Older adults’ oral health follow-up in primary care: A teledentistry feasibility exploratory studyABSTRACT
Teledentistry can help answer the rising demand for oral health in homebound older adults. This study aims to analyze the feasibility of teledentistry in monitoring the oral health of homebound older adults in primary care, focusing on acceptance, barriers, and system quality. It is a cross-sectional and exploratory implementation study with a quantitative approach conducted in Primary Health Care services in Southern Brazil. Twenty older individuals/their caregivers, and five dentists were intentionally selected. A dentist assessed older adults through an online telehealth system via video call. The AdEQUATE questionnaire collected data from older adults/caregivers and dentists. Data was analyzed using descriptive statistics. Twenty older adults received the video calls. Most were women aged 80 years or older; 50% received home care; 90% had no prior home dental care. Older adults generally found teledentistry a comfortable, convenient, safe, and trustworthy care option. However, some dentists expressed skepticism about its diagnostic accuracy and infrequent use. This highlights the importance of addressing dentists’ concerns in integrating teledentistry into public health services. The study also identified challenges, including limited equipment and technical issues. Despite this, teledentistry has proven to be a viable option for timely care, particularly for those unable to attend health facilities.
KEYWORDS
Teledentistry; Primary Health Care; Homebound persons; Frail elderly; Oral health.
RESUMO
A teleodontologia pode ajudar nas respostas às crescentes demandas de saúde bucal dos idosos restritos ao domicílio. Este estudo objetivou analisar a viabilidade da teleodontologia no monitoramento da saúde bucal de idosos domiciliados, na atenção primária, com enfoque na aceitação, barreiras e qualidade do sistema. Trata-se de um estudo transversal e exploratório, de implementação, com abordagem quantitativa, realizado na Atenção Primária à Saúde no sul do Brasil. Vinte idosos/seus cuidadores e cinco dentistas foram selecionados intencionalmente. Os dentistas interagiram com os idosos por meio de videochamada em um sistema online de telessaúde. O questionário AdEQUATE foi aplicado para coletar dados de idosos/ cuidadores e dentistas. Os dados foram analisados usando estatística descritiva. Vinte idosos foram atendidos por chamadas de vídeo. De forma geral, os idosos consideraram a teleodontologia uma opção confortável, conveniente, segura e confiável. No entanto, alguns dentistas expressaram ceticismo em relação à precisão diagnóstica e relataram uso esporádico da ferramenta, revelando a importância de abordar tais preocupações para integração da teleodontologia aos serviços públicos. Identificaram-se desafios, como a falta de equipamentos e problemas técnicos. Apesar disso, a teleodontologia parece ser uma opção viável para atendimento, especialmente para aqueles que não conseguem se deslocar até as unidades de saúde.
PALAVRAS-CHAVE
Teleodontologia; Atenção Primária à; Saúde; Pacientes domiciliares; Idoso fragilizado; Saúde bucal.
Introduction
Population aging and increased health problems are often associated with more significant healthcare needs and barriers to accessing health services1,2. Oral health conditions can also be affected over the years, and older adults with lower socioeconomic conditions tend to have more significant oral healthcare needs3,4. Teledentistry is one of the efforts capable of responding to the rising demands of older adults who have difficulties leaving their homes and accessing health services5.
Teledentistry can be defined as the use of information and communication technologies to facilitate contact between dentists or between dentists and patients when they are physically separated6-9. Several aspects of teledentistry have been studied, including its impact on health promotion and the prevention of oral diseases10, its use as a hospital diagnostic tool11, and its application in long-term care institutions for older adults12. Additionally, researchers investigated the knowledge and practices13, and dentists’ perceptions about teledentistry14.
In the Brazilian Unified Health System (SUS), teledentistry can serve as a tool for Primary Health Care (PHC) professionals to obtain specialized support, diagnostic assistance, and continuing education15. The COVID-19 pandemic has expanded the possibilities for teledentistry, including remote monitoring between appointments and screening to determine the best time for an in-person appointment16. Furthermore, current Brazilian legislation authorizes the use of telehealth, and by extension teledentistry, as a professional practice. It is up to the professional and the patient to decide whether to use it17.
However, there is a lack of information about teledentistry technologies used with older adults, especially those who do not live in long-term care institutions5,14 checking their acceptance18, the barriers to their use9, the potential for diagnosis12, and health promotion and prevention of oral diseases10.
So, this study analyzed the feasibility of using teledentistry to monitor the oral healthcare of older adults in Brazilian public PHC from the perspective of older adults or their caregivers and dentists. It investigated the feasibility by characterizing the experience of using teledentistry as a remote interaction modality in oral health care and evaluating the quality of the telehealth system.
Material and methods
Study design
A cross-sectional, quantitative, exploratory implementation research19-21 was conducted to assess the feasibility22 of monitoring the oral health of older adults using teledentistry in public primary healthcare services. The online Santa Catarina Telemedicine and Telehealth System (STT) platform was used. The intervention and data collection took place between November 2022 and March 2023.
The study was conducted in Florianópolis, the capital of Santa Catarina state in southern Brazil. In 2022, the city had an estimated population of 516,524, comprising 88,256 residents aged 60 or older and 12,493 residents aged 80 or older23,24.
This study adheres to the Brazilian national legislation on human research ethics25. The research project was submitted to the Human Research Ethics Committee of the Universidade Federal de Santa Catarina and approved in September 2022 under opinion No. 5,631,295 (certificate number CAAE 60543822.3.0000.0121). The participants’ verbal informed consent was collected through audio recording. The study adhered to the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology)26 guidelines to ensure transparency and quality in reporting observational studies.
