Barriers and Enablers to Implementing Teledentistry among Dental Healthcare Professionals: A Systematic Review of Quantitative, Qualitative, and Mixed Methods Studies

Imagine a world where a dentist can check a patient's teeth, offer advice, or spot a problem without the two of them ever sitting in the same room. This is the promise of teledentistry, a field that uses video calls, secure messages, and digital photos to bring oral health care to people wherever they are. For years, experts have hoped this technology would solve big problems: it could save patients time and money, help those in remote areas get care, and make the whole dental system more efficient. The idea is that by using computers and phones, dentists can reach more people and keep their practices running smoothly. Yet, despite the clear benefits and the technology being available, most dental offices have not made this a regular part of their daily work. Something is holding them back, and understanding exactly what that is has become a major question for health researchers.

To find the answer, a team of researchers from universities in Canada, France, and the United States set out to look at everything written about this topic. They gathered a massive collection of studies—96 in total—published between 2001 and 2024. These studies came from 22 different countries, including the United States, India, and Saudi Arabia, and they involved thousands of dental professionals, from general dentists to specialists and students. The researchers did not just read these studies to see if teledentistry worked; they wanted to understand the human side of why it was or was not being used. They looked for the specific reasons that made a dentist decide to try the technology or decide to avoid it. To make sense of the thousands of different opinions and experiences, they organized the findings using a structured map of human behavior, grouping every reason into categories like what people know, what they believe will happen, what skills they have, and what support they get from their environment.

The researchers found that the reasons for using or avoiding teledentistry are complex and often depend on the specific situation. On the positive side, many dentists see great value in the technology. They believe it can save time, reduce the need for patients to travel, and lower costs. It allows for quicker follow-ups after a procedure and helps dentists communicate better with each other. Many feel it opens the door to helping people who might otherwise go without care. However, these same benefits are often shadowed by serious doubts. A major hurdle is the belief that teledentistry simply cannot be as accurate as seeing a patient in person. Many dentists worry that a screen cannot show the full picture of a tooth or gum, leading to fears that they might miss a diagnosis or make a mistake. There is also a strong concern about the legal and financial side of things. Dentists are unsure if they will get paid for these virtual visits, if the laws allow them to prescribe medicine remotely, or if they could be held liable if something goes wrong.

Another significant barrier is the lack of clear training and support. Many dental professionals feel they do not have the right skills to use the software effectively or do not know how to integrate it into their daily routine. They also point to practical problems, such as poor internet connections, expensive equipment, or a lack of staff to help manage the technology. Interestingly, the researchers noticed that the same factor could be seen as both a help and a hindrance depending on the person. For example, the COVID-19 pandemic forced many dentists to try teledentistry out of necessity, which helped some overcome their hesitation and see its value. For others, the pandemic highlighted the difficulties of the technology and reinforced their preference for traditional, in-person care. The study also revealed that while there are many reasons to adopt this technology, the most powerful drivers are often about what dentists believe will happen if they use it. If they think it will improve their practice and help their patients, they are more likely to try it. If they think it will create more work or risk their reputation, they will likely avoid it.

The quality of the evidence the researchers reviewed varied. While they found a large number of studies, only a small fraction were considered to be of high methodological quality. Most of the research relied on surveys where dentists reported their own views, which can sometimes be influenced by how they feel at the moment rather than their actual long-term experiences. The researchers noted that very few of the original studies used a formal theory to guide their questions, which means the data was sometimes scattered and hard to compare. Despite these limitations, the review provides a clear picture of the landscape. It suggests that simply introducing new technology is not enough to change how dentists work. To make teledentistry a standard part of dental care, the barriers need to be addressed directly. This means creating clear rules about payment and liability, providing better training so dentists feel confident in their skills, and ensuring that the technology is reliable and easy to use. The path forward requires more than just a new app; it requires a shift in the environment and the mindset of the dental profession to turn a promising idea into a routine reality.