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Use of teledentistry in pediatric dentistry in times
of the covid-19 pandemic: literature review.
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Uso de la teleodontología en odontopediatría en los tiempos
de la pandemia de covid-19: revisión de la literatura.
Landeo Pariona, A.B.a Campos Campos, K.J.b
a.DDS. Postgraduate Resident of Pediatric Dentistry, Universidad Cientíca del Sur, Lima, Perú.
b.MSc. Pediatric Dentistry, Proff. Universidad Cientíca del Sur, Lima, Perú.
Recibido 2024-06-26
Revisado 2024-07-10
Aceptado 2024-10-08
ABSTRACT
At the beginning of 2020, the virus that initiates COVID-19 emerges. Therefore, limitations were imposed on the interactions in
the pediatric dental ofce. Teledentistry became an option to provide dental services to pediatric patients.
The purpose of this literature review was to determine the use of teledentistry in pediatric dentistry during COVID-19
pandemic.
A search was conducted on platforms such as: Ebsco, Scielo, Lilacs, Pubmed and Google Scholar regarding it. It was found
that teledentistry was used for the purposes like as the diagnosis and promotion of oral health, measurement of knowledge
of parents about children’s oral health, to perform dental appliance checks, to measure the attitude and knowledge of
teledentistry by the pediatric dentist and to carry out disease prevention and control in special patients.
OBJECTIVE:
The purpose of this literature review was to determine the use of teledentistry in pediatric dentistry in times of the COVID-19
pandemic.
METHODOLOGY:
The selection criteria included case reports, original articles and randomized clinical trials in Spanish or English published from
2020 to 2022. Articles other than Spanish or English were excluded.
The research question is: What is the use of teledentistry in Pediatric Dentistry in times of the Covid-19 pandemic?
• P= pediatric patients in need of dental care in times of the Covid-19 pandemic
• I= teledentistry
• C= not receiving dental care
• O= reduction in viral exposure of the pediatric patient during dental consultation, guidelines for dental care in times of
pandemic, appropriate use of teledentistry in pandemic.
The article search strategy was conducted on platforms such as: EBSCO, Scielo, LILACS, Pubmed and Google Scholar.
Landeo Pariona, A.B., Campos Campos, K.J. (2025) Use of teledentistry in pediatric dentistry in times of the covid-19 pandemic: Literature review. (A.B. Landeo Pariona, K.J. Campos Campos, Trans.)
Odontología Vital, 1(42) 51-62
https://doi.org/10.59334/ROV.v1i42.663
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INTRODUCTION
In early 2020, health agencies reported a
respiratory illness affecting the population of
Wuhan, which was later identied as COVID-19
(WHO, 2020). This disease presented two
variants: nCoV-2019 and SARS-CoV-2 (Chen et
al., 2020).
In the eld of dentistry, the primary modes of
transmission are respiratory, particularly through
salivary droplets produced during actions such
as coughing, sneezing, or speaking. Aerosol
transmission and contact with contaminated
surfaces also contribute signicantly to the
spread of the virus (Gorbalenya et al., 2020).
Dentists are classied as a high-risk group due
to several factors: airborne viral transmission
during procedures (ALOP, 2020), the persistence
of the virus in clinical settings (Golder et al.,
2000), and frequent exposure to saliva, blood,
and direct contact with patients’ oral mucosa
(Pen et al., 2020; Bizzoca et al., 2020).
To minimize these risks, teledentistry emerged
as an initial preventive measure (Wax et al.,
2020). This modality is part of the broader eld of
telemedicine.
The term “teledentistry” was rst introduced
in 1989 at a conference in Maryland, focusing
on delivering dental care through dental
informatics, telecommunications technology,
electronic medical records, and digital images
(Daniel et al., 2014).
Teledentistry encompasses various aspects of
dental practice, including promotion, education,
diagnosis, and rehabilitation (Sanchez et al.,
2004).
There are two primary types of technology used
in teledentistry: (i) synchronous technology,
which involves live videoconferencing, and (ii)
asynchronous technology, where images are
stored and transmitted remotely for review by
another practitioner (Skifas et al., 1997).
