Effectiveness of a Mobile Image Based Teledentistry Tool to Screen Oral Potentially Malignant Lesions Among a Rural Population in Tamil Nadu, India

Abstract

Background: Considering the vast landscape, and the huge in-country disparity among the distribution of dental manpower, the role played by nonprofessionals is pivoted in the delivery of dental care, especially among the rural Indian population. Traditionally dental professionals have been involved in the screening of oral cancers and oral potentially malignant lesions (OPML) which precede most oral cancer lesions. The recent advent of videographic enabled mobile Internet technology provides an opportunity to be used as tele-dentistry based screening tool involving nonprofessional health providers for screening of OPML. Aim: This study was aimed to determine the effectiveness of a mobile based oral cancer screening program among a rural population in Tamil Nadu, India using nonprofessional health providers. Methods: The study was conducted among 300 Dravidian adults (35 to 44 years) who were part of a rural oral health screening program. During the first phase, a trained male health worker (MHW) graphically recorded the oral cavity of those subjects who had any alteration in the color or surface characteristic of the oral mucosa and/or restriction in mouth opening. Recordings were done in a systematic manner using a Moto G smart phone with 8 megapixel camera and flashlight. Images with file size of maximum 20 MB were saved in Jpeg format and transferred to a hard disk. After the first phase, a calibrated dentist (SP) examined the subjects under standard lighting using a type 3 examination. A punch biopsy was taken and histologic examination was done for confirmation of the diagnosis. Results: Among the 300 subjects examined, 23 subjects were identified as having mucosal alterations by MHW. When cross assessed by the dentist, 19 out of the 23 were clinically diagnosed as having OPML, which were histologically confirmed. Leukoplakia was the most common lesion (12/19) followed by erythroplakia and oral submucous fibrosis. Conclusion: The results of the current study throws light on the effectiveness of a mobile image based screening tool, which could be used for early assessment of OPML by nonmedical personnel, especially for those risk populations who lack access to primary dental care.