Let’s get digital!

Ihave had the opportunity to watch technology enter dentistry since the early 1970s.

Ihave had the opportunity to watch technology enter dentistry since the early 1970s. After a slow start, the advent of the PC and Mac made it feasible for an office to automate its bookkeeping and accounting. As peripherals have been added, computer networks have become an increasing necessity in dental offices. There are still many practitioners who have been doing well without all of the new electronics, ever depending on their outstanding skill at the dental chair to (magically) manage the dentistry. Newer dentists have grown up in an electronic world and consider many of these things second nature. There is no transition from “the way we used to do it” in a new, young practice. However, many older practices - with multiple technological personalities - are being passed on to new generations of dentists (many in the same families). I have often witnessed conflicts as the new dentist tries to convince the other(s) to purchase a particular piece of equipment, or add to or upgrade the office computers.

Dentists resist change, especially if it involves a capital expense. Dr. Dale Miles, noted radiology expert, always gets raised eyebrows when he tells his continuing-education classes that along with the purchase of new digital radiography sensors, offices should also upgrade and replace the X-ray heads. “Oh, no, even more money?” they groan.

A category must be established in the annual practice budget for technology updates and maintenance. The good news (and the bad news) is that computer power and capability change rapidly. The top-of-the-line computer from three months ago is now second on the list and costs $300 less. Everyone jokes that his or her new car depreciates as soon as it leaves the dealership. So goes computer power. You will never have the latest and greatest system, so perhaps you should purchase the second- or third-best system - after all, it is now $300 to $600 less than the top-of-the-line model, and a few months ago (while you were procrastinating), it was the top of the line.

Following this pattern, to keep up with the newer versions of software, you have to consider upgrading computer hardware frequently. A simple example was the introduction of Windows XP. Although Microsoft sold an upgrade from Win98 (or 95), the user soon found that he or she just invested $150 in a computer that was inadequate to properly run the XP system. Be aware that Microsoft’s new “Vista” operating system is coming soon. It will appear to allow you to upgrade, but don’t hold your breath. Take a stroll over to Microsoft’s Web site and see what they consider the minimum hardware requirements, and note there will be several versions of Vista to choose from. It also is important to realize that the computers in your treatment areas require more processing and graphics power than the front desk computer because of graphical and media demands, and these requirements change as the products change. As peripherals become more complex, the power and memory demands increase. In many offices, as the computers are replaced on a continuous basis, the front desk is the “younger sister” that gets the hand-me-downs, which feeds more fuel to the “who is more important” fire that exists in every dental office. This scheme, however, can help even out the cash expenditure in this part of the tech budget instead of replacing everything at once. Many dentists think they can save money by doing their own upgrades, which is an alternative to replacing entire systems, but we have to realize this is a hobby and there are better things to do with spare time. As an aside, anyone who does his or her own maintenance, as I do, can tell tales of all-nighters when that new “simple” card change turned into hours of downloads, upgrades, and bleeding fingertips. (You Mac users can smirk at this point.)

So, is the ultimate goal a paperless practice? That is not possible until the U.S. Postal Service stops coming to our offices. If an existing practice wants to go “paperless,” the better term might be “chartless,” with a lot of scanning and paper shredding. Nevertheless, paperless offices are more of a reality in new practices and, by the way, the federal government has put out a directive looking for all medical offices to have electronic patient records (EPR) by 2014.

The Internet has surely changed the way information comes into the practice of dentistry. Most offices have at least one online communication channel available, with more going to high-speed connections and many putting access in the treatment areas. The obvious reason is to access product information from corporate Web sites, but online communities keep thousands of dental professionals abreast of the latest information. Although there are some online CE opportunities, the coming of age of dental blogs, podcasts, and RSS feeds bring experts right into dental life - in close to real time. Many dentists are challenged to balance family life as they try to keep up with these rapid-fire information streams.

Insurance companies increasingly are turning to online access and even payment. More dental offices are using e-mail or cell phone text messaging to keep in contact with their patients for such things as confirmations, filling in last-minute cancellations, clinical follow-ups, and more. Dentists also are using office Web sites as both marketing tools and information pools for their patients, additionally allowing online registration as well as patient education.

Moving along, it is not all about the computers. Many devices continue to enter the clinical area to improve the quality of treatment as well as make certain procedures less taxing both physically and mentally. Mechanized endodontics, electronic apex finders, and digital radiography have changed the face of endo (speaking of bleeding fingertips). The DIAGNOdent from KaVo has opened up the world of early intervention as well as allowed practitioners to know what lies beneath that brown stain or explorer catch. This device has also given the word “watch” a new meaning. Multimedia patient-education presentations, such as MedVisor®dental and CAESY, have saved a lot of vocal cords as well as pencils and paper and, more important, can act as informed consent. Much has been written about digital radiography, and the discussion continues. However, keep in mind that in mature practices, digital radiography requires a transition; in new practices, it will be the only method ever used. All of the numbers about ROI and discussions about which format is easier will become moot as the age bell curve of new dentists moves to the middle.

So what is ahead? Many new digital products will be involved in treatment and treatment planning. The letters CBCT (Cone Beam Computed Tomography) will become as commonplace as MOD. These new units can give us 3-D renderings of the head, allowing precise inspection of tooth eruption locations, pathology, TMJ, nerve locations, and more. Treatment planning for surgical procedures or placements of implants will be totally predictable. Bone levels, root canal paths, and even restorations will be viewable from angles never before considered. As the scans become better and more commonplace, software will be developed to help the practitioner’s interpretation, treatment plan and, in some cases, a robotic guide will actually aid in the procedure. Merging this and optical scanning with the CAD/CAM world opens up possibilities of impressionless dentistry far beyond the dreams Sirona had - 20 years ago - with its first CEREC.

In the midst of all of my technical writing, research, and speaking, I maintain a full-time general dental practice that has celebrated its 30th year. My patients are amazed at my constant enthusiasm, even after all this time. The physical practice has changed dramatically, and it seems that each day brings a new product, device, or procedure - it surely is not boring. Patients sense this; they are impressed with the feel of the office as well as the flashing lights, although at this point, they expect to see new things at each visit. Look at the technology side of dentistry as your vehicle to enjoy and perhaps prolong your dental career. Who knows? We may soon have a little robot-driven handpiece....

Dr. Paul Feuerstein installed one of dentistry’s first computers in 1978. For more than 20 years, he has taught technology courses. He is a mainstay at technology sessions, an ADA seminar series speaker, and serves as the Technology Editor for Dental Economics®. A general practitioner in North Billerica, Mass., since 1973, he maintains a Web site at www.computersindentistry.com. Dr. Feuerstein can be contacted by e-mail at drpaul@computersindentistry.com.

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