All Digital Everything: All the Places and Ways to go High Tech in the Dental Practice

Dental practices today look, feel, and sound different than they did 20, 10, even 5 years ago, thanks to the constant shift away from analog and toward a more digital world. Tasks that were once done using paper and pencil have been delegated to computers, clearing up clutter and making dentistry more sustainable. Humankind has never had more information or knowledge than it does at this moment, which leads to plentiful innovation in a variety of fields.

Dental practices once stuck in the technological Stone Age have more access and insight into digital technologies than ever before, and leveraging that access and knowledge is key to staying ahead of the curve when it comes to acquiring and retaining patients.

But “digital” is a wide, encompassing term. It’s a large umbrella that a variety of technologies and techniques can fit under, so it can be overwhelming to know where or how to start. It may be helpful to do a walk-through in your dental practice, starting with what every patient is confronted with the second they step into the building-—the front office.

Front Office

The front office is the first place a patient sees, and their first experience with the kind of care they’ll receive at the practice. In a less literal sense, it also houses much of the “business” of the dental practice, including scheduling, payments, and intake.

This is where digitization can be key, according to Steven Maroulis, executive director of patient experience and analytics for Henry Schein One, a dental software and office technology company. “To enhance the front office experience for patients and practice staff, dental practices can optimize 2 key areas: intake and scheduling,” Maroulis says.

Intake can be a huge obstacle and time sink, especially when adding new patients. Historically, patients would enter a dental practice and immediately be confronted by forms and documents, carving out time in their schedule that could be otherwise dedicated to treatment. Digitization enables patients with the flexibility to do things their way, without sacrificing the practices’ needs and requirements for them, Maroulis says.

“Within seconds of entering a practice, patients are overwhelmed with several forms consisting of demographic information, medical history, insurance information, etc,” he says. “By digitizing forms and allowing patients to fill out information on their own time from their own devices, practices can create a more seamless intake experience.”

So instead of wasting precious treatment time, patients can walk in with the confidence of having filled out forms beforehand and the knowledge that they can get right to treatment. These digital forms can be optimized and integrated through the practice management system (PMS), adding further context for future visits as well as vital insight on their medical history for the hygienist and dentist.

Scheduling is another key aspect of the front office, comprising just some of the front office staff’s responsibilities. Getting in touch with patients can be an endless challenge, between missed calls, wrong numbers, and just the general busyness of life. Paper calendars can be helpful, but what if there was a more seamless way to schedule and modify appointments for patients?

“Front desk staff often spend most of their time taking phone calls to schedule or modify patient appointments. By allowing patients to schedule their own appointments online, practices can reduce their overall call volume and enable the staff to maximize their productivity and engage with patients in the front office,” Maroulis says. “Henry Schein One’s scheduler and forms capabilities allow dentists to drive a positive patient experience through increasing convenience and ease of use.”

Online scheduling reduces human error, avoiding those awkward double-scheduling situations that may occur when everything is done on paper in the office. Digital calendars block out time slots, fit the right clinicians to the right treatment, and provide clarity for patients, especially because they integrate directly with the PMS. In the dental practice, time is money, and finding new ways to make everyone’s time more productive and effective leads to better outcomes for both the clinician and the patient, Maroulis says.

“By adopting technologies that remove the need for paper forms, charts, films, and more, practices can streamline their operations,” he says. “Using digital technology to automate scheduling and patient intake can also reduce administrative burdens. And patients are more likely to refer to other patients, with higher satisfaction overall.”

Plus, when everything is digital, dental practices eliminate their paper waste. In a time when sustainability is a draw for many people, this may be key to bringing in new patients and even employees.¹

Different products offer different features for each dental practice, so it’s vital to find the right fit based on practice volume and patient needs. Henry Schein One’s Dentrix has teamed up with artificial intelligence (AI) to further bolster its capabilities. AI, with its machine-learning algorithms and problem-solving capabilities, helps free up time and energy for front office staff.

“Dentrix and Dentrix Ascend Detect AI, powered and manufactured by VideaHealth, offer clinical decision support to detect possible caries on x-rays,” Maroulis says. “Dentrix and Dentrix Ascend Voice, powered by Bola AI, is an intuitive voice assistant that records [periodontal] exam results and clinical notes, providing freedom and flexibility to practice and front office staff.”

