Factors associated with satisfaction with teledentistry care among patients from a rural and an urban population in Peru during the COVID-19 pandemic: a cross-sectional survey

Abstract

Background

During the COVID-19 pandemic, teledentistry emerged as a strategy to deliver dental care, consultation, and education through information and communication technologies. This service encompasses emergency triage, comprehensive consultations, follow-up care, and oral health education and promotion. This study aimed to identify factors associated with the level of satisfaction with teledentistry care among patients from a rural and an urban population in Peru, according to their sociodemographic characteristics.

Methods

An analytical cross-sectional study was conducted including 314 patients who received teledentistry consultations in an urban setting (Metropolitan Lima) and a rural district (Santa Cruz de Cocachacra, Huarochiri, Lima, Peru). A validated 16-item questionnaire was used to assess satisfaction with teledentistry across two dimensions (D1: convenience and D2: communication) and to collect sociodemographic characteristics (age group, sex, marital status, educational level, number of children, area of residence, dedication, vulnerability, and reason for consultation). Pearson’s chi-square test was applied for bivariate analyses, and a Poisson regression model with robust variance was used for the multivariable analysis to estimate adjusted prevalence ratios (APR). A significance level of p < 0.05 was considered.

Results

A total of 314 patients were included (mean age 32.3 ± 12.1 years; 69.1% were women); 54.8% lived in rural areas and 45.2% in urban areas. Overall, 26.1%, 52.2%, and 21.7% reported poor, fair, and good satisfaction, respectively, with teledentistry care. According to the adjusted multivariable model, marital status was the only variable significantly associated with poor satisfaction, as single participants had a 44% lower probability of poor satisfaction compared with married or cohabiting participants (APR = 0.56; 95% CI: 0.36–0.88; p = 0.013). No statistically significant associations were observed for the remaining covariates; however, the estimate for rural residence was inconclusive and compatible with a potentially meaningful increase in poor satisfaction (APR = 1.50; 95% CI: 0.98–2.31; p = 0.063).

Conclusions

Only a minority of patients reported poor satisfaction with teledentistry care. In addition, being single was associated with a lower probability of poor satisfaction compared with being married or cohabiting. No statistically significant associations were observed for age group, sex, education level, number of children, dedication, vulnerability status, or reason for consultation; however, the estimate for rural residence was inconclusive and compatible with a potentially meaningful increase in poor satisfaction.

Background

According to the World Health Organization (WHO), an estimated 3.5 billion people worldwide live with oral diseases, and this burden has increased over the last 30 years. This trend reflects persistent gaps in access to adequate dental care, which disproportionately affect disadvantaged populations, including people with low income, individuals with disabilities, older adults, and those living in remote and rural areas [1]. In Peru, the Ministry of Health (MINSA) reports that 90.4% of Peruvians have dental caries and 85% present periodontal disease, confirming that oral conditions constitute a major public health problem that requires urgent attention [2].

Universal Health Coverage (UHC), promoted by the WHO as a global strategy to ensure healthy lives and promote well-being at all ages, is a cornerstone of sustainable development in public health. However, several reports indicate that millions of children and adults still lack regular access to routine dental care, with a direct impact on their quality of life [3]. Within this framework, oral health care as a fundamental component of general health remains characterized by profound inequities, particularly in low- and middle-income settings, where the limited availability of specialized personnel and the high cost of equipment substantially constrain service provision. Even in high-income countries with more developed health systems, gaps persist that affect the most marginalized groups, and geographic disparities between urban and rural areas further exacerbate barriers, as rural communities often face inadequate infrastructure and transportation difficulties that hinder regular dental visits [4, 5].

Against this background, the COVID-19 pandemic further strained economies and health systems worldwide. To contain viral transmission, governments implemented measures such as mandatory social distancing and restrictions on non-urgent health services, which substantially limited access to medical and dental care [6, 7]. Dental professionals were particularly affected because routine procedures involve close contact and frequent exposure to saliva and aerosols that may contain SARS-CoV-2, with salivary droplets during dental procedures representing a major route of transmission [8–12].

In this context, teledentistry has expanded clinical care, follow-up, and oral health education through digital technologies, integrating services and reducing social and geographic barriers, particularly during the pandemic [4, 12–18]. Its sustained use has improved access in rural areas by providing cost-effective alternatives and enabling remote clinical guidance [19, 20]. In addition, when combined with health promotion activities, teledentistry can strengthen community engagement and contribute to more equitable care and, when embedded within integrated, continuity-oriented care models, may help reduce existing disparities in access to oral health services [4]. Nevertheless, for complex diagnostic or therapeutic needs, timely referral for face-to-face evaluation remains essential [21].

