Sage Journals: Discover world-class research

Abstract

Introduction: Teledentistry has been suggested as an innovative and promising approach, in addition to face-to-face intervention, to improve the access and the continuity of oral health care. Despite the growing evidence on teledentistry, it is still unclear under what context, circumstances, and for whom it works best, as well as how and why its adoption succeeds or fails in different dental care settings.

Objective: To synthesize evidence regarding: i) strategies to enhance teledentistry implementation; ii) interactions between the context-mechanisms-outcomes (CMOs) to maximize its integration in dental care settings.

Methods: A realist review will be conducted following Pawson and Tilley’s framework. Searches were conducted across five databases such as MEDLINE (Covidence), Embase, CINAHL, PsycINFO, Cochrane Library, and grey literature. The review will include all teledentistry modalities, settings, and populations, with no restrictions on language or publication date. Two independent reviewers will iteratively select and screen studies, and extract data from included studies. Data synthesis will involve a narrative summary, along with content and descriptive analyses. Implementation strategies will be categorized using the Expert Recommendations for Implementing Change framework, and outcomes will be mapped with Proctor’s Implementation outcomes Framework.

Conclusion: The results will suggest a better description of the implementation strategies to improve teledentistry implementation. By identifying contexts, mechanisms, and outcomes we will inform policy-makers, researchers, oral health care providers, and patients on what works, for whom, under what conditions and how, for its successful implementation. These findings may contribute to the evidence-based teledentistry practices, inform education, and support policy development.

Keywords

teledentistry realist review implementation strategies digital health virtual oral health care

Introduction

Oral diseases are a global public health concern that significantly impact people’s quality of life and overall well-being (Jain et al., 2024; Watt et al., 2019). According to the World Health Organization, the estimated incidence of oral diseases globally is about 1 billion more than the combined cases of all the next five most common non-communicable diseases (mental disorders, cardiovascular diseases, diabetes mellitus, chronic respiratory diseases, and cancers) (Jain et al., 2024; Peres et al., 2019; Watt et al., 2019). Oral health disparities mostly affect vulnerable groups such as children, seniors, Indigenous people, refugees, individuals with special needs, living in remote and rural regions, and the low-income population (France & Glick, 2022; Levy et al., 2023; Petersen et al., 2005; Watt et al., 2019). The substantial financial burden of oral health diseases and conditions on people and the health care system, along with its inequalities underscore the necessity to ensure timely and patient-centred access to oral healthcare (Peres et al., 2019). In this context, digital technologies such as teledentistry have emerged as a promising, cost-effective intervention to improve both access to oral health care and patients’ outcomes and experiences (Achmad et al., 2020; Daniel et al., 2013; Estai et al., 2018; Kengne Talla et al., 2024).

Teledentistry refers to the use of information and communications technology to provide remote oral health care services, including screening, triage, teleconsultation, telediagnosis, tele-expertise, patient monitoring, prescriptions, referrals, and education (American Dental, 2020; World Health & International Telecommunication, 2021). These services are delivered through both synchronous (real time) and asynchronous (e.g., store-and-forward, and mobile health) modalities (Fortich-Mesa & Hoyos-Hoyos, 2020; Talla & Rodrigues, 2024). A growing body of evidence underscores multilevel impacts of teledentistry. At the patient’s level, teledentistry reduces the need for travel, shortens wait times, and reduces costs for transportation (Wolf et al., 2022). For oral health care providers (OHCPs), it enhances efficiency by reducing chair time, facilitating expert consultations, improving communication with patients, and fostering better collaboration among healthcare providers (Lin et al., 2022). At the system level, authors have highlighted that teledentistry has the potential to address health inequalities, enhance population health, and reduce costs, making it a valuable approach for improving the quality of oral health care (da Silva et al., 2021).

Despite the growing body of literature on teledentistry (Valeri et al., 2023), its adoption into clinical practice is still slow (Irving et al., 2018). A range of macro, meso, and micro factors hamper or enable its implementation. Among the barriers, authors reported the lack of knowledge and acceptability by OHCPs as well as patients, limited training opportunities, insufficient reimbursement mechanisms, the digital divide, inadequate digital health literacy, and the absence of legal regulations and guidelines (Aboalshamat, 2020; Arunagiri et al., 2024; Estai et al., 2016; Shea & Belden, 2016; Tan et al., 2021; Varsi et al., 2019). OHCP’s and patient’s positive attitude toward teledentistry, prior experience with technology, access to digital tools, and government engagement further enhance its successful implementation (Abbas et al., 2020; AlAssad et al., 2021; Kengne Talla et al., 2024; Nayar et al., 2017; Raja et al., 2022; Shwetha et al., 2021). Despite the understanding of the determinants to teledentistry adoption, there is a limited knowledge of optimal implementation strategies to improve its uptake, sustainability, and scale-up, as well as the contexts in which they succeed or fail.

