Bibliometric Analysis of Context, Trends, and Contents of Digital Health Technology Used in Dental Health

Digital tools and apps are revolutionizing healthcare and provide creative answers to urgent problems. Through teamwork and the incorporation of digital technologies, dentistry has experienced a remarkable revolution. A large body of scholarly research backs up this trend. The context, trends, and content of digital health technology in oral and dental health are examined in our bibliometric analysis. Using targeted keywords and synonyms, an organized searching technique was used in the Scopus database, yielding 1942 articles that were extracted into a CSV file. To acquire insights into the content, trends, and context, visualization using VOSviewer 1.6.18 and a variety of analyses—including coauthorship, citation, cooccurrence of author keywords, bibliographic coupling, and cocitation—were executed. The analysis revealed that the USA and the UK contributed to a significant quantity of the literature, with newer contributions coming from nations like India. Cone Beam Computed Tomography, Dental Caries, and Artificial Intelligence were prominent keywords. It is important to note that BMC Oral Health was associated with a sizable number of the papers. This bibliometric analysis provides insightful information about the context, content, and trends of digital health in the field of oral and dental health. By implementing the right technology, policymakers can use this information to increase oral health, encourage dental literacy, and improve access to dental treatment. It is vital to take into account the wide variety of technologies and their classifications based on dental services and contextual variables.

Through the utilization of digital tools and applications, healthcare professionals can explore novel approaches to address pressing challenges such as the heightened vulnerability of the aging population to chronic ailments and the escalating costs associated with lifelong   The advent of artificial intelligence (AI) and machine learning (ML) has ushered in a realm of possibilities for automated processing within the realm of radiological imaging.Building upon this technological foundation, the creation of virtual dental patients by superimposing diverse imaging data and conducting noninvasive simulations to compare various outcomes prior to any clinical intervention has been further augmented by the integration of augmented reality and virtual reality (AR/VR) technologies.These groundbreaking advancements have been made viable due to the exponential growth in computing power, yet their full potential applications are still on the horizon [10].While the digital landscape continues to be explored, the remarkable benefits it holds are not yet fully recognized.It is imperative to shift our focus beyond industry-oriented studies and redirect our attention towards patient-centered outcomes, encompassing basic scientific research, clinical trials, and the valuable information they yield, which can ultimately lead to the development of innovative therapeutic approaches [11].
In recent trends, the field of dentistry has witnessed remarkable advancements in digital radiography, offering significant advantages such as time-saving during treatments, convenient storage, and effortless data transfer [12].This technology has greatly enhanced efficiency by reducing the time required for data retrieval and analysis [13].Moreover, patients' acceptance and understanding of dental procedures have been elevated through the utilization of live videos, three-dimensional animations, voice-activated software, and intraoral cameras9.Over the past decade, CAD/ CAM technology has empowered dental practitioners to shift some restoration manufacturing processes to chairside operations exclusively [14].This transformation not only has enhanced the accuracy and effectiveness of treatments [13] but also has resulted in improved work efficiency while reducing time and cost for patients.A study conducted by Joda and Brägger [15] highlighted the superior efficiency and effectiveness of digital workflows compared to established conventional pathways, offering a more cost-effective treatment option for patients.Furthermore, a controlled clinical trial conducted by Yuzbasioglu et al. [16] concluded that digital techniques for creating impressions not only saved time but also were preferred by patients compared to conventional methods.Additionally, the overall procedure time was shorter for digital techniques, and patients reported higher levels of comfort, even when performed by experienced operators using conventional methods.
Various studies are being conducted with the goal of comparing the effects of various digital technology-based therapies on dental health.For instance, Zolfaghari et al. [17] reported that the examined moms' knowledge and practice of oral health increased after a month of using a straightforward app without gamification and its gamified version.Wallace et al. [18] showed that after introducing a telephone consultation for kids and their parents, both the quantity of pointless in-person consultations and the length of waiting lists were reduced.The use of teledentistry in a children's hospital system pilot has also been shown by Hammersmith et al. [19] with favorable results for both careers and dentists.The profound influence of technology on oral and dental health underscores the importance of comprehending the specific contexts and contents addressed within the current research.In essence, despite the notable impact of digital health technology on oral health, there remains uncertainty regarding the extent to which studies have been conducted to investigate the specific settings and contents related to this subject matter.Hence, in order to investigate the context, content, and trends of digital health technology used in dental health, this bibliometric analysis was conducted.