In Peru, persistent problems of access, gaps in the health system, and limitations in coverage across its different dimensions highlight the need to understand how sociodemographic factors influence the acceptance of and satisfaction with teledentistry [22]. Evidence suggests that variables such as age, sex, educational level, and users’ trust shape satisfaction with teleconsultation services [23, 24]. In addition, marital status has been associated with access to dental care and with patients’ experiences and satisfaction [25], underscoring the relevance of examining this variable in teledentistry research. Therefore, identifying these factors and evaluating patient-reported outcomes is essential to guide interventions aimed at reducing inequities and strengthening oral health care in the country [15]. Accordingly, this study aimed to identify the factors associated with the level of satisfaction with teledentistry care in rural and urban populations in Peru.

Methods

Study design

This cross-sectional, analytical, observational study was reported according to the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines [26]. Data were collected between July and September 2022 from patients receiving teledentistry consultations via the Microsoft Teams platform in two settings in Peru: Metropolitan Lima (urban) and the rural district of Santa Cruz de Cocachacra, Huarochiri Province, Lima.

Population and participant selection

The estimated population according to the National Institute of Statistics and Informatics (INEI) for 2022 was 10,004,141 in Metropolitan Lima and 2,645 in the district of Santa Cruz de Cocachacra, belonging to Huarochiri Province, Lima [27]. These two settings were defined a priori as the urban and rural strata from which study participants were selected. Given the consecutive, non-probability recruitment strategy, no a priori sample size calculation for regression was performed. Instead, all eligible adult patients who completed at least one teledentistry consultation between July and September 2022 were invited to participate. A total of 314 participants were included, with 172 recruited from the rural area and 142 from the urban area, according to the inclusion and exclusion criteria.

Inclusion criteria

• Adult patients (≥ 18 years) of Peruvian nationality residing in the urban or rural study areas.

• Patients who had completed at least one teledentistry consultation during the study period.

• Patients able to understand and answer the virtual questionnaire independently or, if needed, with the assistance of another person (for reading the questions or handling the device).

Exclusion criteria

• Patients who did not complete the virtual questionnaire.

• Patients with severe cognitive impairment, serious communication difficulties, or sensory or physical disabilities that made it impossible to complete the questionnaire, even with assistance.

In this study, ‘patients’ were defined as adult users of the teledentistry service who sought a virtual consultation for any dental or oral health concern, and no restriction was applied based on specific dental or oral pathologies.

Variable

The dependent variable considered in this research was patient satisfaction with teledentistry care. The independent variables were age group [24], sex [28], marital status [25], education level [24], number of children [11], area of residence [29], dedication [28], vulnerability (patient 65 years of age or older and/or with comorbidities) [30], and reason for consultation [6].

Instrument

A questionnaire used in the study by Amtha et al. [6] was adapted and validated to assess patient satisfaction with teledentistry care. This questionnaire consisted of 25 items distributed in two sections: the first included 9 items on associated factors (age, sex, marital status, education level, number of children, area of residence, dedication, vulnerability, and reason for consultation), and the second section included 16 items related to satisfaction about teledentistry, distributed in two dimensions, D1: convenience (Q1 - Q6) and D2: communication (Q7 - Q16) [6]. The questionnaire considered Likert scale-type questions whose answers had values from 1 to 5 (1: strongly disagree, 2: disagree, 3: Indifferent, 4: agree, and 5: strongly agree). Questions Q4, Q5 and Q14, being negative items, were reverse-rated on a Likert scale (from 1: strongly agree to 5: strongly disagree). The questionnaire content was evaluated by three expert judges (one public health researcher and two stomatology researchers). They validated the instrument’s pertinence, objectivity, relevance, timeliness, sufficiency, clarity, and methodology, obtaining an acceptable Aiken’s V (V = 0.94; 95% CI: 0.91–0.96).

Test–retest reproducibility was examined in a pilot study of 50 participants from the rural and urban areas by administering the questionnaire twice within a 10-day interval, with the order of the questions modified at the second administration to minimize recall bias [31, 32]. The intraclass correlation coefficient (ICC) for the total score was 0.99 (95% CI: 0.98–0.99), indicating excellent reliability. The use of the ICC was supported by the approximately normal distribution of the scores, as verified by the Kolmogorov–Smirnov test for both the test and the retest (p = 0.158 and p = 0.089, respectively). Internal consistency was estimated in the full study sample, yielding a Cronbach’s α of 0.66 (95% CI: 0.61–0.72), which indicates acceptable internal consistency.

