Introduction

Tele-dentistry can be defined as the remote provision of dental care, advice, or treatment through the medium of information technology, rather than through direct personal contact with any patient(s) involved. Within the dental practice, teledentistry is used extensively in disciplines like preventive dentistry, orthodontics, endodontics, oral surgery, periodontal conditions, and detection of early dental caries, patient education, oral medicine, and diagnosis. Some of the key modes and methods used in teledentistry are electronic health records,

electronic referral systems, digitizing images, teleconsultations, and telediagnosis. All the applications used in teledentistry aim to bring about efficiency, provide access to an underserved population, improve quality of care, and reduce oral disease burden (Khan & Omar, 2013).

Tele-dentistry is useful among all branches of Dentistry such as in Kopycka-Kedzierawski and colleagues conducted a series of studies addressing the role of teledentistry in the detection and diagnosis of early childhood caries through intraoral images (Kopycka-Kedzierawski & Billings, 2006) and their results suggested that teledentistry could be a potentially efficient means of screening school children for signs of early childhood caries (Kopycka-Kedzierawski, Billings, & Mcconnochie, 2007). The use of teledentistry in oral medicine and diagnosis was assessed through a study conducted in Belfast, (Kopycka-Kedzierawski & Billings, 2011; Kopycka-Kedzierawski, Bell, & Billings, 2008) Northern Ireland, where the authors used a prototype teledentistry system as part of a service improvement scheme and found that teledentistry may represent an alternative approach to manage referrals in oral medicine (Bradley, Black, Noble, Thompson, & Lamey, 2010).

Teledentistry offers a wide variety of clinical applications ranging from patients’ records management, diagnosis, and clinical decisionmaking. Teledentistry has the potential to provide underserved patients with oral healthcare services and for that, we have to be prepared (Nimbulkar et al., 2020). In addition to clinical applications, teledentistry can be a beneficial tool to decrease the disparity because it is quarantine (Patel, Patel, Fulzele, Mohod, & Chhabra, 2020). In spite of the large number of disciplines that can benefit from teledentistry and the wide range of applications, limitations to the use of information communication and technology still exist and ensure equality in the provision of oral healthcare services and moreover, various therapeutic options also have to be thought of which can be provided through teledentistry means (Reche, Kolse, Gupta, Ingle, & Chhabra, 2020). The technology used in teledentistry enables the fast transfer of images, files, and documents and provides access to these information for specialists and practitioners (Khan et al., 2013).

During the times of Covid-19 pandemic has created unique challenges in ensuring healthcare. Nevertheless, the possibility of using telehealth systems and methodologies in dentistry, defined as teledentistry, could improve the quality and efficiency of dental health care.

Besides many advantages of Teledentistry, there are many challenges which decrease the effectiveness of Tele-dentistry in developing countries like India during Covid-19 emergency. There are studies in past which had assessed the barriers but factors affecting them has not been researched, which very important as manipulation of significant factors may increase the effectiveness and decrease the barriers of Teledentistry. Therefore, the aim of the present study is to assess this effectiveness and challenges of teledentistry and factors affecting it, during the times of covid-19 health emergency.

Materials and Methods

The study was conducted in Ajmer city, Rajasthan. All the dental professionals of Ajmer city was the sampling frame. Those dental professionals running their clinics were included in the study. The link was sent to all through the IDA group on WhatsApp and all were sent personal links. Informed consent was availed, and ethical approval was availed, from an independent ethical committee.

Before the start of the main study, a pilot study was conducted on 10% of total samples, to test the validity and reliability of the questionnaire. Internal consistency and reliability of questionnaires were measured by applying Cronbach's-Alpha (α) and Test-Retest. The value obtained was α=0.84, Kappa (k) =0.76 Weighted Kappa (k_w) = 0.80. Those questions with less validity and reliability were removed. Feasibility of the study was also checked.

To increase the response rate, callbacks and link were sent 3-4 times to each study participants. To assess the perspective of Dental professionals, a questionnaire was prepared which consists of 4 parts, first part consists of demographic details of study participants, 2^nd part consists of OPD details of study participant and 3^rd and 4^th parts consists of questions includes effectiveness and barriers of Tele-Dentistry during the times of Covid-19 Health emergency.

Statistical Analysis

Details about Demographic variable and OPD details and perspective towards effectiveness and challenges among dental professionals were assessed by using Statistical analysis and results were expressed in number and percentages. Analysis of Covariance was applied to assess the factors effecting the effectiveness and barriers of Teledentistry. Level of significance was kept at 5%.

Results

Table 1 shows that majority of study subjects {88 (42.5%)} were belonged to the age group of 36-45 years. Male study subjects {128(61.8%)} were more than females. Years of experience of most of the Dental professionals {79 (38.2%)} was 1-5 years. Dental professionals with master's degree {107 (51.7%)} was more than with a bachelor's degree. Mean age of Study participants were 32.3±3 years. Response rate of the present study was 85%.

Table 2 shows that Average number of patients seen per month before lockdown by 134 (64.7%) study participants was 21-40. Clinic of most of the study subjects {94(45.4%)} was Located in urban areas. Average OPD during lockdown and unlock phase was from 0-5 patients among {(87 (42.0%)}.

