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The dentist will scan you now: The next generation of digital dentistry

Alex Howard is delighted by the modern technology at his dentist's office. He describes the dental tech he encountered during his recent visit and explains why it matters.

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Thankfully, describing some technological changes is much less painful than pulling teeth, even when the experience in question is uncomfortably close to that literal action. I'm finding that to be true as I consider my trip to a new dentist's office in Washington, DC, where I unexpectedly encountered more technology during the visit than I had at any previous practice combined.

What I found more impressive was how that technology was integrated into the practice, not bolted on to show that this office "gets" it, or introduced in an effort to modernize that creates friction, not efficiency. I left poorer, cleaner, and impressed not only by the tech but by the excellent service at the front desk and skilled care by the hygienist and the dentist. Here's a quick rundown of what I encountered and why it mattered.

An iPad at sign in

When I first walked into the office and met the receptionist, she asked me if I'd filled in the new patient form online. Whoops! I admitted that I had not, kicking myself for not getting that done at home on a keyboard and steeling myself to fill out paper forms. Instead, the receptionist handed me an iPad, offered me water, and said to let her know when I was done. Five minutes later, I was done -- and the data was already in their systems.

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 Image: Alex Howard

As a rule, I've tried to be skeptical about tablets in health IT, just as I am in other areas of technology. In 2010, Stanford gave all of its incoming medical students iPads. In 2014, iPads are now used by approximately one quarter of medical schools in the US, according to MedCity News, with at least one class equipped with them scoring 23% higher on exams.

Before the iPad came along, tablets weren't in the hands of many doctors or dentists, and for good reasons, as Dr. Atul Gawande reminded me in our 2012 interview:

"I haven't found a better way than paper, honestly. I can flip between screens on my iPad, but it's too slow and distracting, and it doesn't let me talk to the patient. It's fun if I can pull up a screen image of this or that and show it to the patient, but it just isn't that integrated into practice."

Younger doctors, armed with iPads in medical school, are going on to use them in their practices and in emergency rooms around the nation. In 2012, that was true of Dr. Gawande as well, with caveats:

"I do use the iPad here and there, but it's not readily part of the way I can manage the clinic," he said. "I would have to put in a lot of effort for me to make it actually useful in my clinic. For example, I need to be able to switch between radiology scans and past records. I predominantly see cancer patients, so they'll have 40 pages of records that I need to have in front of me, from scans to lab tests to previous notes by other folks."

In the dental practice I visited, after I'd entered my personal information into their system, checked it, and handed the iPad back, I was talking to a dental hygienist about my dental history as she read over my new patient record on her computer screen. As we discussed my teeth and gums, she updated a few fields in the record, added notes using a keyboard, and followed up on specific areas of concern that I'd highlighted. My experience was significantly improved over a paper-based system. At least one study suggests medical residents using iPads find improved efficiency as well. Score one for the tablet.

Digital x-rays

Over the past three decades of dental visits, I've grown used to radiography that use focused radiation and films to produce black and white x-ray images that the dentist slaps onto a backlit rack and discusses with me. This week, I encountered something new: digital radiography where a small sensor was used instead of photographic film.

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 Image: Alex Howard

Such digital intraoral sensors aren't cheap, with the true costs of the system exceeding the price of the hardware alone, but they have numerous advantages over older systems.

According to the hygienist, the digital radiography and intraoral sensor combination uses 90% less radiation, an eye-opening figure that I was subsequently able to confirm through the Health Physics Society.

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 Image: Alex Howard

The images the sensor captured instantly showed up on the screen in the examination room, with no pause for chemical processes, and were stored in the practice's servers. If I need to get them sent somewhere else for a referral, they can be digitally transmitted. That's handy.

"Smile, You're on Candid Toothcamera!"

The experience most likely to stick with me was the unexpected screening of a short horror film, courtesy of the intraoral digital camera in the office. After I immediately dubbed the device "toothcam," I was alternately fascinated and horrified by the trip around my mouth, which unfortunately captured footage that wouldn't have been out of place on "The Walking Dead."

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 Image: Alex Howard

As with the digital x-ray, the pictures captured from the mouthcam were instantly on the big screen in the office and were saved to my record. When the dentist arrived, we were able to use the pictures to discuss what was at issue. Their diagnostic value may be exceeded by their motivational value for this patient: one still (not shared here) will keep me flossing, brushing, and using mouthwash daily for some time to come.

