Tech-savvy dentistry

March 1, 2004
Dentistry in the 21st century is very different than it was when I received my DMD in 1967. Computers were not found in dental offices and were not capable of the many tasks performed by today's computers.

By Howard R. Gamble, DMD, FAGD

Dentistry in the 21st century is very different than it was when I received my DMD in 1967. Computers were not found in dental offices and were not capable of the many tasks performed by today's computers. Most dental offices now accomplish basic business office functions using computers, but the number of dental offices which use computers in the dental operatory is still relatively small.

In the business office, the patient's health record is stored on the computer along with the patient's insurance information. Verification of insurance eligibility is available online and the electronic filing of insurance claims can be accomplished immediately. Some third-party payers make direct deposits to the office bank account.

Other business office functions which can be accomplished with the computer are patient correspondence utilizing merge documents, thus eliminating the entry of pertinent information such as name and address. The printing of statements — in times past a time-consuming process — is now accomplished with only a few keystrokes. Items such as letterhead, envelopes, patient record forms, and statement forms — in times past done by an outside printer — can now be easily created by word processing programs and laser printers.

Today it is possible to book an appointment by e-mail or through an office Web site. Forms which need to be filled out by the patient can be downloaded or completed online prior to the appointment. Appointment reminders can be accomplished automatically by computerized dialing programs.

Upon arrival at the dental office the patient might be greeted by computerized programming customized for the office. This allows the process of patient education to begin immediately. Patient education might begin prior to arrival by directing the patient to an educational Web site, or by sending patient education in the form of CDs or DVDs that patients can view on their own computers.

In the operatory, a patient can be examined with the aid of many computerized peripheral devices. Digital radiography eliminates the use of chemicals, reduces the amount of radiation required by approximately 80 percent, and reduces processing time by approximately 90 percent. The digitized radiographs can be viewed on the computer monitor, allowing images to be enhanced for better viewing and diagnosis and reducing the need for retakes in many instances. The radiographs can be shared either electronically or in print. If proper backups are performed, the loss of radiographs should be a thing of the past.

Intraoral photography is another part of the armamentarium available in the dental operatory. It allows for better documentation and demonstration of existing dental conditions to the patient. Before-and-after photos can be very helpful to the dental team and the patient.

Voice recognition software can be used in the operatory to issue commands and to enter information for the charting and treatment-planning process. The charting of existing conditions and recommended procedures can be entered into the computer entirely by speaking into a headset. There is no need to touch the mouse or keyboard. The entry of progress notes can be accomplished in the same way.

Once the desired information is entered into the computer, a comprehensive treatment plan can be developed utilizing the computer's many capabilities. Cosmetic imaging can be integrated into the treatment plan to demonstrate how patients might look after the procedure. Much can be done with cosmetic imaging software, but it can be time-consuming. One possibility is to send intraoral photographs to an outside agent who can perform the desired cosmetic imaging and return the finished images to the dentist for use in the treatment plan and presentation.

Treatment plans can be as elaborate as desired. They can be assembled in the form of computerized presentations such as PowerPoint and can contain slides of text and graphics. They can also contain video patient education segments. Treatment plans can be developed for presentation in the office or prepared for patients to view with other family members at home. Reasonably priced software is now available to allow the assembly of video presentations using the computer hardware found in most dental offices. The dentist or one of the dental team members could easily develop a video introducing the patient to the office. The addition of video or voice in the treatment plan can be done with ease.

Inexpensive Web cams can be used to capture patient photos for the dental record and can also be used as a consulting device with other dentists anywhere in the world. An image (either radiograph or photograph) can be sent to another dentist or third-party carrier electronically and, within minutes, the two parties could be viewing the image simultaneously and discussing it using the Internet.

Software is now available which allows the dental team to be in direct contact with the dental laboratory for tracking cases or for providing computerized shading information to the lab.

Patient information can also be made available on the office Web site for patients to view on their home computers. Privacy in such cases is provided by the utilization of passwords issued to patients by the dental office. Information which can be made available includes account information, treatment plans, and patient education.

Personal Digital Assistants (PDAs) can also be a useful tool for the dental team. Information such as appointment schedules, patient contact information, prescriptions written, patient notes, drug information, non-patient contact information, calendars, and meeting information can be downloaded to a PDA and carried by a member of the dental team.

External hard drives allow the transport of information between locations — office to office or office to home — allowing for viewing information while away from the office. This same information can be viewed utilizing remote software. High-speed Internet lines have made it possible to do many things from remote locations. It is easy to keep in touch with the office from anywhere in the world. That ease also applies to patients who can contact the dental office by e-mail at any time and from any place. Communication between the office and patients has never been better.

I can only imagine what will be available in the years to come. The future definitely is now.

Editor's Note: This is the second of a yearlong series of articles from the Academy of General Dentistry (AGD). The AGD and Dental Equipment & Materials are working together throughout 2004 to bring you articles that will help you in your practice.

A graduate of the University of Alabama School of Dentistry, Dr. Gamble is a past president of the Alabama AGD and the Alabama Dental Association. He was on the first AGD Internet Committee. He has been a delegate or alternate delegate to the AGD House since 1990. His current positions include executive director of the Alabama AGD, secretary-treasurer of the Eighth District Dental Society of Alabama, and AGD representative on the ADA's Standard Committee on Dental Informatics. Dr. Gamble served two years on the Council on Dental Care; he is serving his third year as chair of the newly developed Council on Communications. Dr. Gamble can be reached by e-mail at [email protected] or by phone at (256) 381-1569.