TLNM: Externally Validated Tooth Detection, Numbering and Segmentation from Smartphone Photographs Using Mask R-CNN

Oral health issues affect billions globally, but the cost and limited access to professional dental care hinder preventive oral healthcare. Research relies on clinical-grade radiographs or intraoral camera images, unavailable for public self-screening. This study introduces a tooth localisation and numbering model for smartphone photographs. We developed a customised Mask Region-based Convolutional Neural Network (Mask R-CNN) pipeline trained on 1,272 annotated smartphone images. To address variability in patient-generated health data, the pipeline incorporates two domain-informed mechanisms: a masked gray-world white-balancing algorithm to mitigate artificial colour casts and an anatomically constrained detection layer to enforce structural validity and suppress false positives. Evaluation comprised four stages: internal held-out testing, independent external testing, a descriptive ablation study, and fold-based training stability analysis using the same internal test set. On the internal test set, the model achieved an instance-mask AP@50 of 0.818, class-aware PQ of 0.780, and operational F1 of 0.884. Training stability showed limited between-model variation: across ten runs, instance-mask AP@50 had a standard deviation of 0.009. On the external dataset, the model achieved an instance-mask AP@50 of 0.901, class-aware PQ of 0.832, and operational F1 of 0.928 despite differences in population, sensors, and acquisition protocols. The inference pipeline is available as an open-source, containerised API. These results demonstrate that consumer-grade smartphone imagery can support automated tooth-level anatomical mapping, offering a scalable, potentially low-cost foundation for remote screening and tele-dentistry in resource-constrained environments.