To estimate the levels of satisfaction with teledentistry according to the overall score, Stanones’ rule [mean (x̄) ± 0.75 (standard deviation)] was used to obtain: poor (< 61 points), fair (61 to 68 points) and good (> 68 points). Likewise, each cut-off point (60.3 and 68.3) was validated according to Livingston’s K² coefficient, obtaining a value of 0.79 and 0.78 for general perception, respectively, acceptable values. For the regression analysis, the satisfaction variable was dichotomized (poor = 1 and fair / good = 0).

Procedures

Teledentistry care was disseminated in the urban (Metropolitan Lima) and rural (Santa Cruz de Cocachacra) communities through social networks and informative talks delivered in educational institutions, inviting residents to schedule a virtual dental appointment. Patients in both settings contacted a commercial WhatsApp number to schedule a teledentistry appointment according to established time slots. Subsequently, a Microsoft Teams link was sent via email or WhatsApp (according to patient preference) to conduct the teledentistry consultation.

At the beginning of the virtual visit, the dentist explained the study, provided the contact details of the principal investigator and the Institutional Ethics Committee, and obtained informed consent. The patient was then seen by a dentist (GBV), who performed virtual triage and, when necessary, referred the patient to a specialist for consultation. The clinical history was completed, including personal data and medical and dental history. The patient was asked to send a photograph or video using a smartphone, with the assistance of another person if needed, ensuring that this person washed their hands properly before touching the patient. In addition, the patient was asked to stand in front of a window to use natural light or to use a flashlight, to lift the lips to expose the problem area, and to focus correctly before sending the material via WhatsApp or email. To facilitate understanding, the dentist showed on the screen how the assistant should focus the camera.

Once the visual evidence of the oral condition or follow-up was obtained, the patient was evaluated and case management was planned, starting with a brief 5-minute educational session on oral health care adapted to the corresponding age group. Subsequently, specific recommendations were given according to each situation and, if the patient needed a clinical dental procedure, he/she was referred to a specialised dental office for in-person care. When appropriate, a treatment plan was proposed and telemonitoring was recommended (within a maximum of 7 days after treatment). Immediately after completing the online teledentistry consultation, and before any potential face-to-face clinical examination or follow-up visit, all eligible patients were consecutively invited to participate in the study and were sent a link to a self-administered online satisfaction questionnaire (via WhatsApp or email, according to their preference), which they completed using a smartphone or computer with an internet connection. Access to a smartphone or computer with an internet connection was therefore required both to join the teledentistry consultation and to complete the virtual satisfaction questionnaire.

Statistical analysis

The SPSS v.28.0 statistical package and Stata v.17.0 were used, and the data were imported from a Microsoft Excel 2019 spreadsheet for analysis. Relative and absolute frequencies, means, and medians were used for descriptive statistics. Pearson’s chi-square test was used for bivariate comparisons. Crude prevalence ratios (PR) were estimated using separate bivariable Poisson regression models with robust variance (one model per independent variable). Variables with p < 0.20 in the crude models were entered into a multivariable Poisson regression model with robust variance to estimate adjusted prevalence ratios (APR). Multicollinearity was assessed using the variance inflation factor (VIF). Statistical significance was set at p < 0.05.

Bioethical considerations

The bioethical principles of the Declaration of Helsinki related to confidentiality, freedom, respect, and nonmaleficence were respected in the present study [33]. The Institutional Research Ethics Committee of the Universidad Privada San Juan Bautista approved the study with letter No. 522-2022-CIEI-UPSJB dated April 8, 2022. Voluntary virtual informed consent was obtained from all adult participants.

Results

The response rate to the satisfaction survey on teledentistry care was 97.81%. The average age of the 314 patients seen by teledentistry was 32.3 ± 12.1 years. Of these, 50.6% were under 30 years of age and 69.1% of the total were women. The majority of those seen, i.e., 54.8%, were unmarried. Of the total, 52.9% had studied only up to secondary school, and 38.9% had no children. In addition, 54.8% of the total resided in rural areas, and 42.4% were self-employed. Finally, 75.5% of the patients did not have a vulnerable condition, and 60.8% of the total came to the teleconsultation to receive some type of dental orientation [Table 1].

Table 1.

Sociodemographic characteristics of patients seen by teledentistry

Variable	Categories	Frequency	Percentage
Age group	< 30 years	159	50.6
	≥ 30 years	155	49.4
Sex	Female	217	69.1
	Male	97	30.9
Marital status	Single	172	54.8
	Married or cohabiting	142	45.2
Education level	Primary	33	10.5
	Secondary	166	52.9
	Higher Education	115	36.6
Number of children	No children	122	38.9
	1 child	56	17.8
	2 children	73	23.2
	> 2 children	63	20.1
Area of residence	Rural	172	54.8
	Urban	142	45.2
Dedication	Student	92	29.3
	Independent worker	133	42.4
	Dependent worker	22	7.0
	Housewife	67	21.3
Vulnerability	Yes	77	24.5
	No	237	75.5
Reason for consultation	Pain	83	26.5
	Orientation	191	60.8
	Control	40	12.7
Age	Mean	Median	SD
	32.3	29.0	12.1

SD Standard Deviation

Of the total number of patients surveyed, it could be observed that 26.1% (95% CI: 21.3% − 31.0%) had a poor satisfaction about the teledentistry, while 52.2% (95% CI: 46.7% − 57.8%) had a fair satisfaction and 21.7% (95% CI: 17.1% − 26.2%) had a good satisfaction [Fig. 1].

