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Dr Vinati Kamani, a medical doctor turned writer, writes about emerging healthcare technology and their applications across industries for Arkenea. She is an avid reader and self-proclaimed bibliophile. When Vinati is not at her desk penning down articles or reading up on the recent trends, she can be found travelling to remote places and soaking up different cultural experiences.
The dental IT revolution is in full swing, but watch out for the next big technology - the Internet of Medical Things, popularly known as IoMT.
The field of dentistry has historically been a technology-driven healthcare domain. It has proven to be one of the forerunners when it comes to adopting new technological revolutions. From CAD/CAM techniques and 3D printing of models to use of advanced visualization techniques, the applications of technology in dentistry are widespread.
The dental IT revolution is already a reality and the next big technology that would have a profound impact on patients as well as practitioners, is the Internet of Medical Things, popularly known as IoMT.
What is Internet of Medical Things?
A network of interconnected computing devices with the ability to share data and have communications across the server is called as internet of things. When the data being transferred is medical, health and fitness related, it is commonly known as the Internet of Medical Things.
Popularly known as smart devices in the market, the list of connected devices currently available is growing constantly. The list of appliances ranges from smartphones to smart homes and the possible applications are limitless. In medicine, smart devices as a part of the internet of medical things are not only revolutionizing self-health management, but it is also facilitating better healthcare management via telehealth and remote patient monitoring. They all communicate with some server hosted on the internet, either directly or indirectly by using your phone or wireless router as a gateway.
IoMT devices have already found footing in the field of conventional medicine. From fitness wearable to clinical grade and hospital wearables, the devices have numerous applications in human health and the field of dentistry is soon to follow.
The connection of the IoMT devices to the healthcare IT framework is not only of immense benefit to the patients availing the services but it also makes life easier for the practitioners.
Current and Future applications of IoMT in dentistry
1. Smart toothbrushes for improved home care
The struggle to demonstrate the correct tooth brushing techniques to the patients is something every hygienist and dentist can relate to. “Hold the toothbrush at an angle of 45 degrees” is something that is conveyed to all patients, but the compliance of the advice is doubtful. Electric toothbrushes eliminated some of the challenges manual toothbrushing techniques posed but measuring their effectiveness has always been a challenge.
Smart toothbrushes are already in the market and are revolutionizing home care practices. These devices operate like the conventional electric toothbrushes, but they have built-in sensors. This gives them the capability to collect user data and send it over to the connected mobile devices. Patient care is becoming more mobile-oriented, and IoMT devices are instrumental in letting the patients be in charge of their own health while easily sharing this data with their dental practitioners.
Empowered by this data, hygienists and dentists can make recommendations regarding a change in brushing techniques, duration of brushing and the amount of pressure to be applied while the patient is brushing their teeth.
Analyzing the brushing techniques is just the tip of the iceberg of what IoMT powered toothbrushes can actually do. Advanced connected brushes capable of providing a comprehensive intraoral examination without the patient ever having to visit the dentist is a possibility in very near future. This could be pretty great in cases where the patient suffers from a phobia of visiting the dentist and could even be utilized as an alternative to routine checkups.
The brush would take intraoral images which are then sent over to the server. Artificial Intelligence algorithms would analyze these images and scan them for signs of cracks, caries or any other abnormalities which require a specialist’s attention. If the preliminary scans show anything of concern, both the patient, as well as the clinician, would be notified via mobile apps and the suggestion to make an appointment at the dental clinic would be made to the patient.
These devices promise a much-needed boost to the segment of preventive dentistry through which dentists can identify the warning signs before it’s too late and catch the progression of dental diseases in the preliminary stages. Work is already underway on development of smart toothbrushes with a HD camera fitted into it with development of Prophix, which is currently in the pre-order stage and has the capability to connect wirelessly via bluetooth and wi-fi to the mobile apps.
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2. Mobile apps for practice management
Gone are the days when elaborate appointment registers and conventional pen and paper-based systems were used for managing the dental practice. Dentists now have the choice of numerous practice management software platforms as well as mobile apps. IoMT devices such as smartwatches with connected mobile apps are transforming practice management.
Ruffling through the previous medical and treatment records just before the patient enters the dentist’s office negatively affects your productivity. The vital patient data about the treatment scheduled, past procedures performed, and the previous medical and drug history is something that should be easily accessible to the dentist before the patient enters the clinic.
This not only increases the dentist’s productivity and efficiency, but it also leads to better workflow and time-management practices. The dentists can cater to a greater number of patients through the day which directly results in increased revenues for the dental practice and better practice management.
A strategic roadmap is the first requirement for leveraging technology for dental practice management. There are a number of practice management software that are commercially available. Use of IoMT to sync the software application with smart devices like smartphones and smartwatches can bring the clinical practice management at the fingertips of the dental practitioner.
A practice management software platform that is synced with a mobile app and utilizes IoMT can be capable of displaying all the pertinent information on the app or even better, on the smartwatch on the doctor’s wrist saving precious clinical time. The range of customization that can be incorporated into the app development is truly limitless. From maintaining the list of daily, weekly or monthly appointments to color coding the patients on the basis of procedure to be performed, creativity is the only limit when it comes to managing your dental practice.
In future, your choice may include an AI-powered mobile app that has voice to text transcription allowing voice input of patient data. Using voice commands, the dentists can pull up the relevant patient data as well as images including past clinical photographs and x-rays, and have it displayed on the connected smart monitors. The possibilities of IoMT application in practice management are immense.