AI is still relatively new in the dental space, making its mark in a variety of areas. The assumption that AI only belongs in the operatory is far from the truth, and practice owners may consider its many applications in every arena of the dental practice.

“AI is making a large splash in the dental industry, specifically in the clinical area. However, key players in the patient communication space are exploring ways to incorporate AI in the front office and how practice staff can leverage AI as a tool to operate even more efficiently,” Maroulis says. “For example, autogenerative AI capabilities are becoming more prominent within reputation management. Analytics tools such as Jarvis Analytics will make morning huddles more efficient and help practice staff determine where to focus, in terms of driving new patients in the door, increasing production, or understanding clinical metrics. Practices using more advanced analytics tools can see a 15% average increase in practice revenue.”

Jarvis Analytics from Henry Schein One directly takes data from the PMS and provides key performance indicators and other insights from that aggregated data, which can be especially useful for dental support organizations (DSOs) to track performance across different dental practices in the network.

Because AI potentially can be a scary word for patients unfamiliar with this technology, clear and concise instruction remains king in such situations, especially in the front office.

“Some patients may be more reluctant to adopt digital communication solely because it’s unfamiliar to them. We can help patients embrace the digital age by educating them and highlighting its value and ease of use while this patient is in the office. Dental practices can also adapt to their patients’ preferred method of communication,” Maroulis says. “For example, if one patient is more comfortable with email communication vs text messaging, a dental practice can take note of that within the practice management software and adjust their communication methods accordingly.”

The dental practice journey typically begins and ends in the front office, so creating a space for the front office staff where they can work efficiently, effectively, and confidently only serves to extend that confidence and optimization to the patients as well.

Operatory

The dental operatory/treatment room is perhaps the most integral part of the dental practice, acting as the point where all clinical work is done and the zone where big treatment decisions get made. As such, ensuring the clinician is equipped with the right tools and technology to properly treat patients is key to ensuring better case results.

Digitizing what was once analog in the operatory is a big task when you consider every aspect of the treatment room. From chairs to handpieces to lights to imaging, there are many working parts that need to be considered in this area of the dental practice, and there is a plethora of ways to digitize.

Much of this digitization is spurred on with the assistance of the internet, connectivity, and the ever-present cloud, according to Margaret Scarlett, DMD, chief science and technology officer at Digital Transformation Partners and a digital consultant.

“Before, we didn’t have the cloud. You couldn’t store data except on some little box that you had somewhere for privacy and security, but now you can digitize and put information on the cloud,” Dr Scarlett says. “Once it’s stored on the cloud, you just pull it down when you need it.”

The cloud is a web-based server that can host files, providing clinicians with the ability to check data and files with the hardware platform of their choice (desktop, laptop, tablet) at the dental office. This offers a flexibility not only in checking files, but also in sending cases to labs without having to deal with the woes of physical shipping and handling.

“Now you can have an [intraoral] scanner that’s handheld, and it can draw a picture of a tooth, it can draw a picture of where the margin is on that, too,” Dr Scarlett says. “It can transmit that to a laboratory somewhere. It goes up on the cloud and through the internet.”

A large part of making the switch of analog to digital means cutting out old techniques and/or products that no longer serve the practice or patient efficiently. For example, a digital intraoral scanner can take full mouth impressions, which, for some dentists, can replace the inventory space and price of standard impression materials.

“Most people are moving onto scanning technology. I’ve used so many of the different scanners on the market, and they’re fantastic,” Dr Scarlett says. “It’s so much better than the goo [impression material]. But overall, you start to look at how much that impression material cost, and when you look at that over time, it does stack up. With scanners, the return on investment is pretty good, and most people say, ‘Oh, that’s a lot easier.’ But I think writing the prescription and then putting it in the box with the impression material and sending it to the lab––that’s becoming analog, but I do see some folks hanging on to that maybe a little bit longer than they should.”

Return on investment is vitally important to keeping a dental practice afloat. In a perfect world, dental professionals could provide the best care possible in the most time- and money-saving ways, but realistically, the business component of the dental office weighs heavily on product purchasing decisions. In fact, per Dental Products Report’s own Tech Census, published earlier in 2023, return on investment is something that almost every dentist considers when it comes to new technology.² If a practice owner can’t be sure they’ll make back their money spent on an expensive digital technology, they may be more reluctant to eat the cost for the sake of digitization.

