Noah Levine

Image Credit: © AndSus / stock.adobe.com

Computers are integrated into every part of a modern dental practice. Software platforms manage almost everything: scheduling, billing, communications, charting, treatment planning, imaging, and more.

By adopting software platforms that integrate smoothly and avoid overlapping functions, practices can develop efficient workflows that drive success and steadily guide operations for everything from clinical procedures to patient communications. Unfortunately, when the opposite happens and a practice uses solutions that do not integrate, workarounds get incorporated into workflows and redundancies creep into processes.

Finding the optimal software mix is critical, but it’s not an easy task. There is a multitude of software platforms designed for dental practices, and many offer a wide array of both native features and add-on modules to expand capabilities.

It can be an intimidating arena to navigate, but with the right mindset and the right partners, any dental practice can find the best software mix to support, streamline, and enhance operations.

When seeking new dental software, there are a number of pitfalls to avoid. Among the most common is not properly assessing your needs or your options when it comes to potential software vendors and their various platforms. It’s important to know what you have, what you want, and what’s available before doing anything else.

“Before any decisions are made in switching or adding software, dental professionals should conduct a thorough audit of the practice and then ask themselves the question, ‘What opportunities for growth exist?’ ” says Alan Rencher, chief technology officer for Henry Schein One.

This audit can be undertaken by the practice, or via a service such as Henry Schein Practice Analysis, powered by Jarvis Analytics, which analyzes practice data to uncover a deeper understanding of operations, Rencher says. Regardless of who performs the analysis, it should provide a good picture of where a dental practice is today. However, Nina Gilbert, senior global product manager, general dentistry, Sensei at Carestream Dental, notes it’s also important to consider the scalability of the software. A practice does not want to buy something that works today but will not keep working tomorrow. Mike Huffaker, chief revenue officer for Planet DDS, notes that it’s important to be ready for something unanticipated in the future.

“You still want to have the ability to make your own choices as technology changes. As technology advances, you want a software platform that will allow you to take advantage of the best tools at any given time,” he says.

With cybersecurity an important consideration today, Gilbert notes that it’s important to not only know if the software is secure, but also that the company making the software is also constantly working to make sure its platform is safe.

As important as it is to gain a sense of what is needed and to evaluate the technical and security capabilities of potential vendors, it’s just as critical to get the staff on board with potential changes. Plan to dedicate time for training when onboarding a new solution.

“Implementing software is where practices will run into problems if their team members, whether office managers or operations team, haven’t bought into the change of switching software. So you need buy-in whether you’re implementing a new artificial intelligence (AI) solution, patient communications tool, or analytics platform,” Huffaker says.

Training is another key detail that is often overlooked by practices during software transitions. Khamzat Asabaev, founder and CEO of SoftSmile, notes that it’s important to not only factor in the time for training but also the cost associated with dedicating that time to training. When viewed as a cost in both time and money, software training might seem like a good area to find savings, but both Asabaev and Alvin Lin, managing director of Aspire Software’s health and dental division, agree this often proves to be more costly in the long run.

“I’ve observed numerous dental offices resist closing for training and implementation, leading to subpar training experiences and inadequate learning for their teams. This often culminates in a challenging first day with the new system, setting a precedent for ongoing struggles,” Lin says.

Once a practice is set up for a successful software search and implementation with a needs assessment and an excited staff, it’s time to start looking for an application to meet the practice’s needs. Dental software can do a lot of different things for a practice, but some capabilities truly stand out for the positive effect they have on operations and efficiency.

It’s vital that software be flexible and interoperable so platforms can easily work with each other for different tasks. The growth of cloud-based dental applications has helped increase software interoperability, making it possible for practices to provide an enhanced patient experience.

“The future of dental technology is interoperable, cloud-based, and innovative. Every dental practice has unique needs. In a world where convenience takes priority in our day-to-day lives, having a comprehensive patient experience software is a must,” Rencher notes.

Lin agrees, noting that software delivering appointment reminders, confirmations, patient greetings, and reputation management is now vital for almost every dental practice. Gilbert also says patient engagement is a key function, adding that this really connects to every part of running a practice from the claims processing to clinical documentation and treatment planning.

Although clinical images are important for dental professionals, they are not easy for patients to understand. However, some treatment planning and case presentation platforms feature high-quality 3D visualizations. This makes it easier for clinicians to communicate the value and potential outcomes of treatment proposals.

“Creating detailed and customized treatment tailored to each patient’s needs is important, but even more important is how you communicate treatment to patients—which is greatly enhanced with realistic graphics and visuals. Better graphics make it easier for doctors to handle complex cases and enhance the patient experience,” Asabaev says.

