Health Disparities
Implementing teledentistry in rural and underserved communities: A review of barriers, facilitators, and implementation outcomes Edmond Kubi Appiah* Edmond Appiah Appiah Children’s Hospital of Philadelphia
Teledentistry has emerged as a promising strategy to improve access to oral healthcare, particularly in rural and underserved communities. While its clinical effectiveness is increasingly documented, less is known about the practical challenges and success factors for its real-world implementation. This scoping review aimed to map the literature on the implementation of synchronous and asynchronous teledentistry programs, focusing on contextual barriers, facilitators, and reported implementation outcomes. We followed the PRISMA-ScR extension and systematically searched PubMed, CINAHL, Dentistry & Oral Sciences Source, and ProQuest Dissertations for studies (2015-2025) describing teledentistry implementation. From 1,250 citations, 98 studies were included. Data were charted using the Consolidated Framework for Implementation Research (CFIR) to categorize barriers and facilitators, and the RE-AIM framework to assess outcomes (Reach, Effectiveness, Adoption, Implementation, Maintenance). Key barriers included restrictive state licensure laws, inadequate reimbursement structures, limited patient/provider digital literacy, and technological inequities (e.g., broadband access). Facilitators included cross-state licensure compacts, institutional champions, and workflow integration. Most studies reported on Reach and Adoption; fewer measured Implementation fidelity or long-term Maintenance. This review identifies critical policy and practice gaps that must be addressed to translate teledentistry from pilot projects to sustainable, equitable components of the oral healthcare system.