The rise of the machines

By Dr Colm Harney Dentolegal Consultant

Practice Management

Drip, drip, drip ... technological advances are moving into the dental space, becoming ever more efficient, and this is exciting news for patients and practitioners everywhere. Digital cameras, 3D scanning, digital radiographs – these are tools of daily practice that most of us take for granted now. However, at risk of showing my age, none of these even existed for practitioners when I graduated as a Dentist.

But what about the next step? What is looming on the horizon? How many bank tellers 20 years ago would have forecast the way a local bank looks right now – we now don’t think twice about standing in line to interact with a machine built into the wall? 

The Center for Global Policy Solutions produced a report in 2017 stating that “more than 4 million jobs will likely be lost with a rapid transition to autonomous vehicles” (1). This has proven to be premature as the date for fully autonomous vehicles keeps getting pushed back, but there is no doubt with the drive (no pun intended) of visionaries like Elon Musk and his competitors this is a sure bet. What about dentistry – how vulnerable are we in our day-to-day practice to the rise of the machines, and what might the downstream implications be?

I have a keen interest in this area and have listened to a number of medical and dental radiologists speak about this over the years – they really are at the front line of this phenomenon. Take an image, run it through software, which can access a database with millions of comparable images, and out the other end comes
a report with none of the flaws relating to human error, biases and any other foibles of the wet-brained
human viewpoint. 

Each radiologist has responded by acknowledging the advances and saying that where the human still adds immense value is stepping out of the dark room and away from the computer screen to interact and communicate with the patient - interpretation and explanation of data to assist the patient (and referring practitioner) understand, differential diagnoses, what happens next, and all this information delivered with empathy, care and consideration. This is where their value is added by their role as living, breathing, human specialist experts.

This progression has now reached the doors of the dental practice. Pearl, a dental AI company has produced ‘Second Opinion’ which, as of March 2022, claims to be “the first and only chairside FDA-cleared AI radiologic detection aid that can help dentists identify numerous common dental conditions.” (2)

As dental professionals it is hard to envisage a scenario where AI takes over all our primary technical tasks, however, recall those bank tellers and the 4 million humans driving for a living whose jobs are in the firing line. It is worth considering that we could be sleepwalking to a time, not very far away, when a machine in a shopping mall booth will 3D scan and image a patient’s mouth and they will leave 5 minutes later with a detailed, accurate, itemised treatment plan in their hands and continue with their day.

Right now, our clinical skills are still required and very much in demand, and we must continually work to understand and improve our knowledge of what we are able to do in terms of diagnosis, treatment planning and provision of care. The machines are coming, and as the evidence points to the increasingly superior performance of the technology and machinery, a tipping point will be reached where it will no longer be clinically justifiable that a human carries out certain procedures (witness the boom in scanning and milling already which, in the right hands, is getting closer and closer to what the best human can do). 

As sophistication increases and capital costs decrease, the machines will become more and more attractive to practice owners as they won’t require lunch breaks, sick days and over time. Neither will they develop a bad back nor suffer declining eyesight.

It is also equally, if not more, imperative that we continue to understand and improve our communication skills – the so called ‘soft skills’ – which is what patients really relate to when they visit us. Patients don’t understand what we obsess about - chamfered margins, selective etching, filler size or perfect cusp shaping and fissure staining. They understand that we asked about their recent holiday, listened to their concerns, gave them appropriate choices and autonomy, creating a relationship based on trust and mutual understanding. 

Ultimately, how effectively we communicate conveys that we are acting in their best interests. When they experience this, they will be much more likely to return for treatment, comply with instructions, and recommend friends and family. The literature is clear from multiple sources that they are much less likely to make a complaint, even if something goes wrong.

In relation to the advance of technology, we, as a profession, should start to consider possible implications for our job descriptions, standards of care for our patients and even the overarching ethics of dental practice. Indeed, Federal ADA has already given this matter consideration and has released a policy statement relating to this very area (3).

Which procedures / aspects of dental practice will be more suited to AI / machine replacement? 

What degree of professional and regulatory oversight is required? We already have a cohort of patients bypassing the ‘bricks and mortar’ based professional and choosing to go online to purchase kits for whitening and orthodontic aligners, with varying degrees of professional oversight.

Should there be a requirement for the machines to demonstrate an equivalence or net benefit over the current accepted standard of care – a dental equivalent of the Turing test?

What will patients prefer and what will precipitate the ‘tipping point’ – price, convenience, guaranteed accuracy, painlessness? 

So, the next time you telephone your bank and sit on hold for 30 minutes waiting to speak to customer service, which will often initially be a machine (select from options 1-4 and press #), think about the value you add in your role in the human-to-human interaction with your patients. It costs nothing to greet them with a smile, ask about their day and demonstrate that you care in a myriad of different ways, all before picking up a handpiece. Just like the radiologists, your value-add is if you can deliver this service in a manner that demonstrates your empathy, care and consideration.

Dentistry is still a relationships business. Perform this aspect of the role well, with purpose and intent, and not only will you enjoy a fulfilling career with more satisfied patients and less complaints – ultimately, when the time comes, those patients who value and trust your care will stick with you and forego the shiny white treatment pod coming soon to a shopping mall near you.




(3) ADA Federal Council, November 20, 2020. Policy Statement 6.34

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