Population
The study population consisted of homebound older adults aged 60 or over and their caregivers, followed by primary care teams. We considered homebound an older adult restricted to their home with a disability (physical, mental, emotional, and/or other) that resulted in limitations in moving outside the house27. Their respective caregivers were included for older adults who were unable to answer the questionnaires for any reason. Dentists linked to primary care and who carried out teleconsultations were also included.
The sample was intentionally and conveniently defined in accordance with the team’s research capacity during data collection. The study included five dentists linked to PHC and 20 homebound older adults followed up by PHC. For older adults who could not understand and/or answer the research questions, their caregivers, who had to be over 18 years old, were included.
Procedures
Dentists were invited to engage in the research through an online meeting previously arranged with the municipal oral health coordination. Once accepted, each dentist identified homebound older adults in their geographical area of coverage assistance, which was already included in the eligibility profile for home care at the PHC. The dentists initiated contact for research purposes. The research team then contacted the older adults/caregivers who were interested in participating.
After being informed about all the procedures, the older adult/caregiver who agreed to participate in the study received a link to access the platform through the WhatsApp LLC® (Meta, Inc.) app.
Data collection
A closed questionnaire was used to characterize the dentist’s experience with teledentistry consultation and the evaluation of the telehealth system. The first block of questions covered sociodemographic characteristics. The second block of questions was adapted from the AdEQUATE questionnaire28, based on the ISO/IEC 25010 standard, which assesses the STT platform quality using a 4-point Likert scale. It encompassed effectiveness/efficiency, reliability, safety, functional adequacy, satisfaction, usability, efficiency, and compatibility dimensions. The selected questions followed other instruments in evaluating software quality29,30. The third block addressed aspects of the teledentistry dentist’s experience.
Likewise, a closed questionnaire with 23 questions was used to characterize the experiences of older adults and their caregivers about the teledentistry consultation. The first block of questions covered sociodemographic characteristics. The second block referred to the evaluation of the STT platform, which was also adapted from the AdEQUATE28, and included some items from the satisfaction and usability dimensions. To characterize aspects related to the experience of older adults and their caregivers regarding teledentistry consultation, the third block of questions was asked, based on studies by Mariño et al. (2014), Murthy et al. (2021), and Torul, Kahveci, and Kahveci (2021)31-33.
The parameters (target population, healthcare level, location, approaches, professional duties, flows, implementation indicators, and content validation by experts) were elaborated in accordance with the Brazilian Health Ministry’s ‘Guide for developing clinical protocols and therapeutic guidelines’34.
Two video calls were held with each older adult/caregiver. In the first call, a teledentistry assistant was present; in the second, data collection was conducted with different dentists. The older adult or the caregiver accessed the STT platform via personal data login. Before concluding the video call, a new video call was scheduled within 48 hours between the older adult/caregiver and the researcher.
Data collection with dentists was done using a closed 38-question questionnaire sent via a Google Forms® app link to their email at the end of the intervention period. The questionnaire was completed online, and informed consent was collected through a digital or printed signature, which was then sent to the researcher. The leading researcher collected the older adults’ experiences and evaluations in a new video call in the same virtual room used for teledentistry consultations within 48 hours after the intervention. Questions were asked, and a 23-question online questionnaire was completed based on the responses of the older adult or caregiver, following the instruction guide.
Data analysis
Data were analyzed using descriptive statistics, obtaining absolute and relative frequencies for the participants’ profiles using Excel® and IBM® SPSS® software (IBM Corp. Released 2020. IBM SPSS Statistics for Windows, Version 27.0. Armonk, NY: IBM Corp). The responses ‘Totally agree’ and ‘I agree’ were considered positive, representing high-quality levels28.
Results
Twenty older adults received remote teledentistry consultations via video call in the PHC. The majority were women, predominantly over 80 years old. 90% have never received dental home care.
The older adults themselves answered half of the questionnaires. Half of the older adults had already received home care, and 75% had received a telehealth consultation via video call from a health professional. However, 90% had never received dental home care from a dentist, and none had received oral health care via teledentistry.
Table 1 presents the results of the STT evaluation by the older adults/caregivers. Considering the Satisfaction dimension, the majority reported an improvement in the quality of the service received and, therefore, they would incorporate its use frequently. Everyone found the valuable system in their care, felt confident using it, and would recommend it to their peers. Only 5% of the older adults felt uncomfortable using the STT platform.
Older adults/caregivers’ evaluation of the STT platform for teledentistry (n = 20). Florianópolis, 2023
Regarding the Usability dimension, half of the older adults indicated that they could not use the system without assistance from others, and 20% found it difficult to use. Despite this, everyone considered the terms in the text understandable, and most thought they could use the system even when they had special needs.
Table 2 presents the STT evaluation carried out by dentists. All participants positively evaluated the security dimension of the system, as well as Reliability, as it was stated that the system is always operational and accessible when necessary. Regarding Satisfaction, although everyone considers that the system provides a good service, the majority feel comfortable and confident during its use and understand that its use improves the quality of the work performed; two of them would not use it frequently and assessed that its use does not increase productivity.
Regarding Usability, dentists assessed that all relevant information is shown on the screen; four of them considered that the system’s functions are well-integrated, that the system is simple to use, and that they needed to learn a few things before starting to use the system. Furthermore, dentists showed proportionally divergent opinions in statements about the system being easy to use, believing that most people would learn to use the system quickly and be able to use it independently, as well as finding the system’s interface pleasant. There were no respondents with special needs.
