Dear Editor,

The novel coronavirus disease 2019 (COVID-19) pandemic is currently the most important public health issue world-wide, which emerged in Wuhan, China in December 2019. ¹ Globally, approximately 500 million people became infected and over six million lost their lives following COVID-19. ^{Reference Chopde2} Due to the transmissibility of COVID-19 through respiratory droplets and aerosols, several preventive measures have been recommended by the World Health Organization (WHO; Geneva, Switzerland) for staying safe, including staying at home, social distancing, using personal protection equipment (PPE) like fitted masks, and self-isolation in case of feeling unwell. ^{Reference Park, Park, Kim and Song3} To observe the health protocols, people avoided going out unless for very urgent matters such as buying foodstuffs. ^{Reference Honarvar, Lankarani and Kharmandar4} Fear of becoming infected even led most people to reduce their unnecessary referrals to hospitals or clinics for elective surgeries or routine health care services. ^{Reference Hartnett, Kite-Powell and DeVies5}

Although this helped prevent the spread of the disease, not receiving treatment for different diseases including dental and oral problems could disrupt public health training programs, delay diagnosis, and complicate the treatment process. ^{Reference Findling, Blendon and Benson6,Reference Obeidat, Masarwa, AlWarawreh and El-Naji7} This was especially important among pregnant women who needed to receive dental care, especially in the second trimester. Nonetheless, studies showed that to reduce any contact with other people, pregnant women mostly delayed or avoided their routine prenatal care, including dental checkups, which might lead to many maternal and neonatal consequences. ^{Reference Maharlouei, Asadi and Bazrafshan8,Reference Adeniyi, Donnelly and Janssen9} To minimize the negative outcomes of not receiving dental and oral health care services by patients, and to reduce the professional and ethical concerns of dental health workers, several virtual platforms such as blogs, websites, and web-based and mobile-based health applications have been designed and promoted. ^{Reference Bastani, Mohammadpour, Ghanbarzadegan, Kapellas and Do10} These platforms have various potentials, including the provision of different services, raising oral hygiene awareness, history taking, examination, diagnosis, consultation, training, treatment, and follow-up. ^{Reference Brown, Northover, Harford and Power11} It should be mentioned that the majority of these platforms are focused on providing preventive care and educational services and they are less treatment-based due to the requirement of special infrastructure schemes. ^{Reference Marino and Ghanim12}

It seems that many people’s need for dentistry-related information has been met using search engines. Using the trends of Google search engine (Google Inc.; Mountain View, California USA), with around four billion users world-wide, two recent studies found a steep upward trend in online searches for dental problems and tele-dentistry. ^{Reference Sycinska-Dziarnowska, Maglitto, Woźniak and Spagnuolo13,Reference Sofi-Mahmudi, Shamsoddin, Ghasemi, Mehrabi Bahar, Shaban Azad and Sadeghi14} Additionally, a five-fold increase in the number of searches for “tele-dentistry” and a 30-fold increase for “PPE dentist” were recorded. Moreover, a 40-fold increase in the question “is it safe to go to the dentist” showed a high level of fear of going to the dentist. ^{Reference Sofi-Mahmudi, Shamsoddin, Ghasemi, Mehrabi Bahar, Shaban Azad and Sadeghi14} Fortunately, answers to most questions could be found in valid health-related websites such as WHO. Besides, history taking and examination in virtual platforms indicated a special opportunity for providing oral health services in remote areas. A study by Alabdullah, et al demonstrated that tele-dentistry could be comparable to in-person oral health visits, particularly in situations where access to dental and oral health care was restricted. ^{Reference Alabdullah and Daniel15} Furthermore, intraoral scans in online examinations provide efficient screening and the correct triage of patients, which facilitate the process of remote diagnosis and detection of dental issues. ^{Reference Steinmeier, Wiedemeier, Hämmerle and Mühlemann16} Thus, it is considered a feasible and potentially cost-effective alternative to visual examination, and is even an appropriate method for children’s dental problems screening that can prevent early childhood dental issues. ^{Reference Kopycka-Kedzierawski and Billings17–Reference Kopycka-Kedzierawski, Bell and Billings19} After a correct diagnosis, dentist’s consultation and communication with patients can also be performed virtually. It is mainly done via video calls, phone calls, or text messages and plays a critical role in advancing dental health, particularly in case of patients’ limited access to health care services. ^{Reference Beauquis, Petit and Michaux20–Reference Fallahi, Keyhan, Zandian, Kim and Cheshmi22} A study by Cook, et al revealed that tele-consultations decreased a great number of inappropriate orthodontic referrals to clinics and allowed dentists to visit more patients at a faster speed. ^{Reference Cook, Edwards, Mullings and Stephens23} Regarding the treatment of oral diseases or dental problems, tele-dentistry has provided a chance for sharing patients’ history, information, and other medical reports among the dentists who are far from each other. ^{Reference Kirshner24} A study by Berndt, et al demonstrated that orthodontic specialists could help general dentists in performing interceptive orthodontic treatments for disadvantaged children in restricted areas. ^{Reference Berndt, Leone and King25} Moreover, tele-dentistry has been reported to be a useful and valid method for patient follow-ups by dental general practitioners and specialists, especially after maxillofacial surgeries. It is, in fact, considered as reliable as in-person visits. ^{Reference Chen, Santo and Wong26}

These online services can benefit dental tourism, which is one of the most popular and profitable medical tourism segments. ^{Reference Crooks, Kingsbury, Snyder and Johnston27} They have a variety of advantages for patients, dentists, and the destination country’s economy. Being virtually visited by well-known dentists and receiving online examinations and counseling can help reduce travel times and save time and money. ^{Reference Bhambal, Saxena and Balsaraf28} Moreover, providing an appropriate patient-doctor relationship and transparency provides a chance for an initial trust for receiving modern technology and high-quality health care services for more specific dental problems in the destination country. In addition, patient satisfaction can help attract more patients, eventually making the market bigger and more profitable in the country. Dentists will also benefit from this online communication. ^{Reference Bhambal, Saxena and Balsaraf28} Less commuting to clinics results in more visits and provides the opportunity for making money beyond the direct income of dental clinics. Furthermore, following the development of dental tourism in the destination country, an economic growth will occur, as this generates job opportunities and brings valuable currencies to the destination country. ^{Reference Crooks, Kingsbury, Snyder and Johnston27}

Nonetheless, there are some factors that reduce people’s access to online dental health platforms. Internet access and limited computer knowledge are the main challenges for not using dental tele-health care by people. ^{Reference Tella, Olanloye and Ibiyemi29} Besides, as the majority of web- or mobile-based tools are in English, non-English speakers do not seem to be easily able to use them and a translated version is needed. ^{Reference Tella, Olanloye and Ibiyemi29} The cost of the telemedicine equipment has also been a matter of concern, and their cost-effectiveness should be checked through preliminary investigations. ^{Reference Whitten, Mair, Haycox, May, Williams and Hellmich30} Moreover, some people have fear regarding the privacy and security of their medical information. Of course, they can use the platforms that meet the standards of the Health Insurance Portability and Accountability Act of 1996, known as HIPAA. ^{Reference Atchinson and Fox31}