***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: Objective The primary aim was to evaluate the validity of a teledentistry system for screening new patient orthodontic referrals . The secondary aims were to evaluate whether the teledentistry system affected i ) referral rates ii ) inappropriate referral rates iii ) number of failed appointments . Study design R and omised controlled trial . Sample Fifteen dental practice s in Greater Manchester , UK , were r and omly allocated to either a teledentistry test group ( n = 8) or a control group ( n = 7 ) . They referred 327 patients over a 15 month period . Method Practitioners in the test group referred patients to one of two consultant orthodontists  via a ' store and forward ' teledentistry system consisting of photographs sent as email attachments . The decision to accept or not accept a referral on this basis was compared with the same decision choice when the same patient was subsequently seen on a new patient clinic . This measured the validity of the system with the clinic 's decision used as the gold st and ard . Patients in the control group were referred using the usual letter system . Referral rates , inappropriate referrals and number of failed appointments were then compared between the teledentistry and control groups . Results The sensitivity ( true positive value ) of the teledentistry system was high at 0.80 with a positive predictive value of 0.92 . The specificity ( true negative value ) was slightly lower at 0.73 with a negative predictive value of 0.50 . The inappropriate referral rate for the teledentistry group was 8.2 % and for the controls 26.2 % ( p = 0.037 ) . There was no statistically significant difference in clinic attendance between teledentistry and control groups ( p = 0.36 ) . Conclusions Teledentistry is a valid system for positively identifying appropriate new patient orthodontic referrals . However , there is a risk that a patient is not accepted on the teledentistry system who would benefit from a full clinical examination . Teledentistry could be a significant factor in reducing the inappropriate referral rate . Patient participation in a teledentistry system does not appear to mean they are any more likely to attend their hospital appointment Ten  facial radiographs with fractures and 10 without fractures were viewed by eight oral and maxillofacial surgery ( OMFS ) and eight accident and emergency ( A&E ) doctors who were each asked questions about the presence and site of any fractures as well as the quality of the images and diagnostic confidence . Each radiograph was then transmitted over a teleradiology link and viewed by the same OMFS doctors who answered the same questions . The position of the fracture was more accurately assessed using plain radiography . Diagnosis by OMFS doctors using telemedicine was broadly comparable with fracture diagnosis by A&E doctors using plain radiography . Poor quality radiographs and frontozygomatic and infraorbital rim fractures were poorly diagnosed by telemedicine . This telemedicine system was a useful tool to aid diagnosis of most facial fractures . The need for appropriate clinical information is vital . Diagnosis of frontozygomatic and infraorbital rim disruption using telemedicine is less reliable than plain radiography BACKGROUND Dental caries affecting the primary dentition of U.S. children continues to be the most prevalent chronic childhood disease . Preventive screening for dental caries in toddlers by dental professionals is labor-intensive and costly . Studies are warranted to examine innovative screening modalities that reduce cost , are less labor-intensive , and have the potential to identify caries in high-risk children . SUBJECTS AND METHODS Two hundred ninety-one children were r and omized into two groups : Group 1 received a traditional , visual tactile examination initially and follow up-examinations at 6 and 12 months , and Group 2 received a teledentistry examination initially and follow-up examinations at 6 and 12 months . The mean primary tooth decayed and filled surfaces ( dfs ) scores were calculated for all children at baseline and 6 and 12 months . RESULTS At baseline , the mean dfs score for children examined by means of teledentistry was 2.19 , and for the children examined by means of the traditional method , the mean was 1.27 ; the means were not significantly different . At the 12-month examination , the mean dfs score for the children examined by means of teledentistry was 3.02 , and for the children examined by means of the clinical method , the mean dfs was 1.70 ; the means were not significantly different . At 12 months the mean fillings score for the children examined by means of teledentistry was 1.43 and for the children examined by means of the clinical method was 0.51 ; the means were statistically significantly different ( p<0.001 ) . CONCLUSIONS These results suggest that the teledentistry examinations were comparable to clinical examinations when screening for early childhood caries in preschool children . The data further showed that color printouts of teeth with cavities provided to parents of children who received teledentistry screenings promoted oral healthcare utilization , as children from the teledentistry study group received more dental care than children from the clinical study group UNLABELLED BACKGROUND / AIM . In the last twenty years significant advances have been made in the fields of information and telecommunication technology in health care applications , with a positive impact on the health care practice . The need for remote diagnosis and planning of interventions is of special importance in military health care , and health management of immobile persons , and those with special needs . In cases such as these , availability of specialist health care is mainly limited by geographic and financial factors . The aim of this study was to investigate practical usability of telemedicine approaches in everyday management of oral surgery patients in terms of reliability of established diagnosis and indications for oral surgery treatment of the third molars . METHODS Our experimental r and omized study enrolled 432 r and omly selected patients of both genders , aged 20 to 87 years , undergoing panoramic radiography for some reason in the Centre for Dental Radiography in Bel grade . In addition to radiography , photographs of the face and mouth cavity were taken . These images were uploaded to the web server specially dedicated to the study purpose s , and then transmitted to teledentists , i.e. oral surgeons , who made remote diagnoses . Diagnostic agreement was determined by way of the Cohen 's kappa coefficient , and diagnostic sensitivity ( SE ) , specificity ( SP ) , and effectiveness ( EFF ) were also established . Statistical significance was determined and comparisons performed by using the z-test , and testing of non-parametric characteristics by using the McNemar 's chi2 test for p = 0.05 significance cut-off . RESULTS The results obtained by analyzed images and diagnostic assessment of the clinical diagnosis ( kappa = 0.99 , SE = 99 % , SP = 99 % , EFF = 99 % , for 95 % CI ) indicate an almost complete diagnostic agreement . The differences in diagnosis were not statistically significant . CONCLUSION Diagnostic assessment of the clinical diagnosis of impacted or semi-impacted third molars assisted by the telemedicine approach was equal to the real-time assessment of clinical diagnosis . Telemedicine , and teledentistry as its branch , represent the present and even more the future of this field of health care PURPOSE The purpose of this study was to assess the feasibility and reliability of using intraoral cameras and telehealth communication technology to screen preschool children for oral disease , in particular early childhood caries ( ECC ) . METHODS The authors used the existing infrastructure of the Health-e-Access telehealth Network to : ( 1 ) assess the diagnostic quality of dental images using the Dr. Camscope intraoral camera ; and ( 2 ) compare the result ing images to a traditional oral examination . A calibrated dental examiner observed 50 preschool children 4 to 6 years old who were enrolled in an inner-city childcare center . Following the oral examination , images of the children 's teeth were obtained by a trained telehealth assistant and transmitted to the remote site computer ; identifiers were removed and the images were r and omized . After a 2-week washout period , the images were read by the same examiner . RESULTS A complete set of dental images was obtained from all 50 children in the study . A greater proportion of children examined using the intraoral camera were observed to have caries ( 42 % ) compared to children examined visually ( 28 % ) . Furthermore , a greater number of carious teeth were detected from the images than from the visual examinations . The mean teledentistry dfs score was 2.10 , and the oral examination 1.50 ( P > .05 ) . The kappa agreement was 61 ( kappa = 0.61 ; 95 % CI = 039 - 0.89 ) . CONCLUSIONS There was no statistically significant difference between a visual examination and an examination using an intraoral camera , thus suggesting that the intraoral camera is a feasible and potentially cost-effective alternative to a visual oral examination for caries screening , especially early childhood caries , in preschool children attending childcare centers 
    Output:
    
Teledentistry could be comparable to face-to-face for oral screening , especially in school-based programs , rural areas and areas with limited access to care , and long-term care facilities .
Identification of oral diseases , referrals , and teleconsultations are possible and valid .