The American Academy of Pediatric Dentistry
(AAPD) established protocols for managing
dental care during the pandemic (AAPD, 2020).
Yang et al. emphasized the importance of
distinguishing between emergencies and non-
emergencies during online consultations and
providing clear instructions to parents (Yang et
al., 2021).
Despite its potential, the use of teledentistry in
pediatric dentistry faces several challenges,
primarily related to legal and ethical concerns
(Castro et al., 2021).
This literature review aims to evaluate the use
of teledentistry in pediatric dentistry during the
COVID-19 pandemic.
RESULTS:
It was found that teledentistry was used for diagnosis and promotion of oral health, to measure parents’ knowledge of
children’s oral health, perform dental appliance checks, measure the attitude and knowledge of teledentistry by the pediatric
dentist and to conduct prevention and control of diseases in special patients.
KEYWORDS:
teledendistry, pediatric dentistry, Covid, pandemic.
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METHODOLOGY
This review includes articles published between
January 2020 and June 2022. A search was
conducted on platforms such as EBSCO, Scielo,
LILACS, PubMed, and Google Scholar.
Articles were selected based on keywords
in both Spanish and English, including
“teledentistry,” “children,” “pediatric dentistry,”
“oral health,” and “COVID-19.” Inclusion criteria
included case reports, original articles, and
randomized clinical trials published in Spanish or
English.
The research question guiding this review was:
What was the use of teledentistry in pediatric
dentistry during the COVID-19 pandemic?
General Objective:
To evaluate the use of teledentistry in pediatric
dentistry during the COVID-19 pandemic.
Specic Objectives:
• 1. To identify the benets of teledentistry
during the COVID-19 pandemic.
• 2. To examine the limitations of teledentistry
during the COVID-19 pandemic.
• 3. To explore how teledentistry has shaped
new habits among the population during
the pandemic.
IDScreeningEligibilityInclusion
Number of records identified in the
searches (n = 245)
(Number of additional records identified in other
sources (n = 0 )
Excluded by title or abstract (n=172):
• Estudios in vitro (n=1)
• Randomized(n=1)
• Retrospective (n=50)
• Editorial (n=10)
• Measure another variable (n=110)
Excluded for:
Limited text (n=2)
Does not answer question of interest (n=20)
Duplicate records
removed (n=35)
Non-duplicated articles reviewed
(n = 210)
Full text articles
(n=38)
Final selection
(n=16)
Figure 1 PRISMA owchart “USE OF TELEDENTODYSTOLOGY IN PEDIATRIC DENTISTRY IN TIMES OF COVID-19 PANDEMIC: LITERATURE
REVIEW”
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RESULTS
A total of 245 articles were initially identied.
After removing duplicates (35 articles), 172
were excluded based on the abstract, and 22
articles were excluded due to lack of full text or
relevance to the specic objectives. Ultimately, 16
articles met the selection criteria.
Teledentistry was applied in the following areas:
1. Diagnosis and Promotion
of Oral Health in Children
Five studies focused on the diagnosis of dental
diseases in children. Alshaya et al. (2022)
assessed the accuracy of mobile phone
cameras for diagnosing dental cavities and
found that they were more reliable for detecting
cavities in primary teeth than in permanent
teeth.
Phone consultations allowed dentists to classify
care needs based on the medical history
and symptoms reported by the patient (Ilyas
et al., 2021), reducing exposure to the clinical
environment. The most common diagnoses
were irreversible pulpitis and dental trauma
(Simpsons et al., 2020).
In Newcastle, the pediatric dental service
used phone calls to classify dental care needs
and found that only 3% required urgent care
(Wallace et al., 2021).
In China, surveys helped distinguish between
dental emergencies and non-emergencies,
facilitating appropriate referrals (Yang et al.,
2020).
In addition to diagnosis, teledentistry facilitated
oral health promotion. The “HI BOGI” app,
developed during the pandemic, improved oral
health knowledge among school-age children
(Rina Putri et al., 2021).
2. Evaluation of Oral Hygiene and Dietary Habits
Teledentistry enabled dentists to investigate
children’s oral hygiene, dietary habits, and
sociodemographic data (Alhayyan et al., 2020;
Sun et al., 2020; Liu et al., 2021).
