在远程牙科中使用家长拍摄的智能手机照片检测龋齿和其他口腔内病变的诊断准确性。
Diagnostic accuracy of detecting caries and other intraoral findings using parent-obtained smartphone photographs in teledentistry.
作者信息
Price Mirissa D, Ureles Steven D, Alhazmi Hesham, Sulyanto Rosalyn M, Ng Man Wai
出版信息
J Am Dent Assoc. 2025 Aug;156(8):601-610.e1. doi: 10.1016/j.adaj.2025.05.003. Epub 2025 Jun 26.
BACKGROUND
The authors evaluated whether parent-obtained smartphone photographs can accurately assess frank caries and other intraoral findings compared with point-of-care clinical examination findings.
METHODS
Children's parents submitted intraoral photographs for a teledentistry consultation before dental rehabilitation in the operating room. Two calibrated dentists recorded hard- and soft-tissue findings from the photographs. These findings were compared with clinical findings recorded in the operating room. Sensitivity, specificity, likelihood ratios, prevalence, accuracy, and positive and negative predictive values were calculated for occlusal, frontal, and combined views. Fagan nomogram was used to predict caries risk graphically.
RESULTS
Of 138 patients, 70% were in primary dentition and 30% were in mixed dentition. All photographic views had high specificity for detecting caries (range, 97.1%-100.0%). Except for the mandibular anterior dentition, which had a sensitivity of 67.2% (95% CI, 53.5% to 79.0%), when all photographic views were combined, the maxillary occlusal and frontal images together showed high sensitivity of 94.8% through 99.1% in detecting caries in the primary dentition. Similar trends were observed for the mixed dentition. Combined photographs had an accuracy of 94.1% through 100.0%, with the positive likelihood ratio exceeding 33.3 for all photographs and sextants. Positive likelihood ratio ranged from 44.5 through 132.7 for detecting caries in primary dentition. Low sensitivity was found for detecting demineralization and soft-tissue findings.
CONCLUSIONS
Parents can reliably obtain accurate and clinically meaningful intraoral photographs using a smartphone when following a written photograph guide.
PRACTICAL IMPLICATIONS
Parent-obtained smartphone photographs can provide accurate and clinically meaningful detection of frank caries in the primary and mixed dentitions.
背景
作者评估了与即时临床检查结果相比，家长用智能手机拍摄的照片能否准确评估明显龋齿及其他口腔内情况。
方法
儿童家长在手术室进行牙齿修复前提交口腔内照片以进行远程牙科咨询。两名经过校准的牙医记录照片中的硬组织和软组织情况。将这些结果与在手术室记录的临床结果进行比较。计算了咬合面、正面及综合视图的敏感性、特异性、似然比、患病率、准确性以及阳性和阴性预测值。使用费根诺模图以图形方式预测龋齿风险。
结果
138名患者中，70%为乳牙列，30%为混合牙列。所有照片视图在检测龋齿方面都具有较高的特异性（范围为97.1% - 100.0%）。除下颌前牙列敏感性为67.2%（95%置信区间，53.5%至79.0%）外，当所有照片视图合并时，上颌咬合面和正面图像一起在检测乳牙列龋齿方面显示出94.8%至99.1%的高敏感性。混合牙列也观察到类似趋势。合并照片的准确性为94.1%至100.0%，所有照片和牙面的阳性似然比超过33.3。在检测乳牙列龋齿时，阳性似然比范围为44.5至132.7。在检测脱矿和软组织情况时发现敏感性较低。
结论
家长按照书面照片指南使用智能手机能够可靠地获取准确且具有临床意义的口腔内照片。
实际意义
家长用智能手机拍摄的照片能够准确且具有临床意义地检测乳牙列和混合牙列中的明显龋齿。
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