Dental hygiene therapy teledentistry triage concordance and in-person periodontal treatment conversion in South African community clinics: a prospective diagnostic accuracy evaluation

Teledentistry triage promises to extend periodontal screening into South African community clinics where dental hygienists are scarce, but its value depends on concordance with in-person assessment and on whether triaged patients actually convert to treatment. The analysis treats concordance and treatment conversion as linked endpoints: a triage decision that agrees with the reference examination but does not lead to periodontal treatment delivers no clinical benefit. Using a diagnostic accuracy framework, the study estimates agreement between remote and in-person periodontal classification, reports conversion from triage recommendation to in-person periodontal treatment, and examines whether conversion varies with triage category and patient characteristics. The design, sampling and analysis plan are specified in full, including the reference standard, index test, blinding arrangements and the statistical methods for agreement and conversion. Because the evaluation is reported as a prospective protocol with a pre-specified analysis plan, the paper contributes a replicable methodological template for teledentistry triage assessment in low-resource dental hygiene services rather than completed outcome estimates. The discussion sets out how concordance and conversion should be interpreted jointly, identifies the conditions under which teledentistry triage is likely to be clinically useful, and specifies the reporting standards that future evaluations in African community dental settings should meet.