Cloud-based dental software does more than just make it easier to connect with patients. As more practices operate as groups, cloud-based software applications make it easier to cohesively manage multiple locations. Huffaker notes that the cloud isn’t just for practices with more than 1 location. Some practices can simplify complex internal systems by shifting to a cloud-based application.

“Dental practices have built software stacks that are becoming unwieldy and create significant integration challenges, particularly for legacy software solutions. To simplify your practice, [information technology], operations, and even vendor relationships, moving to cloud-based practice management software is the natural direction the industry is headed, and I think we’ll see this trend accelerate,” Huffaker says. “The whole industry is at an inflection point. It’s an exciting time as we think about investing in practice management solutions and moving to the cloud. We’re seeing an acceleration in cloud adoption that is becoming more broadly understood by a wider segment within dental.”

It’s also important that the software doesn’t remain static and unchanging. Dentistry and technology are both developing rapidly, and keeping up with these changes remains important. Lin says practices want to find software companies that are always making their products better and looking for new opportunities.

“For a dental practice to remain competitive, its management software must keep pace. Dentists should choose software vendors that regularly update features based on new tech and user feedback. Such dedication ensures the software stays up-to-date with industry standards,” he adds.

Another key area where software can make a huge difference is automating financial processes, notes Erin Smith, software product marketing director for Patterson Dental. Smith says software solutions can simplify managing a practice’s claims, billing, and collections, while other platforms can help patients find financing to cover dental treatment. Both are important to patients and practices today.

“It is important to have electronic claims and attachments for insurance processing integrated into your practice management software as well as credit card processing that is integrated,” she says. “If your office is, or is considering going out of network, or has retired or uninsured patients, dental payment plan software is something that should be considered as well to attract and retain patients and make it easy for them to pay for their care.”

Although there are numerous software options for managing key practice functions, picking the right add-ons and upgrades is another part of the puzzle. Huffaker says keeping your patients top of mind can help you decide which extra services will make the biggest impact on your practice. Try to see your practice through a patient’s perspective to help uncover the biggest needs.

“As a consumer, they will expect to be able to schedule appointments quickly, fill out forms in advance, communicate via text, etc. Keeping patients happy will help your practice grow,” he says.

Having multiple paths of communication with your patients is important, Gilbert notes. Patients want to interact with their dentist on their own terms and their own time, so allowing them to fill out forms online ahead of appointments and automating appointment confirmations can help a practice reduce no-shows and increase patient satisfaction.

“That way, patients feel more involved with their care and have access to their care team,” Gilbert says, noting that this is “a competitive advantage for your office over those that fail to utilize these tools.”

Although numerous software applications include some marketing capabilities, Lin says talking to your software vendor can help find a firm specializing in marketing and familiar with the technology you are using. This can streamline data sharing and help you past other hurdles to effectively market your practice.

Of course, the biggest potential software upgrades right now all feature AI. Practices can add a range of AI tools to handle everything from data analytics to restoration design to diagnostic decision support. Huffaker says AI image analysis and clinical decision support applications help patients understand and feel confident in treatment proposals. Rencher agrees, noting that AI applications can be seamlessly integrated into existing software applications and workflows.

“Adding a clinical-decision support tool powered by AI not only helps the dentist identify issues with confidence, but it also helps build patient trust,” Rencher says. “This technology will only continue to drive forward, so I would encourage practices to have an open mind and consider adding AI to their practice.”

With so many software capabilities available from different platforms for different areas of the practice, it can be a challenge to keep everything in sync. This is why it’s critical to make sure anything new you bring on board can be integrated with the applications you use. Gilbert notes the importance of having a single patient record that contains every bit of information the practice has on each patient. Having solutions designed to work together by the same software vendor or linked via a validated connection between software vendors increases efficiency and reduces the risk of errors.

“The more integrations the better. You want a totally seamless experience for the dental team,” Rencher adds. “Integrations with imaging systems, patient engagement tools, analytics, and others are critical for efficient and accurate practice operations. These integrations ensure that all data are seamlessly accessible within a unified platform.”

This is especially important as practices capture more digital patient information chairside. Those data are often used for treatment planning, and when systems are integrated with practice management and communications solutions, they make it possible for practices to work more closely and efficiently with specialists and labs.

“Software integration capabilities are very important for creating seamless workflows because using and managing multiple software applications isn’t efficient or convenient,” Asabaev says. “One significant advantage of the integration of treatment planning software to practice management software is that it streamlines workflows in the production and timing of different appliances.”