Implementation strategies are methods or techniques applied to enhance the adoption, implementation, sustainment, and scale-up of intervention (Proctor et al., 2013). In dentistry, several authors have explored various strategies while implementing teledentistry in different contexts, including training stakeholders (Crummey et al., 2022), reinforcing health behaviors through messaging (Marchetti et al., 2018), and using monetary incentives and digital tools (White et al., 2020). In the field of e-health, a systematic review identified “training and educating stakeholders” as the most common implementation strategy (Appleton et al., 2023). Similarly, a study in dentistry found that education, reminders, and multifaceted interventions were effective in enhancing the adoption of clinical guidelines (Villarosa et al., 2019). Yet, gaps remain in understanding whether these strategies influence the implementation of teledentistry, and if so, how they influence the outcomes, particularly in specific contexts and populations. To our knowledge, there is no knowledge synthesis on teledentistry implementation strategies resulting in a lack of evidence to inform decision-makers, in developing recommendations for an inclusive and equitable remote access to oral health care. To address these gaps, a systematic and theory-driven approach, such as a realist review is crucial (Chen & Rossi, 1980; Kengne Talla et al., 2024). RR is particularly well suited for understanding the complexities of interventions like teledentistry, which is multifaceted in nature (Islam et al., 2022), within the dynamic context of oral health care service delivery. This type of review is valuable for synthesizing evidence on implementation strategies and examining the interactions between contexts and mechanisms that drive teledentistry outcomes (Rycroft-Malone et al., 2012).

Objectives

To synthesize what context, mechanisms, and outcomes (CMOs) are critical to the implementation of teledentistry in dental care settings to maximize its adoption. Specifically, we will outline: i) strategies to enhance teledentistry implementation; ii) interactions between the context-mechanisms-outcomes (CMOs) to enhance the implementation of teledentistry.

Methods

The protocol for this review is registered on PROSPERO (CRD42024566372) (Arunagiri et al., 2024).

Study Design

We will conduct a RR based on Pawson and Tilley’s realist approach with five iterative stages (Pawson et al., 2005): (i) clarifying the purpose of the review and the research question and drafting an initial program theory; ii) identifying relevant studies; (iii) quality appraisal and data extraction; iv) data synthesis; and (v) dissemination of findings.

Unlike systematic and scoping reviews, which focus on effectiveness or concept mapping, RR emphasizes program theory development and refinement, by using the CMO configuration as their foundational analytical unit (Greenhalgh et al., 2015; Wong et al., 2016). This theory-driven approach also aims to explain various situations in which a programme fails to achieve the anticipated benefits (Greenhalgh & and Manzano, 2022). The realist review will provide insights into how teledentistry works by identifying the contexts that influence mechanisms to produce specific outcomes (O), for which populations, and under what circumstances.

Underlying a realist philosophy, the context goes beyond the physical setting. From Pawson (Greenhalgh et al., 2015) context can be categorized into ‘4 Is’: individuals (e.g., age, literacy rate), interpersonal relationships (e.g., trust between a patient and provider in teleconsultation), institutional settings (e.g., organizational climate; policies supporting remote care), and infrastructure (e.g., availability of high-speed internet for video consultations). A mechanism refers to human reasoning and decisions that influence the outcome of an intervention (Greenhalgh et al., 2015). The outcome is defined as the observed result or effect that occurs within a specific context, triggered by a particular mechanism (Wong et al., 2016). Eliciting, refining, and testing CMO configurations on implementation strategies will allow for a better understanding of black box teledentistry, by showing how it triggers mechanisms in specific contexts to produce outcomes.

Clarifying the Purpose of the Review and Drafting an Initial Program Theory

The goal of this realist review is to synthesize evidence on implementation strategies, examining how they work, in which contexts, and under what circumstances they influence the success or failure of teledentistry implementation

Developing an Initial Programme Theory (IPT)

We will approach the RR by first drafting an initial program theory (IPT), which will provide a theoretical understanding of the teledentistry implementation. The IPT describes how the intervention is expected to achieve its effects and under which conditions it should do so (Greenhalgh et al., 2017). As many authors pointed out, the application of theories, models, and frameworks (TMFs) can facilitate the systematic understanding and explanation of complex interactions between users, practices, technologies, and health system factors (Greenhalgh et al., 2017; Venkatesh & Bala, 2008). Therefore, in developing our IPT, we will incorporate findings from prior empirical and knowledge synthesis on teledentistry implementation (Aquilanti et al., 2020; Kengne Talla et al., 2023; Kruse et al., 2017; Petcu et al., 2017; Rahman et al., 2020; Tan et al., 2021), as well as theoretical constructs from widely used models and frameworks in digital health interventions (Rouleau et al., 2024) and teledentistry (Böhm da Costa et al., 2021; Feliz-Matos, 2023; Northridge et al., 2020; Talla et al., 2024). These common TMFs used in the literature on teledentistry include the Consolidated Framework for Implementation Research (CFIR) (Böhm da Costa et al., 2021; Northridge et al., 2020), the Technology Acceptance Model (Talla et al., 2024), and the Unified Theory of Acceptance and Use of Technology (UTAUT) (Feliz-Matos, 2023). Leveraging these formal theories will enhance our understanding of the interactions between contexts, mechanisms, and outcomes. Thus, the IPT developed in accordance with CMO configurations will be refined through an iterative process and discussions involving key stakeholders and the research team.

