Teledentistry for dental caries screening and preventive care in children and adolescents: a global scoping review

1. Introduction

Dental caries remains the most widespread chronic disease among children globally [1, 2]. The Global Burden of Disease Study estimated that over 530 million children are affected by untreated dental caries in primary teeth, making it the most common untreated condition worldwide [3]. If left untreated, caries can lead to significant complications, such as pain, infections, malnutrition, absenteeism, and reduced psychosocial well-being [4].

Despite being largely preventable through timely risk assessment, behavior modification, and fluoride application, access to preventive dental care remains unevenly distributed. Children in low- and middle-income countries (LMICs) and underserved populations in high-income countries (HICs) face significant barriers, including geographic isolation, limited healthcare infrastructure, shortage of pediatric dental professionals, low oral health literacy, and financial constraints [5]. The COVID-19 pandemic further exacerbated these disparities by restricting in-person dental services, highlighting the fragility of conventional dental care systems [1]. Teledentistry has emerged as a promising, technology-driven approach to extend the reach of dental services, particularly for early caries detection and preventive counseling in pediatric populations [6].

Teledentistry, a subset of telehealth, is defined as the use of telecommunication technology to provide dental care, consultation, education, and public health interventions remotely [7]. It comprises various modalities, including synchronous (real-time interaction), asynchronous (store-and-forward), remote monitoring, and mobile health (mHealth). These modalities can facilitate screening, diagnosis, education, and referral in both community and clinical settings [4]. In pediatric oral health, teledentistry has been used in school-based screening programs, maternal-child health services, and mobile dental units to detect early signs of caries, deliver anticipatory guidance to caregivers, and promote oral hygiene behaviors [8, 9].

Several pilot programs in high-income settings have demonstrated the feasibility and cost-effectiveness of teledentistry. The “Virtual Dental Home” model in California, for example, successfully deployed mid-level dental providers in community sites to collect diagnostic data, which was remotely reviewed by dentists, leading to early intervention and reduced need for advanced treatment [10]. Similarly, school-based teledentistry initiatives in Australia have shown that mobile and asynchronous platforms can significantly improve access to preventive care among rural and indigenous children [11, 12]. In LMICs, although the adoption of teledentistry is still emerging, mHealth interventions using smartphones and instant messaging platforms have been piloted with encouraging outcomes, especially in India, Brazil, and Iran [13, 14, 15].

However, significant implementation challenges remain. Diagnostic accuracy is heavily influenced by image quality, device calibration, and user training [10, 16]. Additionally, ethical considerations, such as data privacy, consent, and legal accountability in remote care models, are yet to be comprehensively addressed in many jurisdictions [5]. Moreover, disparities in digital infrastructure, particularly in rural and low-income settings, may inadvertently exacerbate oral health inequities if not addressed through targeted policy and resource allocation [3].

The existing literature on pediatric teledentistry is expanding but remains fragmented, with limited synthesis of global evidence regarding its use specifically for caries screening and prevention. Previous reviews have either focused on teledentistry in general populations, evaluated treatment-based applications, or were geographically restricted [7, 8, 17, 18, 19]. As the global health community pushes toward digital health integration within Universal Health Coverage frameworks, there is a need for comprehensive evidence to inform scalable, equitable, and context-sensitive teledentistry interventions in pediatric oral health [1, 6].

This scoping review aims to address this gap by systematically mapping the global application of teledentistry for caries screening and preventive care among children. By identifying best practices, contextual challenges, and evidence gaps, this review seeks to inform researchers, policymakers, and clinicians about how teledentistry can be optimized to reduce the global burden of dental caries in children.

2. Material and method

The pre-designed protocol for this review was established and registered in the Open Science Network (Reg. No. osf.io/fs56z). The current scoping review was conducted in accordance with the methodological framework proposed by the Joanna Briggs Institute (JBI) for scoping reviews and reported following the Preferred reporting system for systematic review and meta-analysis for scoping review (PRISMA-ScR) checklist (Supplementary material 1) [20]. The review systematically mapped the existing global literature on the application of teledentistry for dental caries screening and preventive care in pediatric populations.

3. Results

3.1 Study selection

A total of 497 records were identified through database searches, including PubMed (n = 422), EMBASE (n = 13), Web of Science (n = 24), and SCOPUS (n = 38). An additional five records were located through citation searching (Fig. 1). After removing 288 duplicates using EndNote21 (Clarivate Analytics, Philadelphia, PA, USA), 209 records remained for screening. Following title and abstract screening, 159 records were excluded. Of the 50 full-text articles sought for retrieval, two could not be retrieved. Ultimately, 48 full-text articles were assessed for eligibility. Of these, 25 were excluded as they did not match the inclusion criteria (Supplementary Table 2). Consequently, 23 studies were included in the final synthesis of this scoping review.