I could spend several more columns discussing the impact of ubiquitous digital photography on our lives, extending previous considerations of privacy, pill identification, the right to record law enforcement, real estate virtual tours, or the ethical questions surrounding its use. The mouthcam in the dentist office was, thankfully, less ethically challenging and more useful than many of those contexts.

The next generation of digital dentistry

The best integrated technology in the dental practice may have been the most humble: scheduling software on the computer in the exam room that enabled the hygienist to book my next appointment so it would coincide with the dentist's schedule and her schedule, and to provide me with the dentist's email address so I could follow up if I had any questions.

Despite the promise of robotic dentistry, there's still no replacement for a professional, kind human on the horizon any time soon.

Also read

About

Alex Howard writes about how shifts in technology are changing government and society. A former fellow at Harvard and Columbia, he is the founder of "E Pluribus Unum," a blog focused on open government and technology.

65 comments
Pyrrhomaniac
Pyrrhomaniac

Alex, the digital x-rays seem especially promising. There are several other advancements that have improved dental work as well. Not the least of these is the development of scheduling software that many people in the comments are mentioning.  http://www.dentistryranchocucamonga.com 

Pyrrhomaniac
Pyrrhomaniac

Alex, I think that it is interesting how scheduling software can make such a big impact in dentistry. I know that almost every dentist I've been to uses it. It wouldn't even be surprising if a dentist were to tell me that it was the most revolutionary technology they've seen lately. http://familydentalcentertn.com/ 

Eugene Dean
Eugene Dean

I was really excited to read about the new digital x-ray techniques. Getting my teeth scanned has always been my least favorite part of dental checkups. Those little pads they put in your mouth are incredibly uncomfortable. As long as we can eliminate those things, I will be a happy camper.

http://www.familydentalsite.com

geraldvonberger2002
geraldvonberger2002

That's a really cool bit of technology! I'll bet it's a lot more cost-effective as well as efficient at keeping track of patient records. I also like the idea of being able to schedule something way ahead of time using the software mentioned so that I could get the same hygienist every time. http://www.ccdental.com.au

felicitysanderson1
felicitysanderson1

I've never heard of signing in to a dentist office with an integrated iPad software to be congruent with how the dentist technology works. In the digital X-ray section I noticed the new way that you first experienced digital radiography. That would be so much quicker and more cost effective. What other differences did you find with the pros and cons of this new method of digital radiography?

http://www.walkindentalclinic.ca/en/

marcusfillion
marcusfillion

I would really like to see a video of my teeth during a procedure. I'm always curious what the view is like for the dentist, because it's pretty boring on my end. And I think if people could see their teeth like that, they might be more dedicated to brushing and flossing. http://www.eastmalldental.com/en/

jameslisbon
jameslisbon

I liked how you mentioned that x-rays now have the ability to project right onto the screen.   It would seem like this could speed up the process as well as get the patient involved and able to see their teeth.   There seem to be a fair amount of advancements in the dental industry that can probably help the industry. http://www.rivercitydental.ca/dr_vandepeear.html 

kelshigs724
kelshigs724

I love that you referred to the toothcam footage as a horror film! Sometimes I can't help but feel the same way! Whenever I go to the dentist, I always feel pretty good about my teeth until they stick that camera in my mouth and let me take a look around! If there's one thing that makes me want to be better at brushing and flossing, it's that footage! http://accentdentalnwi.com/cosmetic-dentistry/ 

Pyrrhomaniac
Pyrrhomaniac

Alex, I agree that there are several advancements that have improved dental work. The most important one has gone under the radar so far.  Scheduling software has made life much easier for dentists. Gone are the days of accidental double bookings and frustrated customers. http://www.drrichardwilczek.com 

Gary Birtles
Gary Birtles

It is good to see technology advance in this field. I found it interesting that this article talked about how the future of robotic dentistry is still something far away, and it cannot replace a human dentist at this time. I think that is very true, but the technology allows the dentist to work much more effectively than ever before. <a href='http://www.riverdalenydental.com/Dental_Procedures_Dental_Emergency_Riverdale_NY_Services.html' >http://www.riverdalenydental.com/Dental_Procedures_Dental_Emergency_Riverdale_NY_Services.html</a>

tedsmith5752
tedsmith5752

This is insane! Technology has really taken off lately. I like how the dentist has all the information on the iPad. Instead of having computers in every room the dentist can take this iPad with him everywhere. It is really amazing what technology has allowed us to do. http://www.oshawadentalhouse.com/