Identifying Relevant Studies

The electronic search has been conducted in five databases including MEDLINE, Embase, CINAHL, PsycINFO, and Cochrane Library. We also extended our search in grey literature including ProQuest and Google Scholar (see Table 1 for the search strategy).

Table 1.

MEDLINE search strategy.

#	Search strategy	Results
1	(Teledent* or tele-dent*).af	496
2	Telemedicine/or remote consultation/	44,797
3	Cell phone/or smartphone/or text messaging/or videoconferencing/	26,139
4	Computers, handheld/	4,131
5	“Cell phone use”/	411
6	Mobile applications/	12,683
7	(Telemedicine* or tele-medicine* or telehealth or tele-health or mhealth or m-health or ehealth or e-health or digital health or ((remote* or virtual* or mobile) adj3 (consult* or monitor* or screen* or health))).ti,ab,kf	95,392
8	(Cell* phone* or smartphone* or smart phone* or app or apps or text* messag* or (video* adj3 (call or calls or consult)) or (mobile adj3 (application* or intervention* or device* or technolog)) or ((online or on-line or health or messaging or tablet) adj3 application) or ((mobile or handheld) adj (device* or phone* or tablet*))).ti,ab,kf	116,641
9	2 or 3 or 4 or 5 or 6 or 7 or 8	211,162
10	Exp dentistry/or exp “oral health”/or exp dentists/or practice patterns, dentists’/or dentist’s role/or dental health services/	465,564
11	(Dental* or dentist* or oral or orally or maxillofacial* or maxillio-facial* or endodontic* or endodont* or orthodont* or periodont* or prosthodont* or odontolog*).ti,ab,kf	1,210,755
12	10 OR 11	1,415,533
13	(Regulat* or policy or policy or policies or insurance* or intervention* or program* or strategy or strategies or mechanism* or individual* or organizational* or environmental* or contextual* or implement* or disseminat* or knowledge transfer* or knowledge translation* or plan or planning or plans or process or processes or processing or method or methods or technique* or educat* or financial* or restructur* or re-structur* or approach or approaches).ti,ab,kf	18,229,452
14	(9 and 12 and 13) or (1 and 13)	4,259

Inclusion Criteria

Our review will focus on studies examining implementation strategies for integrating teledentistry into the dental practice; including at least one of synchronous and asynchronous modalities; using at least one of digital devices like tablets, computers, videos, text, and audio messaging. Criteria will be drawn on the PICO framework with P referring to OHCPs, patients, dental students; I to Phenomenon of Interest; and Co to Context (e.g., setting, technological aspect, resources). All study designs (e.g., qualitative, quantitative, mixed-method studies) will be considered. There will be no limitations to language or the publication date. We will consider all outcomes reported by the authors, including those defined as success or failure of teledentistry implementation.

Exclusion Criteria

Studies that do not address implementation strategies or fail to include at least one of teledentistry modality will be excluded.

Study Selection and Screening

The retrieved articles will be exported to Covidence (Covidence, 2018) which will serve as screening tools to enhance data management. After removal of duplicate articles in Endnote, the data selection process will be conducted in Covidence. Before conducting this selection, two independent reviewers will perform a calibration exercise with 10% of all identified studies to ensure a mutual understanding of the eligibility criteria. After a conclusive pilot step, reviewers will independently screen studies based on titles and abstracts, rating them as either “Yes,” “No” or “Maybe.” Independent reviewers will screen the full texts of all publications rated as “Maybe” or “Yes” and classify them as either “included” or “excluded” in this selection phase. Discrepancies will be resolved though discussion or in consultation with a third reviewer. Decisions and reasons for exclusion will be recorded in Covidence.

Quality Appraisal and Data Extraction

In RR, data are evaluated based on their relevance (contributions to theory building and testing) and rigor (credibility and trustworthiness of the methods) (Dada et al., 2023). Other types of quality assessments, such as checklists and methodological hierarchies, are not required.

A random sample with 10% of selected papers will be extracted independently by two reviewers. Based on the groups’ experiences, a data extraction sheet will be created (EXCEL). The extracted data will include:

• Characteristics of included studies (e.g., title, first and corresponding authors, year of publication, country of publication, language of publication, aims, study design, methods of data collection, funding, limitations, and conclusions)

• Context

- Participants’ characteristics (e.g., profile, sample, sex/gender, age, location, type of oral health care provider)

- Dental care settings (e.g., University, private or public practice)

- Other specific resources (e.g., Funding, workforce, protocol for usage)

- Characteristics of teledentistry (e.g., synchronous, or asynchronous, hybrid procedure with usual care, along with type of technology used)

• Implementation strategy reported (e.g., educating dental professionals, orienting patients, providing proper compensation, and updating technologies)

• Mechanisms or the process or event through which an implementation strategy operates to affect one or more implementation outcomes (Lewis et al., 2022).

• Study outcomes (e.g., failure or successful implementation of teledentistry, outcomes reported by the authors).

We will contact the authors if they are missing data or if additional information is needed. We will seek potential eligible articles from the references of all included studies.

Data Analysis

The data analysis will include descriptive analysis to present the characteristics of the included studies (Powell et al., 2015). Thematic analysis will identify recurrent themes, patterns, and trends related to implementation strategies, contexts, mechanisms, and outcomes (O), constructing the ISCMO chain. Realist theorizing will also be employed, relying on retroduction (abductive reasoning) as a method of inquiry that draws on prior expertise, experiences, and imagination to generate theories inspired by evidence (Pawson et al., 2005).

