Dr Davinder Raju, also known as ‘The Eco Dentist’, outlines how preventive dentistry is the foundation of sustainable dentistry.
‘Every time we need to do a patient intervention, the patient has to come into the practice, which is resource intensive,’ says Dr Davinder Raju, lead dentist at Dove Holistic Dental Centre.
‘We use materials, energy and single-use plastic devices during every appointment. The gold standard of care is prevention, where patients don’t need any treatment. When disease is present, it’s about early detection and diagnosis because we can manage the patient and disease without surgical intervention.
‘The moment we go in with a drill, we create a cavity. As soon as we put in a material, it is never going to be as effective as the material created by biology, and ultimately the filling will fail.
‘This necessitates additional treatment, which requires additional resources. Furthermore, the amount of dentine left that separates the filling from the pulp is critical (the thinner the dentine, the more likely that your patient will have pulp-related problems), with each treatment becoming increasingly significant.’
The restorative death spiral
Davinder, who founded the app Green Dentistry, which guides practices in transitioning to Greener, more Eco-Friendly dentistry, says this is known as ‘the restorative death spiral’.
‘As soon as a filling is placed in a tooth, it reduces the structural integrity of the tooth, and it is likely tooth decay will form around the filling, and the filling may fail.
‘The patient then requires a bigger filling, requiring more resources, while reducing the thickness between the filling and the nerve, and so the cycle carries on. This is called the restorative death spiral.
‘Eventually, the nerve dies, or the tooth fractures significantly, necessitating root canal treatment and crowns, and when these fail, ultimately an extraction and possible replacement with an implant or denture.
‘Our practice ethos focuses on prevention and minimal intervention dentistry where needed. If we do need to intervene, we want to tackle the causative factors and then try to stabilise everything so that we don’t have to intervene more aggressively.’
Davinder identified a new AI technology called Assistdent, which supports his practice’s ethos.
Assistdent is an Artificial Intelligence (AI)-driven diagnostic tool which, on top of its scope to improve dental diagnoses, can help dental professionals build a more profitable practice by demonstrating the need for preventive oral hygiene regimes to patients.
Disrupting the restorative death cycle
‘What I learnt of the Assistdent software was that it could help detect very small caries lesions. Since starting to use the software, there have already been a couple of patients where I have missed a very small lesion in between the teeth.
‘Without Assistdent, I wouldn’t have identified them. A lot of the time early proximal caries can be missed, which can increase my patients’ risk of poor oral health.
‘We may inadvertently categorise the patients as low caries risk and delay potential remineralising treatments and radiographs, by which point the early caries lesion may become more extensive, with cavitation. With AI software, I’m able to monitor my patient’s health much more closely.
‘Assistdent has allowed me to manage my patients with early proximal caries and lesions differently. If a patient has a small lesion, we can track it regularly and see how it progresses.
‘If they are compliant, brush and floss and amend their diet, we know at this early stage we can stop the lesion from progressing, requiring no surgical intervention from the dentist.
‘From a sustainability perspective, we use fewer resources, which aligns closely with my ethos of protecting the environment. The patient is also relieved not to need a more intense treatment. We would both prefer not to have to put a filling in!’
Enhancing patient compliance
Davinder outlines the role AI technology can play in improving patient compliance. He said: ‘I have a 16-year-old patient who I have been encouraging to floss for the last four years.
‘He’s into computer programming. I knew he would be interested in this new software. I shared how it could help us detect caries and showed him that he had a lesion that was very small. He was excited to see the images with a lesion on the screen, and is much more enthusiastic about flossing now.
‘I’ve been trying to encourage him to floss for years, but now he understands the need for it. It’s helped him take more responsibility for his home care regime.’
Assistdent software empowers practices to put a value on preventative measures and to monetise the actual journey.
‘The AI technology helps me show my patients very clearly that there is a need for more preventative care, allowing me to explain the benefits of a more preventative role, rather than going down a drill and fill cycle. It gives me an opportunity for renewed conversations.’
Assistdent can identify the earliest signs of dental disease, currently early proximal caries, within seconds from X-rays that otherwise might go unseen, especially in a busy practice setting with a high throughput of patients.
Significant impact
The subtle signs of early-stage caries can be difficult and time-consuming to detect on traditional X-rays, so the opportunity for preventative measures can be missed.
In turn, this means dental professionals could miss out on the revenue potential of preventative treatment as well as having a significant impact on improving the patient’s oral health.
Academically credentialed, Assistdent is the first of a planned portfolio of AI software diagnostic tools which have been developed by a ‘spin out’ from The University of Manchester.
It is the only UK AI software company to have been published in a peer reviewed publication (British Dental Journal – October 22nd 2021).
Importantly, the software was developed to be clinically and educationally-led before commercial applications were evolved.
Dental practices using Assistdent simply import patient X-rays into the practice software; it identifies the earliest signs of disease before the dental professional then validates the findings and generates a report, which allows them to recommend preventive treatments. All this within about eight seconds.
For more information about AssistDent visit: www.manchester-imaging.com
