paciente para cada una de las 32 posiciones dentales.Resultados: De un total de 135 pacientes registrados en la plataforma, se registraron 51 marcadores y 33 fotografías asociadas a la superficie de los fantomas virtuales 3D. Para el parámetro Ubicación: Paladar duro 27,6%, encía insertada 15,7%, lengua 15,6%. Para el parámetro Tipo de lesión (según la información ingresada en el selector de patología): no identificado 35,3%, estomatitis subprotésica 23,5%, fibroma irritativo 9,8%. A través del registro de la ubicación exacta del hallazgo en el fantoma virtual mediante un marcador 3D, el modelado 3D de las patologías orales contribuyó a un mejor diagnóstico, mejorando la comunicación remota entre el odontólogo tratante y los especialistas. Conclusión: La combinación del modelado 3D y la referenciación anatómica en una plataforma de teleodontología puede convertirse en una poderosa herramienta para la práctica odontológica, debido a su utilidad y especificidad.

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Objective: To analyze clinical indicators of teledentistry management for the elderly population during the COVID-19 pandemic in Chile. Material and Methods:A pilot teledentistry project was developed for dental care of the elderly in 5 regions of Chile. The data obtained were recorded on the TEGO Platform to be subsequently selected and analyzed by the researchers in terms of clinical management indicators: degree of installed occupancy, degree of available occupation, degree of real occupation, interconsultation indicator per patient attended, urgencies according to reason for consultations, unpostponable prosthetic treatment according to reason for consultations, prevention in relation to granted benefits, prevention in relation to the patients cared for, and project absenteeism indicator. Results: The clinical management indicators obtained were as follows: The average degree of installed occupancy was 67%. The average degree of available occupancy was 78%, which accounts for the clinical time in which there are dental chairs and dentists willing to work. The average real occupancy degree was 86%. The average interconsultation indicator per patient observed was 25%. The indicator of urgencies according to the reason for the consultation was 95%, which indicates that the purpose of the study was fulfilled. The average unpostponable prosthetic treatment according to the reason for consultations was 5%. The prevention in relation to granted benefits reached 39%. Finally, the average indicator of absenteeism was 17%. Conclusion: The measurement of clinical management indicators contributes to meet the Chilean Ministry of Health Explicit Health Guarantees (GES), which are: Access, Timely Attention, Quality and Financial Protection.

Objetivo: Analizar indicadores clínicos del manejo de la teleodontología para la población de adultos mayores durante la pandemia de COVID-19 en Chile. Material y Métodos: Se desarrolló un proyecto piloto de teleodontología para la atención odontológica del adulto mayor en cinco regiones de Chile. Los datos obtenidos fueron registrados en la plataforma TEGO para ser posteriormente seleccionados y analizados por los investigadores en cuanto a indicadores de gestión clínica: grado de ocupación instalada, grado de ocupación disponible, grado de ocupación real, indicador de interconsulta por paciente atendido, urgencias según motivo por consultas, tratamiento protésico improrrogable según motivo de consultas, prevención en relación a las prestaciones otorgadas, prevención en relación a los pacientes atendidos e indicador de ausentismo del proyecto. Resultados: Los indicadores de gestión clínica obtenidos fueron los siguientes: El grado medio de ocupación instalada fue del 67%. El grado medio de ocupación disponible fue del 78%, lo que da cuenta del tiempo clínico en el que hay sillones dentales y odontólogos dispuestos a trabajar. El grado de ocupación real promedio fue del 86%. El indicador medio de interconsultas por paciente observado fue del 25%. El indicador de urgencias según el motivo de la consulta fue del 95%, lo que indica que se cumplió con el propósito del estudio. El promedio de tratamientos protésicos impostergables según el motivo de consulta fue del 5%. La prevención en relación a las prestaciones otorgadas alcanzó el 39%. Finalmente, el indicador promedio de ausentismo fue de 17%. Conclusión: La medición de indicadores de gestión clínica contribuye a cumplir con las Garantías Explícitas en Salud (GES) del Ministerio de Salud de Chile, que son: Acceso, Oportunidad, Calidad y Protección Financiera.

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