Data Synthesis

Building on the iterative analysis of theoretical, empirical literature and the IPT, we will produce Refined Programme Theories (RPTs) showing the interactions among the context, mechanisms, and outcomes of an intervention. Thus, a programme theory is a collection of CMO configurations, supported by formal theories, depicting testable hypotheses. The identified implementation strategies will be categorized according to the Expert Recommendations for Implementing Change compilation (Powell et al., 2015).

As the context in realist reviews extends beyond the setting where the intervention is implemented, we will categorize the context based on Pawson’s “4 Is”: individuals, interpersonal relationships, institutional settings, and infrastructure (Greenhalgh & and Manzano, 2022). With respect to mechanisms, we will draw insights as suggested by Lacouture et al. (Lacouture et al., 2015) where mechanisms are shaped by individuals’ or groups’ reasoning and reactions to available resources in a specific context. The resources can be materialistic, cognitive, social, and psychological (Jagosh, 2020). Material resources include funding, equipment, workforce, etc. Cognitive resources may comprise knowledge, awareness, and confidence from training, information, and guidance. On the other hand, the reasoning/response aspect of a mechanism is always cognitive or emotional and may not be obvious (Keshani, 2022).

Moreover, the identified outcomes will be mapped to Proctor’s model of outcomes for implementation research (Proctor et al., 2011), which are multilevel and varied:

Implementation Outcomes

Include various components. Acceptability, reflecting stakeholders’ perceptions of teledentistry as agreeable and satisfactory; adoption, representing the intention or decision to employ teledentistry; appropriateness, referring to the perceived relevance for a specific setting or issue; feasibility, indicating the extent to which teledentistry can be successfully implemented; costs referring to the financial impact of implementing teledentistry; fidelity, which assesses whether teledentistry is delivered as intended by its developers; implementation cost, addressing the financial implications and complexity of delivering an intervention; penetration, which measures how well teledentistry is integrated into service settings and reaches the target population; and sustainability, the ability to maintain teledentistry within stable operations over time.

Service Outcomes

Efficiency, meaning optimal use of resources with minimal waste; safety, minimizing harm to patients during care delivery; effectiveness, referring to the success of teledentistry in achieving desired outcomes; equity, ensuring consistent the quality of care regardless of personal characteristics like gender, ethnicity, or socioeconomic status; patient centeredness, emphasizing care that respects and responds to individual preferences and values; and timeliness as reducing unnecessary delays in health care delivery.

Client Outcomes

Among these outcomes, satisfaction, reflects how well patients feel their care expectations have been met; function, focusses on improvements in physical, social, or psychological abilities; symptomatology, tracking changes in the presence or severity of symptoms; and quality of life, encompasses overall well-being across physical, emotional, and social dimensions.

The deliverable will be a comprehensive picture of implementation strategies, mechanisms, contexts, and outcomes (ISCMO) chains with the different modalities of teledentistry. Data will be presented to stakeholders to generate insights and refine the IPT. We will conduct a narrative synthesis and share our results in tabular, and graph forms (Siddaway et al., 2019).

Dissemination of Findings

Our results will be reported in accordance with the Realist And Meta-Narrative Evidence Syntheses: Evolving Standards II (RAMESES II) guidelines (Greenhalgh et al., 2015). The review is registered on PROSPERO (CRD42024566372) (Arunagiri et al., 2024). For the knowledge mobilization plan, we will publish this protocol in the International Journal of Qualitative Research. Additionally, we will disseminate the study’s findings through peer-reviewed academic journals. The results will also be disseminated at scientific conferences, and forums. Furthermore, key findings will be disseminated via social media platforms as X, LinkedIn, BlueSky, using plain language summary and infographics. We aim to reach diverse stakeholders, including the health care providers, researchers, patients, families, policy-makers, and educators.

Conclusion

Teledentistry has the potential to bridge gaps in access to care, patient management, and reduced costs. Yet, research on teledentistry implementation remains in its infancy. To our knowledge, this is the first RR focussing specifically on teledentistry’s implementation strategies. This realist review aims to synthesize evidence to provide a better understanding of the interactions between different contexts, mechanisms, and implementation strategies to produce outcomes.

A key strength of this review is its systematic, theory-driven approach along with its comprehensive search and rigorous methodology. The anticipated findings of the RR are a comprehensive list of implementation strategies that can optimize the integration of teledentistry into dental care settings. The research findings may contribute to making oral health care providers (OHCPs) better equipped to integrate evidence-based practices (EBP) into their clinical practices to improve the quality of care. Policy-makers can utilize the findings to develop informed strategies that support the adoption and sustainability of teledentistry. Furthermore, the results may inform educational curricula, equipping future oral health professionals with the knowledge and skills necessary to effectively implement teledentistry in diverse settings.

Nonetheless, this review has limitations. The findings will depend on the availability and quality of existing literature, potentially restricting a comprehensive understanding of causal mechanisms. To mitigate this, we will employ a comprehensive, guided by an experimented librarian, discussion with the research team, and iterative search strategy across diverse sources. This realist review is intended to address gaps in teledentistry implementation into dental settings to enhance patient outcomes and experiences.

