Infallible precision? The multifaceted role of AI in dentistry

The true futurists are delighted that AI has also played a pivotal role in the development of robotic surgery, a trend that is set to expand in coming years. Only months ago, an AI-controlled autonomous robot performed an entire procedure on a human patient for the first time. In terms of executing procedures in this manner, AI initially stands to make the most difference by automating repetitive tasks such as tooth preparation, implant placement and orthodontic adjustments.

A slightly more mundane but no less important sphere of application for AI in dentistry is that of practice management, one aspect of dentistry that generates more than its fair share of frustration. Just as AI-powered platforms may expedite and economise both analytical and technical aspects of dentistry, so too, they may oversee the more quotidian, such as accounts and billing, scheduling appointments, correspondence and even predicting whether or not a patient is likely to arrive for an appointment.

These are just a few of the many areas being opened up and transformed through the swift incorporation of AI platforms into dentistry. Quite clearly, AI intervenes in territory that lies at the epicentre of the profession and which has, until now, been the exclusive province of dentists and their largely manual toolkit. All of the examples provided above underscore one paramount value of AI technologies: they are capable of performing a range of dental tasks both faster and cheaper than when performed by humans alone. But this presents another question that strikes at the heart of contemporary society. If AI makes dentistry faster and cheaper, and if the neo-liberal capitalist world is built on nothing else than the principles of time and money, then does this not mean that inevitably our humanity is to be whittled away to insignificance? Or is it the case that our hallowed grey matter will remain in some ways indispensable, retaining a space of operation into which machines will never invade?

For one, Anna Genge, a Canadian dental expert working at the intersection of medicine and technology, has little doubt that the human must remain an essential aspect of dentistry. She explained to Dental Tribune International, “AI works by taking on tasks that involve pattern recognition, data analysis, and automation. This includes, for example, interpreting radiographs or optimising appointment scheduling. However, final clinical decisions, patient interactions and hands-on treatments must remain firmly in the dentist’s hands owing to the need for professional judgement, patient context, legalities and ethical considerations. Human-retained decisions must include things such as final diagnoses, which require a holistic view of a patient’s medical history; treatment customisation, which must be based on a patient’s specific needs, economics, potential treatment plan compliance and medical conditions; and finally, ethical decisions and informed consent discussions.” Genge emphasised that “AI must complement rather than replace human expertise, and areas like patient empathy and nuanced interpretation are unlikely to be fully understood through data alone.” All of this is to say that while AI possesses a clear superiority in the purely technical and statistical spheres, the flesh-and-blood clinician currently maintains stewardship over the more qualitative, moral and expressive domain. In situations that demand a delicate appreciation of personality, preferences, stresses and propriety, the icy digitalism of AI falls short of human subtleties. How long this will stay the case is, of course, absolutely uncertain.

Another dimension of AI’s spread throughout dentistry and society more broadly that warrants close and critical scrutiny is the extent to which this technology has been embraced without due regulatory and legal consideration. After all, it was only last year that the “Godfather of AI” Dr Geoffrey Hinton outlined a range of social and existential risks associated with these platforms that are being overlooked in our gleeful exploitation of their benefits. Prof. Robert-Andre Gaudin of the BIH Charité Digital Clinician Scientist Program in Berlin, and a world expert in the field of AI in dentistry, shared his thoughts on the matter. “Regulatory frameworks for AI in healthcare in general, including dentistry, are still fragmented or in their infancy. Many countries lack specific guidelines for evaluating the efficacy, safety, and ethical implications of AI in clinical dental settings. But as the first legal cases evolve, the landscape will be shaped. I am totally convinced that there is nothing wrong to be an “early adopter” and dentistry has, and will have, the role as a pioneer in the usage of AI in the daily practice routine. In the long term this cannot harm but only help future dentists to be familiar with the technical development that will powerfully shape medicine in the next years.”

For dental professionals themselves, there are an array of hazards that must be studiously negotiated. Genge continued, “Dentists, eager to stay competitive, may sometimes embrace AI without fully understanding its limitations or ensuring compliance with existing laws. Some lack adequate training to use AI effectively or critically evaluate its output. In some cases, reliance on marketing claims about AI’s capabilities has overshadowed rigorous assessment. There is a gap in ensuring all AI systems meet compliance standards and ethical guidelines.”

These views are echoed by Gaudin, who states that “since the AI algorithms do not perform with a 100% accuracy, the dentist may rely too much on the AI which, for example, may lead to a caries treatment that is actually not there. This diagnostic imperative remains solely in the hands of the dental assistant and the dentist.”

A final and crucial dilemma that problematises the swift uptake of AI is data security and the potential of sensitive patient information to be appropriated and exploited by cyber-attacks, another core focus of Genge’s ongoing work. “Dental practices handle sensitive patient data, making them targets for cyber-attacks. If AI tools are poorly secured, or staff are not trained on what data can and cannot be used in different applications, patient records could be compromised. Additionally, cybercriminals are now leveraging AI which means that more than ever we need to ensure dental teams are receiving proper security awareness training, and that practices have a multi-layered approach to network and system cybersecurity.”

Without question, the inclusion of AI within dentistry is generating extensive transformations and its adoption remains a mixed blessing. Its ability to perform a wide sweep of technical and administrative tasks rapidly, accurately and economically is clearly its principal attraction. However, as this article has shown, both the technology and its human operators are imperfect creations, similarly prone to err. Like the wider economic system of which it is a part, there may be no way of arresting its incessant diffusion, but at the very least, we must ensure that, through rigorous training, regulation and ethical frameworks, its potential for harm is reduced to the bare minimum.