## 4 Discussion

Table 5: Comparison of worldwide relative search volumes for teledentistry applications between 36 months before and 36 months after the COVID-19 outbreak, computed through the Mann–Whitney U test. Additionally, a positive correlation was also found between searches for \"Elderly\" and searches for almost all oral and dental needs common in the geriatric population, including \"Periodontitis\", \"Dentures\", \"Caries\", and \"Stomatitis\", likely revealing that interest in oral and dental problems is partly related to interest in the needs of the elderly. However, searches for \"Tooth loss\" were the only ones that did not correlate with searches for \"Elderly\", although edentulism is a major problem among the elderly [29] and contributes to social awkwardness and isolation [5]. Worldwide Google searches related to teledentistry, the elderly, oral and dental needs, and almost all teledentistry applications showed a general increase in interest in these topics, especially after the COVID-19 pandemic outbreak (January 2020), with the exception of \"Monitoring\". This result suggested an overall increase in health information-seeking during the COVID-19 pandemic, probably due to the delay of medical and dental treatments and the decrease in medical and dental consultancies, which led patients to turn to Internet searches to solve health-related problems [25]. However, the interest in teledentistry in particular has remained relatively low, aside from a slight increase during the acute phase of the COVID-19 pandemic, suggesting that patients still prefer direct contact with healthcare providers over remote care delivery models. On the contrary, the interest in the elderly among Google users increased after the COVID-19 pandemic outbreak, likely due to their vulnerability to severe consequences from SARS-CoV-2 infection [33]. Regarding oral and dental needs diffused among the elderly population, while searches for \"Tooth loss\" and \"Stomatitis\" decreased after the pandemic outbreak, those for \"Dentures\" and \"Tooth extraction\" remained high. However, these Google search trends were consistent with those found before the COVID-19 pandemic outbreak. Similarly, searches for teledentistry applications among the elderly remained consistent before and after the pandemic outbreak, with \"Assistance\" and \"Diagnosis\" being the most searched terms, and \"Screening\" the less searched one. When comparing searches for oral and dental needs in the elderly in the 36 months before and after the COVID-19 outbreak, statistically significant differences were found in worldwide search volumes for \"Elderly\" combined with \"Periodontitis\", \"Tooth extraction\", \"Dentures\", and \"Caries\". Similarly, statistically significant differences were noticed in worldwide search volumes for \"Elderly\" combined with \"Consult\", \"Screening\", and \"Assistance\", when comparing searches for teledentistry applications among the elderly in the 36 months before and after the COVID-19 outbreak. Overall, the pandemic has led to an increase in interest in elderly oral and dental needs and related interventions, including teledentistry applications, and specifically, the provision of oral and dental consult, screening, and assistance, which are more easily practicable remotely [1]. The main limitation of the study is based on the daily changes of information search data in the Google search engine; therefore, the present results should be constantly updated. In addition, Google Trends shows relative search volumes from 1 to 100, so it does not indicate the absolute number of searches. Furthermore, Google is not the only search engine available on the Internet, although it is the only one that records search data and makes it publicly available. Nonetheless, the present cross-sectional analysis was the first to assess the level of interest in Google searches for oral and dental needs and teledentistry applications among the elderly, comparing search volume in the 36 months before and after the COVID-19 pandemic outbreak.