Development of an Oral Health Surveillance Model for Primary School Students Using Teledentistry in Bueng Kan Province

Abstract

This research and development study aimed to develop a school-based oral health surveillance model for primary schools in Bueng Kan Province, Thailand, using an intraoral camera (IOC). School health teachers captured intraoral photographs and video clips, which were transmitted to dental personnel for remote interpretation of dental caries. Screening results were compared with direct oral examination by dental personnel, which served as the reference standard, and the feasibility of real-world implementation was assessed. Participants comprised 400 primary school students and 64 system users. Data were analysed using sensitivity, specificity, accuracy, Cohen's kappa and the continuity-corrected McNemar's test. The teledentistry system achieved a sensitivity of 77.9%, a specificity of 68.3% and an overall accuracy of 73.0%, with moderate diagnostic agreement (kappa = 0.461). Positive and negative predictive values were 70.0% and 76.5%, respectively. McNemar's test revealed a statistically significant difference in the proportion of screen-positive cases between the two methods, with 217 cases identified by teledentistry and 195 by oral examination (p = 0.043); 65 false-positive and 43 false-negative results were recorded. User satisfaction was at the highest level (4.70 ± 0.51), particularly regarding the ease of device connection and the clarity of images for communicating with parents.The system shows potential as a preliminary screening tool to support referral. However, its moderate accuracy indicates a need for refinement, including additional teacher training and the exclusion of non-interpretable images, followed by
re-testing. In conclusion, the "Bueng Kan Model" is an innovation that requires further development before it can be adopted as a standard for proactive school-based oral health surveillance in Bueng Kan Province.