Lin illustrates how an integrated software solution with clinical treatment planning capabilities can help a practice increase case acceptance by creating a comprehensive, understandable, and customized treatment proposal for the patient. This plan should clarify the issue being addressed; highlight potential repercussions of inaction; and clearly explain available treatment options such as required follow-up visits, treatment stages, and payment breakdowns. A solution that pulls data from every part of a patient’s record can create this type of breakdown for each case, and it can track the progress of every treatment proposal, allowing the practice to follow up when necessary.

“The integration of a proficient clinical and treatment planning module into dental practice operations is paramount for achieving a high case acceptance rate. Relying on antiquated methods, such as handing out printed, complex treatment plans filled with obscure dental procedure codes, can leave patients confused and overwhelmed,” Lin says.

Training and support are the other key features that practices need to consider along with the capabilities of any software. It’s important to know what type of installation and initial training are included with the software, as well as how ongoing support is provided once the solution is operational.

Although training at the time of installation is common, some vendors provide ongoing training with regular webinars or in-product videos and tutorials to make software training an always-on service. When something goes wrong and support is needed, it can help to work with a company that is experienced with the dental industry. Huffaker notes that companies such as Planet DDS have focused on developing applications to solve the challenges of dental practices, and this makes a big difference when it comes to support.

“There’s a lot of value in being a provider that understands dental and the needs of our customers,” he says.

For practices looking to take a more analytical approach to evaluating a software vendor’s support service, Lin recommends asking about average response time, live answering rate, typical callback duration, and the percentage of issues resolved within the same day. A reliable vendor will be transparent about performance metrics, he adds, noting that it’s important to engage with your software vendors and to share feedback both positive and negative.

“Entering a partnership with a software vendor is a long-term commitment, similar to any enduring relationship. The cornerstone of such partnerships is regular, constructive communication and feedback, fostering a mutually beneficial association,” Lin says. “It’s essential to align with a software provider who embodies authenticity, transparency, and a genuine commitment to their clients’ success.”

Digital processes are a part of every dental practice, and when it comes to managing data, dental practices face a choice among numerous software titles and vendors. Different practices will need different software capabilities. But no matter what the application will be doing in the practice, it should deliver the key functions you need, come from a vendor that provides training and support, and integrate with existing workflows and solutions.

“Dentists should take their time to evaluate their specific needs, consider these factors, and collaborate closely with their chosen software provider to ensure a smooth and effective software implementation,” Rencher says.

Articles

Software can be the foundation of an efficient dental practice, or it can become a workflow bottleneck that frustrates staff and patients. Selecting the right platforms and getting the most out of the ones you choose are critical steps to success.

Software Solutions for Your Practice

The SmileCon 2023 exhibit hall was never quite full throughout the recent event.

It is hard to cover the recent American Dental Association (ADA) SmileCon event without noting the light attendance in the exhibit hall throughout the event. There was plenty of action in the exhibit hall with multiple educational stages and self-guided continuing education opportunities, but unfortunately, the space never felt full, busy, or energetic.

But, even if there were not large numbers of excited dental professionals on hand, there was still new products worth checking out, and speakers and key opinion leaders on hand to and answer questions and connect with colleagues.

When it comes to discovering innovative new dental products, the SmileCon 2023 exhibit hall was a worthwhile visit. There were companies showing off new solutions for every part of a dental practice. Here are some of the highlights we saw at the show in Orlando.

The Ti-Max Z990L highspeed handpiece can produce up to 44 W of power. | Image Credit: © NSK Dental

NSK Dental was showing off their powerful new Ti-Max Z990L highspeed handpiece which can produce up to 44 W of cutting power. The air-driven handpiece is designed for efficient removal of zirconia and other materials, adding efficiency to procedures and reducing discomfort for patients.

While developing the “Dynamic Power System” for this new handpiece through fluid simulation software, NSK was able to dramatically increase the power, but this also required a re-engineered chuck to hold the burs stable at higher torque. For this the Ti-Max Z990L is equipped with the new, proprietary Durapower Chuck.

Along with these features the new handpiece includes a range of features designed to make operations safer for clinicians and patients, and to make maintenance and repair easier and faster.

Listerine's new Clinical Solutions line of mouthwash is available in Gum Health, Breath Defense, and Teeth Strength formulations. | Image Credit: © Kenvue

A trio of new Listerine formulations also made their debut at SmileCon 2023. The new Listerine Clinical Solutions mouthwash line features three distinct formulations designed to meet specific patient needs.

