The AI Revolution: Transforming Dental Hygiene Care
Erin Kierce, RDH, MS, MPH; and Christopher Balaban, DMD, MSc
Unmet oral health needs continue to impact systemic health, remaining prevalent among the country's most vulnerable populations.1-5 Disparities, such as financial hardship, low health literacy, and inadequate access to care, result in higher rates of oral disease that often exacerbate other chronic conditions, including diabetes, cancer, and cardiovascular disease.1-3,6 In addition, considerations such as cultural and ethnic barriers and dental provider shortage areas further compound these inadequacies.1-7 Dental hygiene has long practiced on the standards of delivering comprehensive care through means reflective of emerging technology and scientific evidence. Innovative approaches to care, such as incorporating artificial intelligence (AI) technology into dental practice software, will assist dental providers in addressing these challenges by improving the standardization, method, and efficiency of each patient encounter.
Oral Health Disparities
Periodontal disease is evident in approximately 42% of American adults, with just under 8% exhibiting severe periodontitis.8 Approximately 92% of American adults between 20 and 64 years of age have had dental caries, while 26% have untreated decay.9 Among youth aged 2 to 19 years, the prevalence of total caries (untreated and treated) is about 45%, with 13% untreated. The prevalence was highest among youth between 12 and 19 years (53.8%), followed by 6-11 (50.5%) and 2-5 (21.4%).9 There is a higher prevalence of periodontitis and dental caries among African-Americans and Hispanics when compared to other racial or ethnic groups, and higher rates of disease are inversely correlated with an individual's level of income, education, and healthliteracy. This demonstrates that disparities remain for certain populations to obtain optimal oral health.5,10-13
The Institute of Medicine's 2011 Report, Im-proving Access to Oral Health Care for Vulnerable and Underserved Populations, was the first to reveal the systemic barriers facing vulnerable populations' access to oral health care. It specified how low health literacy, in addition to social, economic, and geographic factors, limits the capability of certain groups to understand the importance of oral health care, as well as recognize the risk for disease development and options for adequate treatment.14
A systematic review by DeWalt et al revealed low health literacy was associated with improper utilization of health resources, morbidity, and an increased risk of hospitalizations.15 Health literacy is defined by the Centers for Disease Control and Prevention as "the degree to which individuals have the ability to find, understand, and use information and services to inform health-related decisions and actions for themselves and others."
The approach to improving the health literacy of vulnerable populations must incorporate the proper provision of information, as well as utilize effective means of communication.10 For both approaches, it is necessary to first acknowledge the population's underlying determinants of health to tailor the delivery and content specific to the audience.6,7,10 The objective of improving health literacy is to empower individuals to promote sustained action towards health, promoting behavior by means of prevention or treatment.10,16
New technology and innovative approaches to care, such as artificial intelligence (AI), can address the barrier of health literacy by improving the method and means of patient education, standardizing care, facilitating clinical decision making, and promoting intra- and inter-professional collaboration. Using AI technology, dental providers can empower patients by means of presenting unambiguous and visual health information. This empowerment can improve comprehension irrespective of underlying determinants and ultimately increase rates of treatment acceptance and utilization.
AI and the Dental Hygiene Process of Care
Since 2020, technological advancements have resulted in an exponential increase in the utilization of artificial intelligence in daily life, particularly in the field of dentistry. Leading dental clinicians are working with machine-learning scientists to develop and encode computer algorithms to measure and analyze radiographs, photographs, clinical assessments, and chart notes with dentist-level accuracy and understanding. This capability will result in a highly accurate output and clinically relevant results. Leading companies have developed algorithms to detect caries and periodontal disease, in addition to a wide array of clinical determinants. These algorithms and AI-enhanced software can help hygienists improve patient communication and demonstrate the necessity for treatment. The algorithms are built on millions of data points learned through rigorous clinical inputs, and are currently achieving equal to, and in some instances better than, single clinician accuracy.
Since 1985, dental hygiene has practiced on the standards of patient-centered, comprehensive care.17 The development and subsequent revisions of the Standards for Clinical Dental Hygiene Practice provides a framework for care reflective of competence, responsibility, and scientific evidence. The Standards describe a proficient level of dental hygiene practice that includes six components to the process of care: assessment, dental hygiene diagnosis, planning, implementation, evaluation, and documentation. 17 All components are correlated and dependent on the status of ongoing care, subsequent treatment outcomes, and patient needs. 17 The integration of AI technology into the dental hygiene process of care would improve the efficiency and efficacy of the assessment, dental hygiene diagnosis, planning, and evaluation. Navigating dental AI dashboards during patient care will become commonplace in the near future and will empower patients to be better informed in the decision process to accept warranted treatment.
While certain determinants for the development and progression of disease are well-understood (race/ethnicity, age, and gender), explicating the degree of understanding regarding other factors, such as health literacy, behavior, and social determinants, is limited.3-7,10 Low health literacy is associated with inadequate utilization of preventive services, higher rates of chronic disease, and poor health outcomes. Therefore, approaches to care that promote and improve health literacy should be prioritized. AI technology is a means by which dental providers can improve the approach to comprehensive and patient-centered care, reflective of underlying determinants of health, including low health literacy. AI can empower patients by standardizing the process of care and improving the accessibility of health information.
About the Authors
Erin Kierce, RDH, MS, MPH
Chief Compliance Officer, New England Family Dentistry
Adjunct Faculty, MCPHS University
Christopher Balaban, DMD, MSc
Clinical Director, Overjet AI
Clinical Faculty, Boston University
Private Practice, Boston, MA
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