Disruptive technology—enhancing dentistry
The speed of the proliferation of new technologies is breathtaking. Although initially disruptive to our traditional practices, technologies can, and have, enhanced dentistry, improved health outcomes and attracted more fully engaged patients. Now, disruptions are being catalyzed by the intertwined technologies of smart sensors, telemedicine and artificial intelligence (AI).
Smart sensors abound, giving us the power to monitor and modify our behaviors. For example, smart toothbrushes can measure caries levels, evaluate brushing efficiency and provide feedback to the user. In real time, we can monitor our exercise level, blood oxygen level, temperature and heart rate by means of smart watches. Our phones can capture an electrocardiogram. Phone-based pacemaker applications continuously monitor both cardiac characteristics and device performance and alert the individual of any anomalies that need attention. Importantly, smart sensors can report this clinically relevant data directly to health care professionals, providing real-life information—as opposed to in-clinic data—to clinicians. They also enable at least some health care to be delivered remotely via telehealth.
Catalyzed by the COVID-19 pandemic, telehealth, which includes telemedicine and teledentistry, has flourished. In the U.S., dental and nonhospital medical facilities were essentially shut down for a period of some months in 2020, and patients were unable to see their providers face-to-face. Smart-sensor technologies enabled health care providers to remotely triage an individual’s need for urgent care and monitoring and also to provide care for chronic conditions. According to some clinicians, an unanticipated advantage of using these technologies is the ability to get a new perspective on a patient’s environment. They provide insight into environmental conditions that could be influencing the individual’s health that may otherwise not come to light in traditional in-clinic settings.
Digitization of patient information, including electronic patient records and digital imaging, created new opportunities for conversations with patients about treatment options. More importantly, it facilitated health professionals’ cross-disciplinary consultations. The proliferation of digital data across practices, disciplines and cultures creates a rich resource for AI applications that can, and are, enhancing dentistry.
AI and dentistry
AI (used here to include terms such as augmented intelligence, machine learning and deep learning) combines computer science and robust datasets to enable problem-solving. Learning from problem-specific datasets, AI programs have been able to win chess games against masters and to create baroque music that cannot be differentiated from an original composer’s creation. AI allows the analysis of 500,000 medical research papers on a particular pathology or set of symptoms in as few as 15 seconds.
What it does best is to quickly extract pertinent information for a particular problem from an extensive database and, if desired, establish a diagnosis and recommend treatment options. The databases can be assembled from combinations of input from both clinical data and the literature, incorporating best practices, the outcomes/effects of treatment, and the implications of general and oral health on outcomes. In most cases, the output of the AI analysis has been calibrated against the opinions of a group of experts. But even the experts can be surprised. One AI system analyzing radiographs from cancer patients was able to find a new correlation of pathology–patient characteristics that had never before been recognized.
“It is likely that, through AI, new conditions and oral–systemic linkages will be uncovered”
From a dental clinician’s perspective, AI can be useful in a host of applications, including the interpretation of radiographs and CBCT multiple-image slices, the detection of caries, the early detection and assessment of the probable progression of various disease states, the delineation of the influence of systemic conditions on dental health and the assessment of the success of various interventions for each specific individual. AI can suggest treatment options based on the breadth of the patient’s oral and systemic conditions and suggest treatment options to be considered with weighted advantages and disadvantages of each, moving us ever closer to personalized precision medicine and dentistry. It is likely that, through AI, new conditions and oral–systemic linkages will be uncovered.
Even within a single practice, AI information built into the practice management system can be valuable, improve productivity and enhance an individual patient’s experience. Electronic patient records serve as a rich source of information for AI-enriched business operations. Such records can be used in facilitating billing, in establishing the need for, and making, patient appointments, in automating inventory control and the ordering of supplies and in generating patient-specific information prior to a dental appointment in order to give patients information about the choices they are about to make. AI-generated analysis can create phone-based concierge services for patients, giving them personalized information about healing processes and unanticipated symptoms they may experience, as well as follow-up information. Ultimately, AI can enable clinicians to track and evaluate long-term treatment outcomes.
Entering a new era of disruptions
Without question, things are going to change with the introduction of smart sensors, telehealth, and AI. Disruptions in dentistry are far from new. Imagine what dentistry would be like if we still were using slow speed drills and cocaine as an anesthetic, had no radiographic or other modern modality imaging systems, worked with no gloves, used paper rather than electronic patient records and had never discovered implants or adhesive dentistry.
“Imagine what dentistry would be like if we still were using slow speed drills and cocaine as an anesthetic”
Certainly, these technological advancements changed practice, as have CAD/CAM, intraoral scanners, new materials, patient expectations and dental education. Now, as we enter a new era of disruptions, catalyzed by yet another set of technologies, we can look forward to improved ability to predict, preempt, and personalize dentistry, to increased practice efficiencies and productivity, to enriched decision-making, and to additions to our collective knowledge base.