Diagnostic accuracy of smartphone and macro camera imaging for dental caries and oral health conditions

BACKGROUND: This study aimed to assess the diagnostic accuracy of digital intraoral photographs obtained using smartphones and a macro camera in evaluating oral health among adults. METHODS: A total of 200 adult patients underwent clinical and radiographic examinations using the Decayed, Filled Teeth (DFT) Index, Caries Assessment Spectrum and Treatment (CAST) Index, Plaque Index (PI), and Modified Gingival Index (MGI). Intraoral photographs were taken using three devices: Samsung S23 Ultra, iPhone 14 Pro, and Canon EOS 400D with macro lens. Following the clinical recording of DFT, CAST, PI, and MGI scores by two calibrated examiners as the reference standard, intraoral photographs were captured by a third dentist and independently evaluated by two separate blinded examiners to compare the diagnostic accuracy of the devices against the clinical findings. Non-parametric analyses were conducted using the Friedman test with Dunn's post hoc test, Wilcoxon test and agreement between clinical and photographic methods was evaluated via the Bland-Altman method (p < 0.05). RESULTS: The macro camera demonstrated the highest inter-rater reliability for FT scores (ICC = 0.886), while iPhone-derived MGI scores showed the lowest reliability (ICC = 0.624). Statistically significant differences were found among all imaging devices for all indices (p < 0.001), except for MGI. Bland-Altman analysis showed that most values fell within the 95% limits of agreement, indicating good concordance with clinical data. CONCLUSIONS: Smartphone and macro camera photographs provided comparable diagnostic results for caries and restorations. However, limitations remain in the assessment of periodontal parameters via photographic methods. Smartphone-based intraoral photography can serve as a practical diagnostic tool in teledentistry.