Fig. 1.

Frequency of the level of satisfaction of patients seen by teledentistry

Regarding the convenience that teledentistry represented for the patients who agreed to be surveyed, more than 80% were satisfied and comfortable with the consultation. They also felt that this type of care was more economical and allowed them to optimize their time. On the other hand, more than 70% of the patients did not feel that teledentistry would worsen their health situation, and they did not distrust remote care [Table 2].

Table 2.

Level of satisfaction of patients seen by teledentistry, according to convenience and communication

Questions	SD	D	I	A	SA
	f (%)	f (%)	f (%)	f (%)	f (%)
Convenience
Q1. I am satisfied with the session I had with the dentist.			7 (2.2)	56 (17.9)	251 (79.9)
Q2. I feel comfortable presenting complaints about the disease to the dentist.	1 (0.3)	1 (0.3)	4 (1.3)	120 (38.2)	188 (59.9)
Q3. From a financial point of view, if I have to attend a dental care place then I think online consultation is more economical.	15 (4.8)	29 (9.2)	17 (5.4)	117 (37.3)	136 (43.3)
Q4. My situation worsened with this method of online consultation during the pandemic.	107 (34.1)	151 (48.1)	19 (6.1)	10 (3.2)	27 (8.5)
Q5. I don’t like the dentist to see me remotely because he cannot examine me directly.	99 (31.5)	131 (41.7)	25 (8.0)	28 (8.9)	31 (9.9)
Q6. Online consultations for oral diseases can save me travel and waiting time and avoid canceled dental appointments.		4 (1.3)	11 (3.5)	138 (43.9)	161 (51.3)
Communication
Q7. I feel comfortable asking the dentist questions.		1 (0.3)	1 (0.3)	117 (37.3)	195 (62.1)
Q8. Dentists communicate with me effectively.			2 (0.6)	145 (46.2)	167 (53.2)
Q9. I like seeing dentists online; it is like seeing them in the normal way.	2 (0.6)	9 (2.9)	16 (5.1)	139 (44.3)	148 (47.1)
Q10. The dentist provided me with the treatment solution I needed.				105 (33.4)	209 (66.6)
Q11. The dentist gave a good description of the diagnosis of my disease.	1 (0.3)	4 (1.3)	5 (1.6)	145 (46.2)	159 (50.6)
Q12. I think the maximum time of 40 min for the consultation is sufficient.	7 (2.2)	42 (13.4)	23 (7.3)	125 (39.8)	117 (37.3)
Q13. The registration procedure and administration of the service are easy, and the administrator helps it run smoothly.		1 (0.3)	9 (2.9)	153 (48.7)	151 (48.1)
Q14. Not being in the same room as the dentist is a problem for me.	86 (27.4)	122 (38.9)	49 (15.6)	33 (10.5)	24 (7.6)
Q15. I feel safer seeking treatment from an online consultation rather than going to the dentist, thus avoiding COVID-19 transmission.	1 (0.3)	13 (4.1)	24 (7.6)	123 (39.2)	153 (48.8)
Q16. I am satisfied with the information the dentist gave me about my discomfort.			3 (1.0)	146 (46.5)	165 (52.5)

f absolute frequency, (%) relative frequency, SD Strongly Disagree, D Disagree, I Indifferent, A Agree and, SAStrongly Agree

Regarding communication and the implications of teledentistry, more than 90% of the patients felt safe in the face of COVID-19 infection. They also felt comfortable asking questions or conversing with the dentist, just as if they were in person since the virtual environment did not seem complicated for them to handle. They also felt that the diagnosis given was correct. On the other hand, 77.1% were satisfied with the maximum consultation time of 40 min [Table 2].

In this study, the level of satisfaction with teledentistry care was significantly associated with marital status, education level, number of children, area of residence, dedication and vulnerability (p < 0.001, p = 0.002, p = 0.002, p = 0.011, p < 0.001 and p = 0.018; respectively) [Table 3].

Table 3.