Eugene Dean
Eugene Dean

This article has really put my mind at ease. I have not been to the dentist in over ten years, and I am going next week. I have a lot of faith in modern technology, and it is great that dentists have so much of it. That new scanning technique is particularly interesting. I have always worried about the radiation emitted by x-rays.

http://www.lindanicholsdentistry.com/About-Us/

dianabob1980
dianabob1980

Dentistry is really getting better by innovations in the techniques. I had problems with my teeth and I was so worried for that. Then I found a best dental clinic in Dubai and got rid of the problem. Such advancements will reduce our dental issues.

Tyrone Hill
Tyrone Hill

It seems like every profession is finding a way to get in on the whole technology revolution that's happening. I'm really glad dentists are getting in on it; I can only imagine how beneficial the technology can be for them. I'm looking for a dentist right now and I'm really hoping I find one that uses pretty modern methods. Then again, as long as they do a good job on my teeth and I'm not miserable during the process then I'm happy. Thanks for the article! http://www.southshoreprosthodontics.com/services/

Gary Birtles
Gary Birtles

I've seen a few of these advancements used in my own dentist's office. It seems like every time I go in, there is some new gadget they use. I'm glad to see that things are always improving. It gives me added confidence in whatever procedure I'm getting done. <a href='http://www.crestwooddental.ca' >http://www.crestwooddental.ca</a>

maryjaneprincton
maryjaneprincton

I think that it would be really nice to be able to sign into appointments with an Ipad. It is amazing how much technology is advancing every year. I think that all dentists offices should take advantage of these technologies. Something like this would definitely make it a lot easier to get information in their systems.


http://www.dental777.com.au/general-dentistry

janefairfax18
janefairfax18

It is amazing to me the advances that dentistry and medicine in general are making lately. It is becoming easier and easier to keep an eye on your health and what is going on with your body. I am sure it will be no time at all before this kind of technology is everywhere. Until then, the "old-fashioned" dentist will do, though.


 http://www.drpaolosdao.com/about_us.html

janefairfax18
janefairfax18

It is amazing to me the advances that dentistry and medicine in general are making lately. It is becoming easier and easier to keep an eye on your health and what is going on with your body. I am sure it will be no time at all before this kind of technology is everywhere. Until then, the "old-fashioned" dentist will do, though.


http://www.drpaolosdao.com/about_us.html

rbenson1
rbenson1

It is amazing how technology is changing every aspect of our life.  I really like the idea of digital xrays especially because it uses a lot less radiation.  I wonder how long it will take for dentist offices to start implementing this type digital equipment. http://www.alouettedental.ca/en/services_and_gallery.html

jameslisbon
jameslisbon

Technology seems to be advancing at a rapid pace and it has even entered the medical field in various ways.  If the different scans and evaluations can speed along the process and make it easier, then they are probably good things.   I would think that there is a fair amount of accuracy as well when using dental technology. http://www.northridgedental.ca/en/ 

sfreddson2156
sfreddson2156

This is absolutely fascinating! I think it's amazing how technology is permeating every industry. Do dentists use apps like the ones you pictured currently? It seems like an efficient way of keeping records. Thanks for sharing these interesting developments with us. This was a great hub, voted up! http://www.lynncreekdental.ca/our_products_and_services.html

geraldvonberger2002
geraldvonberger2002

This technology sounds like a great thing to have around. Dentists already do some amazing work and this will just help the visit go more smoothly. I think you're right about visiting the dentist on a regular basis. It's good to know that there are dentists that are working to make those visits more pleasant. I think more people will want to go to the dentist because of this work. http://www.absolutesmiles.com.au

paul_bear
paul_bear

I guess the adage is true—there's an app for everything now. Having one device to perform all those functions, including scheduling appointments, is convenient and amazing. Patients being able to take home their own x-rays and information on a tablet or smartphone would be an added bonus. http://www.vanyodentistry.com

paul_bear
paul_bear

I guess the adage is true—there's an app for everything now. Having one device to perform all those functions, including scheduling appointments, is convenient and amazing. Patients being able to take home their own x-rays and information on a tablet or smartphone would be an added bonus. http://www.vanyodentistry.com

laceyrockwell83
laceyrockwell83

Technology never ceases to amaze me! It seems every time I go to the dentist, they have some new gadget. I really like that, just because it seems to help with the whole dentist experience. I don't love going to the dentist office, so anything to help with that, I am willing to try.