Featuring 67% more zinc than other Listerine zinc product, the Listerine Clinical Solutions Gum Health mouthwash is designed to promote a healthy oral microbiome. Michael Lynch, DMD, PhD, Global Director, Oral Care Scientific Engagement at Kenvue, says he’s most excited about the potential of this mouthwash formula, especially for patients who are not able to properly floss.

The Listerine Clinical Solutions Teeth Strength mouthwash is formulated to provide up to 7 times the fluoride uptake of other mouthwashes. The mouthwash features Rapid Fusion Technology® which binds calcium ions with fluoride to create reservoirs that can help increase tooth strength by three times compared with brushing alone.

Finally, the new Listerine Clinical Solutions Breath Defense mouthwash can neutralize the causes of bad breath for as long as 24 hours when used twice daily. The formulation features zinc, essential oils, and additional odor reducing technology designed to kill bacteria responsible for the production of bad odors. All 3 formulations are designed to be a part of a targeted homecare routine for patients, and Dr Lynch says they can be used as tools to help patients prevent potential oral health issues through improved care between dental treatments.

The Reva dispenser from MedTekk provides wet and dry towels on demand reducing a practice's reliance on non-biodegradable wipes. | Image Credit: © MedTekk

A forthcoming innovation on display at SmileCon, the Reva system from MedTekk is a new, sustainable approach to wipes that is expected to launch before the end of the year. Reva appears to be a common touch-free paper towel dispenser, but the system is designed to dispense either dry towels or wet wipes filled with a disinfectant or cleaning liquid.

Reva makes infection control more sustainable because standard wipes contain plastics and do not biodegrade. Using the Reva system allows practices to use paper wipes for all purposes, reducing the amount of non-biodegradable material a practice produces. The wipes are LEED compliant sustainable towels made of organic cellulose fibers.

The system uses a refillable reservoir for the fluid used to provide wet wipes. This allows practices to continuing using the infection control materials they are comfortable with while reducing the amount of plastic waste being produced.

The event might not have always been bustling, but that also meant people had more time for substantive conversations. Dental Products Report was able to catch up with Eric Kukucka who is pushing digital dentures forward in his role as vice president of clinical removable & design technologies for Aspen Dental.

While providing an update on the technology transforming how Aspen is creating dentures, Kukucka notes that while Aspen Dental produces more than 500,000 dentures a year, most young dentists graduate from dental school having only produced a handful of dentures while earning their degree. This gap between patient demand and clinical experience is where technology is critical, and Kukucka says Aspen is employing digital production workflows, while simultaneously providing dentists with hands-on training.

By using the efficiencies of digital production, Aspen is able to meet patient needs, and can even replace a patient’s dentures from any Aspen Dental location. However, these benefits cannot be fully realized without combining them with training for the clinicians in both producing high quality dentures, and explaining the benefits their patients.

For Kukucka, success in this area is a moving target. Both the technology available to dental professionals and the expectations patients bring to a dental appointment are changing, and practices of all sizes must be able to adapt and continue to find new and better ways of providing the care patients want and need.

One area he is excited about is artificial intelligence (AI). Kukucka says this technology can save time and automate processes across a range of clinical and business operations, but it will only be useful as long as it is a tool. AI systems should never be working on their own, as a skilled professional should evaluate AI outcomes before making a final call on whether or not to use the AI-generated suggestion.

The American Dental Association’s 2023 SmileCon event did not draw large crowds, but there were still plenty of exciting things happening during the event in Orlando.

Finding Things to Smile About From a Slow SmileCon

CS 9600 Image Gallery

CS 9600 from Carestream Dental

ChairsideCAD Image Gallery

ChairsideCAD from exocad

MiniBio Auto-Reader from Terragene

Nova Image Gallery

Nova from Bien-Air

PreXion 3D Excelsior Image Gallery

PreXion 3D Excelsior

SprintRay Ceramic Crown Image Gallery

SprintRay Ceramic Crown

Trios 5 Image Gallery

TRIOS 5 from 3Shape

RE-GEN™ Universal Adhesive Image Gallery

RE-GEN™ Universal Adhesive from Vista Apex

Yapi Image Gallery

Yapi™

Simplify Image Gallery

Amplify from Simplifeye

Guided Biofilm Therapy Image Gallery

Guided Biofilm Therapy®  from EMS Dental

QASi™ particles from Nobio

Retraction Paste Image Gallery

Retraction Paste from VOCO

DGSHAPE DWX-42W Plus Image Gallery

DGSHAPE DWX-42W Plus from Roland DGA’s DGSHAPE

DTX Studio Clinic Image Gallery

DTX Studio Clinic from DEXIS

Second Opinion Image Gallery

Second Opinion® from Pearl

Dragonfly from Orascoptic

2023 Cellerant Best of Class Technology Awards

Take a look at the 17 dental products and technology named as winners of the 2023 Cellerant Best of Class Technology award.

