Current and Potential Use of WhatsApp in Oral Health Care - A Narrative Review

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International Journal of Health Sciences and Research
www.ijhsr.org                                                                              ISSN: 2249-9571

Review Article

Current and Potential Use of WhatsApp in Oral Health Care - A Narrative
                                Review
                 Dr. Shweta Somasundara Yale1, Dr. Santosh Kumar C2, Dr. Vasudha Sharma1
                                         1
                                         Reader, 2Senior Lecturer,
 Department of Public Health Dentistry, Rajarajeswari Dental College and Hospital, No.14, Ramohalli Cross,
                        Mysore Road, Kumbalgodu, Bengaluru, Karnataka 560074
                                Corresponding Author: Dr. Shweta Somasundara Yale

ABSTRACT

Smartphones, internet and instant messaging applications have changed the telecommunication
scenario since their advent, with immense benefits for healthcare providers and recipients across the
globe. WhatsApp is one such instant messaging tool that has found favour with health care
professionals working in diverse settings. Although WhatsApp has been extensively used in health
care, the literature on its use in oral health care is sparse. This review explored the current and
potential use of WhatsApp in the field of oral health care. The PUBMED database was searched for
English language articles reporting the use of WhatsApp in dentistry, oral health care, dental
education. Snowballing to find additional relevant articles was done by also using Google Scholar and
grey literature. Tele-consultation, appointment booking, addressing queries from patients, treatment
planning, referral, obtaining second opinions, emergency help in dealing with maxillofacial trauma be
it in routine practice or sites of disasters and conflicts, oral health promotion, tobacco cessation,
facilitating dental education through innovative teaching approaches, online follow up of patients,
data collection for research are some of the possible uses of WhatsApp in oral health care. Addressing
the concerns of privacy issues, by appropriate usage of smartphones and WhatsApp, oral health care
professionals can expand the delivery of oral health care to remote and underserved areas as well as
improve the quality of oral health care.

Key words: WhatsApp, oral health care, dentistry, mouth, smartphone.

INTRODUCTION                                               each other. The entire process of sending the
        WhatsApp is reported to now have                   message/image is free. [2] Smartphones and
1.5 billion monthly active users (MAUs),                   WhatsApp are now being used by doctors in
with over 200 million monthly active users                 health care delivery, for telemedicine and
in India. [1] “WhatsApp Messenger” is a                    teledentistry services. [3] A comprehensive
cross-platform       instant      messaging                systematic review of present literature on
application for smartphones. Cross platform                the use of the WhatsApp Messenger app as
means that the software is available for iOS,              an adjunctive health care tool for medical
Blackberry OS, Android, Symbian, Series                    doctors concluded that pooled data provided
40 and Windows Phone and allows seamless                   compelling evidence that the WhatsApp
communication between the various                          Messenger app is a promising system,
devices, be it a Windows phone, Blackberry                 whether used as a communication tool
phone, Android phone or apple phone. In                    between health care professionals, as a
addition to text messaging, users can send                 means of communication between health
images, video and audio media messages to                  care professionals and the general public, or

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Shweta Somasundara Yale. Use of WhatsApp in Oral Health Care