In a survey of 6–9-year-olds, it was found that
the majority had poor oral hygiene and dietary
habits, which contributed to increased dental
discomfort, cavities, and gingivitis (Varkey et al.,
2022). In Wuhan, caregivers reported improved
attitudes toward children’s oral health during the
pandemic, with increased brushing frequency
(Liu et al., 2021).
3. Pediatric Dentists’ Attitudes
and Knowledge of Teledentistry
A study in Austria revealed that only 10% of
pediatric dentists had received training on
teledentistry during COVID-19.
However, more than 40% expressed a desire for
further education on the topic (Bekes et al., 2021).
Nyodu et al. (2022) concluded that pediatric
dentists were more knowledgeable about
teledentistry than general dentists.
4. Disease Prevention and
Management in Special Patients
Phone consultations helped identify oral health
risk factors in special populations, such as
children with Down syndrome and cleft lip.
A study identied factors like poor oral hygiene,
high sugar consumption, and economic
hardship as contributors to increased risk during
the pandemic (Rojano et al., 2020; Viswanathan
et al., 2022).
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Table 1 Studies using teledentistry for the diagnosis and promotion
of oral health among children
Author’s
name and
year
Sample Method study Method used Summary
Ilyas N et al
(2020)
102 patients
(edad: 1-16 )
Cross-
sectional
study
Structured
online survey
The need for in-ofce treatment
was classied after having suffered
a trauma. Less than half were
treated in the ofce. There were 55%
of dentoalveolar injuries. The most
frequent was a lateral dislocation.
Herawati H
et al (2021)
1 patient
(edad:8 ) Case report Video call
8-year-old patient. He is diagnosed
with anterior crossbite. Tongue
depressor therapy is performed
via video call, achieving successful
treatment.
Fadilah R.et
al (2021)
143 students
(edad: 6 – 12)
Cross-
sectional
study
Structured
online survey
and “HI BOGI”
application
The level of knowledge about
oral health is measured before
downloading the “HI BOGUI”
application, being at a moderate
level. After downloading the
application, the level is good.
Simpson S.
et al (2020)
369
consultations
(edad: 0-16)
Cross-
sectional
study
Structured
survey (phone
calls and in
person)
The most common diagnoses were
irreversible pulpitis and dental
trauma. There was an increase in
the incidence of trauma in anterior
teeth due to the fact that children
had greater recreational activity.
Wallace C.
et al (2022)
653 patients
(edad:0-16)
Cross-
sectional
study
Structured
survey (phone
calls)
Calls were classied according to
their need. It was found that 3%
needed urgent care, 15% required
priority in-person care, and 21% were
discharged.
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Alshaya M.
et al (2021)
95 kids (edad:
5- 10)
Cross-
sectional
study
Cell phone
photography
with Iphone X
Intraoral photography in primary
teeth was found to have excellent
sensitivity and specicity. In
permanent teeth it was good.
Fengjiao
Y.et al
(2020)
474
consultation
(edad:0-18
años)
Retrospective
study Online survey
Analyzes the information of
children’s online dental health
consultation during the COVID-19
pandemic in China, and provide
methods to distinguish between
dental emergencies and non-
emergencies, as well as referral
Table 2 Studies using teleodontology as a tool to measure hygiene and feeding
practices in children during the pandemic
Author’s
name and
year
Sample Method
study
Method
used
Summary
Li Z et al
(2021)
1838 kids
(age::6-13)
Cross-
sectional
study
Structured
online
survey
The 6-9 year-old group had greater oral
discomfort, a high rate of dental caries and
fracture of restorative material. Their eating
habits and oral hygiene were poor.
Varkey IM et
al (2022)
381 parents
(age: 4-7)
Cross-
sectional
study
Structured
online
survey
48% of the population showed increased
consumption of snacks during the pandemic.
Only 28% of parents would take their child for
dental treatment.
AlHayyan W.
et al (2022)
583
caregivers
(age:: 3-10)
Cross-
sectional
study
Structured
online
survey
91.5% of parents saw their children’s oral health
affected by the pandemic. 93% of caregivers
used teledentistry during the pandemic
period. 53.2% were unsure about teledentistry
Sun J. et al
(2020)
148 parents
(age:0-14)
Cross-
sectional
study
Structured
online
survey
A total of 91.89% of parents agreed that their
child/children could become infected with the
virus if they received dental treatment.
