Digital Workflow in Dental Public Health, Preventive Dentistry, and Dental Education
Anne-Marie Agius, Nikolai J. Attard, Gabriella Gatt, and Arthur R.G. Cortes
10.1 Digital Dentistry in Public Health
Dental public health provides community‐based expertise in the surveillance and measurement of oral health status and its determinants. Data collected are utilized to plan appropriate policy changes, prevention strategies, and health promotion across populations. Despite all efforts, the burden of oral disease remains a matter of global concern.
Dental caries is still responsible for most of the oral disease burden in populations worldwide . For too long, efforts to reduce oral diseases have focused on dentist‐centered and technology‐focused approaches that have been unsuccessful and too costly, especially in low‐ to middle‐income countries. Increasing the number of dentists to decrease the dentist/population ratio has done little to change the care index and caries levels in some countries have remained unchanged [2, 3]. The simplistic reduction of prevention strategies aiming to change behaviors by health education will continue to fail to improve oral health and further create inequalities. Low caries populations in high‐income countries, on the other hand, display a highly skewed distribution of disease. This emphasizes the need to break away from traditional delivery operations and embrace new paradigms and evidence‐based technologies in order to provide the ideal care system.
Research clearly indicates that “oral diseases, like most chronic diseases, are socially patterned” , with lower socioeconomic groups bearing the brunt of oral health inequalities. Likewise, the only way we can mitigate these realities is by encouraging behavioral change by improving the social determinants of health. On the other hand, this change also necessitates the coordinated involvement and training of different healthcare teams. Digital dentistry has the potential to provide a health service at optimal standards that is patient centered. Patients’ participation and involvement in decision making will also build trust between clinicians and the public they serve. However, the spiraling costs of treatment, regrettably also with the introduction of more clinical gadgetry, risk outweighing the simplification of digital flows and therefore jeopardizing the widespread use of some of the techniques in digital dentistry.
Recent global events, with the onset of the COVID‐19 pandemic and the need for people to isolate, have emphasized the need for the introduction of novel techniques that safeguard public health, while ensuring the continued provision of health services, including dental treatment. There was a need to reduce spread of infection, decompress hospitals and dental emergency rooms, and preserve personal protective equipment. This prompted the successful use of remote patient monitoring systems with patients engaging with technology, increasing access to care and mitigating digital health disparities .
It is apparent that the novel approaches with digital dentistry have an all‐encompassing scope beyond the specific recommendations related to these global events since the discipline has the potential of simplifying treatment and consequently improving the oral health‐related quality of life of patients.
10.1.1 The Role of Teledentistry
Teledentistry is an emerging method that is intrinsically related to digital dentistry as it is based on the same premises of facilitating and improving patient care. It is proving to be a valuable asset in assessing patients remotely through digital communication. This approach avoids the unnecessary transportation issues and creates a collaborative network that further reinforces the multidisciplinary approach in health. It also has the potential of saving time and human resources related to providing a domiciliary service or dental trauma or orthodontic emergency consultations. Notwithstanding, its effectiveness within the local context of diverse members of society still needs to be determined. These novel techniques obviously require acceptance and behavioral modification from the health professionals involved as well as the client or patient. It is apparent that the dental team involved in these advances require training and professional updating to mitigate undesirable stances related to novel approaches.
Caries risk assessment software available off the internet is used to collect caries risk‐related patient data to provide a cariogenic profile of the patient. The program classifies the patient as being at high, moderate or low risk for caries. Patient‐specific preventive and treatment guidelines and referrals to care may then be initiated accordingly. Such a remote patient monitoring tool may be used by diverse members of the dental team in underprivileged communities with difficulties in access to healthcare , thus reducing public health costs.
Online school‐based oral health programs using real‐time communication or prerecorded messages have been seen to be effective in improving oral health behaviors in children. Such programs have allowed for a wider reach than in‐person school visits by providing added exchange with educators and parents. This has allowed for changes in oral health behaviors advocated at school to be reinforced in the home setting.
The advent of hand‐held x‐ray devices, first used in forensic dentistry and in veterinary and military settings  and archaeological sciences , has extended the use of radiographic diagnostics beyond the clinical setting and into the community. These devices are used in community‐based clinics, mobile dental clinics, for patients unable to attend regular dental settings or in remote areas, offering a noninferior modality to the traditional wall‐mounted device . Their use in caries diagnosis and monitoring and in trauma assessments helps in controlling the flow and costs of patient referrals to primary health centers.
Hand‐held digital image capturing/scanning devices also have a use in community dentistry. Image capture of malocclusions, oral mucosal lesions, sequential images of caries and tooth surface loss lesions, or entire dentitions requiring rehabilitation may be taken remotely in the community. These may then be sent for consultation and virtual treatment planning and referred accordingly. Such exchange of patient data can save on travel time, clinical time, human resources, and materials costs. In addition, radiographs and images related to CAD‐CAM can now be assessed remotely by professionals using DICOM viewers and imaging applications for mobile devices such as tablets and smartphones . This has been suggested to be particularly useful in large clinical settings such as hospitals.
10.1.2 The Expected Role of CAD‐CAM in Public Health
There are several advantages of digital workflow in dentistry that may offer benefits to patients in different aspects of dental treatment using CAD‐CAM technology , as shown in Table 10.1.
Table 10.1 Suggested advantages of digital workflow in dental public health.
|Digital workflow step||Methods||Advantages for public health|
|Image acquisition||Mobile devices|