The majority judged that the system responds quickly, which is a characteristic of efficiency, and that it executes its functionalities efficiently while sharing the environment and resources with other products, raising a question about compatibility. They were unable to answer whether the system allows the exchange of information with other systems when necessary.
Table 3 presents the responses about the experience of older adults/caregivers with video call teledentistry consultation. Most considered the teledentistry consultation time sufficient. Likewise, most were able to express themselves considerably well and felt equally involved in the decisions made, both when compared to face-to-face assistance.
Experience of older adults/caregivers about teledentistry consultation via video call (n = 20). Florianópolis, 2023
Regarding the dentist’s experience with teledentistry consultations via video call, everyone considered it sufficient time and understood that they were successful. Furthermore, they could express themselves in the same way as they would in a face-to-face setting. They would recommend a teledentistry consultation to another colleague to use with a homebound older adult (table 4).
Experience of dentists with teledentistry consultation via video call (n = 5). Florianópolis, 2023
Discussion
This study sought to improve access to oral health services for older adults in PHC by incorporating new information and communication technologies, specifically teledentistry. We committed to enhancing an intervention with digital security, which expands the list of actions carried out by public health services on a scientific basis. Pragmatically, we shared new processes and resources with healthcare professionals and managers to expand access to and qualification of the service, promoting the health and well-being of older adults and their caregivers. The research examined the experiences of older adults, their caregivers, and dentists with teledentistry consultation through the STT platform.
The results demonstrated that a healthcare professional had already seen most older adults via video call. They felt comfortable and involved in the decisions, such as in-person care, and recommended its use to other older adults in similar conditions. This information reinforces the importance of health care being person-centered2,14,35. Besides the professional’s scientific knowledge, aspects such as empathy, the ability to communicate with others, and the perception of their emotions and needs also affect the patient’s satisfaction35. The care received in the comfort of their home can also impact satisfaction with teledentistry consultation, especially for older adults who are sometimes unable to attend health units. This timely access that teledentistry can provide35,36 also proves to be a safe and viable alternative when distancing is recommended, as occurred in the COVID-19 pandemic14,36-42.
The findings indicated that almost half of the older adult participants had already received home care from a healthcare professional, one of the forms of health care3. However, most had never received dental home care, corroborating the evidence that oral health is not prioritized in home care43,44. Having some degree of cognitive impairment and living alone are barriers for older adults to receive home care with a focus on oral health3. This lack of dental home oral health appears to be associated with organizational and structural issues36,45, such as the lack of mobile equipment to perform specific procedures, the dentist’s work overload46, and a lack of training43. Other professionals or family members often carry out daily procedures to maintain oral health, with little knowledge47, which could be improved through teledentistry, with adequate guidance from a dentist4,5,7,14,48,49. The teledentistry consultations focused on improving oral hygiene habits, such as tooth brushing, flossing, and cleaning mucous membranes, as well as daily and weekly hygiene of removable dentures49,50. This aimed to expand the knowledge of older adults and their caregivers, and contribute to self-care and well-being2,36.
As observed in this study, dentists can exchange health information with older adults and their caregivers and indicate referrals when needed using teledentistry51. However, there are reports about dentists who do not feel confident in diagnosing and drawing up a treatment plan via teledentistry consultations without the possibility of an in-person appointment52. Some dentists do not consider teledentistry capable of providing enough elements for a more accurate diagnosis53, or simply because they do not believe in its usefulness54 or efficiency in patient care. Several reasons can be raised for these findings, such as oral images provided by patients with inappropriate quality and the lack of experience using this technology55. Despite this, teledentistry consultations can be used for other purposes, such as instructions, educational actions, screening, follow-up, and referral as a complementary form of care56-60. Furthermore, regarding older adults, home care is an alternative that warrants study for these purposes45,46,61.
In public health services, the literature has reported teledentistry as a tool for professional education and training, oral health surveillance, remote patient care, and interprofessional communication15. Within the Brazilian SUS, teledentistry can strengthen universal oral health coverage by expanding access to dental care, especially in remote and underserved areas and populations62. Additionally, it facilitates collaboration between general practitioners and specialists, thereby improving case discussions and referral systems63. Integrating electronic patients’ records across different levels of oral health care enhances coordination and continuity of care. Considering the PHC teams, teledentistry tools can improve oral health literacy, reduce consultation waiting times, and promote oral health equity. Within the country’s digital transformation strategy, the interoperability of systems and secure data exchange can optimize the coordination of primary health services64.
Investments in digital infrastructure, professional training, and interoperability are essential to maximize the impact of telehealth. By embedding teledentistry into public health policies, Brazil is advancing toward a more equitable, efficient, and connected oral healthcare system16,65-67. Ref The initiative that integrates telehealth into primary care provides a strategic framework for implementing teledentistry, through remote professional second opinions, teleconsultations, and telediagnosis68.
This research utilized a secure and official platform that meets Brazil’s general personal data protection legislation. It is known that standard message apps have the potential to delete information and lack access control to the user’s account, among other features that can expose patient data61. Otherwise, the STT platform seeks to capture personal data while preserving that data privacy through good security practices. The STT center provides a freely accessible page that details information such as the user’s rights and duties, collection of personal data, use, purposes, processing, sharing, storage, elimination, and protection of this data67. Older adults, their caregivers, and dentists considered the system an excellent service. Furthermore, dentists felt that the system was secure and accessible to authorized personnel. In other words, when logging in with a health professional’s login and password, patient data will be available to that professional, and the procedures are also maintained in their medical records. Another study involving the same system showed reasonable satisfaction rates among telehealth professionals28. Using a system that meets the standards of current Brazilian legislation in this research, in addition to providing timely oral health care to older adults with more incredible difficulty accessing the service36,38 allowed for preserving the privacy of participants’ data61.