Some practitioners are very comfortable with what they are using and don’t want to adopt new digital technologies in the practice. As mentioned by Dr Scarlett, perhaps a practitioner prefers their tried-and-true impression material and is concerned about the cost and learning curve around purchasing a digital scanner. This reluctance to adopt is also prevalent in the laboratory space, according to Dr Scarlett.

“A lot of times what I see is people are not thinking beyond the PMS. They’re saying, ‘Oh, I’ve got my electronic records.’ But maybe they don’t have a digital way of doing their referrals, or they’re not using digital methods for reporting and looking at the actual reporting that’s available through their electronic dental health records and aggregating those so that they can become more efficient or more productive,” she says. “I also see that the laboratory seems to be the area where there’s the most analog work being done, because we’re a hands-on profession, literally. Well, hopefully we are gloves-on, but we are very much tactile in the work that we do. And as I have gone to different practices and DSOs, the handling of laboratory information and the transfer of data—that has just been the last place where people are switching to new technology.”

DSOs are often better equipped to create a wholly digital experience because they are more likely to have access to more funding, technology, and dedicated support. Dr Scarlett says that, for private practices, it can just be a matter of finding the right person for the right situation.

“One of the things that I say to practices is, ‘You need to start by finding an IT [information technology] specialist for security and privacy issues.’ Even in the DSO world we’ve seen some big ransomware attacks, so it’s important to ensure privacy and security, whether it’s at a DSO or a private practice,” she says. “It’s not just somebody to make sure that your software is loaded, but also [to ask how you are] preserving privacy and security of the records. This is the way you continue to successfully operate.”

Privacy and security are robust considerations in the dental practice, from the front office to the treatment area to all external communications. Digitization can help in this regard, creating safeguards for patient data that live in the PMS.

Dr Scarlett refers to a “conceptual gap,” meaning dental practices don’t always have the resources or time to make the switch from analog to digital. That’s where experts like Dr Scarlett come in. They consult on the best way to begin this transition.

“I go into practices to help them prepare, whether it’s a transition or setting them up for sale,” she says. “Their challenges have to do with making sure that they’re where they need to be, that they’ve allowed enough time to learn, which is about 4 to 6 weeks for any new software or any new technology. There are also some ‘Aha!’ moments that people in different practices have where they say, ‘Oh, my electronic records are all digital. My patient intake is all digital. Now I’ve got some digital components of that. I have digital components that helped me with my referral systems.’ But then they’re still hand writing a laboratory prescription. That’s all a part of change management.”

At-Home and Outside the Office

Patients have felt the effects of the COVID-19 pandemic just as strongly as practitioners have, and expectations may have shifted over the past 3 years regarding care. One arena that necessitates digitization is telehealth and, by extension, teledentistry. Teledentistry helps patients who need more flexibility in their schedule receive licensed dental consultation without needing to physically walk into the dental practice.

MouthWatch has been at the forefront of the teledentistry conversation, with its software service platform TeleDent taking center stage. Brant Herman, MouthWatch’s cofounder and CEO, stresses the importance of the digital aspect in teledentistry.

“TeleDent allows the practice to have a digital, virtual front door for that patient journey. So they can talk to a dentist, they can ask questions, and it doesn’t always have to happen during office hours. Patients can submit a request for an evaluation or a consultation and hear back from the doctor when it’s convenient for the patient,” Herman says. “They don’t have to get cases presented while they’re sitting in a dental chair and maybe a little bit anxious or nervous about price. They can have a video conference, talk to a treatment plan coordinator or the doctor in the comfort of their home sitting with their partner, and have a better experience when they’re listening and learning about their treatment needs.”

The virtual aspect is a key component of teledentistry, with video conferencing a must for clinicians to perform accurate consultations and triage as necessary. TeleDent has a variety of features that enable proper care, such as video calling, virtual scheduling, a live support team, and even remote intraoral camera capability. All are made possible by the digitization of dentistry.

“With TeleDent, we work with anything from your laptop desktop to your smartphone in terms of imaging that you can share with the provider and a video console that you can have in real time,” Herman says. “In most settings, it can really just be a tablet, laptop, or phone, and that’s enough for the patient to get a lot of that value. What we also do with teledentistry is we can expand the footprint of a practice without building more operatories. Dental professionals can go into schools and nursing homes and outreach settings and screening settings, and with an intraoral camera and TeleDent, that becomes a really valuable encounter with the patient. What we are really excited about is that we can help increase the scope of practice—for example, a hygienist working out in the field, because you don’t need a dentist supervising them. Through telehealth rights through teledentistry, you can get an authorization of services that empowers the hygienist to do more of their scope of work and increase the profitability and reach of the practices.”

