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Dr. John Flucke is in private practice in Lee’s Summit, Mo. He also serves as technology editor for Dental Products Report magazine and keeps an active blog filled with thoughts and tidbits on the world of technology at blog.denticle.com.
Being the kind of practitioner we all desire to be requires a serious commitment.
I remember when I graduated from the University of Missouri-Kansas City (the date is now rapidly approaching when dinosaurs ruled the Earth), one of my instructors told me my diploma was just a passport to a lifelong commitment of learning.
Deep down inside, we all understand that, and many of us continue to consume as much educational data as our grey matter can assimilate. However, in this month’s column, I would like to ratchet that up to another level or approach the educational concept from a bit of a different angle (hey, I’m an obtuse guy after all!).
For most of us, when you speak of “dental education,” the concept imparts one of two concepts: either a CE course taken by the doctor and/or team or perhaps patient education, where the doctor and team strive to impart important knowledge and/or concepts to patients in an effort to help them improve their dental or overall health and quality of life.
Both of these concepts are extremely important to what we do, and both are extremely important ways to help serve our patients. However, I will go out on a limb here and state there is another educational format that is just as important as those previously mentioned.
This other format is self-education or, more importantly, educating ourselves about each patient through the process of data gathering, data evaluation and properly assimilating all current and relevant diagnostic data to help create a proper overall “big picture” scenario of the patient.
Thanks to the proliferation of digital data in our practices, it is now easier than ever to perform data collection that allows us to create a much more discernible “big picture” of our patients. This, if properly created and used, can help us make better decisions, including helping us determine when even more data is needed to help us make a better decision.
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There are many facets to this overall data collection, but, for this article, let’s focus on imaging, as it is one of the most critical components.
It’s hard to get the experts to agree on just how critical vision is to the human existence, but it’s not unheard of for said experts to say around 85 percent of what we learn about our environment comes to us from our eyes. The next sense is hearing, which accounts for around 11 percent of what we perceive about our environment.
Now, I’ve never seen any type of scientific analysis on how those percentages relate to our diagnostic process/decision tree, but I think most of us would agree that, in evaluation of the presentation of clinical symptoms, we discern much more visually than from what we hear. Because of that, I would randomly estimate that at least 85 percent of our diagnostic data comes to us visually.
As my ability to store and analyze data digitally has increased during the last 20 years, I find myself doing more trend-comparative analyses of different diagnostic realms and devices.
Let me provide you with an example. One of the really insightful and forward-thinking things I like about the DEXIS CariVu device is the way it connects/interfaces with DEXIS software. When a new CariVu image is taken, the software pulls up the last bitewing taken of that area and displays the CariVu image and the bitewing side by side. This allows the team to quickly and easily compare the current bitewing to the most current CariVu image. By allowing multiple views of the area with multiple devices, DEXIS gives the doctor as much visual diagnostic data as possible. Needless to say, this merging of visual clinical data from multiple sources allows for the doctor to be able to quickly and efficiently ascertain all pertinent data and use it to provide an accurate diagnosis.
The great advantage of this has begun to evolve as the digital aspect of my practice has grown over the years. Because of the technologies’ storage capacity, the ability to maintain digital radiographical and just plain graphical information has allowed me to accrue more information, which then allows me to make better judgments.
For example, utilizing a visual caries detection system (such as Air Technique’s Spectra device or ACTEON North America’s SoproLIFE or SoproCARE) allows me to get a “baseline” reading of what the tooth looks like-before any enamel breakdown occurs. Then, when breakdown begins, I have an idea of how quickly it can occur, how severe it is when it occurs, etc.
The proper imaging and storage tools allow the doctor and team to get proper baseline readings that can then provide adequate pre-operative diagnostic data. We can also compare these images to previous bitewings, PAs, etc., by opening previous radiographic exams. In this regard, it’s no different than the CariVu (it’s just not quite as efficient because it requires users to open the images themselves).
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With current technologies, it is possible for sensors to provide consistent and state-of-the-art dental imaging that allows outstanding control coupled with a feeling of true autopilot.
This is something that can be easily applied to today’s data from a 2D standpoint. I often tell patients the longer I have them as patients in my practice, the more comfortable I feel in the decision-making process for them-especially in the realm of two-dimensional diagnosis.
By that, I mean comparing digital caries diagnosis (visual detection devices such as SoproCARE and/or SoproLIFE from ACTEON, Spectra from Air Techniques and The Canary System from Quantum Dental Technologies). *
I hope we can soon have this type of discussion regarding 3D as well. The amount of patient radiation exposure has dropped remarkably in the past couple of years (led by the i-CAT FLX from Imaging Sciences and Instrumentarium’s OP300 Maxio), and I feel this radiation drop will continue as the profession continues to demand it. Drop of exposure has been rapidly achieved by developers and continues to be a very popular sales feature for cone beam devices. As cone beam devices such as the i-CAT FLX become a bigger part of what we do and how we diagnose, our diagnostic paradigms will continue to shift.
When you combine the rapidly expanding use of cone beam computed tomography (and with good reason) and then factor in devices such as the NOMAD Pro handheld X-ray generator (which threatens to eliminate the entire product category of wall-/cabinet-mounted dental X-ray exposure generator), this entire category of diagnostic devices becomes capable of a “second life” when paired with the aforementioned digital caries detection devices.
By creating the ability of low/minimal/no radiation monitoring of carious lesions, the dental profession’s entrance into tracking caries by the human body’s most accurate and well used sense is finally within our grasp.
*A bit of an explanation is required here. All four of the systems mentioned above detect decay in the X, Y and Z axes. However, because I am discussing comparing these devices with bitewing radiographs and/or periapical radiographs, this limits my discussions to two dimensions (depth of the lesion from a mesial or distal contact to the pulp and height from a cervical to occlusal dimension). I cannot discuss the lesion size from a buccal to lingual or labial to palatal dimension because that area (which I would refer to as the “width of the lesion”) cannot be determined from the orientation of the “receiving medium.”