Christian S. Stohler, DMD, DrMedDent, Dean, Columbia University College of Dental Medicine & SVP, Columbia University Irving Medical Center
If you fell asleep in a dentist’s office in 1968 and awoke in 2018, you would hardly be astonished by the way your 21st century provider cleaned, filled, or extracted teeth. Dental practice has stayed largely the same over many decades.
But you’d be in for a shock if you woke up in 2028. Like other disciplines, dentistry is poised for dramatic changes, spurred by new information technologies. Artificial intelligence (AI) will prove crucial to this revolution.
"With help from AI, dentistry can develop new insights into the delivery of care"
Researchers are starting to assemble vast data sets of health conditions and treatments, including in dental medicine. With AI to convert data into knowledge, and supportive technologies that put such knowledge to work, dentistry—like medicine—will develop ways to give patients better care and a better experience than possible before.
Columbia University College of Dental Medicine (CDM) is paving the road toward that future by developing technologies to collect and gain insight from data related to oral healthcare and tying it to electronic health records. CDM’s Center for Precision Dental Medicine has developed biometric sensors that will be embedded in each patient chair, video cameras that are trained on patients and clinicians, and radio frequency identification (RFID) tags attached to instruments, to collect volumes of data that, especially when tied to unified electronic health records, will inform dental practice. With this data, IT systems can track vital signs tied to stress levels, monitor minute details of procedures and interactions, and track long-term outcomes. With help from AI, dentistry can develop new insights into the delivery of care.
AI could transform day-to-day dental practice. Today, dentists rely largely on experience and judgment to determine, for example, how much pressure to apply in a procedure, or how to position an instrument. Differences in judgment lead to different approaches from one dentist to another. In the future, data collected in real time will help identify which practices produce the best outcomes, helping dentists refine techniques and shortening the learning curve for dental students.
With AI to analyze thousands of data points, machine learning (ML) algorithms could calculate, for instance, exactly how much pressure to apply during a specific procedure. A dental practice could then use smart instruments to coach dentists as they work, helping them follow optimal techniques. Intelligent machines could help a dental practice avert the small mistakes that often go unnoticed today, but that might cause problems for patients years in the future.
In addition, as AI-supported systems monitor a patient’s stress levels, based on factors such as heart rate and facial expressions, the coaching system could suggest, in real time, how to make that patient more comfortable. As the dentist works, the system could collect data on the techniques, chair positions, and other factors that make each patient feel most relaxed, and automatically make adjustments on that patient’s next visit.
AI will also open doors to precision dental medicine, basing diagnosis and treatment on a fuller understanding of oral health as an element of total health.
The Center for Precision Dental Medicine is located within the Columbia University Irving Medical Center, and Columbia will be among the first academic institutions to combine electronic dental and medical records in a unified system. When AI mines those records, dentists could diagnose disease based on thousands of data points, including health history, genetics, environment, and other factors.
Bioinformatics, which applies advanced analytics to biological data, can reveal patterns in health records that previously went unnoticed. The knowledge gained will let dentists customize treatment and preventive strategies for individual patients. We might learn (for example) that one treatment for periodontitisis most effective for pre-diabetic women under 30, while a different treatment works best for men over 60 with a family history of heart disease.
With systems to analyze data from combined records, medicine will gain new knowledge from dentistry, just as dentistry has long benefitted from medical discoveries. Many chronic health conditions—such as diabetes and heart disease—are linked to oral disease. When researchers examine thousands of parameters related to patient health, they are bound to discover new connections.
For example, we might learn that, in a certain population, periodontitis is closely linked to a particular type of cancer. When a dentist diagnoses periodontitis in a patient from that population, that could trigger a referral to look for other health problems. Discoveries that improve communications among health care disciplines will help us save more lives.
Finally, AI will help dentistry automate some simpler processes, performing those tasks faster and better, letting clinicians focus on their more demanding work. In 2017, the FDA approved a robotic technology that guides a surgeon while placing a dental implant. Some orthodontists today use robots to bend wires for braces, ensuring that the wires exert optimal pressure for a specific patient. We will surely see more robotic dentistry in the future with more intelligence built into those systems.
Today, Columbia’s Center for Precision Dental Medicine uses advanced digital systems to support instruction and research. Scientists and innovators will continue to leverage emerging technologies, making new discoveries, disrupting old models of practice, and launching a new era in oral healthcare.