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LETTER TO THE EDITOR |
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| Year : 2020 | Volume
: 10
| Issue : 3 | Page : 376-378 |
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| Role of telemedicine and smartphone for distant patient management in dentistry: The new way of triage |
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Giorgia Capocasale1, Giulio Perno2, Riccardo Nocini3, Massimo Albanese1, Francesca Zotti1
1 Department of Surgical Sciences, Pediatrics, and Gynecology, University of Verona, Verona, Italy
2 Independent Researcher, Palermo, Italy
3 Department of Otorhinolaryngology–Head and Neck Surgery, University Hospital of Verona, Verona, Italy
| Date of Submission | 08-Jan-2020 |
| Date of Acceptance | 27-Feb-2020 |
| Date of Web Publication | 30-Apr-2020 |
Correspondence Address:
Dr. Giorgia Capocasale
Department of Surgical Sciences, Pediatrics, and Gynecology, University of Verona, Policlinico G.B. Rossi, P.le L.A. Scuro 10, 37134 Verona.
Italy
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jispcd.JISPCD_6_20
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How to cite this article:
Capocasale G, Perno G, Nocini R, Albanese M, Zotti F. Role of telemedicine and smartphone for distant patient management in dentistry: The new way of triage. J Int Soc Prevent Communit Dent 2020;10:376-8 |
How to cite this URL:
Capocasale G, Perno G, Nocini R, Albanese M, Zotti F. Role of telemedicine and smartphone for distant patient management in dentistry: The new way of triage. J Int Soc Prevent Communit Dent [serial online] 2020 [cited 2022 Nov 29];10:376-8. Available from: https://www.jispcd.org/text.asp?2020/10/3/376/283653 |
Dear Editor
Telemedicine (TM) can be defined as the exchange of medical data through technology applications and devices,[1] opening door to different ways in diagnosing and in taking care at different levels and ages.[2],[3]
This communication aimed to draw attention on the feasibility of technology applications in preliminary diagnosis.
A 30-year-old Caucasian woman contacted our department by telephone to explain her signs and symptoms. She reported that 3 days before she had visited the emergency department because of the appearance of lip swelling. This sign was attributed to a food allergy, and she was discharged with a 5-day therapy with prednisone and antihistamine. Also, she reported that she returned to the same institution a day later with vesicular eruptions affecting her upper lip and genital mucosa, so orogenital Herpes simplex virus 2 infection was suspected and she was prescribed valacyclovir 2000mg/day, without any improvement.
On the basis of this report, we asked her to send pictures of oral and other manifestations by WhatsApp Messenger chat room. Telephone agreement in sending pictures was obtained, and the patient wrote in a further text message her consent in sending images for the smartphone triage. Images were self-portrait taken by patient with the smartphone camera (8 MP)[4] [Figure 1] and [Figure 2]. | Figure 1: Oral painful ulcers 3 days after the first administration of fluconazole
Click here to view |
,  | Figure 2: Lip swelling 1 day after the first administration of fluconazole
Click here to view |
Thanks to telephonic indications and pictures sent, we were able to frame the condition and set a multidisciplinary team for the visit: oral pathologist, dermatologist, and gynecologist.
She came to our attention and she signed a written consent to be visited and to undergo blood tests, and on the same occasion, the patient signed a specific form giving us the written consent for storing her photographs shared via WhatsApp Messenger. All sensitive personal information of the patient, including the photographs sent, was recorded and archived in the hospital database.
Signs observed were oral and genital painful ulcers affecting swallowing, sitting and urinating, myalgia, and temperature <38.0°C. No skin rashes were observed.
Our team carried out pathological and medical evaluations, which indicated a previous vaginal candidiasis treated with 200mg/day oral fluconazole for 2 days, prescribed by her gynecologist. To exclude previous diagnoses, serological test for immunoglobulin (Ig)G and IgM anti-HSV was performed, and it revealed only IgG positivity.
After clinical evaluation and serological test, signs were discussed and all three specialists agreed on the diagnosis of incomplete Stevens Johnson syndrome. She, therefore, received deflazacort 30mg, and complete remission was observed in 14 days, without complication.
The diagnosis was actually carried out based on a clinical visit; however, the smartphone triage allowed recruiting a suitable team that was able to effectively assess signs and symptoms. Moreover it was possible, thanks to the images received, to collect data of the patient living far, and in this way, she could avoid further wasted visits.
On the basis of these findings, it might be advisable to discuss the feasibility to improve and increase this first way of communication between patient and physicians to frame diseases early and perform a well-timed diagnosis.
TM incorporates technologies and activities, offering new ways to deliver medical care; apps are downloadable on mobile phones, and they could represent a valuable help in early placement of signs[5] and for saving costs and time for patients and healthcare facilities.
