HJAR May/Jun 2023

HEALTHCARE JOURNAL OF ARKANSAS I  MAY / JUN 2023 57 In machine learning (ML), a subset of AI, algorithms are used to predict if a tooth should be extracted or saved and are used to interpret dental images such as digital radiographs, MRI scans, and cone-beam computed tomography (CBCT). 9 CBCT scans allow dentists to evaluate the mouth, teeth, and bone in a 3D image. These types of scans have proven invaluable in placing implants and in endodontic treatment, since it can capture unknown cracks in roots of teeth. 10 AI technology can predict stages of peri- odontal disease, tooth decay, and root anato- my and pathology in endodontics, plus assist in orthodontic treatment plans. It can also detect if the same film has been submitted for multiple patients in dental insurance claims, which is a fraudulent practice. 10 AI is not free of challenges, as PHI is neces- sary and shared between multiple systems. If high security measures and access con- trols are not in place, this can result in HIPAA breaches of patient privacy information. 11 Safety issues are also a strong concern, as new and constant updates are required for optimal execution. Poor results usually come from inaccurate data. Those who rely on the AI system should be privy to the un- derstanding that AI needs consistent quality assessment and security measures for the dataset administration. Augmented reality (AR) and virtual real- ity (VR) also have a place in dentistry. AR has been used in educational institutions via mannequins, on which dental students perform procedures and receive immediate feedback while their actions are tracked and reviewed. AR simulation for inferior alveolar nerve block (IANB) training has been well documented and results in more successful anesthesia using this mode of education. 12 VR allows dental students to take part in surgeries, gain experience in seeing actual Niki Carter, DMD, MPH Dental Director Delta Dental of Arkansas 3 Javaid, M.; Haleem, A.; Singh, R.P.; Suman, R. “Dentistry 4.0 technologies applications for den- tistry during COVID-19 pandemic.” Sustainable Operations and Computers, 2 (May 29, 2021): 87- 96. doi: 10.1016/j.susoc.2021.05.002 4 Alauddin, M.S.; Baharuddin, A.S.; Ghazali, M.I.M. “The Modern and Digital Transformation of Oral Health Care: A Mini Review.” Healthcare (Ba- sel, Switzerland) 9, no. 2 (Jan. 25, 2021): 118. doi: 10.3390/healthcare9020118. 5 Vilborn, P.; Bernitz, H. “A systematic review of 3D scanners and computer assisted analyzes of bite marks: searching for improved analysis methods during the Covid-19 pandemic.” Inter- national Journal of Legal Medicine 136 (2022): 209–217. doi: 10.1007/s00414-021-02667-z 6 Team Xometry. “3D Printing in Dentistry: Ap- plications and Materials.” Xometry. Aug. 8, 2022. https://www.xometry.com/resources/3d- printing/3d-printing-in-dentistry/ 7 Leonardi, R.M. “3D Imaging Advancements and New Technologies in Clinical and Scientific Dental and Orthodontic Fields.” Journal of Clini- cal Medicine 11, no. 8 (April 14, 2022): 2200. doi: 10.3390/jcm11082200 8 Weintraub, J.A. “The Oral Health in America Report: A Public Health Research Perspective.” Preventing Chronic Disease 19 (Sept. 8, 2022): 220067. Doi: 10.5888/pcd19.220067 9 Nguyen, T.T.; Larrivée, N.; Lee, A.; et al. “Use of Artificial Intelligence in Dentistry: Current Clini- cal Trends and Research Advances.” Journal of the Canadian Dental Association 87, no. 17 (May 2021). PMID: 34343070 10 Shah, H.; Hernandez, P.; Budin, F.; et al. “Auto- matic quantification framework to detect cracks in teeth.” Proceedings of SPIE: International So- ciety for Optical Engineering (March 12, 2018): 10578: 105781K. doi: 10.1117/12.2293603 11 MCCormick, J. “AI Helps Spot Dental Fraud.” WSJ Pro (Jan. 24, 2020). https://www.wsj.com/ articles/ai-helps-spot-dental-fraud-11579861801 12 Ding, H.; Wu, J.; Zhao, W.; et al. “Artificial in- telligence in dentistry—A review.” Frontiers in Dental Medicine 4 (Feb. 20, 2023). doi: 10.3389/ fdmed.2023.1085251 13 Dzyuba, N.; Jandu, J.; Yates, J.; Kushnerev, E. “Virtual and augmented reality in dental educa- tion: The good, the bad and the better.” Euro- pean Journal of Dental Education (Nov. 6, 2022). doi: 10.1111/eje12871 14 Cunningham, A.; McPolin, O.; Fallis, R.; et al. “A systematic review of the use of virtual reality or dental smartphone applications as interventions for management of paediatric dental anxiety.” BMC Oral Health 21, no. 244 (May 7, 2021). doi: 10.1186/s12903-021-01602-3 15 Kaufman, E.; Lamster, I.B. “The Diagnostic Ap- plications of Saliva— A Review.” Critical Reviews in Oral Biology & Medicine 13, no. 2 (2002): 197- 212. doi:10.1177/154411130201300209 16 DaSilva, A.F.; Robinson, M.A.; Shi, W.; McCauley, L.K. “The Forefront of Dentistry-Promising Tech- Innovations and New Treatments.” JDR Clinical and Translational Research 7, suppl. 1 (October 2022):16S-24S. doi: 10.1177/23800844221116850. procedures, and act as the clinician per- forming the surgery. Distraction has long been a device used on the dental phobic or anxious patient, and while utilizing VR sensory glasses is an untapped use in den- tistry, the future may prove otherwise with the many applications of VR. 13 Lasers, robotic dentistry, nanotechnolo- gy, smart toothbrushes, emotional dentistry, universal digital oral health records, dynam- ic navigation system (DNS), teledentistry, and regenerative dentistry are all part of this explosion of Dentistry 4.0. Today, scientists have the ability to grow enamel, which lends the question: What will dentistry look like in the future? 14 Lastly, advances in salivary diagnostics for predicting early and abnormal changes in organ systems in the body have increas- ingly been studied. 15 Groundbreaking results from saliva samples analysis have led to a compelling paradigm shift in diagnostic tests. This shift extended in facilitating mass screening programs in COVID-19 testing the past few years. 16 Saliva is easily obtained and less intrusive than drawing blood. Perhaps one day in the future, dentists will take saliva samples as a prophylactic screening means in ruling out any impending disease their patients may have. This is yet another example of the fact that it is impossible to have good overall health without good oral health. The only barriers that exist in this association and sharing technological advances are the ones we as a society place on them. n REFERENCES 1 “Pierre Fauchard – Father of Modern Dentist- ry.” History of Dentistry. Accessed March 2023. http://www.historyofdentistry.net/famous-den- tists/pierre-fauchard/ 2 Lynch, C.D.; O'Sullivan, V.R.; McGillycuddy, C.T. “Pierre Fauchard: the 'Father of Modern Dentist- ry'.” British Dental Journal 201 (Dec. 23, 2006): 779–781. doi: 10.1038/sj.bdj.4814350