Accuracy of remote diagnosis of oral mucositis in children and adolescents with cancer using a mobile App: a pilot study.

Abstract

Remote examinations have become increasingly common in Dentistry, especially with the use of applications. This preliminary cross-sectional study evaluated the accuracy of remote examination of oral mucositis (OM) and severe oral mucositis (SOM) using photos obtained through the Telepediatric Dentistry in Oncology (TON) application, comparing its results with the in-person clinical examination (gold standard). A total of 21 pediatric patients (13 boys, 8 girls; mean age 9.05 ± 3.46 years) undergoing chemotherapy were examined, totaling 28 in-person examinations and 224 photographic images assessed remotely by four calibrated dentists (Kappa > 0.7). The photos covered eight oral cavity sites (lips, right and left buccal mucosa, tongue dorsum, lateral tongue, palate, and floor of the mouth) and were analyzed for the presence or absence of OM and SOM. Among the 28 examinations, 11 presented OM and 3 presented SOM. The remote examination identified all positive cases (sensitivity 100%; 95%CI: 0.741-1), while specificity was 59% for OM, reflecting the occurrence of false positives, especially in the lips and buccal mucosa. Agreement between remote examiners and the gold standard ranged from 0.17 to 1.0, depending on the region and evaluator, being higher in the tongue dorsum, lateral tongue, and floor of the mouth. The results indicate that remote examination via TON may be feasible and has the ability to detect OM and SOM, potentially serving as a complementary tool in dental monitoring of children and adolescents undergoing oncology treatment, particularly when in-person examination is not possible.