Materials and Methods
A search strategy was formulated using the synonyms for context, trends, and contents of digital and dental and oral health.The search strategy was used in Scopus database, and the search strategy employed is shown in Table 1.Article retrieval was done in CSV format.All the articles were segregated and if duplicates were present were syste-matically removed.A final of 1942 articles were subjected to visualization using VOSviewer version 1.6.18,and coauthor analysis, cooccurrence of keywords, citation analysis, and bibliographic coupling were done on the obtained data.
"Citation analysis" is predicated on the premise that "citations" serve as indicators of "intellectual connections" established between publications, whereby one publication references another.This technique is aimed at ascertaining the influence of a publication by evaluating the quantity of citations it garners.The methodology of "cocitation analysis" is predicated on the assumption that publications which are often referenced together exhibit thematic similarity.One advantage associated with the utilization of "cocitation analysis" is that it enables business researchers to not only identify highly significant publications but also uncover theme clusters within the field.
The coword analysis, also known as "cooccurrence" analysis, is based on the assumption that words that regularly cooccur in a given context are likely to have a thematic 7 BioMed Research International link with each other.The analysis of "coauthorship" investigates the dynamics and relationships between researchers within a certain research domain.

Coauthorship Analysis
3.1.1.Authors.When the coauthorship analysis was done keeping the unit of analysis as authors and setting the threshold of minimum 2 number of documents of an author, it was found that 1930 authors were present; however, only 14 met the threshold level.The total link strength was established between 14 authors wherein it was found that for 2 documents, there were authors who obtained a citation of 158.However, it was observed that there was no link strength between these authors (Table 2 and Figure 1).
3.1.2.Organization.When coauthorship analysis was done keeping unit of analysis as organization, it was observed that out of 6093 organizations meeting the threshold of minimum of 2 documents and minimum of 2 citations per document, it was found that there were 306 universities that were meeting the threshold limit.It was observed that the Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden, had a maximum of 12 documents having 99 citations; however, the Department of Periodontics and Oral Medicine, University of Michigan, 8 BioMed Research International had 10 documents receiving 770 citations, while the link strength appeared to be highest for School of Dental Sciences, Newcastle University, UK, where a highest of 14 link strengths was obtained.Even though there are 306 universities that met the threshold, it was observed that only 20 of them had connected items for coauthorship and the analysis of the same was carried out of 20 items (Table 3 and Figure 2).
3.1.3.Countries.The coauthorship analysis done for the countries revealed that of the 125 countries, only 84 met the threshold of minimum of 2 documents per country and minimum of 2 citations per country.The largest connected data set consisted of 84 countries; of these 84 countries studied, it was found that the highest documents and citation were observed for the USA with 353 documents and the USA had obtained 9468 citations, respectively.Of the 84 countries, only 81 presented largest linked item.The overlay visualization portrays that the largest publication and citation were obtained by the US followed by the UK followed by Australia, Switzerland, South Korea, Saudi Arabia, Sweden, India, etc.While these countries have higher number of publication period of 2017-2020, countries like Indonesia, Kenya, Yemen and Vietnam have been publishing in recent time period (Table 4 and Figure 3).

Cooccurrence
3.2.1.Author Keywords.Keeping the minimum threshold of 2 keywords, it was found that there were 4225 keywords of which 1009 met the threshold limit of which there were more than 60 truncated words which were repeated after appropriate removal; it was found that the final set consisted of 941 items having link strength between them.The overlay visualization depicted that the highest occurring keywords were Cone Beam Computed Tomography followed by Orthodontics followed by Dental Caries; however, it was found that in recent era, a much interest in deep learning and machine learning was developed and a new concept generation acting on primary health care is established.Machine Learning CNN (Convoluted Neural Network) has also seemed to be used as author keywords (Table 5 and Figure 4).9 BioMed Research International et al. [20] wherein the document received the highest citation of 590.However, there were no links present between these documents.