Association of the level of satisfaction of patients seen by teleodontology with their sociodemographic factors

Variable	Categories	Level of satisfaction
		Poor	Fair	Good	*p
		f (%)	f (%)	f (%)
Age group	< 30 years	33 (20.8)	88 (55.3)	38 (23.9)	0.087
	≥ 30 years	49 (31.6)	76 (49.0)	30 (19.4)
Sex	Female	61 (28.1)	109 (50.2)	47 (21.7)	0.447
	Male	21 (21.6)	55 (56.8)	21 (21.6)
Marital status	Single	27 (15.7)	94 (54.6)	51 (29.7)	< 0.001*
	Married or cohabiting	55 (38.7)	70 (49.3)	17 (12.0)
Education level	Primary	8 (24.2)	18 (54.6)	7(21.2)	0.002*
	Secondary	53 (31.9)	90 (54.2)	23 (13.9)
	Higher Education	21 (18.3)	56 (48.7)	38 (33.0)
Number of children	No children	17 (13.9)	70 (57.4)	35 (28.7)	0.002*
	1 child	23 (41.1)	22 (39.3)	11 (19.6)
	2 children	20 (27.4)	40 (54.8)	13 (17.8)
	> 2 children	22 (34.9)	32 (50.8)	9 (14.3)
Area of residence	Rural	56 (32.6)	85 (49.4)	31 (18.0)	0.011*
	Urban	26 (18.3)	79 (55.6)	37 (26.1)
Dedication	Student	19 (20.7)	40 (43.5)	33 (35.8)	< 0.001*
	Independent worker	37 (27.8)	81 (60.9)	15 (11.3)
	Dependent worker	2 (9.0)	10 (45.5)	10 (45.5)
	Housewife	24 (35.8)	33 (49.3)	10 (14.9)
Vulnerability	Yes	25 (32.5)	44 (57.1)	8 (10.4)	0.018*
	No	57 (24.1)	120 (50.6)	60 (25.3)
Reason for consultation	Pain	24 (28.9)	43 (51.8)	16 (19.3)	0.933
	Orientation	48 (25.1)	99 (51.9)	44 (23.0)
	Control	10 (25.0)	22 (55.0)	8 (20.0)

*Based on Pearson's chi-square (p<0.05, significant association)

For the multivariable analysis, the dependent variable was satisfaction with teledentistry care, dichotomized as poor = 1 (16–60 points) and fair/good = 0 (61–80 points). The independent variables (age group, sex, marital status, education level, number of children, area of residence, dedication, vulnerability status, and reason for consultation) were evaluated as candidate predictors. Crude prevalence ratios were first estimated using separate bivariable Poisson regression models with robust variance (one model per independent variable), and variables with p < 0.20 were subsequently entered into the multivariable Poisson regression model with robust variance to estimate adjusted prevalence ratios (APR). In the adjusted model, marital status was the only variable significantly associated with poor satisfaction, as single participants had a 44% lower probability of poor satisfaction compared with married or cohabiting participants (APR = 0.56; 95% CI: 0.36–0.88) (p = 0.013). No statistically significant associations were observed for the remaining covariates; however, the estimate for rural residence was inconclusive and compatible with a potentially meaningful increase in poor satisfaction (APR = 1.50; 95% CI: 0.98–2.31; p = 0.063) [Table 4].

Table 4.

Multivariable analysis of satisfaction with teledentistry care, according to associated factors

Variable	Categories	Crude model					Adjusted model
		β	PR	95% CI		p*	β	APR	95% CI		p**
				LL	UL				LL	UL
Age group	< 30 years	-0.42	0.66	0.45	0.96	0.031*	-0.26	0.77	0.46	1.27	0.303
	≥ 30 years		Ref.				Ref.
Sex	Female	0.26	1.30	0.84	2.00	0.239
	Male		Ref.
Marital status	Single	-0.90	0.41	0.27	0.61	< 0.001*	-0.57	0.56	0.36	0.88	0.013*
	Married or cohabiting		Ref.				Ref.
Education level	Primary	0.28	1.33	0.65	2.72	0.438	-0.15	0.86	0.42	1.77	0.678
	Secondary	0.56	1.75	1.12	2.73	0.014*	0.24	1.27	0.78	2.09	0.340
	Higher Education		Ref.				Ref.
Number of children	No children	-0.92	0.40	0.23	0.70	0.001*	-0.40	0.67	0.35	1.28	0.227
	1 child	0.16	1.18	0.74	1.86	0.490	0.33	1.39	0.86	2.25	0.178
	2 children	-0.24	0.78	0.47	1.30	0.345	-0.29	0.75	0.45	1.25	0.270
	> 2 children		Ref.				Ref.
Area of residence	Rural	0.58	1.78	1.18	2.68	0.006*	0.41	1.50	0.98	2.31	0.063
	Urban		Ref.				Ref.
Dedication	Student	-0.55	0.58	0.35	0.96	0.035*	0.27	1.31	0.70	2.45	0.400
	Independent worker	-0.25	0.78	0.51	1.18	0.240	-0.01	0.99	0.65	1.51	0.974
	Dependent worker	-1.37	0.25	0.07	0.99	0.048	-0.83	0.43	0.11	1.69	0.229
	Housewife		Ref.				Ref.
Vulnerability	Yes	0.30	1.35	0.91	2.00	0.135	0.18	1.20	0.82	1.76	0.349
	No		Ref.				Ref.
Reason for consultation	Pain	0.15	1.16	0.61	2.18	0.653
	Orientation	0.01	1.01	0.56	1.81	0.986
	Control		Ref.