A Class Above: Presenting the 2023 Cellerant Best of Class Technology Awards

The buzz around artificial intelligence (AI) is thunderous and seems to keep growing in volume and scope. This is true for the world at large, as well as for the dental industry. AI technologies seem to be integrated into every product and service, but just what AI is and how it’s being applied is not always clear.

With those questions in mind Digital Transformation Partners and 

created the AI Velocity Summit. This live event in Austin, Texas, September 20-21, is designed to bring leaders in dentistry together to discuss AI opportunities, risks, applications, and potential guidelines, regulations, or limitations.

Ahead of this event, Margaret Scarlett, DMD, chief science and technology officer for Digital Transformation Partners, and 

 editorial director Noah Levine discussed AI in dentistry and the upcoming summit.

 To jump right in, what is the current state of AI in the dental industry?

 There's so much going on in AI right now, I don't know where to start. We have over 200 different products that are either under review at the FDA, or already cleared or approved or exempt from approval. So in a very short period of time to have 200 different companies and 70 investment groups who are getting into this is kind of incredible.

 Why do you think there are so many AI companies and AI applications coming to the dental space right now?

 I think part of it is dental is part of the larger culture. I mean, we've just seen an explosion, how many hundreds of millions of people are now on ChatGPT? It's really remarkable. ChatGPT launched last November, and already, they’ve had several hundred million users. So, these large language models have put a greater focus on the AI technology, different than the AI used for dental patient intake, dental imaging or for validation of claims or adjudication of claims.

Since we use more types of AI than large language models, it's caused us to reimagine oral care on how we might be more efficient, more productive, and utilize the best of AI to make improvements for payers, for providers, for patients, and, even for even supply chain issues. We're seeing a lot of companies who are moving into AI with a supply chain focus. In all of its uses, AI is helping people do these routine tasks much more easily, and I think that's part of the reason it's been so much of an explosion of AI.

The second thing to that's happened is in healthcare there's a lot of emphasis on AI being utilized for imaging purposes. There's been a lot of focus in dentistry on reading images much more reliably—maybe not necessarily more accurately, the jury's still out on that—but definitely more reliably. AI systems don't get tired. AI systems do not get tired, like most of us, are at 5 o'clock, after they've been working since 7 am with their morning huddle. AI doesn't get tired, and it can do things quickly, much more quickly, on what they are trained to do than humans.

 You've touched on a few of the benefits that are out there waiting to be realized, but what are some of the stumbling blocks and pitfalls that could prevent the dental industry from realizing AI’s benefits at a large scale?

 Well, one is workflow and, and costs. I mean, who's going to pay for AI? Usually, it's the providers, and that's just another cost the providers have to absorb at a time when inflation is high and every purchase is being scrutinized. So, the cost is one of the barriers. I think the other one is really the adoption of it. AI can really help with productivity, but it requires some changes in workflow.

With AI image analysis integrated into a practice workflow, I think patients will have more confidence in what we say. Patients couldn't see the little x-rays with a tiny shadow and see what providers see. Now, patients can view images on a big TV screen, and the patient's sees the little triangles, or squares, or lines, or whatever that software uses, to indicate a finding. They are seeing this like the dentist or hygienist, either at the same time or after the provider assesses the image. It is a game changer for patient acceptance! 

Another risk is the fact that most of the algorithms that we have right now are static. Dynamic models continue to learn and the algorithms will change. What we're seeing now that's been cleared or approved by FDA are static algorithms, but dynamic models are a big area of interest. Dynamic is the future and FDA has asked for guidance on what to tell patients and providers about dynamic AI models. Dynamic AI models are continually learning models, but there is also increased risk for bias. How do we provide guardrails and guidance for continuously learning models? Do we need post-market surveillance for safety or AI algorithms that are Class II or III devices? We should talk about this.

We know that both static and dynamic models, there are risks the algorithms can be biased, or the training data can exclude certain demographics, like gender, race, or age. These risks also hurt adoption of AI if that occurs, like it did with the Epic AI Sepsis model. This model failed to identify more than two-thirds of sepsis in hospitals, according to published reports. We've seen that on the medical side, hopefully, we'll avoid that in dentistry. That's part of the reason we're supporting the AI Velocity Summit on September 21st, so we can have some of these conversations to talk about the guardrails and guidance that we need for monitoring ourselves, and the best ways to protect our patients and provide the best oral care possible.

 Can you tell me a little bit about the AI Velocity Summit event? What is it, and who is it for?

