Artificial Intelligence in Dentistry Today

January 1, 2022
By Lisa Germain, DDS, MScD

The original TV show, Lost in Space, was an American science fiction series, which originally aired between 1965 and 1968.  The series follows the adventures of the Robinson family, a pioneering family of space colonists who struggle to survive in the depths of space. The catchphrase “Danger, Will Robinson!” originates with the series, when the Robot, B-9, warns young Will Robinson about an impending threat.  The first season was filmed in black and white yet the futuristic concept of a robot that could be programmed with human qualities loomed large.  It is mind boggling that AI was part of the conversation before color TV.  

If you are too young to remember the original Lost in Space series or Rosie from The Jetsons, think of the dynamic and beloved duo R2D2 and C-3PO from Star Wars, or Optimus Prime, leader of the Transformers, or Lieutenant Commander Data from Star Trek, Deep Space Nine (my personal favorite). Clearly, science fiction’s great rise in popularity during the first half of the 20th century was closely tied to the popular respect paid to science at that time, as well as the rapid pace of technological innovation and new inventions. The fact is that science fiction has often predicted what has become reality in scientific and technological progress and this is probably not an accident. Creative thinking is an essential component of progress.\

So, I asked “Siri” (an acronym for Speech Interpretation and Recognition Interface) the following question, “What is artificial intelligence”? Her response came faster than you can say, “Beam me up, Scotty.” She said,  “ Here is what I found”.  She linked me to an encyclopedia Britannica definition describing it as a branch of computer science that develops machines.  It went on further to say AI is intelligence demonstrated by machines, as opposed to natural intelligence displayed by animals including humans.  

Since the development of the digital computer in the 1940s, it has been demonstrated that computers can be programmed to carry out complex tasks as varied as discovering proofs for mathematical theorems to playing chess—with great proficiency. Leading AI textbooks define the field as the study of “intelligent agents: any system that perceives its environment and takes actions that maximize its chance of achieving its goals.  The term is frequently applied to the project of developing systems endowed with the intellectual processes characteristic of humans, such as the ability to reason, discover meaning, generalize, or learn from past experience.  When you break it down to its essence, AI is a form of software designed as a sequence of operations intended to perform a specific task ordinarily attributed to a sentient being.  

While still in its infancy, AI is rapidly finding its way into the fields of medicine and dentistry.  The amount of documented information and patient data requiring storage, organization and integration has made intelligent software for computation and instant recall an essential element for optimum care. Yet, it is not being used for data processing alone.  In medicine the introduction of robotics in surgery has made procedures more predictable. It is just a matter of time before robotics becomes mainstream in the dental field as well.  

Currently, virtual assistants are helping dentists with differential diagnosis because they can take all aspects of a patient’s health history, radiographic evidence, and clinical examination notes into consideration.  While it still is not a substitute for nor does it have the reasoning power of the human brain to make a final decision for treatment, it is a powerful tool.  In addition, this technology will create more awareness of potential systemic diseases that affect the stomatognathic system. This in turn can result in patients being informed and motivated to seek early treatment for both their dental problems as well as medical concerns.  

Historically, the basis for AI dates back to Aristotle with his attempts to formulate logical thinking with three-part deductive reasoning.  The turning point for current AI technology was in 1950 when a British mathematician, Alan Turing, developed a machine that could decode encrypted messages.  He devised a test called the “Turing Test” which is designed to determine whether a computer exhibits intelligence.  This was the beginning of what we now see as robotics in the fields of aerospace and telecommunications, as well as the ever expanding areas of voice and image recognition.  It is why we now put adjectives like “smart” in front of inanimate objects such as “TV” and “phone”, and how Apple has been able to integrate retinal scanning into their products.

The innovation of artificial neural networks is what has made the biggest difference to date in the field of dentistry.  Inspired by the biological nervous system, these systems can connect dental health care professionals all over the world.  Currently, patients can use apps to enter their symptoms on their personal smart devices to determine the most probable diagnosis of an illness.  For example, “Mole Check App”, “OnlineDerm Clinic”, and “Skin XM” allow patients to help identify the possibility that a skin lesion might be a malignant melanoma because they can compare it with a vast interface of pictures of skin lesions from around the world. A similar system can be applied and implemented for self-examination of suspected oral cancerous lesions. This technology helps patients get an expert opinion at the earliest stage of disease while also helping the dental health care professionals to prioritize the appointments when necessary.  In addition to educating patients who might otherwise get misinformation from non-reliable internet sources, it can bridge the gap between the doctor and the patient. 

