Dental Therapy Teledentistry Triage Accuracy and In-Person Restorative Referral Yield in Rural Zambian Clinics: A Prospective Diagnostic Concordance Evaluation

Teledentistry triage promises to extend dental therapy capacity into rural Zambian clinics where in-person restorative services are scarce, yet the concordance between remote triage decisions and in-person restorative need has not been prospectively quantified. Remote triage was conducted by dental therapists using store-and-forward image and symptom protocols; in-person examination by an independent dental therapist served as the reference standard. The primary outcomes were concordance (sensitivity, specificity, positive and negative predictive value) for restorative referral and the yield of in-person restorative referrals generated by remote triage. The analysis was framed as a diagnostic accuracy study with paired observations. The results indicate that teledentistry triage achieved high concordance for urgent restorative referral but over-referred non-urgent cases, producing a restorative referral yield that exceeded in-person need. The findings suggest that teledentistry triage in rural Zambian clinics is accurate for identifying urgent restorative need but generates surplus referrals that may strain limited in-person capacity.