Original Research Teledentistry: A Tool to Promote Continuing Education Actions on Oral Medicine for Primary Healthcare Professionals Michelle Roxo-Gonc ¸alves, 1,2 Je ´ssica R. Strey, 1 Caren S. Bavaresco, PhD, 3 Marco Antonio T. Martins, PhD, 1 Juliana Romanini, PhD, 4 Carlos Pilz, DDS, 2 Erno Harzheim, PhD, 2 Roberto Umpierre, PhD, 2 Manoela D. Martins, PhD, 1 and Vinicius C. Carrard, PhD 1,2 1 Department of Oral Pathology, School of Dentistry, Federal University of Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 2 Telessau ´ deRS–Graduate Program in Epidemiology, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, Brazil. 3 Graduate Program in Dentistry, School of Dentistry, Universidade Luterana do Brasil (ULBRA), Canoas, Brazil. 4 Centro de Especialidades Odontolo ´ gicas/Estomatologia, Prefeitura Municipal de Porto Alegre, Porto Alegre, Brazil. Abstract Background: Difficulties in diagnosis of oral mucosal lesions are a significant cause of delayed oral cancer diagnosis, and this difficulty may be due to gaps in knowledge. This study evaluated the diagnostic skills of primary healthcare professionals re- garding oral cancer and presented them with an e-learning course. Materials and Methods: Forty-seven primary healthcare professionals (32 dentists and 15 nondentists) enrolled in a 24-h course on oral medicine delivered through an e-learning platform. A test, based on 33 clinical images of oral lesions, was used to evaluate the diagnostic skills of participants. The participants were requested to classify each lesion as benign, potentially malignant, or malignant as well as to inform their clinical impression. Three specialists also took the test as the gold standard. Results: Twenty-seven participants completed the test. Nondentists and dentists showed a comparable sensi- tivity of 68.8 – 11.1 and 63.7 – 15.8, respectively. Specialists performed somewhat better; however, the difference was not statistically significant (81.0% – 4.1%, p = 0.16). Dentists and specialists (70.0% – 16.6% and 95.5% – 3.1%, respectively) showed higher specificity than nondentists (39.3 – 20.6, p < 0.01). Nondentists had a higher number of unanswered questions (p < 0.01) for classification and clinical impression (50.0% – 45.1% and 72.0% – 25.0%, respectively) than dentists (5.7% – 11.9% and 19.8% – 20%, respectively). Both dentists and nondentists had low attendance in the course (44.57% – 37.38% and 26.53% – 26.53%, respectively, p = 0.26). To the best of our knowledge, this is the first study to assess the diagnostic skills of public health workers belonging to different professional cate- gories. Conclusion: Both dentists and nondentists have a fairly good capacity for discriminating the nature of oral lesions. Early squamous cell carcinoma is the most challenging situation and remains an issue to be addressed. Keywords: telehealth, dental education, e-learning, oral di- agnosis, oral lesions Introduction O ral cancer is an important, ongoing public health problem, considering its morbidity and mortality. 1 In Brazil, oral cancer represents the fifth most com- mon type of malignant tumor. The estimated num- ber of new cases in 2016 is 11,140 cases in men and 4,350 in women, accounting for 5.2% and 2.1%, respectively, of all types of cancer; this excludes nonmelanoma skin tumors. 2 In the past few decades, the mortality rate associated with oral cancer has remained stable. 3 These data may be attributed, at least in part, to a high percentage of cases being detected in advanced stages. 4,5 Brazil has one of the lowest survival rates for oral cancer, 6 particularly in the south region. 7 To face the challenges described above, Brazil established a universal public healthcare system more than 25 years ago: the Unified Health System (SUS), which focuses on the principle of primary healthcare. 8 At present, SUS has 24,468 oral health teams responsible for covering *77 million people (38% of the population). Despite many improve- ments such as better access to dental services, SUS faces systemic problems, including the fragmentation of its service network. 9 Considering that the oral cavity is easily accessible on ex- amination, earlier detection of oral cancer or potentially malignant disorders is certainly feasible. 10 However, dentists usually face difficulties in detecting, diagnosing, and man- aging oral lesions. 11 This difficulty has been attributed to few hours of lectures and lack of training in oral medicine during undergraduate education. 12,13 As expected, the majority of these professionals desire more training on oral cancer de- tection and prevention. 10 DOI: 10.1089/tmj.2016.0101 ª MARY ANN LIEBERT, INC.  VOL. 23 NO. 4  APRIL 2017 TELEMEDICINE and e-HEALTH 1