 APR Adjusted Prevalence Ratio under the Poisson regression model with robust variance, VIF Variance Inflation Factor (Mean VIF = 2.80), APR β: Regression coefficient, 95% CI 95% Confidence Interval, LL, Lower Limit, UL Upper Limit

*Simple regression model (crude); variables with p 0.2 were included in the adjusted model

**Multiple regression model adjusted (** p 0.05, significant association)

Discussion

This study was conducted during the third quarter of 2022, a period in which Peru was experiencing the so-called “fourth wave” of the COVID-19 pandemic, characterized by a sustained increase in infections and deaths. This situation led to the extension of the national state of emergency as of 1 July 2022, as part of the measures adopted to mitigate its impact [34, 35]. According to the National Center for Epidemiology, Prevention and Disease Control of the Ministry of Health, during this wave approximately 567,461 cases, 7,617 hospitalizations, and 4,171 deaths were reported, with an estimated case-fatality rate of 0.74% [36]. In this context, teledentistry acquired particular relevance by enabling the continuity of dental care through remote modalities, helping to reduce access barriers and to ensure essential services in a setting marked by public health restrictions and limitations on in-person care [37]. For this reason, the present study aimed to identify the factors associated with the level of satisfaction with teledentistry care in rural and urban populations in Peru. In light of the results obtained, the null hypothesis was rejected.

The results of the present study showed that 26.1% of patients had a low level of satisfaction with teledentistry, 52.2% a medium level, and 21.7% a high level. Overall, these levels are lower than those reported by Amtha et al. [6] in an oral medicine hospital in Indonesia and by Rahman et al. [28] in clinics in England, where satisfaction with virtual and telephone consultations exceeded 90%. This discrepancy may be related to contextual differences: in Peru, teledentistry in this study was delivered through the “Teams” platform, which required downloading to a computer or smartphone in a context where around 60% of the population belongs to low socioeconomic strata [38] and access to fibre-optic internet and suitable devices is limited, especially in peripheral urban areas [38]. These connectivity and infrastructure gaps can hinder the care process, negatively influence users’ perceptions of the service, and reflect broader structural barriers to education and health that became more evident during the pandemic [38–41]. By contrast, Amtha et al. [6] worked in a specialised teaching hospital with robust technological and human resources, and Rahman et al. [28] evaluated a structured system that offered scheduled appointments, access from multiple devices and, when needed, telephone consultations, organizational features that likely enhanced perceived convenience and satisfaction [6, 42].

In the present study, most patients reported that teledentistry was comfortable, convenient and more economical, mainly because it avoided travel and reduced waiting time, which is consistent with evidence that teledentistry optimizes time use and lowers indirect costs [43–45]. More than 70% did not feel that teledentistry would worsen their oral condition and did not distrust remote care, which may be linked to the effectiveness of virtual consultations and the trust generated through interaction with trained professionals [46]. Regarding communication, over 90% felt safe with respect to COVID-19 infection and reported feeling comfortable asking questions and talking with the dentist as in a face-to-face consultation, finding the virtual environment easy to use and perceiving the diagnosis as correct. This pattern is consistent with the role of teledentistry during the COVID-19 pandemic as a practical solution to reduce infection risk and strengthen communication [47] and with its potential ongoing relevance, as technological platforms facilitate oral health education and follow-up without physical contact [48]. Familiarity with digital tools, the possibility of sharing images and information, and the convenience and accessibility of teledentistry support more accurate assessments and open communication, reinforcing confidence in the diagnostic process [49]. Finally, 77.1% of patients were satisfied with a maximum consultation time of 40 min, suggesting that this duration is adequate for effective evaluations while improving the patient experience by avoiding travel and reducing waiting times. Taken together, these findings indicate that the satisfaction scores obtained in this study reflect not only the professional competencies and communication skills of the dentist, but also key service attributes such as convenience, time and cost savings, ease of registration, and the usability of the virtual platform, as captured by the “convenience” and “communication” dimensions of the questionnaire.