Liu C. et al
(2021)
4495
parents
(age:3-6)
Cross-
sectional
study
Structured
online
survey
96.9% of Wuhan residents reported higher
frequency of tooth brushing compared to
residents of other cities
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Tabla 4. Studies that showed the prevention and control of diseases in special patients through
teleodontology
Author’s
name and
year
Sample Method study Method
used Summary
Rojano A. et al
(2022)
15 families
of patients
with Down
syndrome
Case report
Anticipatory
treatment
guidelines
(Video
call via
WhatsApp)
A patient with Down syndrome was
monitored for 3 months, with weekly
consultations using the WhatsApp
application. Risk factors for the oral
health of the patient and her family
were identied, such as: presence of
dental biolm, high sugar consumption,
low frequency of brushing and limited
source of income due to the COVID-19
pandemic, among others.
Viswanathan
A. et al (2021)
208
patients
with cleft
palate
(age: 1-16)
Retrospective
study
Telephone
calls
Effect of prioritizing dental care in
patients with cleft lip during the
COVID-19 pandemic, using the RAV
classication (red/emergency, amber/
urgent, green/ambulatory). 88% were
classied as green, 3% were classied
as red, which led to multidisciplinary
care.
Table 3. Studies that evaluated the attitude of pediatric dentists
and knowledge of teleodontology
Author’s
name and
year
Sample Method
study
Method
used Summary
Bekes K et al
(2021)
58
dentists
(93%
women)
Cross-
sectional
study
Structured
online
survey
Only 10% were trained on the care they should
take when caring for patients with Covid-19. 24%
perceived general infection as very dangerous.
Nyodu T. et
al (2022)
108
dentists
Cross-
sectional
study
Structured
online
survey
Structured online survey Knowledge and
awareness about teledentistry and its use in the
treatment of Early Childhood Caries are high
among dentists who completed postgraduate
studies, followed by postgraduate students..
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DISCUSSION
The purpose of this study was to explore
the applications of teledentistry during the
pandemic and to identify the factors that
either promote or limit its use, based on the
perspectives of pediatric dentists, pediatric
patients, and parents.
Teledentistry During the Pandemic
Teledentistry has proven to be a valuable tool
during the pandemic, as it allowed for the
identication of reasons prompting dental visits.
Ilyas et al. (2021) found that 51 patients required
emergency care during the pandemic, with
dentoalveolar trauma being the primary cause.
In contrast, Simpson et al. (2020) reported that
irreversible pulpitis and dental trauma were the
leading causes of dental need among children.
One of the main limitations of teledentistry is
its inability to resolve all cases requiring dental
care. However, teledentistry can facilitate
prescription issuance when clear infections are
identied.
During the pandemic, teledentistry was
particularly benecial, as it enabled dentists to
obtain an initial diagnosis of dental conditions
in children. Telephone consultations, along with
information provided by parents through surveys
developed by various organizations, played a
crucial role in classifying cases and determining
whether an in-person visit was necessary or if
a prescription alone would sufce (Yang et al.,
2020; Ilyas et al., 2021).
Managing Pediatric Cases via Teledentistry
In pediatric dentistry, cross-consultation cases
should be managed with an appropriate initial
analysis. Key documents such as questionnaires,
initial x-rays, and clinical photographs should be
requested from the treating physician. Parents
should also provide any additional relevant
information (Mutis et al., 2018).
All documents must be stored in the patient’s
digital le, whether in virtual appointments or
within the teledentistry record (ALOP, 2020).
High-quality intraoral and extraoral photographs
are essential, and appropriate training in
photography is required. In a study by Alshaya et
al. (2022), high-end mobile phone photographs
were found to be more reliable for diagnosing
issues in deciduous teeth compared to
permanent dentition, possibly due to the higher
proportion of deciduous teeth in the sample.
Although intraoral photography is useful for
diagnosing carious lesions, it has limitations in
detecting treatments such as ssure sealants.
