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.
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.
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.
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.
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.
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."
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.
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