Furthermore, it might be taken into account the great opportunity to avail of TM in weak countries or in rural areas where healthcare facilities and healthcare financing are poor. Literature reports valuable works about the effectiveness of TM in early diagnosis of oral alterations[6] and skin diseases.[7] It is proven that the feasibility to use images sent by smartphone in performing first diagnoses or planning referral results in saving time and costs, and preserving the health of patients who are not able to easily reach healthcare facilities.[6],[8],[9]
Advantages of this helpful method are surely performing a triage and the feasibility to address patients to most suited specialist avoiding time-consuming visits, unnecessary instrumental examinations, and delayed diagnoses. However, some criticism has to be taken into account, especially regarding privacy and treatment of sensitive data. In this perspective, it is advisable to inform patients about the storing of data and it would be even more desirable if healthcare adequate their privacy systems of data collected performing telemedicine. Moreover, instructing patients to send images of lesions avoiding, to the extent practicable, personal details, which can make them recognizable in photographs could be helpful in protecting privacy. Another critical point is represented by the quality of sent images, even if performances of smartphone cameras are notably improved in the last years.
By well considering the routine medical practice and clinical evidences obtained, we think it would be possible to improve several aspects of health management in terms of early diagnosis. Of course, it might be useful to enhance and to better set the privacy context to protect data shared by apps or patient’s smartphones.
Declaration of patient consent
The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
Ethical considerations
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional research committee (University of Verona, Italy) and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Author contributions
PG: Substantial contributions to the conception or design of the work; NR: the acquisition, analysis, or interpretation of data for the work; CG: Drafting the work or revising it critically for important intellectual content; ZF: Final approval of the version to be published; AM :Agreement to be accountable for all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.
 References | |  |
| 1. | Koparal M, Ünsal HY, Alan H, Üçkardeş F, Gülsün B. WhatsApp messaging improves communication in an oral and maxillofacial surgery team. Int J Med Inf 2019;132:103987.  |
| 2. | Zotti F, Pietrobelli A, Malchiodi L, Nocini PF, Albanese M. Apps for oral hygiene in children 4 to 7 years: Fun and effectiveness. J Clin Exp Dent 2019;11:e795-801. |
| 3. | Zotti F, Zotti R, Albanese M, Nocini PF, Paganelli C. Implementing post-orthodontic compliance among adolescents wearing removable retainers through Whatsapp: A pilot study. Patient Prefer Adherence 2019;13:609-15. |
| 4. | Haron N, Zain RB, Nabillah WM, Saleh A, Kallarakkal TG, Ramanathan A, et al. Mobile phone imaging in low resource settings for early detection of oral cancer and concordance with clinical oral examination. Telemed J E Health 2017;23:192-9. |
| 5. | Verzantvoort NCM, Teunis T, Verheij TJM, van der Velden AW. Self-triage for acute primary care via a smartphone application: Practical, safe and efficient? PLoS One 2018;13:e0199284. |
| 6. | Petruzzi M, De Benedittis M. WhatsApp: A telemedicine platform for facilitating remote oral medicine consultation and improving clinical examinations. Oral Surg Oral Med Oral Pathol Oral Radiol 2016;121:248-54. |
| 7. | Rat C, Hild S, Rault Sérandour J, Gaultier A, Quereux G, Dreno B, et al. Use of smartphones for early detection of melanoma: Systematic review. J Med Internet Res 2018;20:e135. |
| 8. | Bhatt S, Isaac R, Finkel M, Evans J, Grant L, Paul B, et al. Mobile technology and cancer screening: Lessons from rural India. J Glob Health 2018;8:020421. |
| 9. | Tesfalul M, Littman-Quinn R, Antwi C, Ndlovu S, Motsepe D, Phuthego M, et al. Evaluating the potential impact of a mobile telemedicine system on coordination of specialty care for patients with complicated oral lesions in Botswana. J Am Med Inform Assoc 2016;23:e142-5. |
[Figure 1], [Figure 2] |
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| This article has been cited by | | 1 |
How to deal with coronavirus disease 2019: A comprehensive narrative review about oral involvement of the disease |
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| Giorgia Capocasale,Riccardo Nocini,Paolo Faccioni,Dario Donadello,Dario Bertossi,Massimo Albanese,Francesca Zotti | | Clinical and Experimental Dental Research. 2021; 7(1): 101 | | [Pubmed] | [DOI] | | | 2 |
A Snapshot of Knowledge about Oral Cancer in Italy: A 505 Person Survey |
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| Riccardo Nocini,Giorgia Capocasale,Daniele Marchioni,Francesca Zotti | | International Journal of Environmental Research and Public Health. 2020; 17(13): 4889 | | [Pubmed] | [DOI] | |
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