Footnotes

Authors’ Note

The views expressed in this submitted article are our own and do not represent the official position of our institution or any funding organization.

ORCID iD

Krithika Priyadharshini Arunagiri

Statements and Declarations

Funding

The author(s) disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This research has received financial support from the Faculty of Dental Medicine and Oral Health Sciences, at McGill University.

Conflicting Interests

The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

References

Abbas

Wajahat

Saleem

Imran

Sajjad

Khurshid

(2020). Role of teledentistry in COVID-19 pandemic: A nationwide comparative analysis among dental professionals. European Journal of Dentistry, 14(S 01), S116–S122. https://doi.org/10.1055/s-0040-1722107

Aboalshamat

K. T.

(2020). Awareness of, beliefs about, practices of, and barriers to teledentistry among dental students and the implications for Saudi Arabia vision 2030 and coronavirus pandemic. Journal of International Society of Preventive & Community Dentistry, 10(4), 431–437. https://doi.org/10.4103/jispcd.JISPCD_183_20

Achmad

Tanumihardja

Ramadhany

Y. F.

(2020). Teledentistry as A solution in dentistry during the covid-19 pandemic period: A systematic review. International Journal of Pharmaceutical Research, 183(12), 272–278. https://doi.org/10.31838/ijpr/2020.SP2.045

AlAssad

Alqhtani

Alshammery

(2021). Implementation of teledentistry in postgraduate dental education during COVID-19 pandemic in Saudi Arabia. Annals of Dental Specialty, 9(1–2021), 20–26. https://doi.org/10.51847/pMOdC5ilbT

American Dental

(2020). ADA policy on teledentistry. accessed 12 April 2025. https://www.ada.org/about/governance/current-policies/ada-policy-on-teledentistry

Appleton

Barnett

Vera San Juan

Tuudah

Lyons

Parker

Roxburgh

Spyridonidis

Tamworth

Worden

Yilmaz

Sevdalis

Lloyd-Evans

Needle

J. J.

Johnson

(2023). Implementation strategies for telemental health: A systematic review. BMC Health Services Research, 23(1), 78. https://doi.org/10.1186/s12913-022-08993-1

Aquilanti

Santarelli

Mascitti

Procaccini

Rappelli

(2020). Dental care access and the elderly: What is the role of teledentistry? A systematic review. International Journal of Environmental Research and Public Health, 17(23), 9053. https://doi.org/10.3390/ijerph17239053

Arunagiri

K. P.

Allison

P. J.

Kengne Talla

(2024a). Implementation strategies to enhance teledentistry adoption in dental practices.pdf. PROSPERO. https://www.crd.york.ac.uk/PROSPERO/view/CRD42024566372

Arunagiri

K. P.

Dawson

Morneau

Verdon

Gagnon

M. P.

Talla

P. K.

(2024b). A workshop on envisioning a sustainable virtual oral health care: A meeting report. Journal (Canadian Dental Association), 90, o9.

10.

Böhm da Costa

da Silva Peralta

Aurelio Maeyama

Goulart Castro

Lúcia Schaefer Ferreira de Mello

(2021). Teledentistry system in dental health public services: A mixed-methods intervention study. International Journal of Medical Informatics, 153, 104533. https://doi.org/10.1016/j.ijmedinf.2021.104533

11.

Chen

H.-T.

Rossi

P. H.

(1980). The multi-goal, theory-driven approach to evaluation: A model linking basic and applied social science. Social Forces, 59(1), 106–122. https://doi.org/10.2307/2577835

12.

Covidence . (2018). Covidence-better systematic review management. Covidence. Retrieved 12 April 2025 from. https://www.covidence.org/

13.

Crummey

Graham

Besi

(2022). Virtual consultations for oral surgery patients. BMC Oral Health, 22(1), 83. https://doi.org/10.1186/s12903-022-02076-7

14.

Dada

Dalkin

Gilmore

Hunter

Mukumbang

F. C.

(2023). Applying and reporting relevance, richness and rigour in realist evidence appraisals: Advancing key concepts in realist reviews. Research Synthesis Methods, 14(3), 504–514. https://doi.org/10.1002/jrsm.1630

15.

Daniel

S. J.

Kumar

(2013). Teledentistry: A systematic review of clinical outcomes, utilization and costs. Journal of Dental Hygiene: JDH, 87(6), 345–352.

16.

da Silva

H. E. C.

Santos

G. N. M.

Leite

A. F.

Mesquita

C. R. M.

de Souza Figueiredo

P. T.

Dos Reis

P. E. D.

Stefani

C. M.

de Melo

N. S.

(2021). The role of teledentistry in oral cancer patients during the COVID-19 pandemic: An integrative literature review. Supportive Care in Cancer: Official Journal of the Multinational Association of Supportive Care in Cancer, 29(12), 7209–7223. https://doi.org/10.1007/s00520-021-06398-0

17.

Estai

Kanagasingam

Tennant

Bunt

(2018). A systematic review of the research evidence for the benefits of teledentistry. Journal of Telemedicine and Telecare, 24(3), 147–156. https://doi.org/10.1177/1357633x16689433

18.