http://www.parkavepd.com/services/sedation-dentistry 

jameslisbon
jameslisbon

That is interesting when you talked about tooth cameras getting more sophisticated.   It seems like the technology is getting better with time.  My uncle worked as a dentist for years so I think he might have some good opinions on the subject.  Thanks for the article! http://www.fourcornersdentalfairbanks.com/about 

jamesclarkson93
jamesclarkson93

@jameslisbon Dental technologies has made great strides in recent years. It is incredible how much they can implement the use of digital technology in the dentist office. When I was a child we had to wear a lead bib and have x-rays taken. Digital technology will not pose the health risks that are associated with radiation.

http://www.westwooddentalcoquitlam.com/about-1

caaseyboostjones
caaseyboostjones

It is awesome how technology in enhancing the dental field.  When I went to get my teeth cleaned the other day, I noticed my dentist also had one of those digital displays for the xray machines.  I am glad to hear it has 90% less radiation than the older x-ray machines.

http://www.highlandadvanceddentalcare.com 

DavidHiltz
DavidHiltz

That's amazing that they can do that nowadays with modern technology. I program for various places and I was asked to write a few programs for a dental office. It was very interesting to see how they would do things. I also learned a lot about how the body is impacted by the teeth. It was all very facinating.

http://www.jeffcottdentalclinic.com.au 

rbenson1
rbenson1

I hope my dentist office gets digital x-rays soon. I love the idea of having less radiation when I get the x-rays done.  I have a small mouth and I hate getting regular x-rays because it hurts.  How do they take an x-ray digitally?    <a href='http://www.guerradental.com' >http://www.guerradental.com</a>

skyjensen
skyjensen

I have such a hard time getting my kids to go to the dentist. However my kids love technology and these advances might make them excited to go. The biggest problem for them is getting there teeth x-ray. Their mouths are so small that biting down on that plastic white thing hurts. It seems like getting their teeth digitally scanned will be way better for them.

 <a href='http://www.southdaledentaloffice.com' >http://www.southdaledentaloffice.com</a>

JamesSimon123
JamesSimon123

To be honest, this sort of technology should have probably been implemented long ago. I hope it becomes more widespread. The technology exists, so why not implement it? It's being implemented in other areas. Maybe tech that high isn't necessary, but it sure is cool.

http://www.djydental.com.au 

Ashleyreed
Ashleyreed

I think in twenty years everything will be digital, it's already starting to replace papar. I like that things are becoming more digital though, so if you move you can just have your information sent over. I wonder if my new dentist uses iPads to sign in or not, I guess I'll find out next week! http://www.dentalmed.ca/services 

17nathansouza
17nathansouza

The "toothcam" is what I find most interesting about your high tech visit to the dentist! We always see in movies people going on adventures in the human body after being shrunken to a microscopic size. This makes it strange a bit surreal to be able to take a guided tour of your own mouth! I think that this kind of thing would probably help me have better dental hygiene.
http://www.campbelldentalcentre.com/

JaxWillis23
JaxWillis23

It's interesting to see how much technology is advancing and becoming a part of our daily lives. I definitely never thought that a dentist's office would use this much technology when I was a kid. I hope these types of trends continue to grow over the next few years. It will be really cool to watch it all develop.

http://www.concerneddentalcare.com/about-us/ 

angelakillpack
angelakillpack

I noticed my dentist's office had iPads when I was in there last too. I think they really like that it's portable and they can have the whole system on there. I've also really liked the digital x-rays! They used to be uncomfortable things that you had to bite down on and not it's a lot easier. I hope they keep getting better and better technology to help us care for our teeth! http://www.lawrencechendds.com 

Shining Smiles
Shining Smiles

Shining Smiles is a modern dental office for the entire family. We havelocations in Plainfield IL 60585 and Bolingbrook IL 60440. We performCosmetic dentistry, dentistry for kids, Implants, Braces, Root Canals,Wisdom teeth extractions, Veneers, Whitenings, Cleanings, Emergencytreatments, dental check ups, and much more. We treat adults and childrenand accept all PPO insurances and All Kids. 

http://www.shiningsmiles.com/
radiocarl
radiocarl

" Five minutes later, I was done -- and the data was already in their systems" And since it was done on an Ipad Apple had all the information also

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