The protocol for this review is registered on PROSPERO (CRD42021293376). This protocol has been written in accordance with the PRISMA-P (Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Protocols) checklist [37]. The systematic review will be reported in accordance with the PRISMA checklist [38].

We will follow the PICOS (participants, interventions, comparators, outcomes, and settings) framework [39].

We will include studies about the adoption of teledentistry by DHCPs. The DHCPs are dental professionals directly involved in clinical acts with patients. This review will include any dental professionals involved in oral health care. These DHCPs include general and specialist dentists, dental hygienists, dental therapists, dental nurses, dental students, dental hygiene students, and dental therapy students. All specialties in dentistry will be considered (eg, orthodontics, oral medicine, oral pathology, prosthodontics, periodontics, endodontics, pedodontics, and oral and maxillofacial surgery). If other participants such as patients, other health professionals, or managers are involved in a study with these DHCPs, the study will be included.

We will include only those studies that use teledentistry for the delivery of oral health care. Teledentistry interventions could be compared to usual or standard dental care or face-to-face dental visits (in-person) or no comparator. DHCPs can use several devices including cell phones, tablets, telephones, computers, personal digital assistants, text messaging, and apps [40-44] to interact with colleagues, other health professionals, or patients. We will include any studies on teledentistry delivered through different modalities such as synchronous (in real time; ie, direct interaction between a person [patient, caregiver, or health professional] and a DHCP) and asynchronous (store and forward; ie, transmission of health information to DHCPs to evaluate a patient’s condition or render a service outside of a real-time or live interaction) modalities. These interventions can be delivered through videoconference (eg, Zoom), telephone, websites, or any applications such as WhatsApp or other web-based mechanisms.

We will include all studies with an original data collection. If there are several publications on the same project presenting similar data, we will include only the most recent publication, and if results are complementary and relevant, we will include all of them. We will include quantitative, qualitative, and mixed methods studies.

We will include studies with different synonyms related to teledentistry implementation such as adoption, usage, uptake, readiness, and intent to its use. We will include studies reporting factors that could influence teledentistry implementation as reported by DHCPs; for instance, knowledge, intention, behavior, self-efficacy, satisfaction, skills, social influences, environmental context, and resources. We will include studies where data are collected using a variety of techniques, including individual interviews, focus groups, or questionnaires. We will include studies using validated or nonvalidated measurement tools to collect data. In this review, we will consider an enabler as any circumstance, factor, or variable that positively influences teledentistry implementation. A barrier will refer to any circumstance, factor, or variable preventing teledentistry implementation.

We will consider all dental settings such as dental offices, community-based care, hospitals, schools, long-term care facilities, nursing homes, home dental care, university, and private or public dental settings. We will consider any geographical setting (eg, rural or urban regions) and any country (low-, middle-, or high-income).

We will exclude any study using teledentistry only for education, training, and research. Studies may include other participants such as patients and other health care professionals, but DHCPs must be part of the studied population in the methodology, with the possibility to extract information from DHCPs. We will exclude studies that do not have a clear distinction between DHCPs and other participants’ findings. We will exclude any study focusing on health care providers other than DHCPs. We will exclude any studies focusing on the features of a platform for teledentistry, or the validity of teledentistry. Studies that are limited to describing the feasibility, usability, or technical evaluation of certain systems, interfaces or platforms will also be excluded. We will exclude editorials, letters, abstracts, reviews, commentary reports, legal issues, protocols, and press releases.

A health science information specialist will assist us in developing the literature search strategy in PubMed and will translate it after validation and revision in other electronic databases. A second health science information specialist will review the initial search strategy with the Peer Review of Electronic Search Strategies Tool [45]. The main concepts considered in the search strategy are “teledentistry,” “telemedicine oral health,” or “remote dental care,” “remote oral care,” “virtual dental care,” or “virtual oral care” and “dental health care providers,” “health personnel,” or “dentistry.” The electronic search will be carried out to identify all relevant studies from the following databases: PubMed, Cochrane Library, Web of Science, CINAHL, Embase, and PsycINFO. We will perform additional searches in Google, Google Scholar, and ProQuest Dissertations & Theses Global. We will screen the references of included studies to capture additional relevant studies.