Today, there are many AI based virtual dental assistants available on the market. These software programs have the ability to perform a number of simple tasks for the dental office with greater precision, less manpower and fewer errors than human counterparts. Some of these tasks include:

• Booking and coordinating regular appointments that are convenient for both the patients and dentists. 
• Managing paperwork and insurance

• Alerting the dentist before every appointment about any allergies that the patient may have or changes in their medical history.
• Alerting the dentist when a patient may need prophylactic antibiotics.
• Provide support for re-care appointments and notification of regular hygiene follow up.
• Missed appointment rescheduling
• Last minute appointment scheduling when the dentist has a cancellation
• Assisting with clinical diagnosis and treatment planning.
• Providing emergency tele assistance in cases of dental emergencies when the dental health care professional cannot be contacted.  

Augmented reality and virtual reality are another way that AI is currently being used in the dental field.  The advancements in dental education have grown significantly since the inception of intelligent tutoring systems in the 1980’s.   Labs that simulate clinical procedures on patients are being widely used to increase practice time while eliminating the risks associated with training on a live patient. With the recent incorporation of AI in systems like in the Unified Medical Language System (UMLS), there is a huge improvement in the quality of feedback that the pre-clinical virtual patient can provide for a student.  The interactive interface allows the students to evaluate their work and compare it to the ideal thus creating high-quality training environments. A number of studies carried out on the efficacy of these systems have indicated that students attain a competency-based skill level at a faster rate than with traditional simulator units.

The ability of AI technology to effectively acquire information and sync it with established decision support databases, imaging systems, and, individual patient data has completely changed the way many dentists treatment plan and carry out prosthodontics, orthodontic realignment procedures, and implant cases. AI software enables a dental practitioner to create a complete virtual database for every patient, which can be both detailed and accessible at the same time. Voice recognition and interactive interfaces enable the software to help the dentist perform different tasks effortlessly.  AI software can document all necessary data and present it to the dentist much faster and more efficiently than their human counterpart. For example, it can collect all necessary dental records, extra oral photographs and radiographs necessary for diagnosing the dental condition. 

AI in conjunction with sophisticated software design currently aids many dentists in creating the best possible functional and aesthetic prosthesis for patients while considering a number of variables like anthropological calculations, facial measurements, ethnicity and even the patient’s desirable aesthetics.  The fabrication of the prosthesis is currently carried out with CADCAM technologies like subtractive milling as well as additive manufacturing technologies like 3D printing. It is beginning to replace many of the time consuming and laborious processes involved in conventional casting.  In addition, it can drastically reduce the human errors in a final prosthesis.  

In the field of orthodontics the software can perform a number of analysis on radiographs and photographs that aid in diagnosis and treatment planning. With the advent of intra-oral scanners and cameras, dental impression can be made with accuracy. These digital impressions are quicker and eliminate all the laboratory steps thus drastically reducing the number of human errors. With the help of AI, the computer can actually guide the dentist during the entire procedure of making a digital impression in addition to aiding them in taking an ideal impression.  Based on the information that is fed into the system, the set of algorithms and statistical analysis, the AI software helps to predict tooth movement and final outcome of treatment as well.

In the field of implantology and surgery, AI software has helped plan surgeries to the smallest detail prior to the actual surgery.  Surgical guides can be created, bone health assessed, and virtual treatment planning of any implant on the market can be tried in the space due to the sophistication of data base integration with almost infallible accuracy.  For this field, we have only scratched the surface of what is possible.  While not yet common place, one of the most innovative applications of AI is seen is in the field of “bioprinting”, where living tissue and even organs can be constructed in consecutive thin layers of cells which in the future may be used for reconstruction of oral hard and soft tissues lost due to pathological disease processes or trauma.

By now you might be wondering whether dentists will eventually be completely replaced by AI.   My answer at this point is, probably not in your lifetime. Still, despite continuing advances in computer processing speed and memory capacity, there are as yet no programs that can match human flexibility over wider domains or in tasks requiring much everyday knowledge.  (Maybe that’s why when I tried to instruct Alexa to do my laundry the other day she told me I was being rude).