Artificial intelligence is accelerating the input of evidence into everyday medical care. A.I. now reaches deeply into the treatment of chronic conditions like diabetes and Alzheimer’s, as well other life-threatening diseases like cancer. A.I. is just now beginning to become more prevalent in dentistry.
One of the greatest benefits of using A.I. in dentistry will be that A.I. has the potential to unlock clinically relevant information hidden in relatively massive amounts of data, which in turn can assist in clinical decision-making. Another form of A.I. is machine learning, whereby machines can autonomously learn from this data to continuously improve accuracy in decision-making.
Machine learning is an application of artificial intelligence that provides systems with the ability to learn and improve from experience without being externally programmed. Machine learning focuses on the development of computer programs that can access data and use it learn for themselves. No human being is needed, allowing for fast learning speed.
Introducing New Tools
As in medicine, evidence-based practice is the second tool needed to make A.I. successful in dental care. Simply put, evidence-based dentistry is the synthesis of outcomes from high-quality studies that use meta-analytic statistical techniques. Those studies will also become the backbone of clinical guidelines developed by professional societies and academic institutions that assist in determining what Medicare, states, and private insurers will cover and pay for.
Despite A.I.’s positive trajectory, there are key issues surrounding A.I. usage in dentistry that will need to be addressed — digital coverage that includes privacy and security; good data; reproducibility of A.I. decision-making published in high quality journals; proper regulatory oversight; health insurance modeling and payment; and allocating responsibility for the A.I. “black box.” While this is a long list, experts agree that these issues will be addressed quickly and resolved. But the biggest barrier to A.I.’s development and deployment in dentistry will be dentists and the dental culture itself.
Dentists will mightily resist having machines make decisions. Dentists will strongly contest A.I. because it will directly affect their sovereignty. The motives of dentists to thwart A.I. are obvious.
Dentists will feel their independence directly threatened. Third parties, patients, employers, and state boards will also know which dentists are following the A.I. evidence-based diagnosis and treatment plans, and which dentists are not.
AI: Changing the Face of Dentistry
According to this seminal article by Bader and Shugars, patients with the same oral condition who were sent to different dental offices saw their diagnoses and treatment plans vary widely depending on which dentist the patient saw — from prophy to full mouth reconstruction. A.I. will standardize diagnosis and treatment planning and shift those decisions away from dentists.
Dentists will lose autonomy. Because all data will eventually be cloud-based, this will allow not only dentists to receive and review the data, but also make it available to all stakeholders, resulting in total transparency.
A.I. will directly impact reimbursement. What A.I. presents as the diagnosis and treatment plan, along with best practices, is what insurance and government entities will reimburse.
Equally as important, A.I. will be able to measure outcomes, reporting which dentist delivers the best outcomes. A rating system of dentists per region wil result. Patient satisfaction will also contribute to rankings.
A.I. will foster collating seemingly unrelated data sets at an accelerated pace. It took years to see the relationship between heart disease and periodontal disease, and this was achieved by certain insurance codes finally being connected. Rather than years, it will be seconds for these kinds of connections to be found. The impact on diagnosing and treatment planning will be tremendous.
Advances in Technology
The efficacy of treatment will be tested. What will happen for instance, when A.I. looks at ortho cases over a 5, 10, or 20-year period? There’s also endo, implants — and the list goes on. Many unanswered questions will be answered. Does the treatment really work? And if so, under what circumstances?
A.I. will combine all dental software with the patient’s Electronic Patient Records (EPR). EPR will be basic to all dental-practice software. EPR will result in pushing dentistry integration into primary care. The inclusion into primary care will have a profound and direct effect on what kind of dentistry can be delivered.
As dentistry becomes more and more integrated into primary care, a dental visit will significantly change. Vital signs will be read in dental offices, for example, and uploaded to the patient’s records. Blood draws as well, for lab analysis.
Dental procedures and their payments will be based not only on the patient’s oral health but also the overall health of the patient. Closure of “care gaps” will be part of the dentists’ incentive package. Dentists will become part of healthcare team consisting of physicians, hospitals, pharma, and payers.
How will dentists respond to being part of a healthcare team where the team’s results influence everyone’s compensation? If the patient doesn’t return for their hygiene appointment, every player on the team suffers.
If a patient is not compliant in managing their chronic disease, this might also impact what level of dentistry is available to them. Should an uncontrolled diabetic receive a crown? At what level of diabetic control is an implant approved?
A Changing Trajectory
When you look at what the Cleveland Clinic has done with their data and what A.I. enables them to deliver the highest-quality care in a number of diseases, or what A.D. Anderson has achieved with IBM’s Watson in cancer treatment, it is clear that A.I.’s influence will only continue to expand in medicine, and in dentistry as well.
Dentists and their organizations better get ready because A.I. is already here and growing rapidly. As A.I. becomes central to diagnosis and treatment planning, A.I. will be the primary determinant in what dentists do and how dentists get paid. A.I. will completely alter the practice of dentistry. Dentists and their dental organizations should prepare for the impact of A.I.
A.I. will expand exponentially in the next few years, and the dental profession is wholly unprepared for its impact. Rather than more C.E. courses on smile design or implant placement, maybe having dentists understand the meteoric impact of A.I. would be appropriate.