There will be no restriction on the date of publication of the studies. We will include studies published in French, English, and Portuguese. A draft search strategy for MEDLINE has been developed with the support of a health science information specialist and is available in Multimedia Appendix 1.

Two independent reviewers will assess the methodological quality of the included studies using the core quality criteria in the Mixed Methods Appraisal Tool (MMAT) [47]. The MMAT is a reliable tool, and its use has been widely reported in the literature to facilitate the critical appraisal of mixed studies reviews [48-51]. It was first reported in 2009 as a single tool to evaluate the methodological quality of 5 categories of study designs: qualitative studies, randomized controlled trials, nonrandomized studies, quantitative descriptive studies, and mixed methods studies [50]. Further attempts to refine and improve the MMAT led to the development of its current version in 2018, based on the findings from a literature review on critical appraisal tools, pilot and interrater reliability testing, interviews with MMAT users, and the Delphi approach [52]. There are 5 questions each for quantitative and qualitative study designs and 15 for mixed method studies. The answer categories include “yes,” “no,” or “can’t tell” [47]. As required by Hong et al [47], we will present in detail the ratings of each criterion to better inform the quality of the included studies. We will present the overall quality score of the included studies using a descriptor such as an asterisk (*) or the percentage of quality criteria met [49]. For instance, 1 (*) refers to 20% of the quality criteria met, while 5 (*) refers to 100% of the quality criteria met. For mixed methods studies, we will provide 3 scores including one for qualitative, one for quantitative, and one for mixed methods components. The overall quality of the mixed methods study cannot exceed that of its weakest component [49].

We will consider for the included studies the following cutoff: studies with 1 and 2 (*) will be considered as being of low quality, 3 stars as medium quality, and 4 and 5 stars as high quality. Any discrepancy will be resolved through discussion and consensus or with the consultation of a third reviewer.

A narrative synthesis will be conducted. We will analyze the data extracted using descriptive statistics (eg, frequencies and percentages). For instance, we will report the types of study designs, type of teledentistry interventions, countries where studies were conducted, and the study characteristics. We will synthesize and map the factors influencing teledentistry implementation in accordance with the theoretical domains of Theoretical Domains Framework (TDF) [53] and the context of information reported by the authors in order to allocate the factor to the appropriate theoretical domain. The likelihood is relatively low to miss a potential determinant of teledentistry implementation considering the wide range of factors considered within the TDF. We will report any new construct that is not considered in the TDF.

The robust theoretical model of TDF is more appropriate for this review because of its comprehensiveness. It is a promising and useful way of mapping the broad range of factors that influence a range of behaviors. It has been used in the literature to synthesize and classify the different determinants of a behavior and to target the relevant interventions [54,55]. In its original version, the TDF was composed of 12 theoretical domains (eg, knowledge, skills, social or professional role and identity, beliefs about capabilities, beliefs about consequences, motivation, goals, memory attention and decision processes, environmental context and resources, social influences, emotion, and action planning) that were derived from 33 behavior change theories using a process of expert consensus. The domains are considered as potential determinants of behavior and clearly indicated as barriers and enablers or factors positively or negatively influencing the behavior being studied. Some years later, the TDF has been refined and included in its revised version 14 theoretical domains and 84 theoretical constructs that can influence behavioral change [54]. These 14 individual and environmental theoretical domains include knowledge; social or professional role and identity; beliefs about capabilities; beliefs about consequences; skills; goals; optimism; reinforcement; intention; memory, attention, and decision processes; environmental context and resources; social influences; emotion; and behavioral regulation [54] (Multimedia Appendix 3).