Fig. 1.PRISMA flowchart 2020 for study screening and selection.

3.4 Diagnostic accuracy of teledentistry programs

The comparison of sensitivity and specificity across various teledentistry modalities and diagnostic quality levels is illustrated in Fig. 2. The modalities assessed included mHealth, mobile teledentistry, store-and-forward systems, and teledentistry screening, with diagnostic performance. Fourteen studies reported sensitivity, specificity, and overall accuracy of teledentistry in caries detection and prevention. The highest performance metrics were noted in studies using targeted mobile applications and trained personnel.

Fig. 2.Specificity, sensitivity, and accuracy of different caries detection programs utilized in pediatric dentistry.

Ashtiani et al. [21] and Seyfi et al. [15] both reported high overall accuracy, with Seyfi’s study showing near-perfect agreement with clinical examinations [15, 21]. On the contrary, Kohara et al. [29] and Park et al. [25] reported lower sensitivity, particularly for initial caries lesions (specificity 0.73, sensitivity 0.69), indicating underdiagnosis in earlier stages (Supplementary Table 3).

The integration of AI-driven applications and the use of intraoral photographs captured by caregivers or school staff helped expand access while maintaining reliability [32]. Programs combining diagnostic and educational components, such as those by Aluditasari et al. [34] (2023) and Kale et al. [31] (2019), demonstrated comprehensive success in both prevention and detection.

Overall, mobile teledentistry and store-and-forward modalities under high or acceptable quality conditions showed the most favorable diagnostic accuracy in terms of both sensitivity and specificity (Fig. 2). In contrast, mHealth and low-quality teledentistry screening demonstrated suboptimal performance, emphasizing the importance of diagnostic quality and modality selection in teledentistry-based caries detection and prevention programs in children.

4. Discussion

This scoping review aimed to map and synthesize the global evidence on the application of teledentistry for dental caries screening and preventive care in pediatric populations. The findings underscore the growing utility, effectiveness, and potential scalability of teledentistry as a supportive tool in pediatric oral healthcare, particularly in the domains of caries detection and prevention.

The review noted the diagnostic robustness of teledentistry in detecting carious lesions among children, with performance metrics often approaching clinical gold standards. Store-and-forward systems and mobile teledentistry emerged as the most reliable modalities, with studies demonstrating high sensitivity, specificity, and inter-rater reliability. Seyfi et al. [15] reported near-perfect agreement between photographic assessments and clinical exams (kappa 0.89–0.93), while Bissessur & Naidoo demonstrated kappa values above 0.94 in caries detection by photographs provided by the parents to the dentists through web-based e-files [27]. These results indicate that high-fidelity intraoral imaging, even when captured remotely, can effectively support diagnostic workflows.

Mobile health (mHealth) applications also showed promise but exhibited greater variability in diagnostic accuracy. While studies like those by Estai et al. [11] and AlShaya et al. [26] showed high sensitivity and specificity when mobile apps were used by trained individuals, Kohara et al. [29] noted a marked decline in accuracy when detecting early lesions. This suggests that while mHealth broadens access, its effectiveness is contingent on both image quality and user training. Notably, applications involving caregiver-captured images [38] and AI-powered interpretation [32] demonstrated that non-dental personnel could perform effective caries screening when adequately supported by technology and training.

In the current review, application of teledentistry was evaluated for different age groups and the results showed a promising outcome for different ages. For infants and preschool children (0–5 years), teledentistry is most effective for parental counseling, anticipatory guidance, caries risk assessment, and reinforcement of preventive practices, such as feeding habits and oral hygiene routines [24, 34]. In school-aged children (6–12 years), teledentistry can be leveraged for screening of caries, malocclusion, and early periodontal conditions, often through school-based programs where teachers or allied health workers assist in data collection [14, 37]. For adolescents (13–18 years), programs are particularly valuable for promoting self-care behaviors, monitoring orthodontic treatments, addressing trauma or sports-related dental issues, and supporting adherence to preventive visits [2, 22]. This stratified approach highlights that while teledentistry is applicable across the pediatric age spectrum, tailoring interventions to the developmental stage and oral health needs of each subgroup enhances its effectiveness and clinical impact.