Impact of the Pandemic
on Children’s Oral Health
It was observed that younger children were
more susceptible to cavities, likely due to
changes in their eating habits during the
pandemic, including an increase in snack
consumption. Additionally, gingivitis observed
in girls may have been caused by hormonal
changes typical for their age, as well as stress
related to the pandemic.
Changes in dietary habits during the pandemic
have been identied as a major contributor to
dental conditions (Alshaya et al., 2022). Alhayyan
et al. (2022) found that 32.8% of parents
identied diet as the main factor affecting their
children’s oral health, a nding consistent with
Mallineni et al. (2021), who observed similar
dietary changes in most Brazilian families.
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Oral Hygiene Practices During the Pandemic
In Wuhan, the fear of COVID-19 led many
parents to improve their children’s oral hygiene
practices. Residents of Wuhan demonstrated
an increase in brushing frequency compared to
other cities in China, likely due to the severity of
the pandemic.
Similar improvements were observed in cities
in Italy, which faced a similar level of COVID-19
severity (Spinazze et al., 2020). This shift in
parental behavior may also reect concerns
about the risk of COVID-19 transmission in
dental ofces. Parents perceived the dental
environment as more dangerous than other
public spaces and, as a result, were more
likely to seek dental care only if their children
experienced severe pain (Sun et al., 2020).
Lack of Preparedness Among Pediatric Dentists
The lack of knowledge regarding the risks
associated with COVID-19 affected not only
parents but also pediatric dentists. Bekes et
al. (2021) found that only 27.6% of pediatric
dentists felt adequately prepared to address the
challenges posed by the pandemic. This lack of
preparedness may be attributed to insufcient
training, particularly for those working in the
private sector.
Similarly, Putrino et al. (2020) observed that
only a small number of dentists had received
specic COVID-19 training. Teledentistry
as a Tool for Expanding Access to Care
The rise in COVID-19 cases disrupted access to
pediatric dental appointments. In light of this,
teledentistry emerged as a valuable tool for
providing preventive dental care, helping to
expand pediatric care capacity.
Pediatric Dentists’ Knowledge of Teledentistry
Nyodu et al. (2022) concluded that pediatric
specialists have a greater mastery of
teledentistry compared to general dentists. This
nding aligns with the study by Ata and Ozkan
(2009), who also noted that general dentists had
lower awareness of teledentistry than specialists.
Expanding Dental Services Through Teledentistry
Teledentistry offers the potential to expand
dental services and improve access, particularly
for special patient populations. In the future,
it is expected that this modality will allow
more patients to participate in activities led
by dentists, facilitated by the availability of
advanced equipment, economic resources, and
fast communication networks.
For example, Yuen et al. (2009) demonstrated
the use of video conferencing to provide
care to patients with physical and motor
limitations, as well as older adults. Effective
Communication in Telehealth Visits
Effective communication is crucial during
telehealth visits. It is essential to maintain a
welcoming, calm, and reassuring tone of voice
(Truppe et al., 2011). The rst step is to reassure
the patient and their caregiver, guardian, or legal
representative, and provide a brief explanation
of the scope, benets, and responsibilities of the
telehealth appointment. The practitioner should
listen attentively, demonstrate empathy, and
update the patient’s medical record with the
information provided (ALOP, 2020).
CONCLUSION
Teledentistry offers an effective strategy for
diagnosing, treating, and managing pediatric
dental issues during the pandemic. It is an
alternative that can reduce patient exposure to
COVID-19 and improve dental health outcomes
for children. Further research and training are
necessary to optimize its integration into routine
pediatric dental care.
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AUTHOR CONTRIBUTION:
The authors have contributed to the conception,
planning, execution and approval of the nal
version of this article.
Conict of interest:
The authors declare that they have no conicts
of interest.
Funding:
No funding was received to assist with the
preparation of this manuscript
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Author contribution statement:
Conceptualization and design: AL
Literature review: AL
Methodology and Validation: JC
Formal analysis: JC
Investigation and data collection: AL
Resources: AL
Data analysis and interpretation: AL
Writing-original draft preparation: AL
Writing-review & editing: JC
Supervision: JC
Project administration: AL
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