Artificial Intelligence Goes Back to the Future

Patti DiGangi, RDH, BS


Here we are in a new decade. It seems like we were talking about Y2K just five years ago. Instead, we’ve seen 20 very pivotal years of change. Every day, we learn more about the ways that dentistry connects with the body beyond oral health. 

The power of artificial intelligence (AI) can continue to enhance dentists’ ability to make these connections, but not by doing more of the same. To get the most from AI, we need to go back to the future. 

No More Oral-Systemic Health 

It’s time to stop using terms like oral-systemic health. Though I support and was a founding member of the American Academy for Oral Systemic Health (AAOSH), an organization of healthcare leaders and health professionals dedicated to expanding awareness of the relationship between oral health and whole-body health, the phrase “oral-systemic” still keeps oral health and systemic health separate.

As Mary Otto reminded us in her book Teeth, the story of the division between the medical and dental realms is long and deep. Using terms like oral-systemic have done little to change that. If dentistry continues the same behaviors and just uses oral-systemic as a marketing game, our patients will gain little. 

The connection between various parts of the body is well recognized without a language of separation. Embracing the technologies and diagnostics of our medical brethren provides a common language to share data and personalized health information that can potentially create change.

Mobile Health

Some recent personal health issues put this into clearer focus. Dizziness, numbness, and other symptoms I was experiencing were not discussed through any neuro-cardiac language. At the same time, I had both a flare of my chronic urinary tract infection anda failed endo with infection. These connections were not considered, measured, or seen through an oral-systemic lens. Why not? 

I recently wore a 30-day event monitor. Event monitoring involves wearing a very small and portable EKG recorder over a period of time. Four small adhesive electrodes were attached to my chest and connected to a small device. This cardiac event monitoring recorded my heart rhythm. I activated it when I experienced symptoms to help diagnose what was causing them. When I pushed a button, the recorded data was sent over the phone for my physicians’ analysis.

Gathering and documenting, this point-in-time AI technology provides robust information that acts as a clinical decision support tool for individualized care. Its value is enhanced not only when we have current information but also when it is combined with knowledge of the patient’s medical history. 

AI Already in Use in Dentistry 

Some smart toothbrushes are designed to connect to apps on smartphones. When the brush is put in the mouth, it scans the teeth. Images automatically upload to the cloud. AI then analyzes them and finds, say, a cavity in a tooth or a hairline crack in a molar. The scans and preliminary analysis are transmitted to the dentist, who then texts the patient to schedule an appointment.

A friend’s granddaughter under orthodontic treatment has been scanning her mouth weekly with a device connected to her phone with a special app. Dental Monitoring’s Smile Mate produces data that AI analyzes and dental and orthodontic specialists verify. She gets feedback from the orthodontic practice about her progress and her self-care.

Generation Z, or the generation born between the mid-1990s and the early 2010s, is very comfortable with using AI. Those born after 2010, identified as Generation Alpha, will be more technologically immersed and have even greater expectations of AI. The media consumption habits of Generations Z and Alpha differ from previous generations, even millennials. These generations do not fear AI. They expect it. 

There are many other uses of AI in dentistry. Yet what hasn’t been tapped in any real way are the charts themselves. A huge treasure trove of information is lodged or may not be lodged in our patient charts. 

Back to the Future

Coined and first used in computer science in 1957, garbage in garbage out (GIGO) implies that bad input will result in bad output. Because computers operate using strict logic, invalid input may produce unrecognizable output, or garbage.

GIGO applies to the traditional methods of data collection and documentation in dentistry too. Many people consider Common Dental Terminology (CDT) to be insurance codes, which is incorrect on many levels. There is no such thing as dental insurance. A more accurate term is dental benefits. I think of these benefits like Kohl’s Cash. I want to get my full value for that cash and hate when it expires. Dental benefits are the same for our patients.

The connection with AI comes with the data. In an era of big data, metrics are everything. CDT codes create important data about what is happening in our practices. GIGO applies here. AI algorithms crunch data. If we aren’t gathering as much data as possible by maximizing our use of CDT, holes are created, or data is missing from our information set. 

Further, dentistry already should be recording ICD-10 medical diagnosis codes. Box 34a on the standard dental claim form has space for four ICD-10 codes. Learning to use these spaces is a great baby step to filing medical coding. 

Coding is generally left to the business professionals in our practices. This can no longer be the case. Clinicians have a duty to get involved. The problem is that there is limited or no coding curriculum in either dental or dental hygiene education.  

At best, coding is learned on the fly, with students learning more about policies than about coding. Or, we only see the name of the code in our computer systems. Many available codes aren’t even being used, so that data is lost.

It’s now time for a change. Each day, each patient encounter, we add to our data sets and ultimately AI. It’s time to create the most accurate information possible. The first step is to have both CDT 2020 and the CDT 2020 Companion app on your phone. The CDT Companion includes ICD codes. With this immediate access combined with a desire to improve, clinical professionals can access the system readily.

It’s time go back to the future and stop the GIGO! 

Ms. DiGangi believes dentistry is no longer just about fixing teeth. Dentistry is oral medicine, and it’s time we got around to truly practicing it. Her new brand, Beyond Oral Health, challenges us do so. We can have a world with no oral cancer. We can cure, not just manage, perio disease. And, we can have a caries-free world. But not by doing more of the same. Patti’s specialty is medically necessary coding. Her efforts have helped thousands of professionals code more accurately and efficiently. She teaches the why behind the codes. In fact, the ADA recognized her expertise by inviting her to write a chapter in its CDT 2017 Companion book and again for CDT 2018 Companion. Patti holds publishing and speaking licenses with ADA for Current Dental Ter­minology2020. She can be reached at

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