One of the key strength of this review is the inclusion of studies from both high-income countries (HICs) and low- and middle-income countries (LMICs), offering insights into how contextual factors shape the implementation and impact of teledentistry. In HICs like Australia, the USA, and Germany, teledentistry interventions were often embedded within structured school-based or health-system-supported models, featuring high-bandwidth communication infrastructure, trained mid-level providers, and integration with electronic health records [4, 10, 36]. Programs such as the “Virtual Dental Home” in the USA or school dental tele-screening in Queensland, Australia demonstrate the feasibility and cost-effectiveness of such integrated approaches [5, 8, 23]. Conversely, in LMICs such as India, Iran, Brazil, and South Africa, teledentistry was primarily implemented through pilot studies or community-based outreach programs, often relying on mobile phones, WhatsApp, and store-and-forward imaging [14, 27, 31, 36]. While these models successfully demonstrated feasibility and community acceptance, they were often constrained by infrastructural limitations, lower digital literacy, and lack of regulatory frameworks. Nevertheless, such programs have proven critical in improving access to care in rural and underserved regions, especially where pediatric dentists are scarce.

Programs in LMICs showcased impressive creativity and adaptability. Subbalekshmi et al. [28] demonstrated the feasibility of school-based screening with intraoral cameras in India, while Aluditasari et al. [34] validated a parental risk assessment app (“SKOR GIGI”) that achieved perfect agreement with CAMBRA in Indonesia. These interventions highlight the untapped potential of low-cost, community-driven models in promoting pediatric oral health.

Another key point addressed in the current review is implementation of preventive programs for caries detection with the help of teledentistry. The Telesmile app by Fageeh et al. [35] demonstrated significant knowledge gains among blind and deaf adolescents by offering disability-tailored content. Similarly, the use of WhatsApp-based behavioral messaging improved parental eHealth literacy for early onset of childhood caries among low-income families [36]. Moreover, the findings of this review indicate that teledentistry can support reliable early detection of caries and periodontal conditions, improve triaging, and reduce unnecessary in-person visits, thereby optimizing clinical time. It also facilitates follow-up care, patient education, and referral pathways, especially in underserved and pediatric populations, highlighting its potential as a complementary tool within routine dental practice.

School-based teledentistry programs, by Ward et al. [37], successfully combined synchronous and asynchronous modalities to screen, refer, and counsel children across 64 rural school sites. These programs not only facilitated early intervention, but also served as models of interprofessional collaboration, engaging dental hygienists, assistants, and remote dentists. Moreover, in the studies by Azimi et al. [38] and Kale et al. [31], the inclusion of caregivers in the diagnostic and preventive loop promotes family-centered care and enhances long-term behavioral change. In the study by Al-Jallad et al. [32], AICaries app enabled caregivers to perform accurate caries screening at home, with high usability scores and diagnostic success. Teledentistry offers scalable, personalized guidance and can be tailored to support anticipatory guidance, fluoride varnish application reminders, or dietary assessments. However, teledentistry programs have several challenges, including cultural and linguistic adaptation, limited standardized content, and variability in caregiver engagement. Future research should prioritize the co-design of digital interventions with community stakeholders to ensure relevance, acceptance, and sustainability, especially in low- and middle-income countries.

Although the present review did not specifically focus on pandemic-related adaptations, it is important to acknowledge that the COVID-19 pandemic acted as a major catalyst in accelerating the uptake of teledentistry worldwide. Lockdowns and restrictions on in-person dental visits highlighted its value for preventive counseling, registration of urgent cases, and continuity of care, particularly for pediatric populations. While this review did not analyze these developments in detail, future research should examine how pandemic-driven changes have influenced the long-term sustainability, accessibility, and equity of teledentistry programs.

5. Conclusions

This scoping review presents a comprehensive overview of how teledentistry is being utilized globally for pediatric dental caries screening and prevention. It reveals strong diagnostic performance particularly for store-and-forward and mobile models alongside growing innovation in preventive education and caregiver engagement. However, challenges related to infrastructure, training, digital equity, and long-term evaluation remain. With targeted investment, policy support, and community involvement, teledentistry holds transformative potential to improve pediatric oral health worldwide.

Availability of data and materials

Data will be available on request from the corresponding author.

Author contributions

MKA—developed the initial protocol; performed the initial search and registered the protocol; has done initial search on PubMed and extracted the final articles; did the final data extraction and charting of the data; has written and drafted the manuscript for publication.

Ethics approval and consent to participate

Not applicable.

Acknowledgment

Author would like to thank the College of Dentistry Research Center and Dean ship of Scientific Research at King Saud University, Saudi Arabia, for funding this research project. The author wants also to thank his colleagues Saad Bin Saleh and Ayman M Sulimany working in Department of Pediatric Dentistry and Orthodontics, College of Dentistry, King Saud University, for contributing to data collection, data extraction and initial drafting of this scoping review.

Funding

This research received no external funding.

Conflict of interest

The author declares no conflict of interest.

Supplementary material

Supplementary material associated with this article can be found, in the online version, at https://oss.jocpd.com/ files/article/2028733654400679936/attachment/ Supplementary%20material.docx.