Estai

Kruger

Tennant

(2016). Perceptions of Australian dental practitioners about using telemedicine in dental practice. British Dental Journal, 220(1), 25–29. https://doi.org/10.1038/sj.bdj.2016.25

19.

Feliz-Matos

(2023). Improving Satisfaction of non-English-speaking dental students using the electronic dental record. Nova Southeastern University. https://www.proquest.com/docview/2911050200?fromopenview=true&pq-origsite=gscholar&sourcetype=Dissertations_&_Theses

20.

Fortich-Mesa

Hoyos-Hoyos

(2020). Applications of teledentistry in dental practice: A systematic review. Revista Facultad de Odontología Universidad de Antioquia, 32(1), 77–88. https://doi.org/10.17533/udea.rfo.v32n1a8

21.

France

Glick

(2022). Long COVID and oral health care considerations. Journal of the American Dental Association, 153(2), 167–174. https://doi.org/10.1016/j.adaj.2021.08.007

22.

Greenhalgh

Manzano

(2022). Understanding ‘context’ in realist evaluation and synthesis. International Journal of Social Research Methodology, 25(5), 583–595. https://doi.org/10.1080/13645579.2021.1918484

23.

Greenhalgh

Wherton

Papoutsi

Lynch

Hughes

A’Court

Hinder

Fahy

Procter

Shaw

(2017). Beyond adoption: A new framework for theorizing and evaluating nonadoption, abandonment, and challenges to the scale-up, spread, and sustainability of health and care technologies. Journal of Medical Internet Research, 19(11), Article e367. https://doi.org/10.2196/jmir.8775

24.

Greenhalgh

Wong

Jagosh

Greenhalgh

Manzano

Westhorp

Pawson

(2015). Protocol--the RAMESES II study: Developing guidance and reporting standards for realist evaluation. BMJ Open, 5(8), Article e008567. https://doi.org/10.1136/bmjopen-2015-008567

25.

Irving

Stewart

Spallek

Blinkhorn

(2018). Using teledentistry in clinical practice as an enabler to improve access to clinical care: A qualitative systematic review. Journal of Telemedicine and Telecare, 24(3), 129–146. https://doi.org/10.1177/1357633x16686776

26.

Islam

M. R. R.

Islam

Ferdous

Watanabe

Yamauti

Alam

M. K.

Sano

(2022). Teledentistry as an effective tool for the communication improvement between dentists and patients: An overview. Healthcare (Basel), 10(8), 1586. https://doi.org/10.3390/healthcare10081586

27.

Jagosh

(2020). Retroductive theorizing in Pawson and Tilley’s applied scientific realism. Journal of Critical Realism, 19(2), 121–130. https://doi.org/10.1080/14767430.2020.1723301

28.

Jain

Dutt

Radenkov

Jain

(2024). WHO’s global oral health status report 2022: Actions, discussion and implementation. Oral Diseases, 30(2), 73–79. https://doi.org/10.1111/odi.14516

29.

Kengne Talla

Allison

Bussières

Giraudeau

Komarova

Basiren

Bergeron

Emami

(2024). Teledentistry for improving access to, and quality of oral health care: A protocol for an overview of systematic reviews and meta-analyses. PLoS One, 19(1), Article e0288677. https://doi.org/10.1371/journal.pone.0288677

30.

Kengne Talla

Inquimbert

Dawson

Zidarov

Bergeron

Chandad

(2023). Barriers and enablers to implementing teledentistry from the perspective of dental health care professionals: Protocol for a systematic quantitative, qualitative, and mixed studies review. JMIR Research Protocols, 12, Article e44218. https://doi.org/10.2196/44218

31.

Keshani

(2022). A realist review of understanding how community-level oral health promotion programs for humanitarian migrants work, in which contexts, and why: Initial program theories. McGill University. https://www.proquest.com/docview/2838439688?pq-origsite=gscholar&fromopenview=true&sourcetype=Dissertations_&_Theses

32.

Kruse

C. S.

Krowski

Rodriguez

Tran

Vela

Brooks

(2017). Telehealth and patient satisfaction: A systematic review and narrative analysis. BMJ Open, 7(8), Article e016242. https://doi.org/10.1136/bmjopen-2017-016242

33.

Lacouture

Breton

Guichard

Ridde

(2015). The concept of mechanism from a realist approach: A scoping review to facilitate its operationalization in public health program evaluation. Implementation Science: IS, 10(1), 153–163. https://doi.org/10.1186/s13012-015-0345-7

34.

Levy

B. B.

Goodman

Eskander

(2023). Oral healthcare disparities in Canada: Filling in the gaps. Canadian Journal of Public Health, 114(1), 139–145. https://doi.org/10.17269/s41997-022-00692-y

35.

Lewis

C. C.

Klasnja

Lyon

A. R.

Powell

B. J.

Lengnick-Hall

Buchanan

Meza

R. D.

Chan

M. C.

Boynton

M. H.

Weiner

B. J.

(2022). The mechanics of implementation strategies and measures: Advancing the study of implementation mechanisms. Implementation Science Communications, 3(1), 114. https://doi.org/10.1186/s43058-022-00358-3

36.