as a learning tool for providing health care        oral health care including dental education,
information to professionals or to the              oral health promotion/smoking cessation.
general population. [4]
        The WhatsApp business app is now            Literature search:
actively used by over 3 million people. It                   The PUBMED database was
was launched in January 2018 for Android            searched using the term “WhatsApp”
users in six countries including India,             yielding 156 articles; then a search for
Indonesia, Italy, Mexico, Britain and the           English language articles reporting the use
US. Users can now download WhatsApp                 of WhatsApp in dentistry, oral health care,
Business app for free from Google Play              dental education, using the search details:
store but the new app, is yet to come on            WhatsApp         [All       Fields]     AND
Apple App Store in India. [5] This tool can         ("mouth"[MeSH Terms] OR "mouth"[All
potentially be used by dental practices to          Fields] OR "oral"[All Fields]) was done and
communicate with patients regarding dental          eleven articles were found. Snowballing to
procedures, treatment costs, and most               find additional relevant articles was done by
importantly, getting appointments over              also using Google Scholar and grey
WhatsApp; [6] basically, interact with              literature.
customers, patients, and dental labs easily
by using tools to automate, sort, and quickly       Reported uses of WhatsApp in oral
respond to messages. [7]                            health care
        With improved encryption in the             Use of WhatsApp in oral medicine and
current version of WhatsApp, its use in the         radiology
health sector is expected to grow. [3] For                  WhatsApp has been reported to be
general communication, or for sending de-           used for submitting clinical images and
identified protected health information             diagnostic questions by general dentists,
(PHI), WhatsApp could be safely used by             dental hygienists, patients and physicians
healthcare professionals. [8] In the USA, the       for telemedicine consultation reducing the
Health      Insurance       Portability    and      geographic      barriers   to   preliminary
Accountability Act, commonly referred to            consultations. Telemedicine impression via
as HIPAA, sets national standards for the           WhatsApp agreed with the clinicopathologic
confidentiality, security, and transmissibility     impression in 82% of the cases in a study
of personal health information. Healthcare          from Italy. [11] Another study carried out
providers are required, under the HIPAA             among Oral medicine and radiology (OMR)
Privacy Rule, to protect and keep                   specialists across India, reported that
confidential      any      personal     health      WhatsApp was the most frequently used
information. [9] In order for WhatsApp to be        application for m-Teledentistry (mobile-
HIPAA compliant, there would have to be a           Teledentistry) practice. Telediagnosis and
significant number of security mechanisms           treatment planning using patient images,
added to the software. [10] Till then,              videos and radiographs, accessibility of the
additional security controls may be installed       specialists to rural areas, was positively
on a smartphone to authenticate users before        considered. Many OMR specialists agreed
the device can be accessed, [8] and app locks       that sharing patient information over
may have to be used so that health                  WhatsApp may lead to breach of patient
information downloaded on the phone                 confidentiality; however, many concurred
remains confidential.                               that they discussed diagnosis and treatment
        Despite these concerns WhatsApp is          planning in WhatsApp chat rooms. The
being increasingly used in oral health care.        study reported that CBCT image quality
This review explores the current and                transmitted over WhatsApp may be less.
potential use of WhatsApp in the field of           Most respondents felt that WhatsApp would
                                                    be useful in improving dental practice,

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Shweta Somasundara Yale. Use of WhatsApp in Oral Health Care

patient management and patient satisfaction.        have reported using Smartphones having a
[12]
                                                    high definition camera, and WhatsApp as an
                                                    image and video transfer program to send
Use of WhatsApp in oral pathology                   Computerised Tomography (CT) sequences.
        Smartphones allow pathologists and          Views of CT images from a computer
other image dependent disciplines in low            screen were sent as images and serial
resource areas to transmit consultations to         images were recorded as videos and sent
experts anywhere in the world. [13] Second          through WhatsApp. [15] WhatsApp can also
opinion diagnosis of 34 different oral              be used by surgically active dentists in
pathologies that had been captured as               structurally weak areas to seek guidance
photomicrographs,       using     smartphones       from experienced maxillofacial surgeons or
through compound microscopes has been               emergency doctors to treat potentially life-
reported to be effectively and conveniently         threatening conditions, utilizing the real
accomplished by oral pathologists in India          time video communication feature of
using     WhatsApp       to    transfer   the       WhatsApp. [16]
photomicrographs to 20 different oral
pathologists. Considering that a second             Use of WhatsApp in Orthodontics
opinion diagnosis was obtained in nearly                    A study that tested mobile
three hours, diagnostic delays can be               applications for patient to orthodontist
minimised leading to better patient                 contact, compared WhatsApp and Telegram,
management. [14] WhatsApp can be used at            found that: the majority of patients (75%)
the time of community surveys on oral               preferred WhatsApp; it enabled them to
cancer detection, wherein second opinion            send pictures, and the most frequently
can be sought for suspicious cases of oral          reported messages were pertaining to
cancer. Faster second opinion will aid in           bracket failures esp. of second molars, pain
early detection of oral cancer. [14]                due to moving wires at the end, additional
                                                    information on oral hygiene and using
Use of WhatsApp in Oral and                         elastics, which prompted the adoption of
maxillofacial surgery                               protocols to improve the same, thereby
        A study from South India has                increasing patient contact with the
reported that they have greatly eliminated          orthodontic practice and increasing patient
the communication gap, reducing the                 compliance. [17] Another study that
possibility             of            arbitrary     evaluated the influence of a WhatsApp-
misdiagnosis/mismanagement in their Oral            based approach in a protocol for domestic
and maxillofacial unit, by using a                  oral hygiene maintenance in a group of
WhatsApp protocol that is followed for              adolescent     patients     wearing    fixed
communication between post graduate                 multibracket appliances, instructed the
trainees and teaching faculty, junior and           patients who were enrolled in a WhatsApp
senior colleagues. WhatsApp is used to              chat room-based competition to share
share patient photographs, radiographs              monthly, with the other participants two
between the first on-call post graduate             self-photographs (selfies) showing their oral
trainee and all other seniors in the group; the     hygiene status. Improved oral health status
theatre list along with the pre-operative and       during orthodontic multibracket treatment
post- operative photos and radiographs,             was observed by significantly lower values
treatment plans and outcomes, are also              of both plaque index, and gingival index,
reviewed, thereby keeping all members of            and a lower incidence of new white spot
the unit informed and also a creating a             lesions and caries, as compared with the
digital archive for future reference. [2] For       control group. [18] Studies using messaging
night time consultations on maxillofacial           apps have reported their effectiveness in
traumas, in Turkey, emergency services              reducing the treatment duration and bracket

