The development of e-commerce in oral health can be understood and analyzed in at least five business dimensions: connections through telecommunications links that connect dentists to the World Wide Web and the internet; applications, which are software that organizes defined business functions; goods, including disposables and other supplies necessary for operating the buyer’s business; services, which include the maintenance of advertising records, transaction compensation, and other business support activities; and information, which involves direct access to databases, publications, educational resources, insurance eligibility benefits, and credit reports [26]. In the field of teledentistry, several key issues arise, including licensing, jurisdiction, security technology, and ethical aspects. Various measures can be employed to effectively implement teledentistry. Dentists must make every effort to ensure the security of their systems and any data that may be transmitted. For example, data encryption, password protection, and user access logs can help protect both dentists and patients [27].

According to Bauer and Brown (2001) [26], national and state dental societies must develop and implement plans for their own digital transformation. These should include cutting-edge resources to provide public information on dentistry, electronic journals, web-accessible libraries, fully automated records, management systems, continuing dental education, and other online association services. Based on recent experiences in hospitals and medical practices, dentists can anticipate revolutionary changes resulting from digital transformation. The internet, the World Wide Web, and other developments of the information revolution will redefine patient care, referral relationships, practice management, quality, professional organizations, and competition. To respond proactively to this digital transformation in dentistry, dentists must understand the benefits that new information technology offers to them and their patients and develop creative applications to advance their profession and treatment approaches.

According to Costa et al. (2018) [28], information technology is of great importance in the healthcare sector, helping to organize and manage patient information. Moreover, the increasing sophistication of health-focused software systems has played a prominent role in minimizing diagnostic errors, supporting decision-making processes, and providing feedback on completed care.

In Brazil, since 2001, the Brazilian Public Key Infrastructure (ICP-Brasil) has been established to ensure the authenticity, integrity, and legal validity of digital documents. Documents must be certified by ICP-Brasil to establish equivalence and legal parity with electronic documents. In 2007, Federal Council of Medicine (CFM) Resolution No. 1821 introduced regulations mandating digital certification. The CFM and the Brazilian Society of Health Informatics (SBIS) established norms, standards, and regulations for the use of electronic medical records by healthcare professionals, resulting in the Certification Process for Electronic Health Record Systems. In 2009, the Federal Dental Council (CFO) approved the standardization of digitalization and the use of computerized systems for storing and handling patient record documents [29], following the same principles set by the CFM and SBIS in the Manual for Certification of Electronic Health Record Systems [30].

The security standards refer to the use of electronic health records as well as their combination with paper records. The CFM/SBIS certification process defines that for a digital record to be considered secure, it must have mechanisms that ensure the authenticity, confidentiality, and integrity of the documents. To achieve this, two security levels have been defined: NSG1 and NSG2. NSG1 requires version control of the software, access control and authentication, availability, remote communication, auditing, and documentation. To achieve NSG2 security, the software must meet all the requirements of NSG1 and be certified by ICP-Brazil for signature and authentication processes. To obtain SBIS/CFM certification, the software must meet the NSG2 security level, which allows for the elimination of paper records, based on the same premise defined by CFO and SBIS [30].

A study conducted by Costa et al. (2018) [28] on the commercialization of dental software regulated under Brazilian standards highlighted that most of these software solutions exhibit deficiencies in basic security, functionality, and interface criteria. According to the authors, this finding underscores the need to develop dental clinic management systems that include security features, user-friendly interfaces, and essential components for electronic dental records, in accordance with recommendations from the Federal Dental Council (CFO).

In an analysis of the certification status of electronic dental record software available in the market, Santos and Carvalho (2014) found that most leading solutions were not certified by the Brazilian Society of Health Informatics (SBIS) and were therefore noncompliant with CFO Resolution No. 91/2009 [30]. This resolution deems certification indispensable not only for legal purposes but also for evaluating the software's quality and security.

Issues such as the lack of certification for dental software and compliance with the General Data Protection Law (Law 13.709/2018) are key concerns in the development of teledentistry prototypes [31]. These considerations arose during the development of an application, highlighting the importance of tying innovation to the regulatory compliance of dental software as mandated by prevailing norms.

