Abstract: Teledentistry offers possibilities for improving efficiency and quality of care and supporting cost-effective healthcare systems. This umbrella review aims to synthesize existing systematic reviews on teledentistry and provide a summary of evidence of its clinical- and cost-effectiveness. A comprehensive search strategy involving various teledentistry-related terms, across seven databases, was conducted. Articles published until 24 April 2023 were considered. Two researchers independently reviewed titles, abstracts and full-text articles. The quality of the included reviews was critically appraised with the AMSTAR-2 checklist. Out of 749 studies identified, 10 were included in this umbrella review. Two reviews focusing on oral-health outcomes revealed that, despite positive findings, there is not yet enough evidence for the long-term clinical effectiveness of teledentistry. Ten reviews reported on economic evaluations or costs, indicating that teledentistry is cost-saving. However, these conclusions were based on assumptions due to insufficient evidence on cost-effectiveness. The main limitation of our umbrella review was the critically low quality of the included reviews according to AMSTAR-2 criteria, with many of these reviews basing their conclusions on low-quality studies. This highlights the need for high-quality experimental studies (e.g., RCTs, factorial designs, stepped-wedge designs, SMARTs and MRTs) to assess teledentistry’s clinical- and cost-effectiveness.
Objectives: The Toddler Oral Health Intervention (TOHI) was launched in 2017 to promote oral health prevention at well-baby clinics, with a focus on parents with chil- dren aged 6–48 months. This study aims to evaluate the integrity of motivational in- terviewing (MI) as one of the core intervention pillars in the TOHI study. Methods: The TOHI study was conducted at nine well-baby clinics in the central and southern regions of the Netherlands, with 11 trained oral health coaches (OHCs) de- livering a tailored individual counselling programme. Audio recordings of counselling sessions were uploaded by the OHCs into an online portal for feedback and integrity evaluation purposes. A trained independent assessor evaluated MI integrity using the MITI 4.2.1 coding scale. IBM SPSS Statistics was used to analyse the data, with rat- ings on technical and relational components and behavior counts computed by add- ing up the scores and categorizing them into six key MI skills. Descriptive statistics, including frequencies, percentages and median scores with interquartile ranges, were calculated. Results: The median ratings on the technical and relational components were 2.5 (IQR 2.0–3.5) and 3.5 (IQR 3.0–4.0) out of a maximum of 5, with 45% and 58% of record- ings showing fair or good MI integrity, respectively. A median of 38% (IQR 25–55%) of complex reflections and a reflection-to-question ratio of 0.7 (IQR 0.4–1.0), with 47% and 24% of recordings showing fair or good MI integrity, respectively. Median counts of MI-adherent and non-adherent statements were 3.0 (IQR 2.0–5.0) and 0.0 (IQR 0.0–1.0), respectively. The duration of recordings and MI integrity varied among oral health coaches. Conclusion: Overall, this study revealed that, while intensive training was provided, not all OHCs in the TOHI study met fair thresholds for MI integrity. These findings emphasize the necessity of ongoing training, reflection and support to achieve and maintain a fair or good level of MI integrity in clinical practice.
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The purpose of this study was to identify predictors of oral hygiene behaviour (OHB) based on the Theory of Planned Behaviour (TPB) among dental care seekers in two cultural different regions: the Caribbean (Aruba/Bonaire) and Nepal. In addition, measures of oral health knowledge (OHK) and the expected social outcomes of having healthy teeth (ESO) were investigated. The main effects of the predictors as well as their interactions with region (Caribbean vs. Nepal) were examined. The interaction term contributed significantly to the amount of explained variance. In the Caribbean, OHB was determined by Attitude and Social Norms, and in Nepal by Perceived Behaviour Control and ESO. On the basis of these findings, quite different oral health care interventions are called for in developing and underdeveloped countries.
