healthcaretechoutlook

Envisioning Dentistry of the Future

By Dr. Petra Wilder-Smith, Professor and Director of Dentistry, UCI Health And Cherie Wink, Research Specialist, University of California/Beckman Laser Institute and Eileen Alice Derr, Dental Hygiene Program Director/Educator, Concorde Career College

Dr. Petra Wilder-Smith, Professor and Director of Dentistry, UCI Health

Three seasoned dental professionals put their heads together (one dentist and two hygienists) to peer into the future for both hygienists and dentists. Each professional read her crystal ball and provided a glimpse into the future. This article shares those visions with you.

Development of musculoskeletal disorders is a significant problem in the profession of dental hygiene with nearly 75 percent of all dental hygienists experiencing hand and/or wrist pain at some point in their career. Current instrument handles are hard, rigid and fixed in one configuration. They are uncomfortable to grip, increase the risk of muscle fatigue as well as long- term finger, hand, back and arm pain. In addition, they cannot access all areas of the mouth, leading to poor treatment outcomes.

Recently, uniquely manufactured material (patent pending) which is soft and self conforms to the shape of the clinician’s grasp with a 360 degree adaptive ergonomic capability has been added to traditional scaling tips. These handles maintain optimum functional shape during instrumentation, ensuring comfort and the best treatment outcomes as well as reducing clinician’s hand and muscle fatigue and risk of muscular-skeletal injury. They are made from specialized material that reduces the transmission of cold to the fingers, since low temperatures reduce manual dexterity and accentuate the symptoms of nerve-end impairment. Market research revealed that roughly 90 percent of clinical hygienists experience challenges with accessibility or adaptation and hand fatigue. With hands being the most important asset of any oral health care provider, why risk using traditional curette handles any longer?

Moving the focus from the operator to the patient, the spotlight beams on oral cancer. Oral cancer is on the rise and is more prevalent in underserved populations. Because the appearance of oral mucosal lesions is not an adequate indicator of their diagnosis, status or risk level, additional means of assessing these lesions are needed to ensure accurate and early detection, diagnosis, as well as monitoring. Most oral cancers are diagnosed in the later stages when outcomes are poor. Clinicians’ accuracy and ability to diagnose and/or refer oral cancer increase with the use of diagnostic aids. While useful, the currently available diagnostic aids still leave room for improvement. There are two diagnostic aids in the pipeline for future use which show promise: 1) Smartphone based auto fluorescence and 2) high resolution fiber-optic micro endoscope.

Cherie Wink, Research Specialist, University of California/Beckman Laser Institute and Eileen Alice Derr, Dental Hygiene Program Director/Educator, Concorde Career College

"Market research revealed that roughly 90 percent of clinical hygienists experience challenges with accessibility or adaptation and hand fatigue"

A simple explanation of those two diagnostic aids follows. A fluorescence imaging device is attached to a simple smartphone. The light images are already available through the inbuilt camera optics. After exposure, the images are forwarded to a cloud based algorithm. Inbuilt calendaring options allows for routine monitoring. Research has shown that the ability to distinguish between healthy vs. dysplastic and malignant oral mucosa is 92 – 95 percent accurate. In the future, the vision is use of this aid by non- specialist field workers; perhaps patients might eventually even be able to upload photos that they have taken and forwarded to clinicians for their ongoing monitoring.

The second diagnostic aid would use the introduction of an exogenous fluorophore such as topical application of 0.01 percent proflavine with a fiber optic microendoscope. This would allow in vivo identification of both qualitative and quantitative differences between normal and pre-cancerous or cancerous tissues. Such a portable, inexpensive device would be a useful tool assisting in the identification of early neoplastic changes in epithelial tissues at the point of care in low resource settings.

One of the truly exciting innovations in dentistry which is happening right now is teledentistry. In 2018, the American Dental Association created insurance codes for use by dental personnel, which is a sure sign that this concept is here to stay.

Teledentistry has been around for awhile (in 1994 the Department of Defense launched a program entitled “Total Dental Access”) but has just recently come into popular use. Teledentistry allows personnel in one location to share images and progress notes with a person in a totally different location either in real time or at the convenience of the second operator. Teledentistry requires a computer and a tablet or two computers, an intraoral camera, certain designated software and access to the internet.

With the appropriate technology, teledentistry can be utilized in public health, research or mobile dentistry to name a few uses. Expanded function hygienists have found this particularly useful in collaborating with dentists for oral exams. While teledentistry does allow underserved populations to have greater access to treatment, there are numerous other potential uses. Dentists and hygienists are limited only by their creativity. Since teledentistry is currently being implemented into all phases of dentistry and dental hygiene, it is critical that the concept is imbedded into the curriculum of both dental schools and dental hygiene programs. Education in the use of teledentistry is no different than teaching dental/ hygiene students any other tool which increases the chance of a positive outcome.

The future of both dentistry and dental hygiene is exciting and challenging. The above three products are examples of what the future holds for dentists and hygienists.

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