 So, this is a Leaders Conference. It's not for everyone, it's for leaders in all parts of the dental industry with an interest or a stake in AI. Leaders in the investment community who are investing in AI now really only have a very small amount of investments in the oral health space. We hope to increase that, from about 1% to 4%. 

We’re looking to connect leaders from dental support organizations who are rolling out AI solutions across a wide number of practices, as well as medical processionals looking to create connections with the dental industry. Payors are using AI to detect fraudulent claims, with payors leveraging AI to verify treatment plans submitted and resolve claims more quickly. Payor leaders can suggest their support. Providers want to provide the best oral care. Patients want quicker validation of benefits, and prompt payment of claims for dental bills. Investors want to invest wisely in AI products and services. AI can be a win-win-win-win. There is a 360-degree view of AI that encompasses everything from supply chain to patient intake, patient treatment, and payment of claims to patient recall visits.

We want to have those leaders all coming together to dialogue on these issues, and more. The purpose of the summit is to come out at the end of the day and have some actions steps, lessons learned and next steps.

During the event we'll have 6 different panels that will talk about a variety of topics that are of interest. At the end of the conference, we're going to have lessons learned about what we know and what we agree upon. We'll also have a list of next steps.

This is going to be in a talk show style format, so we'll be able to talk candidly about what we know, and honestly, what we don't know, in an open forum that is casual, but also allows us to exchange important information.

 Is there anything else people should know about AI in dentistry and the upcoming AI Velocity Summit in Austin on September 21, 2023?

 The scale of oral disease can only be met with the scale of technology. This conference is about reimaging oral prevention, care and treatment with AI and technology to finally meet our national goals and objectives. We're just at the beginning of this new technology, AI. If we get this right now, we can avoid the mistakes that have already been made elsewhere. That's what I'm really excited about, so that we have this national conversation with leaders about AI in a reimagined oral care system.

This is going to be, "The Room Where it Happens." We're going to have lots of time for networking so that we can have candid discussions on the stage and off the stage and in this talk show format. We're very, very excited about the potential for AI to reimagine oral care to make it better for DSOs, payors, providers, patients and investors.

The AI Velocity Summit will be held September 20-21, 2023 at the Hyatt Regency in Austin, Texas.

For more information on the AI Velocity Summit or to register, 

Margaret Scarlett, DMD, chief science and technology officer for Digital Transformation Partners, joins Dental Products Report editorial director Noah Levine to discuss artificial intelligence in dentistry, and the upcoming AI Velocity Summit hosted by Digital Transformation Partners and Dental Products Report.

Preparing For Dentistry’s AI Summit

Image Source: © freshidea / stock.adobe.com

Although it likely comes as no surprise to anyone working in a dental practice, the prevalence of oral diseases can be staggering to think about. When this is coupled with the growing body of knowledge linking these oral conditions to other systemic health problems, it is clear that dental professionals need to find the most effective preventive and restorative options and guide patients toward oral care products that also help protect their overall health.

For dental educator, clinician, researcher, and current president of the 

American Academy for Oral and Systemic Health

, Mark Cannon, DDS, MS, this means keeping up on the latest research and being willing to adapt when it becomes apparent a better solution is available for his patients. He hopes other dental professionals will take a similar approach as new research findings point to enhanced oral and systemic efficacy of different treatment and home care options.

“According to the Centers for Disease Control [and Prevention (CDC)], we have oral disease that ranges from cavities to gum disease to oral cancer. It causes pain and disability for millions of Americans, and it costs the taxpayers billions…of dollars for just the oral care, let alone what we now know are the [adverse] effects, where we have a very significant systemic illness that occurs,” Dr Cannon says in a recent interview with 

Dr Cannon notes that although the CDC reports that 47% of adults have some form of periodontal disease by age 30, and 70% have periodontal issues by age 65, many dental professionals think that second number might actually be a low estimate. The impact of this disease is felt in many ways, with Dr Cannon noting that tooth loss leads to a 59% increase in overall mortality, whereas the presence of periodontal disease means a patient is 49% more likely to face cardiovascular issues.

“All these have immense costs down the road, and I think everyone’s starting to realize this,” Dr Cannon notes. “Why is this occurring? Why is it such a scourge of mankind?

Well a lot of it, sadly, is diet. Our diet is heavy in carbohydrates. Foods are not nutritious, and heavily preserved, which affects our health and is the cause of many issues.”

Although the challenge is significant, the growing knowledge of the connection between periodontal disease and other systemic health conditions is leading to new approaches to patient care. With research data showing that airway issues can hamper the effectiveness of periodontal treatment, Dr Cannon notes that clinicians should now make sure they are checking periodontal patients for complications that might arise from mouth breathing.