Authors of previous reviews on teledentistry implementation have identified several potential factors influencing its implementation such as awareness, attitudes, knowledge, skills, training, lack of reimbursement, lack of infrastructure, self-confidence, organizational difficulty, quality of information, fear, lack of evidence, lack of guidelines, and data security issues [16,30,31,56]. These constructs can fit under the TDF domains of knowledge, skills, beliefs of capacities, beliefs about consequences, reinforcement, goals, emotion, identity and social roles or responsibilities, environmental context, and resources. In a systematic review of reviews on the barriers and facilitators to clinical behavior change by primary care practitioners, the authors have reported that 3 TDF domains were most commonly reported across many reviews, regardless of the type of behavior change and context: knowledge, environmental context and resources, and social influences [57].

Based on this information and our experience in dentistry, the preliminary step of selection of the TDF domains’ constructs could include without exhaustivity: procedural knowledge, knowledge, skills, skills assessment, competence, professional identity or role, self-efficacy, beliefs, attitudes, incentives or reimbursement, resources, infrastructures, social norms, fear, stress, and breaking habits.

The domains of the TDF are further mapped in 3 major essential conditions predicting behavior change, which are components of the COM-B model [33]. The COM-B component “Capability” can be psychological or physical and includes knowledge and skills. The component “Opportunity” can be social or physical and could include social influences and environmental context or resources. Finally, the component “Motivation” can be a reflective process, or automatic process and could include intention and emotions. This approach guides the understanding of behavior in all contexts. The COM-B model is a part of the “behavior system,” which helps to design interventions [33] through BCTs [58]. According to the analysis of the nature of behavior and the relevant mechanisms to elicit change, the Behavior Change Wheel is a reliable framework that aims to link the determinants of the target behavior to the design and selection of interventions and policies (Multimedia Appendix 4). Considering the critical need for theory-based implementation interventions to improve the use of evidence-informed practices, we will organize the barriers and enablers by these essential conditions, which could be behavioral change components with high potential to improve teledentistry implementation. If possible, we will perform subgroup analysis based on the number of eligible studies with the following variables: age, gender, type of dental professionals (eg, dentists versus dental hygienists), category of dentists (eg, generalist and specialists), type of setting (eg, private or public), and time period (before and after 2020 with the COVID-19 pandemic), and their methodological quality. Results will be reported in tabular form, graphics, and quotes to reflect the extent of included literature.

At the end of the review, we will have an in-depth understanding of barriers and enablers from DHCPs’ perspectives as well as the comprehensiveness of TDF domains, constructs, and predicting factors.

This review will identify and synthesize the enablers and barriers influencing teledentistry implementation from DHCPs’ perspectives. These factors can represent micro to macro levels of analysis, which will affect implementation success and predict implementation efforts. The TDF, one of the robust and common theoretical frameworks used in implementation science, will allow us to comprehensively classify the range of barriers and enablers related to teledentistry implementation, which could assist later in the development of tailored implementation interventions [35]. The TDF has also been used as a coding framework for the analysis of barriers in systematic reviews [34,59,60]. However, to our knowledge, its use is limited in dentistry and was not used to synthetize the factors influencing teledentistry implementation as reported by DHCPs. The knowledge of determinants from the TDF and COM-B model will inform the selection of targeted BCTs, which, in turn, can be used to design behavior change interventions to improve the implementation of teledentistry. We will present the strengths and limitations of this review. As such, implications of the review findings for future research, practice, and policy will be discussed and presented.

This systematic review protocol presents the methodological steps aiming to identify and synthetize the barriers and enablers to implementing teledentistry from DHCPs’ perspectives using strong theoretical frameworks. The results of this review can be relevant for different knowledge users including patients, DHCPs, researchers, managers, academics, policy makers, and professional decision-makers in regulatory bodies to design behavioral change interventions to improve the success of teledentistry implementation in dental settings.