Sources.
The citation analysis for source unit revealed that for a minimum of 2 documents and 2 citations per source out of 109 sources, 93 met the threshold.The analysis revealed that BMC Oral Health had obtained the highest citation for 339 published documents followed by Dentomaxillofacial Radiology journal which had received 2904 citations for 119 documents published; however, it was also observed that there were no link strengths present between them; it was found that BMC Oral Health has obtained these higher citations post 2020 (Figures 5 and 6).

3.4.1.
Authors.There were 1930 authors of which only 14 met the threshold of having 2 documents with 2 citations; it was elaborated that Ayoub and Pulijala [21] had the highest citation of 158; however, there was again no link strength between authors (Table 6).

3.4.2.
Organizations.There were 6930 organizations present of which 306 met the threshold of minimum of 2 documents and 2 citations; of these organizations, it was found that the highest citation was obtained by the Department of Periodontics and Oral Medicine, University of Michigan School of Dentistry, USA (770), followed by the University of Varese (327) (Figure 7).

3.4.3.
Countries.Citation analysis for countries portrayed that of the 125 countries, 84 met the threshold of having citations.The trend depicted that the USA had the most citation of 9468 followed by the UK (4982) whereas India was observed to be having citation of 468 for 88 documents published.It was observed that in recent time, it was the UAE, Egypt, Qatar, and Nepal that published more literature (Figure 8).

Bibliographic Coupling
3.5.1.Documents.Of the 1942 documents assessed for the bibliometric coupling, it was found that only 1407 met the threshold limit of minimum of 2 citations per document.It was observed that Ludlow et al. [20] had the highest citation of 590 whereas Revilla-León et al. [22] had the highest link strength with 111 documents.However, only 1025 of the 1047 data were depicting link strength.The overlay visualization depicted that Bayraktar and Ayan [23] who published a study on diagnosis of interproximal caries lesion with deep CNN in digital bitewing radiographs was receiving a high bibliographic coupling in recent time, and similar finding was observed for Kühnisch et al. [24] who studied caries detection on intraoral images using AI (Figure 9).

Sources.
The bibliographic coupling for sources revealed that for 109 sources, only 93 met the threshold of 2 documents and 2 citations of a source; it was observed that BMC Oral Health journal had maximum documents with 3990 citations and 1637 total link

Authors.
Of the 1930 authors, only 14 authors met the threshold limit of 2 documents and 2 citations; however, it was observed that there was no link present between these 14 authors.
3.5.4.Countries.The bibliographic coupling for countries revealed that of the 125 countries, only 84 met the threshold limit.The highest bibliographic coupling was for the USA with 9468 citations followed by the UK with 320 documents and 4982 citations; it was found that India had 83 documents with 468 citations having a total link strength of 3029.The overlay visualization depicted that the bibliographic coupling was highest for the USA, the UK, and India; however, these couplings were obtained from 2017 to 2019 whereas in recent era, countries like Qatar, Nepal, and Vietnam obtained bibliographic coupling (Table 7).
3.6.Cocitation Analysis 3.6.1.Cited References.Of the 66238 references, it was found that 3421 met the threshold of minimum of 2 cited references.However, it was also observed that only 3333 had the largest connected sources.The highest cocitation for references was obtained by Landis and Koch [25].
3.6.2.Cited Authors.Cocitations between cited authors were present for 31219 of 95068 having a minimum of 2 citations; it was observed that authors Jacob R and Wenzel had the highest citation for cocited authors whereas the least cocited author was Moradian-Oldak J (Figure 11).