Lin

G. S. S.

Koh

S. H.

Ter

K. Z.

Lim

C. W.

Sultana

Tan

W. W.

(2022). Awareness, knowledge, attitude, and practice of teledentistry among dental practitioners during COVID-19: A systematic review and meta-analysis. Medicina (Kaunas), 58(1), 130. https://doi.org/10.3390/medicina58010130

37.

Marchetti

Fraiz

F. C.

Nascimento

W. M. d.

Soares

G. M. S.

Assunção

L. R. d. S.

(2018). Improving adolescents’ periodontal health: Evaluation of a mobile oral health app associated with conventional educational methods: A cluster randomized trial. International Journal of Paediatric Dentistry, 28(4), 410–419. https://doi.org/10.1111/ipd.12371

38.

Nayar

McFarland

K. K.

Chandak

Gupta

(2017). Readiness for teledentistry: Validation of a tool for oral health professionals. Journal of Medical Systems, 41(1), 4. https://doi.org/10.1007/s10916-016-0654-7

39.

Northridge

M. E.

Littlejohn

Mohadjeri-Franck

Gargano

Troxel

A. B.

Bowe

R. B.

Testa

P. A.

(2020). Feasibility and acceptability of an oral pathology asynchronous tele-mentoring intervention: A protocol. Journal of Public Health Research, 9(1), 1777. https://doi.org/10.4081/jphr.2020.1777

40.

Pawson

Greenhalgh

Harvey

Walshe

(2005). Realist review--a new method of systematic review designed for complex policy interventions. Journal of Health Services Research & Policy, 10(Suppl 1), 21–34. https://doi.org/10.1258/1355819054308530

41.

Peres

M. A.

Macpherson

L. M. D.

Weyant

R. J.

Daly

Venturelli

Mathur

M. R.

Listl

Celeste

R. K.

Guarnizo-Herreño

C. C.

Kearns

Benzian

Allison

Watt

R. G.

(2019). Oral diseases: A global public health challenge. Lancet, 394(10194), 249–260. https://doi.org/10.1016/s0140-6736(19)31146-8

42.

Petcu

Kimble

Ologeanu-Taddei

Bourdon

Giraudeau

(2017). Assessing PATIENT’S perception of oral teleconsultation. International Journal of Technology Assessment in Health Care, 33(2), 147–154. https://doi.org/10.1017/s0266462317000319

43.

Petersen

P. E.

Bourgeois

Ogawa

Estupinan-Day

Ndiaye

(2005). The global burden of oral diseases and risks to oral health. Bulletin of the World Health Organization, 83(9), 661–669.

44.

Powell

B. J.

Waltz

T. J.

Chinman

M. J.

Damschroder

L. J.

Smith

J. L.

Matthieu

M. M.

Proctor

E. K.

Kirchner

J. E.

(2015). A refined compilation of implementation strategies: Results from the expert recommendations for implementing change (ERIC) project. Implementation Science: IS, 10, 21. https://doi.org/10.1186/s13012-015-0209-1

45.

Proctor

Silmere

Raghavan

Hovmand

Aarons

Bunger

Griffey

Hensley

(2011). Outcomes for implementation research: Conceptual distinctions, measurement challenges, and research agenda. Administration and Policy in Mental Health, 38(2), 65–76. https://doi.org/10.1007/s10488-010-0319-7

46.

Proctor

E. K.

Powell

B. J.

McMillen

J. C.

(2013). Implementation strategies: Recommendations for specifying and reporting. Implementation Science: IS, 8, 139. https://doi.org/10.1186/1748-5908-8-139

47.

Rahman

Nathwani

Kandiah

(2020). Teledentistry from a patient perspective during the coronavirus pandemic. British Dental Journal, 229(3), 1–4. https://doi.org/10.1038/s41415-020-1919-6

48.

Raja

K. P.

Pal

Nayak

S. U.

Pai

Shenoy

(2022). Teledentistry: A new oral care delivery tool among Indian dental professionals - a questionnaire study. F1000Research, 11, 666. https://doi.org/10.12688/f1000research.122058.1

49.

Rouleau

Ramamoorthi

Boxall

Liu

R. H.

Maloney

Zelmer

Scott

Larsen

Wijeysundera

H. C.

Ziegler

Bhatia

Kishimoto

Steele Gray

Desveaux

(2024). Mapping theories, models, and frameworks to evaluate digital health interventions: Scoping review. Journal of Medical Internet Research, 26, Article e51098. https://doi.org/10.2196/51098

50.

Rycroft-Malone

McCormack

Hutchinson

A. M.

DeCorby

Bucknall

T. K.

Kent

Schultz

Snelgrove-Clarke

Stetler

C. B.

Titler

Wallin

Wilson

(2012). Realist synthesis: Illustrating the method for implementation research. Implementation Science: IS, 7, 33. https://doi.org/10.1186/1748-5908-7-33

51.

Shea

C. M.

Belden

C. M.

(2016). What is the extent of research on the characteristics, behaviors, and impacts of health information technology champions? A scoping review. BMC Medical Informatics and Decision Making, 16, 2. https://doi.org/10.1186/s12911-016-0240-4

52.