3. Devices for monitoring diet and eating habits
Smart teeth implanted into the patient’s oral cavity which can collect and relay information has traditionally been something only found in old school spy movies. With IoMT the technology has the potential to move out of the pages of science fiction and actually become a reality.
Implantation of advanced chips within the prosthesis or chipping off part of the existing tooth to implant the chip could be done to monitor numerous factors. These implants would help create, “Smart Teeth” that can be used to detect the pH of saliva, the food intake, the quantity of acidic beverages and food consumed, blood alcohol level etc.
The data collected can be transmitted over to the server and enable the dental practitioners to keep live track of oral hygiene and eating habits of the patient. It can also enable the dentist to make data-backed personalized recommendations about diet and nutrition practices of the patient resulting in betterment in overall health and wellness.
Analyzing the data via artificial intelligence and big data analytics to come up with patterns and associations resulting in a rise in preventive dentistry that is based on recommendations for individual patients.
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4. Digital impressions using 3D technology
No matter how advanced the impression materials get, the traditional techniques of recording intraoral impressions can be quite cumbersome for a lot of patients. In cases of patients who have a high gag reflex, taking traditional impressions becomes quite the hassle for the dentists. IoMT makes a digital recording of intraoral impressions possible with 3D technology.
The 3D scanning devices allow for replication of the hard and soft tissue structures within the mouth in an accurate manner in a short period of time without the inconvenience associated with traditional impression materials. The computer-generated, virtual impression can be easily shared with the lab technicians via email or other network making the entire process more efficient and less time-consuming.
The combination of digital impression techniques with 3D printing technology can result in the construction of immediate restorations and prosthesis making. This is also beneficial to the patients who get to avoid multiple follow-up visits to the dental office and makes the entire treatment more efficient and increases productivity.
5. Early detection of caries and periodontal diseases
Research is already underway for early detection of periodontal diseases by analysis of saliva and gingival crevicular fluid samples. An interdisciplinary team of researchers from Washington university school of medicine and school of engineering and applied science are working on a development of an advanced sensor for early detection of periodontitis. Implantation of a biological sensor that measures the specific peptides active in periodontal diseases in combination of a wireless device to intercept the data transmitted by the sensor can revolutionize the treatment of periodontitis.
The sensor would be embedded with the gingival lining by using a minimally invasive technique or could be inserted as a part of an intraoral appliance. Once the specific peptides connected to bone loss in periodontal disease are identified by the implanted sensor, the device can send out a notification or an alert to both the patient as well as the practitioner. The patient is then prompted to book the appointment with the dentist at the earliest opportunity.
Analysis of salivary pH also is important for the prevention and early detection of caries. A low or acidic pH is associated with increased demineralization and rise in caries incidence. By monitoring the salivary pH data of the patients, the dentists can identify the patients at elevated risks of cavities and recommend preventive measures such as pit and fissure sealants.
Smart devices would also impact patient compliance positively. Patients who have access to their own data are more likely to seek preventive treatments recommended by their dentist.
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6. Management of bruxism
The biggest challenge in the management of bruxism is the fact that the patient does not give any subjective input about the prevalence and frequency of the habit. The grinding of teeth often takes place in the patient’s sleep and thus the patient is not conscious of the habit.
Mouth guards do act as a preventive measure to treat bruxism but the use of IoMT in the form of pressure sensors attached to the mouthguards can turn out to be a more effective way to treat the condition. The device could identify the areas of teeth which are most affected by the clenching and grinding. Identification of tooth surfaces that are subjected to the maximum amount of pressure can help dentist devise effective treatment and restoration plans. The data so gathered has the potential to help find a cure for bruxism.
7. Personalized dental insurance plans
One out of three people in the US does not have dental insurance covered under their insurance plan. A reason for this problem is the fact that it is difficult for the insurance company to scope out the rates of the insurance policy compared to the actual need.
The actual patient data collected by the connected dental devices helps build an accurate picture of the actual need resulting in personalized dental insurance plans based on an individual’s habits and requirements. For example, a patient who has greater susceptibility for dental diseases such as periodontitis would likely require greater dental visits for disease management.
An accurate estimate of the actual need for treatment that would arise in the future results in lowering of the premiums required by providing an accurate picture of the likelihood of future claims. Depending upon the personal data, the insurance companies can come up with dental insurance plans curated at an individual level which results in optimal utilization of insurance leading to lowering of premium amounts.
The applications of smart technology in the field of dentistry are currently just scratching the surface of its true potential. The influx of artificial intelligence algorithms, machine learning techniques, big data analytics and cloud computing would transform the dental practice in the years to come.
Tools for inventory management exist in dental practices, but incorporation of artificial intelligence would transform the way you manage your practice. You could set up patient appointments and material orders with voice commands. Internet of Medical Things would allow you to get an overview of all your ongoing cases on your smartphone or smartwatch. The possibilities are endless and while it may sound like something out of a science fiction movie, research along the same lines is already happening.
There are considerable challenges in the implementation of IoMT and its widespread adoption as well. Privacy and data security concerns, regulatory challenges such as HITECH, HIPAA compliance and GDPR regulations and lowering the initial setup costs are some of the barriers this technology would have to cross for its successful implementation. The future of technology in the field of dentistry is bright nonetheless. The smartification of the dental office is making dental treatments more accessible to the patients while helping dental practitioners incorporate best practices and provide better treatments.