By Brett Kessler, D.D.S., ADA 14th District Trustee
From the Summer 2023 Journal of the Colorado Dental Association
In 2014, I wrote an article for the Journal of the Colorado Dental Association, “Who is John Galt? Disruptors in Dentistry.” It won the runner up for the William J. Gies Editorial Award for the best editorial that year. In the article, I referenced disruptors in our lives that were fairly new to the market such as Amazon, Apple and Netflix. It is amazing how these companies have affected/changed our culture. All of them capitalized on the advancement of stronger computing mechanisms and memory storage (laptops, PCs, phones, tablets and wearables) and more readily available internet bandwidth (wifi, 5G, fiber internet) – all leading to an easier-to-access and exponentially more user-friendly internet.
In 2014, I recognized DSO’s as a disruptor to the dental market. As CDA president, I challenged every dentist in our membership to welcome DSO dentists into our community, mentor them and learn from them. Many new DSO and group practice models have appeared in our communities since then and are highly successful. Little did we know that the DSO market now accounts for 21% of practicing dentists in Colorado. Over 30% of dentists in their first five years of practice are in a DSO setting.[i] The solo private practice market is shrinking but still thriving. Many have joined together creating large group practices to create efficiencies. Many have joined buyer’s groups such as Smile Source to get a reduction in costs for dental supplies. Many have incorporated membership plans within their practices to create deeper relationships with their patients.
The ADA Council on Dental Practice has identified many new disruptors entering the market in dentistry. As I mentioned earlier, our new cultural norms driven by constantly improving digital technology, the opportunities for disruption in the traditional dentistry model with digital transformation are unlimited.
In office CAD/CAM is now highly prevalent in our practices. Digital scanners are replacing traditional PVS and alginate impressions. Digital workflow for planning implants and prosthetic design integrating CT-scans, digitally designed and 3D-printed dentures are becoming more widespread. 3D printed crowns and temporaries are on the horizon.
As these technologies become more prevalent, patient care has become more predictable and efficient.
Teledentistry is being used to screen/evaluate patients at their convenience. Patients are wanting to go online to schedule their appointments, pay their bills and even leave a review.
Artificial Intelligence (AI) and Augmented Intelligence (AuI) have been around for several years, but now are becoming a new frontier in healthcare. Karen DeSalvo, M.D., M.P.H., chief medical officer at Google, said in an interview with the New England Journal of Medicine, “Silicon Valley is predicting AI will create a seismic shift in health care akin to the invention of the internet and smartphones.” And without surprise, Google and other companies are investing in AI in the healthcare space.
I am sure you have heard about ChatGPT (www.openai.com), an open-source AI interface that was introduced earlier this year. Playing around with the program, I am amazed at what it already can do. I asked it to create post op instructions after an impacted wisdom tooth extraction. This was formulated in less than 30 seconds. I can modify it to my liking and hand it to my patient. My patient can also access ChatGPT online if I am not available to ask specific questions – in essence making it a “virtual assistant.”
You may be thinking that there is no way that this technology could replace the personalized attention to our patients that we pride ourselves in. It may not be there yet, but I see the potential and encourage all of us to be open to the possibilities.
Consumers are using virtual assistants in their lives though programs like Siri and Alexa. It is always available and provides answers to our commands with ease. People now expect the immediate access that Siri and Alexa provide in many areas of their lives.
Google created an AI platform called Med-PaLM. Physicians programmed Med-PaLM with all the information a medical student will receive in their education. In version 1.0, the program passed the medical licensing test (USMLE) with a 67.5%. This is a test that requires logic and critical reasoning to determine the readiness of medical students to practice medicine and is required prior to residency training. As they improved the technology, it now passes the same test with an 85.4% rate. This proves that AI can be taught to the level of humans in medical training. (I think of the character “Data” from Star Trek, the Next generation.)
AI and AuI are currently being used in dentistry. It can recognize decay and alveolar bone loss on digital radiographs with precision that is better than the human eye. It is being used to trace margins on digital scans and design crowns, occlusal guards and dentures for 3D printing and CAD/CAM milling. It is answering questions for our patients on chat-boxes present on our websites. This is creating efficiencies and positive patient experiences.
Dr. DeSalvo encourages medicine to embrace this new technology. We, in dentistry, need to as well. This needs to happen with dentistry not to dentistry. This can only happen if we are constantly considering new ways that this can be beneficial to our practices.
There is a saying in the Artificial Intelligence circles, “AI won’t replace doctors. But doctors who use AI will replace those that don’t.” AI can be your virtual assistant to improve the experience you have with your patients. It will complement the relationships we have with our patients, our labs, and those we do business with. It will create efficiencies that will make things easier and cheaper.
AI is limited by our finite beliefs. Its impact will be unlimited based on our imagination.
Disruptors will disrupt, the status quo will dig in. Where will you be on this spectrum?
“Who is John Galt?”
[i] Trend Report, June 2023, Health Policy Institute, American Dental Association.