Friday, December 2, 2011

The Future of Dentistry: Technology

How will technology affect dentistry?  Well, technology is already playing in increasingly important role in this age old profession.  Here are the major developments I foresee:

1.  Diagnostic technology such as digital radiography (x-rays) will continue to become more common. Digital Panoramic and intra-oral x-ray machines will completely replace chemical films and developing.  Computerized image management software will be able to store, display and enhance digital images.  3-D imaging will become more common.  Instead of several intra-oral films, panoramic and cephalometric x-rays, yucky impressions for models and photographs, there may only be the need for one imaging machine or technology which can do all of the above.  Computerized diagnostic software will be able to detect and identify decay and other anomalies and pathology

2.  There will be continuing development of information technologies for the business and record keeping end of dentistry.  As in most health businesses, physicians offices, hospitals, etc., there will be even further incentives for electronic medical records (EMC), computers in the dental office for scheduling, management of financial and patient records, and insurance claim filing.  Ipads, flat screen TVs, and digital entertainment will become more common.

If you are in doubt about the impact of robotics in medicine and dentistry, check out how wearable robotics developed by the military are helping paralyzed individuals walk:

                                 click photo for link: Wearable Robots help Paralyzed warriors walk again

3.  Laboratory technology, which I have often viewed as remaining in the dark ages using proven but old techniques, will transition to CAD/CAM (Computer Aided Design/Computer Aided Manufacture).  This may manifest as in office or laboratory fabrication of crowns and other prostheses by computerized milling machines and digital printers.  Intra-oral cameras will advance to be able to easily take virtual impressions of teeth and transmit the information for production.

4.  Currently lasers are used for soft tissue surgery and some hard tissue preparation.  A little further into the future, there may be new devices to more efficiently and simply prepare (drill) teeth for fillings, crowns and other things with more precision and less effort.

5.  Diagnosis of at-risk patients, targeting medications to particular problems will become more sophisticated.  The use of DNA techniques in diagnosis and treatment will continue to advance.  A caries vaccine?  -They have been talking about that one for 20 years so I do not anticipate an effective vaccine in the near term.  Techniques to replace teeth with laboratory grown teeth for a patient's own DNA or tissues may become a reality.  Advances in oral surgery including nanotechnology in the targeting of cancer cells will enable less traumatic and more successful treatment of these debilitating and often fatal diseases.

6.  Newer techniques of anesthesia and the development of new medications will make dental care even more pleasant and comfortable.  Safer and more effective sedative agents and/or advanced anesthesia techniques will enable any surgical procedure to be completed more easily for the patient and the doctor.

What might all this mean for the practicing dentist?  Well, you cannot say that just because a great technique exists that it will be incorporated into daily routine practice.  There are so many other things to be factored into the equation.  Financial issues and/or insurance may or may not pay enough to make these technologies feasible.  Patients may not be willing to cover the increased cost to use a $100,000 machine to do just a few minor procedures.  I do know many of these technological advances will make dentistry more efficient.  There may be a need for fewer laboratory technicians, but the ones remaining will be skilled in these new techniques.  There may even be a reduced need for as many dentists as each dentist becomes able to accomplish more treatment.

Sunday, November 20, 2011

St. Elsewhere

While in my residency, I did an anesthesia rotation at Charity Hospital in New Orleans.  As Pediatric Dentistry residents, we spent every day for a month providing anesthesia for all kinds of surgical cases.  Later on, we did a rotation at Children's Hospital.  During these rotations, with often minimal supervision, we started IVs, calculated and administered medications, intubated the patients and provided whatever was needed to keep the patient asleep and alive during surgery.


It could be stressful, as we were no as familiar with the OR as the medical residents.  Moreover, Charity was a unique place.  It was built like Fort Knox with 24 operating rooms on the 12th floor.  It was an old building and had an eerie St. Elsewhere atmosphere.  In fact, it seemed every time I entered the building, I'd hear the theme song from that TV show.  We didn't get too much help from anyone there and kind of had to fend for ourselves, scrounging up supplies.  If you didn't have an IV setup or a pulse oximeter, you'd just "steal" one from an adjacent unoccupied operating room before someone was the wiser.  We also sat in on anesthesia resident meetings.  Some of the surgeries were interesting to watch.  Of course, we were actually quite busy keeping the patient monitored.  There were orthopedic cases and a few jaw reconstructions, sometimes abdominal surgeries, but mostly minor stuff.

Every now and then they brought in patients from the local prisons for treatment.  One day one of them escaped and somehow in the ensuing melee, was chased outside, where the police promptly shot him.  They brought him right back in the hospital to get patched up and go back to jail.  That was a typical day at Charity.  Of course Charity became even more infamous during hurricane Katrina.  I was so glad to finish with the rotation, but was thankful to have had the experience.  I learned a lot about sedation and anesthesia.