Although the research employed a system not typically used by older adults, everyone found the terms understandable. These participants also found the system helpful in providing care, but half felt that they were unable to use it without assistance. This understanding on their part may be related to conditions expected with advanced age, cognitive impairment9,37,69, physical impairment37, and cultural resistance9. Older adults appear to be in favor of using technological resources and recognize their benefits. Still, as they age, they may feel that they lack the necessary skills to utilize them, and it is possible that their level of education also has an impact. Therefore, by observing the types of limitations that influence their acceptance or use of technology, adaptations and support can be provided to improve accessibility70.
For the dentists, divergent opinions occurred regarding the system used to increase productivity, and not everyone would use it frequently. Such resistance, combined with the low adherence of dentists observed in this study, may be associated with factors such as problems during connection14,16,18, human and infrastructure resources71, little skill in using information and communication technologies16,57,58,71, a lack of institutional incentive72, insecurity57, and even a lack of interest59. At the beginning of this study, it was challenging for dentists to find devices in their work environments that were adequately equipped to facilitate video calls (audiovisual resources). Furthermore, there were problems related to the internet network for patients and dentists during teledentistry consultations. It is possible that these interruptions during teledentistry consultations made them take longer compared to face-to-face consultations, reducing productivity. Likewise, it is likely that the knowledge and skills that favor more significant use of this resource, resulting from institutional incentives to practice using information and communication technologies through courses and technical support, can improve its effectiveness16.
Implementing telehealth services faces challenges related to access inequalities, making it essential to maintain a strong relationship between the healthcare system, teams, and users. However, both modalities are complementary and interdependent in promoting equitable access to healthcare60. In addition to improving access, teledentistry offers the potential to reduce costs7, provided that there is a balance between the necessary investments in equipment acquisition and maintenance9,72, as well as the quality of internet infrastructure on both sides18. This cost reduction can maximize teledentistry’s potential and foster equity, especially among vulnerable populations, such as the age group addressed in this study36,69. Furthermore, when carried out synchronously, both sides involved must also require availability at the same time49, making it another challenge to reconcile the professional’s agenda with the routine of an older adult. Training and awareness can contribute to greater acceptance16.
Despite being an exploratory study, this research has some limitations, including the small number of participants and the short intervention period, which compromise more in-depth analyses. Also, only older adults who were monitored by primary care health services and those treated by the geriatric medical specialty were included. Those older adults who were not registered or lived in areas not covered by dental primary health teams were excluded.
Considering the participants’ satisfaction with teledentistry, the professionals’ recommendation to their colleagues, the various possibilities that can be addressed, and the potential to promote access to health services, we recommend further studies with a more significant number of older adults and caregivers to understand the difficulties in using this technology and what strategies can be implemented to improve its use. Likewise, we must have a deep understanding of the reasons for the low adherence of PHC dentists, aiming to scientifically contribute to decisions regarding the organization of the work process and the allocation of public resources.
Conclusions
The research showed that older adults and caregivers considered teledentistry consultation equally appropriate compared to in-person care regarding call time and their involvement in decisions made with the health professional. They recommended its use to peers. Additionally, they considered the system helpful, but most did not feel capable of using it without help.
Through teledentistry consultations, dentists can exchange the necessary information with older adults and their caregivers, resolving what was previously presented as a remote demand. Dentists consider the system safe, but not everyone views its use as a means to increase productivity, so they do not use it frequently.
-
Financial support:
Non-existent
Data availability:
Research data are available on request, condition justified in the manuscript
References
-
1 World Health Organization. Ageing and health. WHO [Internet]. 2024 Oct 1 [accessed 2021 Dec 10]. Available from: https://www.who.int/news-room/fact-sheets/detail/ageing-and-health
» https://www.who.int/news-room/fact-sheets/detail/ageing-and-health -
2 World Health Organization. Ageing and Health Unit. WHO [Internet]. [date unknown] [accessed 2021 Dec 11]. Available from: https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/ageing-and-health/universal-health-coverage
» https://www.who.int/teams/maternal-newborn-child-adolescent-health-and-ageing/ageing-and-health/universal-health-coverage -
3 Ishimaru M, Shigeishi H, Yamashita Y, et al. Domiciliary dental care among homebound older adults: A nested case-control study in Japan. Geriatr Gerontol Int. 2019;19(7):679-83. DOI: https://doi.org/10.1111/ggi.13676
» https://doi.org/10.1111/ggi.13676 -
4 Peres MA, Macpherson LMD, Weyant RJ, et al. Oral diseases: a global public health challenge. Lancet. 2019;394(10194):249-60. DOI: https://doi.org/10.1016/S0140-6736(19)31146-8
» https://doi.org/10.1016/S0140-6736(19)31146-8 -
5 Aquilanti L, Cazzolla S, Montemurro N, et al. Dental care access and the elderly: What is the role of teledentistry? A systematic review. Int J Environ Res Public Health. 2020;17(23):1-13. DOI: https://doi.org/10.3390/ijerph17239053
» https://doi.org/10.3390/ijerph17239053 -
6 Chen JW, Hobdell MH, Dunn K, et al. Teledentistry and its use in dental education. J Am Dent Assoc. 2003;134(3):342-6. DOI: https://doi.org/10.14219/jada.archive.2003.0164
» https://doi.org/10.14219/jada.archive.2003.0164 - 7 World Dental Federation. Evidence-based use of teledentistry in oral health services. Geneva: FDI; 2021.