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Shweta Somasundara Yale. Use of WhatsApp in Oral Health Care

bond failure and improving the attendance          that group discussion and reminders via
in orthodontic patients besides being useful       WhatsApp social group were effective to
for outpatient education and management.           reduce smoking relapse. [23]
[19]
     Therefore WhatsApp can be made use of                 Another study from Saudi Arabia
similarly in the Indian scenario.                  reported that Twitter and WhatsApp users
                                                   found it easier to quit smoking than those
Use of WhatsApp in dental education                who did not take part in these social media
        A study reported that WhatsApp was         groups. Social media provides a good
the most used instant messaging (IM) app           platform to discuss smoking cessation
among dental students of a university in           treatment, and thus reduce smoking
U.K because of its popular features such as        relapses. [24] WhatsApp can be a more
being able to check if recipients have read        effective tool for providing dental education
and received messages and group work.              on tobacco and oral cancer as compared to
WhatsApp was used a lot to undertake               conventional audio-visual aids. [25] Social
group work and share files for their dental        media can play an important role in
studies. [20]                                      strengthening the health care system to
        WhatsApp was introduced as a               provide valuable information, educational
teaching tool in an Oral Radiology course.         programs and interventions to promote
Undergraduate dental students at the               healthy life styles among the people. [26]
University of Brasília were provided with
weekly quizzes via a WhatsApp discussion           Potential uses of WhatsApp
group over a 14-week period. The quizzes                   Teleconsultation using WhatsApp
consisted of a tomographic or radiographic         can potentially be used in the dental setting
image from a real clinical case and a              to seek specialist opinions in rural areas,
multiple-choice      question.       Students      war torn areas, underserved areas, disaster
reportedly had a positive attitude towards         sites and for various purposes such as:
the use of WhatsApp and considered it had          diagnosis and treatment planning for
helped them to learn about Oral Radiology          patients requiring prosthetic or oral
although participation decreased over time.        rehabilitation treatment, video-consultation
So, WhatsApp can facilitate participatory          in dentistry; remote diagnosis of children’s
learning among dental students and further         dental problems based on non-invasive
research can be carried out in this direction.     photographs, identifying root canal orifices
[21]
                                                   based on images of endodontically accessed
        Insufficient weekly hours to cover         teeth, diagnosis of periapical lesions of the
the extensive curricula of English for Dental      front teeth, reducing the costs associated
Purposes (EDP) courses in Iran, led to the         with distant visits and making urgent help
use of a WhatsApp based approach that the          available; The general dentist can send all
dental students believed enhanced their            the pertinent information (radiograph of the
learning of English for Dental Purposes; this      area, an intraoral photograph, all charting
research showed that WhatsApp mobile               and health history information) of a patient
language learning activities carry benefits        via the internet to a periodontist/other
for university students’ achievement and           specialists who would then evaluate and
attitudes towards blended learning and             suggest the appropriate treatment plan. [27]
teaching. [22]                                             Oral teleconsultation could also
                                                   improve the quality of oral care in prisons.
                                                   [28]
Use of WhatsApp in oral health                          Other unique uses of WhatsApp in
promotion                                          healthcare which can be applicable in the
        A    pilot    cluster   randomized         oral health care scenario are suggested by
controlled trial in Hong Kong developed            the experience of a Brazilian study that used
and provided the first preliminary evidence        WhatsApp for online follow up of patients

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Shweta Somasundara Yale. Use of WhatsApp in Oral Health Care

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      How to cite this article: Yale SS, Santosh KC, Sharma V. current and potential use of WhatsApp
      in oral health care -a narrative review. Int J Health Sci Res. 2018; 8(6):278-284.

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