Dental News - Prof. Andrew Dickenson and Dr Hatim Abdulhussein discuss digital readiness in dentistry

Brendan Day, Dental Tribune International

Wed. 31. August 2022

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Though the era of digital dentistry is well and truly underway, there are still significant numbers of dental professionals and patients who are not in a position to take advantage of it. Recently, Prof. Andrew Dickenson, Dr Hatim Abdulhussein and Jessie Tebbutt published an article on this topic, titled “An overview of digital readiness in dentistry—are we ready?”, in the British Dental Journal. Dental Tribune International spoke with Prof. Dickenson and Dr Abdulhussein about the concept of digital readiness and asked them what they felt should be considered in order to improve access and education moving forward.

Prof. Andrew Dickenson. (Image: Andrew Dickenson)

In your article, you wrote “The digital divide will continue to be a persistent challenge unless actively addressed”. In your view, where does this digital divide lie, and what factors have caused it?
Prof. Andrew Dickenson: It’s quite a complex issue, and there are a number of reasons for this digital divide. The most significant factor is education. Dentistry is delivered by small teams, working in relative isolation, where access to regular educational updates can be a challenge. Funding is another factor because dentistry in the UK is still very much an owner-provider service—dentists own their practices, and investment in digitally compatible equipment will have a financial implication.

It’s an issue that reaches the policy level within healthcare. We really do not have a framework that sets out what the expectations and potential benefits are of adapting to a more technologically driven health service, and so it becomes harder to bid for sustainable investment. This ties into the final factor, which is an underlying suspicion of technology. As we wrote in the article, technology is not a tool to be adopted but a culture to be grown. There has been investment in technology that has subsequently been under-utilised because the underpinning educational element is missing. This inevitably generates a negative attitude that can be difficult to overcome. Frustration not only leads to practitioners abandoning technology but also reinforces the assumption that it does not work. So, it is increasingly important to instil in people the confidence to believe that digital tools can actually support their clinical practice. However, for this to be sustainable, all members of the team need to be provided with appropriate education and training.

Dr Hatim Abdulhussein: This digital divide isn’t just a dentistry thing but rather a larger societal issue. We’ve massively changed the way we do things; for example, many of us do online banking and online shopping. The way in which we interact with technology on a daily basis creates a divide itself because not everyone has internet access or the skills and the capabilities to use digital devices effectively. If you then consider healthcare providers, dental care providers and so on, you’ll realise that there is a wide range of technical proficiency, going from those who are very proficient to those who need considerable training and support. This divide exists in patients too and affects how they access care and how they are able to access dental services.

Overall, the digital divide is something that, as Andrew said, needs to be tackled with an approach that involves educating the dental workforce so that everyone is able to have similar capabilities. This will help to reduce any sort of divide in terms of the way services are provided to different patient groups.

“The digital divide is something that [...] needs to be tackled with an approach that involves educating the dental workforce so that everyone is able to have similar capabilities” – Dr Hatim Abdulhussein

Does the general level of digital readiness vary between dental professionals and patient groups? Are dentists able to influence their patients in this regard?
Dickenson: Dentistry is a very adaptive profession—one that has adopted a great deal of clinically oriented technology—and so I think there is a real opportunity for dentists to educate their patients. Currently, dentists are generally seeing fewer patients than before COVID-19, and so we need to maximise the time we have with them and, if possible, empower them to communicate through digital technologies. For example, tools such as QR codes haven’t really been widely used in dentistry but have the potential to benefit patients by providing instant access to digital self-care resources. The availability of remote consultations and treatment monitoring software, available through smartphone technology, allows members of the dental team alternative ways to interact with patients. This offers significant benefits for patients in terms of personalising care while also influencing their health behaviour. Of course, we need to consider that not all patients may have the digital literacy or the equipment to access this type of care, but it is important to help those who might have some resistance to digital technology to overcome it.

Dr Hatim Abdulhussein. (Image: Hatim Abdulhussein)

Abdulhussein: Last year, the Health Foundation published an interesting report called Switched On. It investigated the level of familiarity with artificial intelligence (AI) found among different members of the healthcare workforce and the general public. The results showed that dentists and doctors clearly have a higher familiarity with AI than members of the general public do. However, the report stated that the majority of healthcare workforce members are still not familiar with AI and might be suspicious of its benefits. So, there’s clearly a divide not just between dentists and the general public but also between different members of the healthcare workforce.

Many factors contribute to these divisions, but the greatest impact comes from prior experience. If healthcare professionals train in an area with substantial technological infrastructure, they’re going to be more digitally ready. If they train in a more rural practice with less technological infrastructure, their skills and experience in this area may be lacking. Overcoming this difference in digital readiness between different groups of healthcare workers is key if these workers are then going to have an impact on the readiness of their own patients.

What role could artificial intelligence and robotics play in the future of dentistry, and what needs to be considered to ensure that these technologies are adopted safely and ethically?
Abdulhussein: For AI, it comes down to the quality and the accuracy of the data you obtain. AI is going to augment healthcare and support the way we work—it might support our decision-making, automate certain processes and take away some of the administrative burden. An area in which we believe AI has much potential is the prevention of oral disease. The gathering of information about the way in which patients manage their own health can guide dentists in providing advice about what patients can change in their oral health routines in order to stay healthy or what new ideas they can implement.

To ensure that AI and similar technologies are used ethically and safely, there have to be clear regulations regarding their use. They need to provide a clear benefit for your patients and make a difference in their experiences and to their health. Also, the dentist needs to clearly understand how he or she can use this technology to enable these benefits to be experienced by patients.

Dickenson: I think that’s a really important point because, in the past, UK government funding has gone to different parts of the health system to invest in technology without the educational underpinning that should go with it. And this is the point at which people become suspicious about whether a new technology will work and safety concerns arise. What COVID-19 has helped us to understand is that we can use certain digital technologies to conduct remote check-ups and monitoring more successfully than we ever thought possible, but this requires greater adoption if we are to effectively expand into AI. Further investment in research, product development, software design and education will be necessary to lead the growing integration of AI into clinical practice. Equally, we must ensure that the public are involved in these developments, as their compliance is essential in safely adopting new technology.

Are there any frameworks in other countries or regions regarding digital readiness in the dental profession that could serve as an example for the UK to follow?
Dickenson: Scandinavia is a good place to look in this regard. I have seen dental practices there utilise simulation technologies for the education of both dental teams and patients, and provide in-house training on new equipment using innovative interactive resources. This concept of in situ simulation for training teams, within their own clinical area and not in the artificial environment of an education centre, is something we’ve started to adopt.

Abdulhussein: So digital readiness, broadly speaking, is the ability to be digitally literate and work in a digital society. Measuring it can be difficult—you need to understand what the individual needs to know in order to succeed at his or her job. On a wider level, this means understanding what the learning needs are for digital healthcare technologies, and this is something which we’re working on in the UK but which has already been implemented in other countries. The Australian Medical Council, for example, published a capability framework for digital health and medicine last year that acts as a really useful guide for what medical practitioners in Australia need to know in order to work with their digital infrastructure. I think this is an important process that could help dentists understand how being digitally ready applies directly to their work.