Teledentistry for improving access to, and quality of oral health care: An overview of systematic reviews and meta-analyses (Preprint)

Abstract

BACKGROUND Digital interventions including teleledentistry are promising approaches to address some of the inadequacies of healthcare systems. Despite systematic reviews (SRs) on the benefits and implementation challenges of teledentistry, its impact on the quality of care remains unclear. OBJECTIVE The purpose of this overview of SRs is to summarize evidence on the impact of teledentistry in promoting access to and enhancing the quality of oral health care. METHODS We searched electronic databases in MEDLINE (Ovid), Embase (Embase.com), CINAHL (EBSCO), Web of Science, Cochrane Library, Epistemonikos and grey literature to identify SRs and meta-analysis of quantitative, qualitative, and mixed reviews, with the support of an expert librarian, from inception to March 2024. In addition, we checked the reference lists of included SRs. We included studies without data and language restrictions. Two independent reviewers performed data screening and data extraction and assessed the quality of included SRs using the AMSTAR 2 and ROBIS tools. We assessed the overlap of the included reviews. We reported on the certainty of evidence and on the heterogeneity from the included studies. Data are synthesized narratively and presented with tables and graphs. RESULTS The search yielded 1020 articles, of which 30 SRs were included in the overview. The number of participants across these reviews ranged from 130 to 7913 people. All dimensions of the quality of care were addressed to varying extents, with the domains of effectiveness, efficiency, and patient-centered care being the most extensively studied. Conversely, patient safety and equity were the least explored domains. Several SRs exhibited a critically low to low methodological quality and a high risk of bias. The overlap (corrected covered area) of the primary studies in all the SRs was slight (2.3%), while it as moderate (5.7%) for SRs with meta-analysis (SR-MAs). CONCLUSIONS The findings of this overview suggest that teledentistry is an effective and efficient alternative to in-person oral health care, in line with the Quintuple Aim. However, concerns with the quality of the reviews warrant a call for more rigorous studies to obtain more robust evidence, notably on its potential to achieve equity.