In an integrative literature review on the Situational Panorama of Teledentistry, Teixeira et al. (2018) concluded that teledentistry is a global reality and an important tool for improving dental care, particularly for vulnerable populations, as well as for the ongoing education of dentists [32]. Furthermore, the results from implementing this technology must be broadly disseminated within the scientific community to expand and consolidate these services globally, filling existing evidence gaps and providing greater scientific backing for its adoption.

The potential of teledentistry as an opportunity to improve dental care in the context of social isolation was highlighted by Gebczynski et al. (2020) [33]. The authors suggest that teleconsultations, before clinical care, with access to patients' radiographic and photographic images, either archived or in real-time, would greatly facilitate accurate diagnosis and treatment monitoring. The authors also emphasize that teledentistry: reduces restrictions on access to dental care with specialists, particularly for isolated and excluded patients, who can thus experience improvements in their quality of life; has great potential for reducing the costs allocated to dental procedures within the healthcare system; serves as a form of remote contact that, under social isolation conditions, proves to be one of the most effective methods to support patient healthcare; and contributes to the professional development of dentists, enabling the implementation of postgraduate curricula, conducting scientific research, and playing a crucial role in responding to future global and national crises.

Teledentistry, during the lockdown period, proved to be an effective tool for dentists and dental specialists, providing oral healthcare within the SUS (Unified Health System). However, it is necessary to revise the regulations to include procedures such as consultations and prescriptions to expand professional possibilities [34]. In 2022, Ali and Ansari conducted a study to evaluate the reliability of preliminary diagnoses using audio-teledentistry (AD) compared to definitive in-person clinical diagnoses (CFTF) and whether the concordance was influenced by the dentist's experience, the practitioner-patient relationship, and the consultation duration [35]. The study results demonstrated that: 1) there was very good concordance between AD and CFTF for diagnosis, 2) the AD diagnosis of pulpitis and periodontitis showed the most frequent discrepancies, 3) tele-dentists with more than 20 years of experience exhibited the highest level of concordance, 4) perfect concordance occurred when mothers mediated the call, and 5) very good concordance was found for calls received between 7 a.m. and 2 p.m. compared to calls received between 2 p.m. and 10 p.m. The authors concluded that remote experimental diagnosis using AD is safe and reliable; however, it varied with the dentist's experience, the caller-patient relationship, and the call duration. They also suggested that the results indicate that using AD in a home setting is safe and reliable. The authors concluded that experimental remote diagnosis using AD is safe and reliable, though influenced by factors such as dentist experience, caller-patient dynamics, and consultation timing. These results suggest that AD use in home environments is safe and reliable.

Dental professionals must become aware of and demand the certification of the systems they use from the entities responsible for regulating dental software. There must also be openness to the digital transformation of dentistry, with professionals seeking training for the effective implementation of technology in their practices. Special attention should be given to the General Data Protection Law: strategies must be developed, and dental care structures adapted to comply with this legislation. Advancing teledentistry will depend significantly on interaction between these sectors.

Digital tools should be designed to reduce, not exacerbate, inequalities in access to healthcare. Technology presents opportunities to promote healthy behaviors, reduce oral diseases, and mitigate disparities in oral health. Additionally, such tools can accelerate the implementation of universal health coverage and digital health access, aligning with the Sustainable Development Agenda 2030 proposed by the WHO. Digital oral health should become a cornerstone of post-COVID-19 oral healthcare [36].

Teledentistry is a promising tool for patient care, particularly for those living in remote areas where access to oral health services is challenging. Issues related to the lack of certification for dental software, as mandated by CFO Resolution No. 91/2009, and compliance with the General Data Protection Law (Law 13.709/2018), are major obstacles to the development of suitable tools for teledentistry. Advances in dental treatment resulting from the incorporation of technologies must be supported by legal principles, adapting to the new reality of integrating information technology with human healthcare.

Acknowledgments: None to declare.
Funding: This research received no external funding.
Conflicts of Interest: The authors declare no conflict of interest.
Regulatory Statement: Not applied.