-
8 Jampani ND, Nutalapati R, Dontula BSB, et al. Applications of teledentistry: A literature review and update. J Int Soc Prev Community Dent. 2011;1(2):37-44. DOI: https://doi.org/10.4103/2231-0762.97695
» https://doi.org/10.4103/2231-0762.97695 -
9 Tan SHX, Lee CKJ, Yong CW, et al. Scoping review: facilitators and barriers in the adoption of teledentistry among older adults. Gerodontology. 2021;38(4):351-65. DOI: https://doi.org/10.1111/ger.12588
» https://doi.org/10.1111/ger.12588 -
10 Fernández CE, Hsu CL, Weiner L, et al. Teledentistry and mHealth for Promotion and Prevention of Oral Health: A Systematic Review and Meta-analysis. J Dent Res. 2021;100(9):914-27. DOI: https://doi.org/10.1177/00220345211003828
» https://doi.org/10.1177/00220345211003828 -
11 Giraudeau N, Camman P, Pourreyron L, et al. The contribution of teledentistry in detecting tooth erosion in patients with eating disorders. Digit Health. 2021;7:20552076211019250. DOI: https://doi.org/10.1177/20552076211019250
» https://doi.org/10.1177/20552076211019250 -
12 Queyroux A, Laurier C, Levy S, et al. Accuracy of teledentistry for diagnosing dental pathology using direct examination as a gold standard: Results of the Tel-e-dent study of older adults living in nursing homes. J Am Med Dir Assoc. 2017;18(6):528-32. DOI: https://doi.org/10.1016/j.jamda.2016.12.082
» https://doi.org/10.1016/j.jamda.2016.12.082 -
13 George PP, Papachristou K, Tan BK, et al. Knowledge, awareness, and attitude among practicing orthodontists on teledentistry during COVID pandemic in Kerala: A cross-sectional survey. J Pharm Bioallied Sci. 2021;13(5):846-50. DOI: https://doi.org/10.4103/jpbs.JPBS
» https://doi.org/10.4103/jpbs.JPBS -
14 Menhadji P, Patel R, Asimakopoulou K, et al. Patients’ and dentists’ perceptions of tele-dentistry at the time of COVID-19. A questionnaire-based study. Journal Dent. 2021;113:103782. DOI: https://doi.org/10.1016/j.jdent.2021.103782
» https://doi.org/10.1016/j.jdent.2021.103782 -
15 Costa CB, Peralta FDS, Ferreira de Mello ALS. How has teledentistry been applied in public dental health services? An integrative review. Telemed J E Health. 2020;26(7):945-54. DOI: https://doi.org/10.1089/tmj.2019.0122
» https://doi.org/10.1089/tmj.2019.0122 -
16 Costa CB, Peralta FS, Maeyama MA, et al. Teledentistry system in dental health public services: A mixed-methods intervention study. Int J Med Inform. 2021;153:104533. DOI: https://doi.org/10.1016/j.ijmedinf.2021.104533
» https://doi.org/10.1016/j.ijmedinf.2021.104533 - 17 Presidência da República (BR). Lei nº 14.510, de 27 de dezembro de 2022. Autoriza e disciplina a prática da telessaúde em todo o território nacional, 2022. Diário Oficial da União, Brasília, DF. 2022 dez 27; Seção I:1.
-
18 Byrne E, Watkinson S. Patient and clinician satisfaction with video consultations during the COVID-19 pandemic: an opportunity for a new way of working. J Orthod. 2021;48(1):64-73. DOI: https://doi.org/10.1177/1465312520973677
» https://doi.org/10.1177/1465312520973677 -
19 Peters DH, Adam T, Alonge O, et al. Republished research: Implementation research: What and how to do it. BMJ. 2013. DOI: https://doi.org/10.1136/bmj.f6753
» https://doi.org/10.1136/bmj.f6753 - 20 Peters DH, Tran NT, Adam T. Implementation research in health: a practical guide. Geneva: Alliance for Health Policy and Systems Research, World Health Organization; 2013. 67 p.
-
21 Theobald S, Brandes N, Gyapong M, et al. Implementation research: new imperatives and opportunities in global health. Lancet (London, England). 2018;392(10160):2214-28. DOI: https://doi.org/10.1016/S0140-6736(18)32205-0
» https://doi.org/10.1016/S0140-6736(18)32205-0 -
22 Bowen DJ, Kreuter M, Spring B, et al. How we design feasibility studies. Am J Prev Med. 2009;36(5):452-7. DOI: https://doi.org/10.1016/j.amepre.2009.02.002
» https://doi.org/10.1016/j.amepre.2009.02.002 -
23 Instituto Brasileiro de Geografia e Estatística. Florianópolis: Panorama [Internet]. [Rio de Janeiro]: IBGE; 2022 [accessed 2022 Mar 29]. Available from: https://cidades.ibge.gov.br/brasil/sc/florianopolis/panorama
» https://cidades.ibge.gov.br/brasil/sc/florianopolis/panorama -
24 Ministério da Saúde (BR). DATASUS [Internet]. População residente por faixa etária segundo capital 2022. Mnistério da Saúde: DATASUS; 2022 [accessed 2022 Mar 29]. Available from: http://tabnet.datasus.gov.br/cgi/tabcgi.exe?popsvs/cnv/popbr.def
» http://tabnet.datasus.gov.br/cgi/tabcgi.exe?popsvs/cnv/popbr.def - 25 Conselho Nacional de Saúde (BR). Resolução nº 466, de 12 dezembro de 2012. Aprova as diretrizes e normas regulamentadoras de pesquisas envolvendo seres humanos. Diário Oficial da União, Brasília, DF. 2013 jun 13; Edição 112; Seção I:59-62.