According to the bivariate analyses, the level of satisfaction with teledentistry care showed statistically significant differences across categories of marital status, education level, number of children, area of residence, dedication, and vulnerability. However, in the multivariable regression model, age group, sex, education level, number of children, dedication, vulnerability, and reason for consultation were not significantly associated with satisfaction with the care received by teledentistry. This suggests that the statistically significant differences identified in the bivariate analyses do not necessarily imply causality or independent effects [50, 51]. Furthermore, these results provide evidence that, despite demographic and social differences, patients value key aspects of teledentistry, such as accessibility, convenience, and clarity of communication [52]. In addition, regardless of these characteristics, patients’ increasing acceptance and adaptation to digital technologies in healthcare contribute to a more satisfying experience [52].

According to the multivariable Poisson regression model with robust variance, marital status was the only factor independently associated with poor satisfaction: single participants had a 44% lower probability of poor satisfaction than married or cohabiting participants. This may relate to greater competencies and adaptability to information and communication technologies (ICT) among single (often younger) individuals, who may be more willing to interact in virtual environments and more engaged in their oral health [38, 53–55]. Although rural residence was not statistically significant in the adjusted model (APR = 1.50; 95% CI: 0.98–2.31) (p = 0.063), the point estimate and confidence interval remain compatible with a potentially meaningful increase in poor satisfaction; therefore, this result should be interpreted in terms of effect size and uncertainty rather than as a dichotomous “significant/non-significant” finding [56]. Although rural residence did not meet the conventional threshold for “statistical significance,” this should be interpreted as inconclusive evidence rather than evidence of no association; methodological guidance cautions against declaring “no difference” solely because p > 0.05 and recommends focusing on the point estimate and the full range of values compatible with the data [56]. If present, rural–urban differences in satisfaction may plausibly reflect constraints related to internet access and quality, digital affordability, and platform usability, which show marked regional disparities in Peru [38, 39, 57]. Future studies with probabilistic sampling and more granular measures of digital access and technological conditions are warranted to clarify this association.

This research is important because teledentistry proved a valuable tool during the COVID-19 pandemic [13, 21, 42, 58], limiting hospital traffic and reducing exposure to coronavirus, which benefited patients and healthcare workers [42]. On the other hand, it is now essential to evaluate patient satisfaction regarding the implementation of teledentistry, since various experiences have shown that teledentistry can reduce oral health inequalities, thus improving access to dental services [20, 21, 28]. Teledentistry offers significant advantages, such as early access to health care, the possibility of receiving specialized care, and the reduction of time off work and travel for consultations; it has also proven to be practical in preventive care and in performing initial and follow-up evaluations, thus favoring early detection of oral problems and allowing more timely interventions [6, 20, 21]. Implementing this modality of care can facilitate access to dental services, especially in rural areas and underserved and vulnerable communities facing geographic and economic barriers where dentists are limited [28, 59]. On the other hand, teledentistry offers healthcare providers the opportunity to optimize the care process by eliminating inappropriate referrals and reducing extensive waiting lists for specialist consultations [21]. In addition, this approach not only decreases the need for unnecessary emergency department visits in densely populated areas but also helps to mitigate the risk of disease transmission [21, 60, 61]. In this sense, it is essential to promote tele-dentistry as a key tool to achieve universal health coverage and contribute to the Sustainable Development Goals (SDGs), as it represents a strategy to reduce oral health disparities and ensure equitable access to dental services for the entire population [62]. The strength of the present research lies in the fact that satisfaction with the teledentistry service was evaluated from the patient’s perspective, which provided, to some extent, a comprehensive view of their experience. This evaluation allows us to identify not only the perceived benefits, such as accessibility and convenience, but also possible strategies for improvement of this modality, as it focuses on patients’ opinions, needs, and expectations, which is essential to promote the acceptance and continued use of teledentistry, thus contributing to its effective integration into the healthcare system.

Despite its advantages, teledentistry also presents important limitations. It cannot substitute emergency oral health services that require definitive clinical and radiographic assessment, and its effectiveness depends on the quality of the available technologies, which raises concerns about the privacy and security of patient information and the potential for technical failures [62]. A multifaceted approach that addresses individual, community, and organizational barriers, as well as the development of clear medico-legal regulations, is therefore essential for effective integration into conventional oral health systems [63, 64].

