How AI will become the next standard of care in dentistry

The use of artificial intelligence in dentistry is growing as practices realize the full potential of this technology, and it is expected to continue to grow, according to two execs.

Dental software company Henry Schein One and dental AI company VideaHealth launched a partnership in 2022 to integrate AI technology into Henry Schein One's practice management software. 

Alan Rencher, chief technology officer at Henry Schein One, and Florian Hillen, founder and CEO of Videahealth, recently spoke with Becker's about their partnership and how AI is becoming the standard of care in dentistry.

Editor's note: Responses were lightly edited for length and clarity.

Question: How is Henry Schein One partnering with VideaHealth on artificial intelligence technology?

Alan Rencher: I think the negotiation and evaluation we did among several competitors of Videa started about three years ago and Videa was named our exclusive partner. We actually embedded Videa AI inside of our practice management system. What that means is in under a second we can deliver AI-driven clinician information that shows the caries or periodontal disease or whatever it is that we're detecting. If you think about some of the competitors, you have to pop out of the practice management system, you have to upload the image, you have to go through this workflow and then jump back into the practice management system. That's why we believe that we're the market leaders, because we've done that seamlessly. The workflow is natively embedded in the tool and it provides a much richer and better user experience.

Florian Hillen: I think we were selected because [we have] the most accurate AI. We did a really good job integrating the AI system with the practice management system. That took quite a while. There was a lot of effort put into this, as you can imagine. We really just went live earlier this year and by now we have thousands of clinicians using our joint product ... The three things that really deliver value are, number one, it helps the clinician to not miss anything and have greater confidence in their own diagnosis. The second and most important aspect is that it can be used for chairside patient presentation. It helps the clinician convey the optimal treatment plan to the patient as it verifies the treatment plan through an FDA-cleared AI algorithm. Our AI algorithm is trained on over 50 times as much data as a single dentist uses in their entire lifetime. And then the AI has been trained on 100 dental experts. So you have to imagine that if you look at the X-ray, you can have the power of 100 experts looking over your shoulder, who all have seen 50 times as much data as you have ever seen in your life. The third aspect is that we can also have time savings. So there are a lot of automations we can do around AI and the practice management system, which now, and also in the future, will help more and more with time. That's why this product, AI in and of itself and then also the partnership is so powerful.

AR: There's another aspect to this around the profitability of the dental office. Our number one priority is better patient care, but we also have a stewardship to help the doctors and the offices and our DSO partners with their profitability. There are some really interesting statistics that came out of this study that we did. Out of 100 dental practices that we evaluated for three months, we saw very clearly a 19% increase in restorative care because, in the past, patients would either refuse treatment planning or it wasn't detected or a variety of factors. Additionally, [we saw] 26% more periodontal treatment because it's indisputable. The ultimate goal as I said is better patient outcomes, but also, remember these dentists are running a business, and this is helpful from that perspective as well.

Q: How have you seen interest and the use of AI grow in the dental field?

FH: I did two years of research at MIT and Harvard around AI and breast cancer, radiology, chest X-rays and then also dentistry. Everyone was saying, "What is AI? I don't believe it will work. I don't need it." That was five years ago. And I do believe that changed to, "I think that's the future. I need it. How can I get access to it?" That's where we were and that's where we are now. From my perspective, having spent all my life in healthcare and AI, I think what we are seeing is that [dentistry] has been five to eight years behind the AI applications in healthcare and now we are just three years behind. I'm confident in three years we will be ahead of healthcare. The reason for that is that dentists are entrepreneurs themselves and they're excited about new technology, which can help them provide better care or make their life easier, spend less time in the back office and spend more time in the front office with the patient.

Because of this big incentive for our entrepreneurial dentists to use new technology for better care, we've been seeing in the last few years a huge adoption of AI. That is on the one side, AI for diagnostics, and also other AI algorithms for patient engagement, for automation of certain analytics, et cetera. So I think we are seeing more and more AI algorithms creeping through the entire PMS system to automate processes. The things that will happen with AI and our society, as well as in dentistry, are still underestimated. 

AR: There's a whole series of industry things that we can do here with artificial intelligence. I'll try and briefly paint the picture. We know that the health of your mouth has a lot to do with the greater healthcare of a human being. We can work with the large data set we have to help researchers and others really come to conclusions about improving systemic health outcomes based on what's happening in people's mouths. We can work with other partners to do a whole bunch of demographic information. Why do certain demographics have certain health outcomes? As the market leader, we can use AI to help with that and to improve the health of our society in general. When you hear about artificial intelligence, people's minds go right to the terminator and all these scary things, but they ignore the positive things that can come out of artificial intelligence. Florian's company is an absolutely amazing example of just scratching the surface of what can be done in this area. This is an area of significant investment for our company. The key to unlocking artificial intelligence is data and we have a lot of it, and we're using that very effectively.