-
26 von Elm E, Altman DG, Egger M, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement: guidelines for reporting observational studies. BMJ. 2007;335(7624):806-8. DOI: https://doi.org/10.1136/bmj.39335.541782.AD
» https://doi.org/10.1136/bmj.39335.541782.AD -
27 Schirghuber J, Schrems B. Homebound: A concept analysis. Nurs Forum. 2021;56(3):742-51. DOI: https://doi.org/10.1111/nuf.12586
» https://doi.org/10.1111/nuf.12586 - 28 Alves JM. The adequate model: software quality evaluation model for telemedicine and telehealth systems [dissertation]. Florianópolis: Universidade Federal de Santa Catarina; 2017.
-
29 Maramba I, Chatterjee A, Newman C. Methods of usability testing in the development of eHealth applications: A scoping review. Int J Med Inform. 2019;126:95-104. DOI: https://doi.org/10.1016/j.ijmedinf.2019.03.018
» https://doi.org/10.1016/j.ijmedinf.2019.03.018 -
30 Hajesmaeel-Gohari S, Khordastan F, Fatehi F, et al. The most used questionnaires for evaluating satisfaction, usability, acceptance, and quality outcomes of mobile health. BMC Med Inform Decis Mak. 2022;22(1):22. DOI: https://doi.org/10.1186/s12911-022-01764-2
» https://doi.org/10.1186/s12911-022-01764-2 - 31 Mariño R, Hopcraft M, Tonmukayakul U, et al. Teleconsultation/telediagnosis using teledentistry technology: A pilot feasibility study. Int J Adv Life Sci. 2014;6(3-4):291-9
-
32 Murthy V, Herbert C, Bains D, et al. Patient experience of virtual consultations in Oral Medicine during the COVID-19 pandemic. Oral Dis. 2022;28(Suppl 2):2400-5. DOI: https://doi.org/10.1111/odi.14006
» https://doi.org/10.1111/odi.14006 -
33 Torul D, Kahveci K, Kahveci C. Is tele-dentistry an effective approach for patient follow-up in maxillofacial surgery. J Maxillofac Oral Surg. 2021;22(3):1-7. DOI: https://doi.org/10.1007/s12663-021-01596-z
» https://doi.org/10.1007/s12663-021-01596-z - 34 Ministério da Saúde (BR), Secretaria de Ciência, Tecnologia e Insumos Estratégicos, Departamento de Gestão e Incorporação de Tecnologias em Saúde. Guia de elaboração de protocolos clínicos e diretrizes terapêuticas: delimitação do escopo. 2nd ed. Brasília, DF: MS; 2019. 28 p.
-
35 Mason AN. The most important telemedicine patient satisfaction dimension: patient-centered care. Telemed J E Health. 2022;28(8):1206-14. DOI: http://dx.doi.org/10.1089/tmj.2021.0322
» http://dx.doi.org/10.1089/tmj.2021.0322 -
36 Medeiros KKAS, Pinto Júnior EP, Bousquat A, et al. O desafio da integralidade no cuidado ao idoso, no âmbito da Atenção Primária à Saúde. Saúde debate. 2017;41(Spe 3):288-95. DOI: https://doi.org/10.1590/0103-11042017S322
» https://doi.org/10.1590/0103-11042017S322 -
37 Ben-Omran MO, Livinski AA, Kopycka-Kedzierawski DT, et al. The use of teledentistry in facilitating oral health for older adults: A scoping review. J Am Dent Assoc. 2021;152(12):998-1011.e17. DOI: https://doi.org/10.1016/j.adaj.2021.06.005
» https://doi.org/10.1016/j.adaj.2021.06.005 -
38 Organização Pan-Americana da Saúde. Década do envelhecimento saudável nas Américas (2021-2030): As quatro áreas de ação da década. OMS [Internet]. 2021 [accessed 2022 Feb 22]; Início. Available from: https://www.paho.org/pt/decada-do-envelhecimento-saudavel-nas-americas-2021-2030/quatro-areas-acao-da-decada
» https://www.paho.org/pt/decada-do-envelhecimento-saudavel-nas-americas-2021-2030/quatro-areas-acao-da-decada -
39 Guo S, Chen Y, Mallineni SK, et al. Feasibility of oral health evaluation by intraoral digital photography: a pilot study. J Int Med Res. 2021;49(2):300060520982841. DOI: https://doi.org/10.1177/0300060520982841
» https://doi.org/10.1177/0300060520982841 -
40 Muniz IAF, Campos DES, Shinkai RSA, et al. Case report of oral mucosa garlic burn during COVID-19 pandemic outbreak and role of teledentistry to manage oral health in an older adult woman. Spec Care Dentist. 2021;41(5):639-43. DOI: https://doi.org/10.1111/scd.12605
» https://doi.org/10.1111/scd.12605 -
41 Rollings L, Castle-Burrows C. Domiciliary dentistry - remote consultation and risk assessment tool. Br Dent J. 2021;231(12):741-6. DOI: http://dx.doi.org/10.1038/s41415-021-3724-2
» http://dx.doi.org/10.1038/s41415-021-3724-2 -
42 Venegas B, Rueda S, Flores M, et al. Prevention of oral cancer through the implementation of a teledentistry platform for the elderly. J Oral Res. 2022;1(1):1-8. DOI: http://dx.doi.org/10.17126/joralres.2022.027