Discussion
In the present study, a total of 1942 literature works have been studied.All the literature assessed belonged to English language which were purely published in open access journals.13 BioMed Research International telemedicine, mobile applications, virtual reality, and medical information were commonly associated with terms like dental caries and dental procedures.Furthermore, we noticed a notable rise in publications, particularly from 2015 onwards, with the majority of articles published in 2021.This trend suggests a parallel occurrence of the COVID-19 pandemic and the development of teledentistry.An interesting finding was the cooccurrence of keywords such as Cone Beam Computed Tomography, Orthodontics, and Dental Caries.However, we also observed a recent surge of interest in deep learning and machine learning, indicating the emergence of innovative concepts that impact primary healthcare.Additionally, our study revealed a gap in the implementation of newer digital technologies, such as IoT, artificial intelligence, and gamification (online gaming, video games, etc.), in the field of oral and dental health.
In the present literature of our bibliometric analysis, it was found that the coauthorship between organizations has revealed that the Department of Dental Medicine, Karolinska Institutet, Stockholm, Sweden, and the Department of Periodontics and Oral Medicine, University of Michigan, followed by the School of Dental Sciences, Newcastle University, UK, were the top leading institutes with the highest coauthorship.A similar reflection of the finding was noted with the countries that the USA followed by the UK depicted a higher coauthorship, cocitation, and citation.The main reason behind this is a higher number of publishing houses belonging to American nations followed by European nations while due to availability of research and grants, it is easy to perform and conduct multiple researches in this soil.Our finding is in consensus with bibliometric analysis conducted by Bastani et al. [26], which elicited that the highest publication was observed for the United Kingdom followed by the United States of America whereas in bibliometric analysis presented by van der Wouden et al. [27], a yet again similar trend was observed wherein a higher amount of literature has been published by the United States of America.As per our studied trend of publication from 1985 to 2015, we still sought a similar finding.Our study also revealed that the most recent publication is occurring from countries like Yemen, Ecuador, and India where a plethora of research has just initiated.
Strengths were not depicted in the overlay visualization.With respect to context, it is explored from the visualization that a higher number of research publication include keywords of CBCT and Caries Diagnosis.Due to the emergence of artificial intelligence, many authors have started to conduct, develop, and publish their research work related to the field.The study published in 2021 includes AI as important keywords wherein it was found that Mertens et al. [28] conducted a study that used AI-based diagnostic support for proximal caries detection whereas Cantu et al. [29] published studies which included caries, AI, and Bitewing Radiographs as cooccurring keywords while their study is aimed at applying deep learning to detect caries lesions of different radiographic extension on bitewings, hypothesizing 15 BioMed Research International it to be significantly more accurate than individual dentists.Similarly, an explicit number of research was published having CBCT as keywords as well.
An interesting finding revealed from our bibliometric analysis was that the highest source of articles having coauthorship, cocitation, and citation was published in BMC Oral Health.This journal published the work related to prevention, diagnosis, and management of disorders of the mouth, teeth, and gums, as well as related molecular genetics, pathophysiology, and epidemiology.The journal promises 42 days to first decision for all manuscripts (median) and 56 days to first decision for reviewed manuscripts only (median) while having an impact factor of 3.748 (2-year impact factor) (2021) and 3.917 (5-year impact factor) (2021).Open access journal with substantial publication charges a higher number of articles which were observed to be published in this journal.
Our results have portrayed the context, content, and trends of published literature regarding digital health and oral and dental health.Our limitations included only single database which was used for analysing and visualizing our objective, while our key strengths include the usage of the most holistic software (VOSviewer) developed for visualization of our objective.

Conclusions
This bibliometric study showcases the increasing adoption of digital technology in oral and dental health, presenting policymakers with a unique chance to enhance access, literacy, knowledge, and services.Nevertheless, it is essential to acknowledge that technology types and classifications differ over time and across various dental areas.Through the utilization of insights derived from this study, decision-makers acquire valuable knowledge regarding technology trends, types, applications, benefits, and limitations in the realm of oral health.This knowledge equips them to make informed decisions when implementing efficient technologies, thereby improving access and ultimately enhancing oral health outcomes within specific contexts.

Figure 5 :
Figure 5: Overlay visualization of analysis of citation for sources.

Figure 9 :
Figure 9: Overlay visualization of bibliographic coupling for documents.

Figure 10 :
Figure 10: Overlay visualization of bibliographic coupling for sources.

Table 1 :
Sources and searched strategy information.OR ALL (constituents)) OR trends OR shift OR course OR drift OR tendency OR context OR factors OR circumstances OR condition AND digital AND dental AND health OR digital AND oral AND health AND (LIMIT-TO (DOCTYPE, "ar"

Table 4 :
Top 100 cited countries with documents published.

Table 5 :
Cooccurrence of author keywords with citations and total link strength.

Table 6 :
Citations obtained by authors.

Table 7 :
Citations obtained by country-wise.