This approach is also leading to new approaches for dental professionals. Dr Cannon says dentists should be asking periodontal patients about their diet and potential diabetic conditions. The standard of care for a dental visit was once just to clean the teeth, but Dr Cannon says it is time for dental professionals to be more comprehensive in how they approach patient diagnostics and care.

“The periodontal probe was first designed by Dr Charles Williams back in 1936,” he notes. “We’re looking at 90 years, and we have got to improve the standard of care.”

Looking at ways to improve on the standard of care is something Dr Cannon says is critical to the future of dentistry, as well as health care in general. One part of that mission is to continue to search out more effective and safer options in all areas of oral care, and he believes mouthwashes and home care products are due for an update when it comes to the active ingredients being used.

Dr Cannon notes that according to marketers and manufacturers, approximately 200 million Americans use some type of mouthwash. Many of these products feature similar formulations of their inactive ingredients, but there are major differences when it comes to the actual antiseptic agent at work.

Chlorhexidine is among the common active mouthwash ingredients, and it is especially used for periodontal patients, but Dr Cannon says evidence from a growing body of research should be leading dentists away from those solutions. Although chlorhexidine does kill microbes, the adverse effects can be counterproductive.

“Chlorhexidine can cause an increase in calculus formation. It can alter taste perception. But that’s not the big problem with chlorhexidine,” Dr Cannon says. “The big problem with chlorhexidine is the systemic effect.”

Troubling data show that chlorhexidine might cause problems for patients with cardiovascular issues. This is because it is very effective at killing Neisseria bacteria, which Dr Cannon explains are bacteria that break down nitrates to become nitric oxide, which helps regulate blood pressure and cardiovascular health. He also notes that preserving Neisseria is among the guidelines issued by the American Heart Association.

“Sadly, in studies done with just 2.2% chlorhexidine, they find it reduces your nitrate-producing bacteria by over 90%, which has a really bad effect upon both systolic and the diastolic blood pressure,” Dr Cannon says.

He finds this data most troubling because it shows that patients with cardiovascular issues and periodontal disease could be using chlorhexidine to treat their oral condition without knowing that it could be exacerbating their cardiovascular problems.

Although these findings are troubling, Dr Cannon believes there are options proving to be just as effective for treating periodontal disease without the drawbacks of chlorhexidine. To find those options, he and other researchers are looking to the human body’s natural function to find solutions that provide a more systemic approach.

“We’re finding that you need to maintain your natural defense mechanisms, especially saliva, and saliva has incredible properties,” he says. “It lubricates while you eat food, it starts enzymatic digestion, it buffers, it has calcium and phosphate to remineralize teeth, it helps with tissue repair, and of course, the lubrication helps with the eating and talking, and all that enhances taste.”

Issues with saliva production can lead to problems with taste and can affect a patient’s speech. But more importantly, issues with saliva production correlate with an increase in periodontal disease, and Dr Cannon notes that with more than 1100 prescription medications causing dry mouth as an adverse effect, it should not be a surprise that dry mouth issues affect 20% of the adult population.

“So we do need to have a mouth rinse that is effective, that helps with a little lubrication, helps reduce decay, and does not cause more decay,” he says.

“Saliva has all these enzymatic complexes, which are just fascinating. In fact, there [have] been studies showing over 63 antimicrobial proteins and peptides in our saliva, and they’re part of our innate defense mechanism.”

With those goals in mind, Dr Cannon is excited about the results he sees from mouthwashes and toothpastes featuring combinations of polyols such as xylitol and erythritol.

 Both are prebiotics which Dr Cannon explains means they encourage the growth of “good” bacteria and discourage growth of pathogenic bacteria. Additionally, he notes that research findings show xylitol can serve as a calcium carrier and enhance remineralization of tooth structure.

Research into these new mouthwash formulations is showing that xylitol can be as effective as chlorhexidine, and it does so without the adverse effects.

When it comes to promoting a health oral environment, Dr Cannon says xylitol has been shown to inhibit the growth of periodontal disease–associated bacteria groups including 

. It also helps enhance the effectiveness of the natural salivary defense systems, he notes. This has led to some research data showing xylitol as an effective approach to reducing cancer growth.

“The growth of the cancer is reduced by xylitol, because xylitol enhances the innate defense mechanism by reducing the cancer cells’ resistance to hydrogen peroxide, which is produced by our killer defense cells,” Dr Cannon says. “It is fascinating, the research on xylitol and cancer.”