» http://dx.doi.org/10.17126/joralres.2022.027 -
43 Cunha Junior AP, Santos MBF, Santos JFF, et al. Dentists’ perceptions and barriers to provide oral care for dependent elderly at home, long-term care institutions or hospitals. Braz J Oral Sci. 2018;17:1-11. DOI: http://dx.doi.org/10.20396/bjos.v17i0.8654155
» http://dx.doi.org/10.20396/bjos.v17i0.8654155 -
44 Salmi R, Narhi T, Suominen A, et al. Oral health-related quality of life among home-dwelling older people with and without domiciliary care. Gerodontology. 2023;40(3):340-7. DOI: http://dx.doi.org/10.1111/ger.12659
» http://dx.doi.org/10.1111/ger.12659 -
45 Kerr E, Watson S, McMullan J, et al. General dentists’ attitudes and perceived barriers in providing domiciliary dental care to older adults in long-term care facilities or their homes in Northern Ireland: A descriptive qualitative study. Gerodontology. 2022;39(3):257-65. DOI: http://dx.doi.org/10.1111/ger.12565
» http://dx.doi.org/10.1111/ger.12565 -
46 Nomura Y, Okada A, Kakuta E, et al. Workforce and contents of home dental care in Japanese insurance system. Int J Dent. 2020;2020:1-6. DOI: http://dx.doi.org/10.1155/2020/7316796
» http://dx.doi.org/10.1155/2020/7316796 -
47 Salmi R, Tolvanen M, Suhonen R, et al. Knowledge, perceived skills and activities of nursing staff to support oral home care among older domiciliary care clients. Scand J Caring Sci. 2018;32(4):1342-7. DOI: http://dx.doi.org/10.1111/scs.12579
» http://dx.doi.org/10.1111/scs.12579 -
48 Croonquist CG, Dalum J, Skott P, et al. Effects of domiciliary professional oral care for care-dependent elderly in nursing homes - oral hygiene, gingival bleeding, root caries and nursing staff’s oral health knowledge and attitudes. Clin Interv Aging. 2020;15:1305-15. DOI: http://dx.doi.org/10.2147/cia.s236460
» http://dx.doi.org/10.2147/cia.s236460 -
49 Gurgel-Juarez N, Torres-Pereira C, Haddad AE, et al. Accuracy and effectiveness of teledentistry: a systematic review of systematic reviews. Evid Based Dent. 2022:1-8. DOI: http://dx.doi.org/10.1038/s41432-022-0257-8
» http://dx.doi.org/10.1038/s41432-022-0257-8 -
50 Nunez MDRR, Raulino ML, Castro RG, et al. Dental plaque control strategies for the elderly population: A scoping review. Int J Dent Hyg. 2021;20(1):167-81. DOI: http://dx.doi.org/10.1111/idh.12497
» http://dx.doi.org/10.1111/idh.12497 -
51 Sanzana-Luengo C, Díaz L, Abarza L, et al. Teledentistry protocol for the elderly in the context of the COVID-19 pandemic through a web platform/mobile app: approach from the general dentist. J Oral Res. 2022;1(1):1-8. DOI: http://dx.doi.org/10.17126/joralres.2022.026
» http://dx.doi.org/10.17126/joralres.2022.026 -
52 Migas K, Kozlowski R, Sierocka A, et al. Evaluation of tele-dentistry and face-to-face appointments during the provision of dental services in Poland. J Pers Med. 2022;12(10). DOI: http://dx.doi.org/10.3390/jpm12101640
» http://dx.doi.org/10.3390/jpm12101640 -
53 Soegyanto AI, Wimardhani YS, Maharani DA, et al. Indonesian dentists’ perception of the use of teledentistry. Int Dent J. 2022;72(5):674-81. DOI: http://dx.doi.org/10.1016/j.identj.2022.04.001
» http://dx.doi.org/10.1016/j.identj.2022.04.001 -
54 Zhou MX, Johnson EF, Arce K, et al. Teledentistry in the management of a non-Hodgkin’s lymphoma manifesting as a gingival swelling: A case report. Spec Care Dentist. 2022;42(1):86-90. DOI: https://doi.org/10.1111/scd.12638
» https://doi.org/10.1111/scd.12638 -
55 Raucci-Neto W, Souza Pereira M, Cerqueira NM, et al. Knowledge, perception, and experience of dentists about teledentistry. Int Dent J. 2022;72(4):456-62. DOI: http://dx.doi.org/10.1016/j.identj.2021.07.007
» http://dx.doi.org/10.1016/j.identj.2021.07.007 -
56 Conselho Federal de Odontologia (BR). Resolução nº 26, de 4 de junho de 2020. Dispõe sobre o exercício da Odontologia a distância, mediado por tecnologias, e dá outras providências [Internet]. Diário Oficial da União, Brasília, DF. 2020 jun 5 [accessed 2020 Jun 4]. Edição 107; Seção I:61-2. Available from: https://sistemas.cfo.org.br/visualizar/atos/RESOLU%c3%87%c3%83O/SEC/2020/226
» https://sistemas.cfo.org.br/visualizar/atos/RESOLU%c3%87%c3%83O/SEC/2020/226 -
