The field of dental medicine is ripe for disruption. Artificial intelligence (AI) is beginning to integrate into administrative tasks, personalized treatments based on unique patient risk factors, and into the prosthetic workflow. With risks and hallucinations of AI models managed, AI has the potential to create a more efficient, personalized, and effective dental experience. However, widespread adoption of AI within the field remains limited.
In this fictitious case study, we explore the potential of AI in dental medicine, highlighting possibilities for change within both administrative and clinical practice. Of note, GPT-4 was used for interactions with the patient and the large language model.
Fictitious case study
Joe has always hated the dentist. The distinctive smells, sounds, and feeling of vulnerability while sitting in the dental chair have kept him away from routine dental cleanings and necessary checkups. Last night, however, the pain on his lower molar was excruciating—a throbbing pain extending deep into his lower jaw, making it nearly impossible for him to sleep. For Joe it was clear: he needed to see a dentist.
A conversation with the dental AI assistant
Joe opened up MolarMate, a dental AI assistant he had seen online.
Joe: “I have throbbing pain on the lower left part of my mouth. It is keeping me up at night. What could this be, and what should I do?”
MolarMate: “Throbbing pain in the lower left part of the mouth can be a sign of several dental issues. The most common causes include:
Tooth decay or cavity: If the pain is localized to a specific tooth, it could indicate decay or a cavity. The discomfort tends to intensify when eating something hot, cold, or sweet.
Tooth abscess: An abscess is a serious infection that occurs when bacteria enter the tooth pulp.
Gum disease: Perio-dontal issues like gingivitis or periodontitis can cause discomfort and sensitivity in the gums and teeth.
Impacted wisdom tooth: If the pain is toward the back of the mouth, an impacted wisdom tooth could be the cause.
Temporomandibular joint disorder (TMJ): Issues with the jaw joint can lead to discomfort radiating through the lower jaw.
“To address the issue, consider consulting a dentist. What is your availability like for the coming week? I’ll schedule an appointment with a dentist in your network.”
Knowing Joe’s location, insurance, and calendar, MolarMate schedules an emergency visit with a local dentist: Dr. Grin.
Preparing for the dental appointment
Before the visit, Joe gives MolarMate his medical history, dental history, and relevant allergies. The information is summarized and inserted directly into Joe’s chart for Dr. Grin to see.
Joe confides in MolarMate:
Joe: “I have extreme dental anxiety. Please help me find ways to relax before the visit. What should I expect?”
MolarMate: “Dental anxiety is quite common, and there are several strategies you can use to manage it effectively. Here’s how you can prepare and what to expect during your dental visit:
Deep breathing: Practice slow, deep breaths to calm nerves.
Progressive muscle relaxation: Tense and relax different muscle groups.
Distractions with music or audiobooks: Bring headphones and listen to soothing music or an engaging audiobook.
Sedation: Ask your dentist about nitrous oxide, oral sedatives, or IV sedation.
Before your visit: Avoid caffeine. Consider bringing someone for emotional support.”
The day of the dental visit
Upon arriving, MolarMate has already sent all insurance and background information to the dental office.
Joe has a full-mouth radiographic series taken, which is analyzed by AI Computer Vision for signs of decay and bone loss. Dr. Grin views the prelabeled radiographs when conducting her exam.
Following the exam, Dr. Grin makes her diagnosis: “Joe, your left mandibular first molar has a deep cavity that has reached the pulp: you have irreversible symptomatic pulpitis.”
AI dental software integrated into Dr. Grin’s dental software uses multimodal diagnostic data of Joe’s medical history, chief concern, HPI, radiographs, etc., to compile a list of potential treatment options with their associated in-office costs for Dr. Grin to present to Joe. MolarMate sends Joe a guide on each possible treatment plan and the associated benefits and risks with image explanations for each distinct plan. Joe can interact with MolarMate to ask specific questions regarding each plan in a chat-based format.
Joe decides to proceed with treatment: root canal on tooth no. 19 with a crown following the procedure.
The AI Computer Vision software has given Dr. Grin a rough estimate of the number of roots and their associated working lengths of tooth no. 19. She proceeds with a root canal, and Joe can use anxiety management tools with the help of MolarMate.
The root canal is successful, and Dr. Grin instructs MolarMate to send detailed post-op instructions, including which medications to take, dosages, and explanations of safety precautions. Chair time is saved for Dr. Grin, allowing her to see another patient, and Joe can chat with MolarMate regarding his unique case. Following proper healing, Dr. Grin is ready to begin preparing the crown.
Making and delivering the crown
A 3D scanner is used to take a digital impression of the crown preparation. Using data from previous scans and associated success or failure rates of similar crowns, the software guides Dr. Grin: “Recommend occlusal reduction of 0.5 mm more on the mesiolingual cusp and address the distal undercut.” Dr. Grin makes the relevant changes, rescans, and allows the software to create an idealized crown shape, thickness, and material choice.
Joe is told to walk around the shopping plaza, find some lunch, and return in three hours. CAD/CAM in-house printing allows for same-day crown fabrication.
Dr. Grin welcomes Joe back into the dental chair and begins the crown delivery process. With the custom-designed crown prepared, margins, occlusions, and contacts checked, and radiographs confirming findings, Dr. Grin cements the crown.
Dr. Grin informs MolarMate of the procedure, and Joe leaves the office thrilled, pain-free, and ready to use MolarMate for relevant post-op instructions. He receives tailored follow-up care recommendations based on his medical history and treatment details, schedules his follow-up appointment, and plans his next cleaning, ensuring he stays on track for a healthy recovery and future dental care.
Editor's note: The article appeared in the September 2024 print edition of Dental Economics magazine. Dentists in North America are eligible for a complimentary print subscription. Sign up here.
