Efficacy of a remote screening model for oral potentially malignant disorders using a free messaging application: A diagnostic test for accuracy study

Abstract

ObjectiveTo assess the feasibility of using a remote sensing model as a free messaging application tool in the preventive screening of oral potentially malignant disorders in a rural area of India.DesignAn observational cross‐sectional study.SettingPrimary care setting in Udupi District, Karnataka, South India.ParticipantsOne‐hundred and thirty‐one individuals with a mean (SD) age of 37.34 (11.31) years, of whom 64.1% and 35.9% were men and women, respectively.InterventionsClinical oral examination followed by photo capture of five areas of the patients' mouth.Main outcome measuresReliability measures for the use of a photo messaging service in diagnosing oral potentially malignant disorders, as compared to the clinical examination.ResultsWhen lesions were categorised as normal and abnormal, the reliability (kappa) between the diagnoses, based on photo messaging and clinical oral examination, was 0.68 and 0.67 for Examiners 1 and 2, respectively. The sensitivity values for Examiners 1 and 2 were 98.5% and 99.04%, respectively, whereas the specificity was 72% and 64%, respectively. When the agreement between photo messaging and clinical oral examination for an exact diagnostic match was assessed, the reliability (kappa) was 0.59 and 0.55 for Examiners 1 and 2, respectively. The sensitivity values for Examiners 1 and 2 were 98.1% and 98.7%, respectively, whereas the specificity was 64% and 52% respectively.ConclusionThere was a substantial agreement between the diagnosis based on clinical examination and WhatsApp image for both the examiners, when the lesions were dichotomised as normal and abnormal, but slightly reduced when assessed for the exact diagnostic match. Screening for oral potentially malignant disorders using photo messaging can serve as an effective adjunct and a potential cost‐effective tool in a low‐resource setting.

Teledentistry during COVID-19 pandemic

“…With the use of a telediagnosis program EstomatoNet, patient referral to specialists reduced from 96.9% to 35.1% [14]. While the use of smartphones for detection of dental caries is well advocated [15,16]; it has also served as a reliable adjunct for screening of oral potentially malignant lesions [17]. An addition to telediagnosis is telecytology, a system for early detection of oral potentially malignant or malignant lesions [18].…”

<p>Clinical applications of intraoral camera to increase patient compliance - current perspectives</p>

“…Similarly, a study was done to evaluate the feasibility of a mobile phone camera and WhatsApp application in remote screening oral premalignant lesions. Substantial agreements were seen between actual and remote app-based diagnosis when the lesions were categorized as normal and abnormal,35 suggesting a suitable alternative method. IOCs can also be useful in the diagnosis and referral of oral mucosal regions and can be a critical imaging tool in hard to reach areas of the oral cavity.…”

Comparison of the accuracy of diagnoses of oral potentially malignant disorders with dysplasia by a general dental clinician and a specialist using the Taiwanese Nationwide Oral Mucosal Screening Program

“…This was also observed in the current study, in which the general dental clinician tended to make non-specific diagnoses such as unexplained persistent mass, unhealed ulceration for > 2 weeks, and abnormal mucosa without a definitive diagnosis. Notably however, in some countries, there is a lack of professional medical resources, and the presence or absence of a mucosal lesion may serve as an indication of whether further investigations or referral to a specialist are required [37].…”