57 Lin GSS, Koh SH, Ter KZ, et al. Awareness, knowledge, attitude, and practice of teledentistry among dental practitioners during COVID-19: a systematic review and meta-analysis. Medicina (Kaunas). 2022;58(1). DOI: http://dx.doi.org/10.3390/medicina58010130
» http://dx.doi.org/10.3390/medicina58010130 -
58 Martínez HLH, Artmann E, Cruz SCS, et al. A telemedicina no combate à Covid-19: velhos e novos desafios no acesso à saúde no município de Vitória/ES, Brasil. Saúde debate [Internet]. 2022 [acesso em 2025 out 7];46(134):648-64. Disponível em: https://www.saudeemdebate.org.br/sed/article/view/6787
» https://www.saudeemdebate.org.br/sed/article/view/6787 -
59 Cheuk R, Adeniyi A, Farmer J, et al. Teledentistry use during the COVID-19 pandemic: perceptions and practices of Ontario dentists. BMC Oral Health. 2023;23(1):72. DOI: http://dx.doi.org/10.1186/s12903-023-02772-y
» http://dx.doi.org/10.1186/s12903-023-02772-y -
60 Bhatia R, Gilliam E, Aliberti G, et al. Older adults’ perspectives on primary care telemedicine during the COVID-19 pandemic. J Am Geriatr Soc. 2022;70(12):3480-92. DOI: http://dx.doi.org/10.1111/jgs.18035
» http://dx.doi.org/10.1111/jgs.18035 -
61 Masoni M, Guelfi MR. WhatsApp and other messaging apps in medicine: opportunities and risks. Intern Emerg Med. 2020;15(2):171-3. DOI: http://dx.doi.org/10.1007/s11739-020-02292-5
» http://dx.doi.org/10.1007/s11739-020-02292-5 -
62 Haddad AE, Rendeiro M, Correia ADMS, et al. Experiência da Rede Brasileira de Teleodontologia. J Br TeleS. 2013;2(2). DOI: https://doi.org/10.12957/jbrastele.2013.8133
» https://doi.org/10.12957/jbrastele.2013.8133 -
63 Brito TDLV, Baptista RS, Lima Lopes PR, et al. Collaboration between medical professionals: Special Interest Groups in the Brazilian Telemedicine University Network (RUTE). Telemed J E Health. 2019;25(10):902-10. DOI: http://dx.doi.org/10.1089/tmj.2018.0075
» http://dx.doi.org/10.1089/tmj.2018.0075 - 64 Ministério da Saúde (BR), Departamento de Informática do SUS. Estratégia de Saúde Digital para o Brasil 2020-2028. Brasília, DF: MS; 2020. 128 p.
-
65 Oliveira Júnior AJ, Mialhe FL. Saúde digital e a odontologia no Brasil no âmbito do Sistema Único de Saúde. Rev Eletrônica Acervo Saúde. 2022;15(6). DOI https://doi.org/10.25248/reas.e10510.2022
» https://doi.org/10.25248/reas.e10510.2022 -
66 Braga RD, Panel of Specialists in Oral H, Lucena FN, et al. Oral e-Health: definition of essential attributes of oral health for the information record in primary care. Stud Health Technol Inform. 2019;264:1431-2. DOI: https://doi.org/10.3233/SHTI190469
» https://doi.org/10.3233/SHTI190469 -
67 Meurer MI, Von Wangenheim A, Zimmermann C, et al. Launching a public statewide tele(oral)medicine service in Brazil during COVID-19 pandemic. Oral Dis. 2022;28(Suppl 1):947-9. DOI: https://doi.org/10.1111/odi.13528
» https://doi.org/10.1111/odi.13528 - 68 Ministério da Saúde (BR). Portaria nº 2.546, de 27 de outubro de 2011. Redefine e amplia o Programa Telessaúde Brasil, que passa a ser denominado Programa Nacional Telessaúde Brasil Redes (Telessaúde Brasil Redes). Diário Oficial da União, Brasília, DF. 2011 out 28; Edição 208; Seção I:50-2.
-
69 Siqueira Silva I, Araujo AJ, Lopes RH, et al. Digital home care interventions and quality of primary care for older adults: a scoping review. BMC Geriatr. 2024;24(1):507. DOI: https://doi.org/10.1186/s12877-024-05120-z
» https://doi.org/10.1186/s12877-024-05120-z -
70 Ha J, Park HK. Factors affecting the acceptability of technology in health care among older Korean adults with multiple chronic conditions: a cross-sectional study adopting the senior technology acceptance model. Clin Interv Aging. 2020;15:1873-81. DOI: https://doi.org/10.2147/CIA.S268606
» https://doi.org/10.2147/CIA.S268606 - 71 Estai M, Kruger E, Tennant M, et al. Challenges in the uptake of telemedicine in dentistry. Rural Remote Health. 2016;16(4):3915.
-
72 Fahim A, Saleem Z, Malik KA, et al. Exploring challenges and mitigation strategies towards practicing Teledentistry. BMC Oral Health. 2022;22(1):658. DOI: https://doi.org/10.1186/s12903-022-02685-2
» https://doi.org/10.1186/s12903-022-02685-2
Edited by
-
Editor in charge:
Paulo Victor Rodrigues de Carvalho
Publication Dates
-
Publication in this collection
17 Nov 2025 -
Date of issue
2025
History
-
Received
21 Oct 2024 -
Accepted
21 May 2025
