Accuracy of teledentistry in detecting dental caries among school children in Makkah City: a diagnostic comparative study

Early detection of dental caries is essential to prevent disease progression and reduce treatment burden. In school settings, access to conventional dental screening is often limited, highlighting the need for scalable approaches to support early identification and referral. This study aimed to evaluate the diagnostic accuracy of smartphone-based teledentistry for detecting dental caries among schoolchildren in Makkah, Saudi Arabia. A diagnostic accuracy study was conducted among 12–13-year-old students from ten intermediate schools. A total of 336 students completed both in-field clinical examination and remote assessment of intraoral photographs captured during the same visit using a standardized protocol. Caries was assessed using the International Caries Detection and Assessment System (ICDAS) and analyzed at the tooth level by assigning the highest score per tooth. Diagnostic accuracy measures, including sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), overall accuracy, and Cohen’s kappa, were calculated. Receiver operating characteristic (ROC) analysis was performed, and mean decayed, missing, and filled teeth scores (DMFT/dmft) were compared between both modalities using paired t-tests. Remote assessment demonstrated a sensitivity of 77.4% and specificity of 96.6%, with an overall accuracy of 93.4% and substantial agreement with clinical examination (kappa = 0.76). The area under the ROC curve was 0.774. Mean DMFT for permanent dentition was slightly lower in remote assessment compared with clinical examination (3.47 ± 2.71 vs. 3.80 ± 2.61; p < 0.001), while no statistically significant difference was observed for dmft in primary dentition. Smartphone-based teledentistry demonstrated high specificity, and acceptable diagnostic accuracy for caries detection among intermediate schoolchildren in mixed dentition stage. Despite moderate sensitivity, it may serve as an effective screening and triage tool in school-based oral health programs serving populations similar to those included in the present study.