This study has several limitations. First, its cross-sectional design precludes establishing causal relationships between the factors evaluated and reported satisfaction. Second, some responses may have been influenced by social desirability bias, as participants may have tended to provide more favorable ratings so as not to affect the perceived performance of the professional who provided the teledentistry consultation, thereby underreporting socially undesirable experiences and overreporting those considered acceptable or positive [65–67]. Third, limitations related to the measurement instrument must be acknowledged, as some items may not have captured with sufficient precision the dimensions and nuances of user satisfaction with teledentistry. In addition, the use of a consecutive, non-probability sampling strategy may have introduced selection bias, as only patients who had access to and chose to use the teledentistry platform and agreed to complete the virtual questionnaire were included; therefore, the observed levels of satisfaction and associated factors may not be fully representative of all dental patients in Peru. Additionally, the study may have had limited statistical power to detect small to moderate associations; therefore, null findings should be interpreted with caution due to the potential for type II error. Given that poor satisfaction was not a rare outcome in this sample (26.1%), prevalence ratios were estimated using Poisson regression with robust variance to facilitate interpretation; nevertheless, estimates with confidence intervals that include potentially important effects should be considered inconclusive rather than evidence of no association [56]. The study also does not explicitly address existing inequalities in access to dental care, a central issue in public health. Although teledentistry is a promising alternative to expand service coverage, its impact depends on critical conditions such as continuity of care, users’ access to technological resources, and adequate integration of information systems. The absence of a detailed analysis of how these structural gaps may affect the implementation and effectiveness of teledentistry constrains a comprehensive interpretation of its potential to reduce disparities among vulnerable populations. Furthermore, it was not possible to compare satisfaction across different life stages or socioeconomic strata. Finally, although these findings cannot be generalized to the entire country, they provide an initial reference for future research on satisfaction with teledentistry, and similar studies including patients from different regions of Peru are warranted.

Based on the results obtained, it is recommended that health managers implement the necessary conditions to continue with the implementation of teledentistry in Peru, which includes the allocation of an adequate budget for access to information and communication technologies with fiber optic internet, as well as the establishment of regulations, guidelines, and policies that facilitate the integration of teledentistry in health establishments, thus ensuring its development and sustainability in the health system. In addition, it is suggested that dentists implement teledentistry services through personalized consultations tailored to each patient’s dental needs and individual characteristics [20, 60]. On the other hand, studies are recommended to consider other factors that may influence patient satisfaction with teledentistry, such as Internet access, the use of different virtual platforms, and different socioeconomic, geographical, and cultural conditions. Finally, studies that assess patient satisfaction with teledentistry in the short, medium, and long term are suggested to identify areas for improvement in dental care and contribute to developing practices that optimize the patient experience.

Conclusion

Only a minority of patients reported poor satisfaction with teledentistry care. Being single was associated with a lower probability of poor satisfaction. In contrast, age group, sex, education level, number of children, dedication, vulnerability status, and reason for consultation were not significantly associated with teledentistry satisfaction; however, the estimate for rural residence was inconclusive and compatible with a potentially meaningful increase in poor satisfaction. These findings should be interpreted with caution due to the cross-sectional design, the use of a non-probability sample drawn from only two settings, the potential for social desirability bias in self-reported satisfaction, and the lack of a more detailed assessment of access gaps and technological conditions.

Abbreviations

CI

Confidence interval

COVID-19

Coronavirus Disease 2019

MINSA

Peruvian Ministry of Health

PR

Prevalence ratio

APR

Adjusted prevalence ratio

SDGs

Sustainable Development Goals

STROBE

STrengthening the Reporting of OBservational studies in Epidemiology

SPSS

Statistical Package for the Social Sciences

UHC

Universal Health Coverage

WHO

World Health Organization

Authors’ contributions

G.B.V conceived the research idea; G.B.V., M.L.C., N.C.L., and C.C.R elaborated the manuscript; G.B.V., M.L.C., and M.C.M., collected and tabulated the information; M.A.V., Y.H.S., N.G.V., M.L.C., and M.C.M. carried out the bibliographic search; C.C.R. interpreted the statistical results; M.L.C., G.B.V., N.C.L., and C.C.R. helped in the development from the discussion; M.L.C., G.B.V., M.C.M, and C.C.R. performed the critical revision of the manuscript. All authors approved the final version of the manuscript.

Funding

This study with Code PI0092 was financed by the Cost Centre No. 06050518 of the Universidad Privada San Juan Bautista, Lima, Peru.

Data availability

The datasets used and/or analyzed during the current study are available from the corresponding author on reasonable request.

Declarations

Ethic approval and consent to participate

The present study respected the bioethical principles of confidentiality, freedom, justice, respect and non-maleficence set out in the Declaration of Helsinki. The study was approved by the Institutional Research Ethics Committee of the School of Stomatology of the Universidad Privada San Juan Bautista by letter No. 522-2022-CIEI-UPSJB dated 8 April 2022. In addition, participants gave their voluntary informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.