Shwetha

Sujatha

Rakesh

Kumar

T. P.

Vaishnavi

Sreekanth

(2021). Teleconsultation – the pandemic mantra or the new norm? Journal of Head & Neck Physicians and Surgeons, 9(2), 142–146. https://doi.org/10.4103/jhnps.jhnps_4_21. https://journals.lww.com/jhns/fulltext/2021/09020/teleconsultation___the_pandemic_mantra_or_the_new.14.aspx

53.

Siddaway

A. P.

Wood

A. M.

Hedges

L. V.

(2019). How to do a systematic review: A best practice guide for conducting and reporting narrative reviews, meta-analyses, and meta-syntheses. Annual Review of Psychology, 70(1), 747–770. https://doi.org/10.1146/annurev-psych-010418-102803

54.

Talla

P. K.

Kamalabadi

Y. M.

Durand

Michaud

P. L.

Emami

(2024). Applying an extended theoretical approach to identifying Canadian dental students’ acceptance of teledentistry: A cross-sectional study. Digital Health, 10, 20552076241258472. https://doi.org/10.1177/20552076241258472

55.

Talla

P. K.

Rodrigues

(2024). What does teledentistry mean? Mapping of current definitions. Digital Health, 10, 20552076241292681. https://doi.org/10.1177/20552076241292681

56.

Tan

S. H. X.

Lee

C. K. J.

Yong

C. W.

Ding

Y. Y.

(2021). Scoping review: Facilitators and barriers in the adoption of teledentistry among older adults. Gerodontology, 38(4), 351–365. https://doi.org/10.1111/ger.12588

57.

Valeri

Quinzi

Di Giandomenico

Fani

Leonardi

Marzo

(2023). Teledentistry: A bibliometric analysis of the scientific publication’s trend. Digital Health, 9, 20552076231204747. https://doi.org/10.1177/20552076231204747

58.

Varsi

Solberg Nes

Kristjansdottir

O. B.

Kelders

S. M.

Stenberg

Zangi

H. A.

Børøsund

Weiss

K. E.

Stubhaug

Asbjørnsen

R. A.

Westeng

Ødegaard

Eide

(2019). Implementation strategies to enhance the implementation of eHealth programs for patients with chronic illnesses: Realist systematic review. Journal of Medical Internet Research, 21(9), Article e14255. https://doi.org/10.2196/14255

59.

Venkatesh

Bala

(2008). Technology acceptance model 3 and a research agenda on interventions. Decision Sciences, 39(2), 273–315. https://doi.org/10.1111/j.1540-5915.2008.00192.x

60.

Villarosa

A. R.

Maneze

Ramjan

L. M.

Srinivas

Camilleri

George

(2019). The effectiveness of guideline implementation strategies in the dental setting: A systematic review. Implementation Science: IS, 14(1), 106. https://doi.org/10.1186/s13012-019-0954-7

61.

Watt

R. G.

Daly

Allison

Macpherson

L. M. D.

Venturelli

Listl

Weyant

R. J.

Mathur

M. R.

Guarnizo-Herreño

C. C.

Celeste

R. K.

Peres

M. A.

Kearns

Benzian

(2019). Ending the neglect of global oral health: Time for radical action. Lancet, 394(10194), 261–272. https://doi.org/10.1016/s0140-6736(19)31133-x

62.

White

J. S.

Ramos-Gomez

Liu

J. X.

Jue

Finlayson

T. L.

Garza

J. R.

Crawford

A. H.

Helman

Santo

Cheng

Kahn

J. G.

Gansky

S. A.

(2020). Monetary incentives for improving smartphone-measured oral hygiene behaviors in young children: A randomized pilot trial. PLoS One, 15(7), Article e0236692. https://doi.org/10.1371/journal.pone.0236692

63.

Wolf

T. G.

Schulze

R. K. W.

Ramos-Gomez

Campus

(2022). Effectiveness of telemedicine and teledentistry after the COVID-19 pandemic. International Journal of Environmental Research and Public Health, 19(21), 13857. https://doi.org/10.3390/ijerph192113857

64.

Wong

Westhorp

Manzano

Greenhalgh

Jagosh

Greenhalgh

(2016). RAMESES II reporting standards for realist evaluations. BMC Medicine, 14(1), 96. https://doi.org/10.1186/s12916-016-0643-1

65.

World Health

International Telecommunication

(2021). Mobile technologies for oral health: An implementation guide. World Health Organization. https://iris.who.int/handle/10665/345255

Implementation Strategies to Enhance Teledentistry Adoption in Dental Care Settings: A Realist Review Protocol

Abstract

Keywords

Introduction

Objectives

Methods

Study Design

Clarifying the Purpose of the Review and Drafting an Initial Program Theory

Developing an Initial Programme Theory (IPT)

Identifying Relevant Studies

Inclusion Criteria

Exclusion Criteria

Study Selection and Screening

Quality Appraisal and Data Extraction

Data Analysis

Data Synthesis

Implementation Outcomes

Service Outcomes

Client Outcomes

Dissemination of Findings

Conclusion

Footnotes

Authors’ Note

ORCID iD

Statements and Declarations

Funding

Conflicting Interests

References