Imagine if all the patient information you record could be seen with interactive charts. Do you think patients would be better educated about their disease progression if they could see computer renderings of their bone receding over time? Could interpreting pocket depth measurements graphically help with diagnosis or patient education?
Dentists are meticulous, analyzing and recording patient information and perfecting our preparations to the millimeter. Yet there is a general lack of awareness regarding dental informatics, a spectrum of dentistry dedicated to data collection, analysis and interpretation of what we practice regularly.
In the May 2001 cover story of the “Journal of the American Dental Association,” Schleyer and Spallek define dental informatics as “the application of computer and information sciences to improve dental practice, research, education and management.” Dental Informatics is centered on harnessing technology to obtain clinical information that can be used to improve patient care or support treatment plans.
Dentists are aware of evidence-based practice and data collection, but many struggle with incorporating these components into their own dental practice. Dental information systems can use more resources to find clinical information or support models of care.
Passive systems require clinicians to reach their own decision by presenting all available options. These include things like pathology atlases or online search engines. The user must sift through results to form a conclusion. Active systems use algorithms guided by statistical significance to offer specific suggestions. For example, VisualDX Dental uses various clinical terms to reach a pathology diagnosis based on probability from similar descriptors matching confirmed cases.
In practice, these decision support systems (DSS) embed clinical knowledge from research archives to analyze patient data with the goal of predicting diagnoses, disease prevention and treatment outcomes. Working with patient-management software (e.g. AxiUm, Dentrix), DSS can access specialized knowledge so that even the non-specialist can obtain expert-level information. For example, a dentist could provide a patient a more accurate prediction of their periodontal disease status based on metrics from the individual’s demographics, oral health and current rate of disease progression.
Put more simply: practicing dentistry shouldn’t rely on anecdotal experiences. We can use informatics to achieve more personalized evidence-based treatment plans with access to far more supporting data.
Dentistry also relies heavily on data collection to guide public health protocol, identify appropriate deviations to standard care and conduct research. The dentist with the most successful patient outcomes is the dentist who can interpret the information they record promptly and properly. Using computer systems that incorporate statistically significant evidence into clinical care encourages more informed decisions.
Diagnostic information includes digital instruments that detect caries based on changes in tissue density. There are programs that can outline caries on radiographs by analysis of the variance between pixels. Risk calculators determine the diagnosis and prognosis of periodontal disease based on clinical exam findings. Recording metrics and comparing them to previous data points can help determine disease progression. That information can then guide patient education by showing it along a timeline. Additionally, different software can use patient characteristics and clinical features to develop a differential diagnosis for radiographic pathology lesions. Computerized logic-trees have also been developed to determine different conditions and treatment interventions, such as surgical resections versus curettage models.
Information is the cornerstone to dependable clinical decision-making. The faster information can be accessed, analyzed and exchanged, the more quickly and accurately we can provide answers to our patients. This ensures that the care we provide is informed and as accurate as possible.
~ Corey Stein, M.S., WesternU ’18