Burçin AVCI, Hüsniye Tuğçe ZELCEK
Clinical Dentistry and Research - 2026;50(2):98-110
Background and Aim: This study aimed to evaluate the diagnostic accuracy of smartphone-based intraoral photographs compared with face-to-face clinical examination in pediatric patients and to assess children's behavioral responses during intraoral image acquisition. Materials and Methods: Sixty children aged 4-13 years were included in this prospective diagnostic accuracy study. Each participant underwent both a clinical examination and a smartphone-based intraoral imaging session performed one week apart. Participants were allocated to two examination-order groups to control for potential sequence effects. Five standardized intraoral photographs were obtained for each child and evaluated remotely by two independent pediatric dentists using a store-and-forward model. Face-to-face clinical examinations were performed by a pediatric dentist and served as the reference standard. Diagnostic agreement was assessed using Cohen's kappa and intraclass correlation coefficients. Behavioral responses were evaluated using the Facial Image Scale and a behavioral observation form. Results: Almost perfect diagnostic agreement was observed among examiners ( kappa = 0.841-0.896, p < 0.001). Sensitivity and accuracy for the detection of sound and carious teeth exceeded 89% and 93%, respectively. Intraclass correlation coefficients were 0.888 and 0.959. Facial Image Scale scores decreased after both procedures. Age significantly influenced behavioral responses during clinical examinations, whereas no association was observed during intraoral imaging. Conclusions: Smartphone-based teledentistry demonstrated high diagnostic accuracy and strong agreement with face-to-face clinical examinations. Intraoral imaging was well tolerated and demonstrated consistent behavioral responses across demographic groups. These findings support its use as a reliable adjunct for remote dental screening and follow-up in pediatric patients.
