The Digital Dental Office
From administrative applications to intraoral cameras, technological advances can improve detection, documentation, and compliance in the dental arena.
The technological age has hit dentistry as more than 85% of dental offices are currently using computers in their offices for administrative purposes.1 Information technology (IT) applications for dental practices continue to develop rapidly.
Software Systems
IT software has become much more sophisticated today. New patient registration can be completed online or in the office using a PC tablet or a patient information center at a waiting area workstation.1 Electronic patient signatures can also be saved in the patient’s digital record. Insurance claims can be submitted directly to the patients’ insurance company, expedited with the use of electronic signatures.2,3 The electronic processing of patient information eliminates the need for copying completed handwritten forms, boosting office productivity and reducing costs. The electronic patient record can be accessed by more than one provider simultaneously and eliminates the need for the hand pulling and filing of patient charts.
Scheduling and confirming patient appointments can be accomplished via email or simply by highlighting the patient telephone number in his or her digital record. Patient management systems must protect patient information with security mechanisms in order to comply with the Health Insurance Portability and Accountability Act (HIPAA).1
Speech recognition technology allows clinicians to dictate clinical findings into the computer system, which then digitizes the voice input and creates a document or clinical record.4 Some software systems allow the dictation of notes at normal dictation speeds of up to 180 words per minute with good accuracy rates. Some voice recognition systems offer a large dental-specific vocabulary and the capability to recognize multiple voices.5
The efficiency in documentation is enhanced by eliminating illegible handwriting and increasing the consistency of patient record entries. Periodontal findings, including bleeding, attachment loss, and probe depths, can be recorded in a digital chart with periodontal charting software. Instruments take pocket depth measurements and record the findings.
For patients who are visual learners, software applications that create personalized patient instructions can be helpful. Programs offer the ability to create individualized messages and integrate patients’ digital radiographs and photographs into take-home instructions for patients.
Periodontitis Risk Assessment
The assessment of risk in the prevention and management of periodontitis is complex.6 A new diagnostic tool, PreViser Risk Calculator*, is designed to address this issue. A diagnostic tool, it is designed to identify the risk of periodontal diseases, tooth loss, and oral cancer. The PreViser Risk Calculator creates a risk score for each patient based on an analysis of key risk factors and current health. A risk analysis report is given to each patient with a risk score, disease score, trend graph, and guided treatment selection. The report also provides patients with the characteristics of health and an analysis of their oral health status characteristics.
The BANA Test** is another tool designed to detect periodontal risk. The chairside test looks for an enzyme found in Treponema denticola, Porphyromonas gingivalis, and Bacteroides forsythus, three anaerobic bacteria associated with periodontitis. To use the BANA Test, a tongue swab or subgingival plaque sample is placed on a BANA test strip. If any of the three bacteria are present, the test strip turns bright blue.
Detection Tools
Prevention is one of the dental hygienist’s major responsibilities. Caries detection technology can now digitally assess tooth surfaces for the presence of decay during the dental examination. The most widely used caries detection technologies are DIFOTI® (Digital Imaging Fiber Optic Transillumination)***, DIAGNOdent™****, Inspektor Pro System*****, and Logicon Caries DetectorTM******. DIFOTI captures visual images of incipient, frank, and recurrent decay on all tooth surfaces using a digital charged couple device (CCD) camera, which are then sent to a computer monitor and stored in the patient database. The DIAGNOdent uses a low level laser fluorescence device that transmits the light into a hand-held probe with a fiber optic eye in the tip with high resolution images displayed on a monitor. The instrument readings range from 0-99 with readings greater than 20-25 reflecting the possibility of demineralization on occlusal and smooth tooth surfaces.
The Inspektor Pro System uses quantitative light-induced fluorescence (QLF) to detect early carious lesions. The system uses a handpiece containing a particular wavelength of blue light to illuminate the tooth, which illustrates the tooth’s fluorescence level, reflecting the mineral content of the enamel. The contrast between healthy and diseased enamel is magnified through the light-induced fluorescence. The Inspektor Pro System captures these fluorescent images and then stores and analyzes them, allowing for the tracking of problem areas. Logicon Caries Detector is a new device for caries detection designed to detect and characterize proximal caries.4 The Logicon uses algorithms based on laboratory data to outline lesions on the image of a tooth directly on a computer.
These caries detection methods provide objective data to increase confidence in treatment decisions and promote minimally invasive treatment, thereby helping patients maintain more of their tooth structure without x-ray exposure.7 Dental hygienists can provide preventive services, such as sealants, with the certainty that decay is not present in the fissures to be sealed. This technology allows the teeth to be monitored during all maintenance appointments without the use of ionizing radiographs for diagnostic confirmation.
To determine the presence and location of subgingival calculus, the DetecTarTM******* can be used to assist the dental hygienist in subgingival calculus detection. The DetecTar fiber optic tip reads light reflecting off of tooth surfaces and emits an audible tone directing the clinician to the location of calculus. Prior to using the DectecTar, biofilm and partially calcified deposits should be disturbed using an ultrasonic scaler because they may interfere with the light transmission or obscure burnished or tenacious calcified deposits. Periodontally involved patients with pocket measurements greater than 5 mm are good candidates for checking site-specific areas.
Intra-oral cameras present visual images of the patient’s mouth, which can be very effective in increasing cooperation and compliance. As a visual society, the ability for the patient to see teeth with disclosed biofilm and the location of supragingival calculus deposits makes the intra-oral camera an excellent educational tool. This technology features a small handpiece with a fiber-optic camera enclosed, which displays the patient’s oral images on a monitor and then stores them as a part of the patient’s digital record.
Technology can help minimize subjective diagnoses that lead to misjudgments, mistakes, and imprecision by facilitating a scientific, reproducible, and measurable means to obtain diagnostic criteria. The incorporation of technology into the delivery of dental hygiene preventive services can enhance the involvement of the patient as partner in care with the goal of increased patient compliance.
*PreViser Corp, Mount Vernon, Wash
**OraTec Corp, Manassas, Va
***Electro-Optical Sciences Inc, Irvington, NY
****KaVo America, Lake Zurich, Ill
*****OMNII Oral Pharmaceuticals, West Palm Beach, Fla
******Logicon Inc USA, Los Angeles
*******Ultradent, South Jordan, Utah
References
- Schleyer TK, Spallek H, Bartling WC, Corby P. The technologically well-equipped dental office. J Am Dent Assoc. 2003;134:30-41.
- Schleyer TK. Digital dentistry in the computer age. J Am Dent Assoc. 1999;130:1713-1720.
- Berry J. Pioneering the high-tech practice: fully integrated system boosts efficiency. J Am Dent Assoc. 2004;135:105.
- Umar H. Capabilities of computerized clinical decision support systems: the implications for the practicing dental professional. J Contemp Dent Pract. 2002;3:27-42.
- Levato C. Talking to your computer: voice recognition software in dentistry. Compend Contin Educ Dent. 2004;25:914-18.
- Persson GR, Mancl LA, Martin J, Page RC. Assessing periodontal disease risk: a comparison of clinicians’ assessment versus a computerized tool. J Am Dent Assoc. 2003;134:575-582.
- Taylor MH. Handheld computing in dentistry. Dent Clin North Am. 2002;46:539-551.
From Dimensions of Dental Hygiene. October 2005;3(10):32-33.
