Emeritus Professor Laurence J Walsh looks at an exciting new development for the future of dentistry.

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Artificial intelligence (AI) is hardware and software that performs tasks that would normally require human input. It is a disruption that has arisen from the overlap of several areas of technology, especially the Internet of Things (big data), enhanced computational power and machine learning, and better algorithms.

Earlier in 2023, the US Food and Drug Administration gave clearance to the first AI-powered dental radiological detection software, and for dental AI-automated charting. There is increasing interest in AI systems that analyse clinical images or dental radiographs for caries, defects around restorations, endodontic pathology, and more. Periodontal AI classifies cases and identifies bone loss, while endodontic AI searches for vertical root fractures and apical lesions. While orthodontic AI classifies cases, finds landmarks, and predicts treatment outcomes. AI in oral medicine tracks oral premalignant lesions, while AI systems allow robotic devices to place dental implants or drill teeth using lasers.

AI should be a positive thing for a clinician, as it can reduce cognitive workload at any one moment in time, in the same way that automated systems in a modern jet aircraft reduce the number of separate individual systems that the pilot has to monitor and control. This means you can concentrate more on the task at hand, hopefully leading to lower error rates and less performance-related anxiety. AI can also be important for cross-checking, to make sure there are no missed steps.

Given these positives, what are the big challenges in AI in dentistry for the future? Currently, no machine learning approach is able to model all the elements of human intuition, because of complex pattern recognition processes that we apply.

The next issue is the notorious ’garbage in, garbage out’ problem. It doesn't matter what form of AI machine learning or block chain is being used, if you have poor-quality data coming in, you're going to have the same coming out. Hence, datasets used to develop AI need to be free of bias and confounding factors.

The third major area is whether AI poses a challenge to the independence and autonomy of clinicians. Well-designed AI systems will not disempower clinicians, but instead will enhance their work. The big questions are: will AI tools be an optional aid that clinicians can choose to use to help achieve quality outcomes, or will AI be a mandatory ‘must have’? How will the availability of AI change the tolerance of patients and regulators for mistakes, errors, and misadventures? Will patients and regulators expect that AI will be used to check and verify decisions, to make sure that what dentistry we do is precise and accurate, and that our diagnoses and prognoses are correct?

These are important questions to ask, because they determine whether AI will be, overall, an improvement to practice, rather than yet another form of micromanagement, interference, or barrier in our professional lives.

The final area to consider is what AI will do in terms of workload. It will certainly alter workflow and efficiencies. In some cases, it will reduce workload. So, how does that then translate to our work/life balance and the inherent attractions and challenges of dentistry as a career? Fortunately, because of the complexity of dentistry and the need to deal with patients one on one, many of who are anxious and apprehensive, a caring human approach will always be required – something no robot or AI suite of technology can provide. We are very fortunate in that regard.

There are two very good recent reviews of AI in dentistry publicly available. These are a good introduction to the literature of over 100 papers on the topic – I recommend reading both if you want to learn more about this field.

The first is a 2023 narrative review that looks at some of the major developments that are emerging.

The second is a 2021 high-level systematic review.

Laurence Walsh was one of the speakers at the Spotlight on Risk Dental Conference on Saturday 27 May 2023. He explored in depth the impact of artificial intelligence on the working life of the clinician and shared his insights on how to embrace a forward-thinking mindset to thrive in dentistry in a constant changing world. The Spotlight on Risk Dental Conference, brought to you by Dental Protection, is available to watch on demand now.Dental Protection members can watch the Spotlight on Risk on-demand here.