Q: Why do you think some people may be hesitant to use this technology?

AR: If you go back and look at the creation of the automobile in the early 1900s, people said there would be all these devastating consequences, the horses would become extinct, and all this stuff. That hasn't happened. The invention of the airplane, same thing. The invention of the personal computer, same thing. The invention of the internet, same thing. Now, the number of people that can be treated by one doctor goes up because they can rely on AI to help with diagnosis, claims management [and] all these different aspects of what happens in dentistry. People's minds sometimes go to the gloom and doom. Humans are generally reluctant to change. That's a factor, too. I would say it's almost a psychological thing. If you think about it, artificial intelligence is already everywhere. It's in your car, your interlock breaks in your car use AI, and they have for quite some time to know when to not lock up. The way airplanes fly, again, AI. It's been there for a couple of decades. The way your bills are paid by your payment company, artificial intelligence. It's very pervasive. It's just now showing its face in dentistry.

FH: I think there's a misconception in general right now, also with ChatGPT and all of that, of AI versus the expert. In some fields that may be true. In dentistry, this is not true. The AI never makes treatment plans on its own. It is just a supportive tool for the clinician to save time and reduce the noise for the clinician to make the best treatment plan.

What we were able to show in clinical FDA studies is that the dentist with AI has an overall better clinical outcome. The dentist is better in detail because the dentist understands the patient [and] the history. The AI, though, never gets tired [and] is always consistent. In dentistry, it's one of the few fields where it's a true win-win situation ... If you ask our customers, they all need to hire more people. We actually enable them to have more space, to have more time, et cetera. It's all about us educating the market that it's not AI versus a clinician. It's a clinician and AI together to provide a better patient experience, which helps everyone.

Q: Do you agree with the sentiment of others that dentistry has been historically slow to adopt new technology?

AR: I would say that may have been true historically, but I think things are changing. I think the pace of innovation is speeding up and there are some generational and demographic changes in dentists that are changing that. I think that it's only going to accelerate.

FH: I think in some aspects that's true and in some aspects that's not true. I did work in healthcare all my life before, and if you try to implement new processes or software into hospitals, trust me, that's really difficult as well. What I love about dentistry is that the dentists are almost technology-driven entrepreneurs themselves. They understand that with technology, they can actually improve patient care and also their financial performance. So I actually have seen a much more savvy customer base than in healthcare before ... A dentist is so much. A dentist is a diagnostician, a primary care physician, a surgeon and a business person on top. That also means it's really hard to do all these four roles all the time. [Our] mission is to help them in the diagnostician aspect, which frees up more time with them to be the surgeon, to be the primary care physician, to have this patient-facing communication.

Q: What are some challenges dental practices and companies face when implementing AI?

AR: There's a lot to talk about in this area. Change is hard. So teaching people to do something that's outside of their normal workflow, something they've never done, there are some challenges there, but we've worked very hard to incorporate the AI into the existing workflow to help with that. Another aspect is there's this almost a big brother type feeling, like "Whoa, why do we need AI to look at this?" You educate people and explain to doctors that, no, this is to confirm what you already know. AI never gets tired. It doesn't have a fight with its partner. It wasn't up the night before with sick kids. It's not four o'clock for the AI, it's always going. You have to teach people that aspect as well.

Maybe the most important and one of the biggest barriers is that this isn't a free service. It costs money. So you have to be very clear about the cost-benefit. The value far outweighs the cost. Then, when someone purchases something, they need to use it to get the value out of it. So that's one component here as well.

FH: Educating the clinician that it's not AI versus the clinician, but it's AI with the clinician. That concept is just super important and, unfortunately, because of movies and some stories, people don't think like that, but that's really true here. I believe you have almost an ethical responsibility to use AI for the better care of your patients, but [the second aspect] is the return on investment. If it helps you to just convert one crown because the patient trusts you more, it already paid for itself threefold on the first day of you using it and the next 29 days of the month is just pure add-on ... We have to do a little bit more education around this. If those two things are happening, and that's what we are working on to make that happen, this will become the standard of care in dentistry in the next two, three years.

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