Dental informatics is the application of computer and information science to improve dental practice, research, education and management. Dental informatics is a sub-specialty of medical informatics.
Ultimately, goals of dental informatics are to improve patient outcomes, and make delivery of dental care more efficient. This can be achieved through incorporation of informatics in the various tasks performed in dentistry, such as dental education, licensure, training and continuing education, administrative aspects of dental care (scheduling, billing, insurance claims), electronic oral health records, literature reviews and clinical decision making, dental imaging and radiography, construction of restorations2,and possibly patient monitoring systems.
There are many topics, methods and applications that can be shared such as methodologies of decision support and health quality care, issues of evidence based medicine, medical decision making, bioinformatics, imaging informatics, and telemedicine.
A computer can be used to augment, enhance, or replace traditional teaching strategies to provide new methods of learning. They can support personalized one-on-one education, at any time, any place, any pace. It can place the student in simulated clinical situation, or in a simulated examination, and exercise the student’s knowledge and decision-making capabilities in a non-threatening environment. It can be individualized and inter-active, which can maintain the enjoyment, engagement and interest of the student. Many modes exist that use computers and technology in education, whether it is medical or dental; such as drill and practice quizzes, computer based didactic lectures, and simulations among others. In dentistry Computer-assisted learning packages have been developed in several dental disciplines such as oral pathology, tooth anatomy, trauma, for general teaching and as interactive programs to provide students the ability to develop their critical thinking and decision making skills.
Immersive simulation environments, with a physical simulation of a patient, have evolved into sophisticated learning environments. In dentistry specifically ; the use of simulation has been used widely, especially since dentistry is a very hands-on profession that requires students to learn how to perform procedures such as, cavity preparations, restorations, root canal treatment, and crown preparation among others, in a pre-clinical course on manikins, before performing them on patients. These previously were performed on ivorine teeth or extracted teeth placed in a jaw model on a simulated phantom head to mimic clinical situations. Faculty instructors would evaluat steps in procedures performed on these teeth. Currently, units are being developed as Virtual Reality Simulators.
These units consist of a simulated patient or manikin with head and dentoform, dental handpiece and light, infrared camera, and two computers. The manikin head and handpiece contain infrared emitters that allow the infrared camera to detect their orientation in space. As a student prepares a tooth in the manikin head, the computer can formulate a virtual image of the tooth being prepared in the computer. The virtual tooth can then be compared to the ideal preparation approved by the faculty, and abundant, detailed visual feedback can be given, including a grade (Figure 1). The unit can evaluate the process of the preparation and not just the end product. Other units currently being developed are completely simulated and teeth (with levels of decay) and instruments are all completely virtual.
Electronic Oral Health records (EOHR)
In the Institute of Medicine report in 1991, healthcare specialties, including dentistry, are the target for the use of computer-based patient record technology. This technology is used first to provide patient care with respect to that individual's health conditions and second to concurrently manage the resources needed to provide that care. Around that time, the American Dental Association (ADA) began collaboration with others to describe a specific electronic oral health record that complements the electronic health record used for general healthcare. The monograph, "The Computer-based Oral Health Record," was an early statement of this description. The ADA then established a Standards Committee for Dental Informatics (SCDI).
Although there might be some similarities in the compilation of general medical history, there are some elements such as the dental history, oral health status, and charting, that have no equivalent in medicine. Dentists collect, display and analyze data differently than do their medical counterparts. Most design work that is used in the development of computer-based medical records are simply not applicable for computer-based dental records.3
There have been many productions of the EOHR, with different approaches and different focuses: such as inclusion of dental history, oral status, treatment planning, progress notes, Patient Care Database, medical alerts, clinical care guidelines, care modifiers, and diagnostic decision support. Input may be by voice recognition, digital pen input, touch screens or a variation thereof. The EOHR should be designed to integrate with the EHR, so that data entry of information that is common among medical specialties must be recorded in a consistent manner.
Construction of tooth restorations
Dentistry, being the multi-disciplinary profession that it is, has borrowed and imported a plethora of innovations from other industries. One of such is the CAD/CAM technology from the science of architecture and engineering. CAD/CAM is an acronym for computer-aided design/computer-aided manufacturing. The technology was introduced to dentistry in 1988 in Germany and is widely used today to generate tooth-colored fillings that are bonded to front and back teeth. CAD/CAM can be used for making fillings chairside in the dental office or for fabricating restorations in a dental laboratory. When creating a chairside CAD/CAM filling, the dentist takes a digital picture of the prepared tooth with a small intraoral camera. An improved imaging technique that is accomplished with 2-dimensional line grids is projected onto the tooth, which allows for a mathematical reproduction of prepared and unprepared tooth surfaces, including those that are outside the direct line of light. The relative position of the sensor to the surface of the object is controlled automatically. This digital image contains three-dimensional information about the size of the tooth and defect being restored, as well as the adjacent teeth. The acquired digitized data points are directly translated from the sensor to the electronic controls of the milling machine to provide various manufacturing possibilities, including copy milling and accurate reproduction of tooth surfaces in various materials. The dentist can design the desired filling directly on a computer screen using CAD/CAM software. Once all data is entered, a tooth-colored block of ceramic or composite material is machined to produce the designed filling. The CAD/CAM filling is then tried in the mouth, adjusted, and cemented in place.
The latest technology in dental imaging equipment, actually morph the picture of the patient's face to show how restorations, braces or surgery will change the jaw, cheekbones and teeth. The dentist takes a photograph of the patient with a digital camera, makes the probable change in appearance on a computer screen and presents the patient with a printout. Before the morphing feature was available, dentists and orthodontists used slower computer systems, and spent a lot of time moving the images by cutting and pasting. They would have to call the patient back for another appointment to see the results.
Radio-VisoGraphy (Digital xray Imaging)
The advancements in digital radiography are really a break-through in the field of dentistry, particularly in the specialty of endodontics (root canal therapy). The most significant advantages of digital imaging are computer-aided image interpretation, image enhancement, in addition to the obvious options of standardized image archiving and image retrieval. The reduction in radiation exposure( by 1/10th) and speed (4 seconds) in which these images are produced can reduce the amount of chairside the patient spends by more than half. This means less accumulated chairside cost, less expense on dental film, less exposure to toxic chemicals, and more comfort to the patient. , The possibility of changing the look of a digital radiograph has raised the question of how trustworthy a digital image is. Clinical imaging software should always keep the original of the image, even if other characteristics have been changed by the viewer. Electronic files have several time stamps that indicate the creation date and time of the file, when it was accessed, and if and when the file may have been changed. In most cases, software does not allow deletion of a digital image from the database, something that is quite simple to do in an analog archiving system.
Teledentistry’s roots lie in telemedicine. Telemedicine has been practiced since the late 1950s, and a substantial amount of money has been spent on research and demonstrations. The term "teledentistry" was used in 1997, when Cook defined it as "the practice of using video-conferencing technologies to diagnose and provide advice about treatment over a distance." Teledentistry can extend advanced care to patient populations at a reasonable cost throught their health care providers, as well as ease the problem of a shortage of specialized dental consultants and professional isolation in rural areas. Teledentistry can be an important tool for long-distance CE programs. An interactive videoconferencing system would be more effective than a Web-based system because of its ability to provide immediate and adequate feedback. Teledentistry in dental education can provide primary care professionals with easy access to efficient consultation and case-based CE opportunities.
Some barriers still exist for teledentistry practice, including legal, educational and insurance issues. Most important, an experienced instructor is required for designing protocols, instructing students and providing necessary technical support. With thorough planning, however, teledentistry has a bright future.
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Submitted by: Ebtissam Al-Madi