Table 3 shows that during Covid-19 Pandemic about 114 (55.1%) of Dental professionals had consulted the patients through Tele-consultation. According to 115 (55.5%) of study participants teledentistry less effective in clinical treatment and very much effective {109 (52.6%)} in the prevention of dental diseases. About 81 (39.1%) of study participants partially agree with the statement that Teledentistry is not much effective in clinical dentistry and prescribing drugs only will leads to recurrence.

Table 4 shows that according to the majority of study participants major challenges to practice of Teledentistry during Covid-19 Pandemic was lack of proper infrastructure {(189 (91.3%)}, negative attitude of Dental professionals {(93 (44.9%)}, fear of fraud in the online transfer of money {(132 (63.8%)}, Illiteracy of the patient in use of internet {(145 (70.0%)}, Limited knowledge about the software and instrument {(135 (65.2%)}, Lack of acceptance to Tele dentistry among dentists {82 (39.6%)}. In India, according to 98 (47.3), dental professionals to practice Tele dentistry challenges are more than its effectiveness.

Table 5 shows that according to majority of dental professionals {123 (59.4%)} think that effectiveness of Tele-dentistry in India is limited, according to {172 (83.1%)} dental professionals there are many challenges for practicing Tele-dentistry.

Table 7; Table 6 shows the impact of factors on effectiveness and barriers to teledentistry, it was reported that Factors which has a significant impact on the effectiveness of teledentistry was age (p=0.00), Average number of patients seen per month before lockdown (p=0.00), Years of experience (p=0.03*), Practice closed due to Covid-19 outbreak (p=0.00). While the factors effecting challenges were education (p=0.00), Average OPD during lockdown and unlock phase. (p=0.05).

Discussion

The present study was conducted to assess the effectiveness and challenges of teledentistry during the times of covid-19 health emergency. Not many studies conducted in the past on this topic, so this research was conducted.

Till now a lot of articles have reported the advantages, applications, usefulness of practicing Tele dentistryNutalapati, Boyapati, Jampani, and Dontula (2011) during Covid-19 pandemic which has provided a deep insight into this topic which really helped dental professionals, but in a country like India where ignorance about dental treatment was widespread and people were fearful in dental treatment during normal times and after warning of WHO about the dental treatment during Covid-19 pandemic, it was very difficult for dental professionals to provide clinical treatment to patients.

In the present study, the meaning of teledentistry was consultation about dental diseases on the mobile phone between patient and dentists. As the knowledge of Dental professionals was close to nil about the infrastructure needed in teledentistry, the scope of teledentistry is not very bright in India.

In the present study, the majority of study subjects belonged to the age group of 36-45 Years. In contrast to this in a study by (Pradhan, Verma, Sharma, & Khaitan, 2019) majority of study, participants were of 20-30 years of age group. This may be due to the fact that in the present study, only dental professionals with age group more than 25 years were included while in a study by (Pradhan et al., 2019) postgraduate students were also included. In the present study males were more than females; the same results were shown in a study by (Pradhan et al., 2019).

In the present study, majority of dental professionals were agreed with the statement that Teledentistry is a valuable tool in the prevention of diseases; same results were seen in the study by (Aboalshamat, 2020; Murererehe, Uwambaye, Isyagi, Nyandwi, & Njunwa, 2017).

In the present study majority of dental professionals does not agree with the statement that Teledentistry is effective reducing cost and saving time for dental professionals in the times of Covid-19 pandemic. Contrary results were seen in the study by (Aboalshamat, 2020; Murererehe et al., 2017).

In the present study, major challenges to practice teledentistry in India during Covid-19 pandemic was lack of proper infrastructure, negative attitude of Dental professionals, fear of fraud in the online transfer of money, Illiteracy of patient in use of the internet, the traditional system of state-by-state licensing, Limited knowledge about the software and instrument, Lack of acceptance. In the study by (Pradhan et al., 2019), major challenges in teledentistry are illiterates, population below the poverty line, and lack of infrastructure in India. In a study by (Aboalshamat, 2020), major challenges were lack of patient compliance, violation of patient privacy, Low level of population education, Lack of current infrastructure. Still, no study has been reported, which explores factor which has a significant impact on effectiveness and barriers of Teledentistry, so dentists have to be prepared and learn teledentistry uses and other means by which the society can be benefitted in terms of appropriate oral healthcare (Singh et al., 2020).

Conclusion

From above it was concluded that majority of dental professionals reported that effectiveness of Teledentistryduring Covid-19 is good, but altogether there were a large number of challenges to practice Teledentistry in India due to which its effectiveness decreases. Factors affecting its effectiveness barriers were age, an average number of patients seen per month before lockdown, Years of experience, Location of Practicing field, Practice closed due to Covid-19 outbreak, education, Nature of practice, Average OPD during the lockdown and unlock phase.

Funding Support

The authors declare that they have no funding support for this study.

Conflict of Interest

The authors declare that they have no conflict of interest for this study.