, the bacteria responsible for cavities, can also be an initiator of oral and gastric cancer, and he is excited by the concept of protecting oral health and possibly preventing cancer at the same time with the same materials.

Preventive Dentistry With a Systemic Impact

Research into this area is ongoing, but according to Dr Cannon there are already options available that take advantage of the benefits of xylitol. One formulation that Dr Cannon has helped evaluate at Ann & Robert H. Lurie Children’s Hospital of Chicago features xylitol and erythritol, which strongly inhibited all the oral pathogens tested. In addition, the research team includes renowned scientists from Brazil who added a patented trimetaphosphate nanoparticle for greatly enhanced remineralization. The formula is now called EnamelMax, and it is available in several products from the Xlear Spry Dental Defense product line.

“It also has L-arginine; L-arginine actually increases the pH of the plaque. So it’s the toothpaste that looks at everything,” he says.

Formulations like EnamelMax are important in making dental products more effective for patients. Although most fluoride toothpastes help patients, they reduce decay by only 20% to 25%. Dr Cannon notes that research data today show that is no longer good enough.

Today we know enough to focus on formulations that augment natural defense systems and help maintain a stable, healthy oral environment.

“No one should be utilizing a toothpaste that only prevents decay,” Dr Cannon says. “Your toothpaste should also be working at preventing the periodontal pathogens—like 

—from attaching to and then invading the gingival epithelial cells. Once they get within the cells, they’re very difficult to remove. Xylitol does that. It prevents attachment of the pathogens to your epithelial cells, which protects the host from attachment and invasion.”

Bescos R, Ashworth A, Cutler C, et al. Effects of chlorhexidine mouthwash on the oral microbiome. 

. 2020;10(1):5254. doi:10.1038/s41598-020-61912-4

Dodds M, Roland S, Edgar M, Thornhill M. Saliva: a review of its role in maintaining oral health and preventing dental disease. 

 2015;2:15123. doi:10.1038/bdjteam.2015.123

de Toledo PTA, Delbem ACB, Cannon ML, Sakamoto AE, Pedrini D. The effect of toothpaste with reduced concentration of fluoride-containing sodium trimetaphosphate and polyols on initial enamel erosion. 

. 2022. 26(12):7243-7252. doi:10.1007/s00784-022-04684-7

Marcato RA, Garbelini CCD, Danelon M, et al. In situ evaluation of 200 ppm fluoride toothpaste content trimetaphosphate, xylitol and erythritol on enamel demineralization and dental biofilm. 

. 2021;111:103724. doi:10.1016/j.jdent.2021.103724

Miake Y, Saeki Y, Takahashi M, Yanagisawa T. Remineralization effects of xylitol on demineralized enamel. 

 2003;52(5):471-476. doi:10.1093/jmicro/52.5.471

Cardoso CAB, de Castilho ARF, Salomão PMA, Costa EN, Magalhães AC, Buzalaf MAR. Effect of xylitol varnishes on remineralization of artificial enamel caries lesions in vitro. 

. 2014;42(11):1495-1501. doi:10.1016/j.jdent.2014.08.009

Park E, Na HS, Kim SM, Wallet S, Cha S, Chung J. Xylitol, an anticaries agent, exhibits potent inhibition of inflammatory responses in human THP-1-derived macrophages infected with 

. 2014;85(6):e212-e223. doi:10.1902/jop.2014.130455

Krupa NC, Thippeswamy HM, Chandrashekar BR. Antimicrobial efficacy of xylitol, probiotic and chlorhexidine mouth rinses among children and elderly population at high risk for dental caries – a randomized controlled trial. 

. 2022;63(2):E282-E287. doi:10.15167/2421-4248/jpmh2022.63.2.1772

O’Connor M, Harrison G, Lenahan D, Moran GP. A dentifrice containing salivary enzymes and xylitol exhibits superior antimicrobial activity in vitro against adherent 

 compared to a chlorhexidine dentifrice. 

. 2023;76(2):ovad026. doi:10.1093/lambio/ovad026

Zi M, Zhang Y, Hu C, et al. A literature review on the potential clinical implications of streptococci in gastric cancer. 

. 2022;13:1010465. doi:10.3389/fmicb.2022.1010465

Mark Cannon, DDS, MS, outlines data indicating the dental industry should move away from using chlorhexidine and toward a xylitol-erythritol combination.

Following the Science to Better Preventive Dental Products

Any dental lab using digital production solutions

At all times the lab is using digital production

The Manufacturing OS platform works with almost any digital dental solution to significantly reduce data preparation time while simultaneously doubling machine productivity.

This advanced software platform from Oqton optimizes and automates digital production workflows for dental labs.