Diagnostic Accuracy and Behavioral Acceptance of Smartphone-Based Teledentistry in Children

Background and Aim: This study aimed to evaluate thediagnostic accuracy of smartphone-based intraoral photographscompared with face-to-face clinical examination in pediatricpatients and to assess children’s behavioral responses duringintraoral image acquisition.Materials and Methods: Sixty children aged 4–13 yearswere included in this prospective diagnostic accuracy study.Each participant underwent both a clinical examination and asmartphone-based intraoral imaging session performed one weekapart. Participants were allocated to two examination-order groupsto control for potential sequence effects. Five standardized intraoralphotographs were obtained for each child and evaluated remotelyby two independent pediatric dentists using a store-and-forwardmodel. Face-to-face clinical examinations were performed by apediatric dentist and served as the reference standard. Diagnosticagreement was assessed using Cohen’s kappa and intraclasscorrelation coefficients. Behavioral responses were evaluated usingthe Facial Image Scale and a behavioral observation form.Results: Almost perfect diagnostic agreement was observedamong examiners (κ = 0.841–0.896, p < 0.001). Sensitivity andaccuracy for the detection of sound and carious teeth exceeded89% and 93%, respectively. Intraclass correlation coefficientswere 0.888 and 0.959. Facial Image Scale scores decreasedafter both procedures. Age significantly influenced behavioralresponses during clinical examinations, whereas no associationwas observed during intraoral imaging.Conclusions: Smartphone-based teledentistry demonstratedhigh diagnostic accuracy and strong agreement with face-to-faceclinical examinations. Intraoral imaging was well tolerated anddemonstrated consistent behavioral responses across demographicgroups. These findings support its use as a reliable adjunct forremote dental screening and follow-up in pediatric patients.