At-home dental health monitoring can also be a huge component of teledentistry, putting the patient’s care in their own hands while still ensuring they are receiving care safely and effectively. Teledentistry, an almost-entirely digital endeavor, also assists in triaging care properly, keeping patients from emergency appointments by allowing them to hop on a virtual call with a dental practitioner first who can then direct care as needed, according to Herman.

“We found that 3 out of 10 emergencies didn’t require an in-office appointment. So it makes some practices much more efficient with their chair time, which, in turn, can help with staffing issues. When a practice is limited in the number of hygienists or dentists that they have, they need to make the most of the operatory time,” he says. “We can help shift some appointments out of an office completely. So sometimes a postoperative visit is really like a look-see appointment. It’s not required. We know there’s going to be a high success rate and a high patient satisfaction rate if you did a follow-up with them virtually. A 10-minute video call saves you a half hour of operatory time, plus you have that operatory available for other higher value, higher revenue services.”

Modern patients and practices require modern digital solutions, and teledentistry is a service that plenty of dental practices can benefit from. And although there might be fear in adopting a new service into the practice’s offerings, the benefits greatly outweigh anything else, according to Herman.

“You are trying to find an efficient balance [with] in-office care, and you will always need in-office care. You’re not escaping it, and you’re never going completely virtual. But you can make it so much smarter and so much more accessible and efficient that I think practices are going to start to see it,” he says. “Frankly, we’ve seen larger practices with a strong business efficiency mindset deploy TeleDent because they know it helps to reach more people, more efficiently, and provides patients with the experience they want and expect through the technology.”

Not to mention that teledentistry markets itself, Herman says.

“You can also make a case for increased case acceptance when it’s not done with cotton in your mouth, lying back in a chair nervous and feeling like, ‘I have no option right now,’ ” Herman says.

MouthWatch’s newest platform, Dentistry.One, has a focus on virtual-first visits, working with dental practices and DSOs to deliver quality care that bridges the divide between dental and medical.

“We have a nationwide network of dentists; we have the ability to be that virtual first touchpoint for a patient,” Herman says. “Then we do care coordination, where we’re getting patients into dental offices. And when they know what they need, we can make a more effective referral into the practice.”

Incorporating teledentistry in the dental practice sets owners and practice staff ahead of the curve, enabling them to bring in more patients, be more flexible with their scheduling, and find new ways to provide care for patients. Not to mention, teledentistry can meet the needs of dental practices that are feeling staffing crunches that have swept the industry, according to Leah Sigler, president of The TeleDentists.

“The No. 1 concern in the dental industry right now is staffing; hygienists don’t want to work where turnover rates are high…. Teledentistry is an incredibly great option for making the dental office almost like a hybrid working situation,” Sigler says. “Hygienists and dentists can utilize teledentistry from the comfort of their home a couple days, and then go in for those patients that they’ve triaged appropriately with a full schedule. That would be such a powerful tool to help improve the current situation.”

The TeleDentists, which was founded in 2014, connects practices to patients for virtual care. Sigler focuses on the productivity aspect of teledentistry, echoing the fact that reaching patients virtually can eliminate cancellations, patient anxiety in the dental office, and other barriers to best care.

“It’s an excellent way to break that fear factor because people are scared of 2 things when it comes to dentistry: how much it’s going to hurt and how much it’s going to cost,” Sigler says. “Behavioral health has seen an incredible response through telehealth. Just being able to talk to someone through a camera makes people a lot more open and a lot more comfortable. We’ve seen the exact same thing in teledentistry: That ‘white coat phobia’ is gone because they’re able to have a face-to-face conversation. No personal protective equipment blocking them, no shields, and masks, and N95s. It’s just a personal conversation with the dentist, and that really helps bring people’s anxiety back down and helps them be able to get their treatment done.”

This relatively simple digital solution can be a steppingstone for solo practice owners who wish to offer something new and modern for patients—and for DSOs that want to implement care effectively and efficiently.

A New Digital Age

Whether it’s new software in the front office, new digital imaging tools in the treatment room, or even a new platform to better serve patients from the comfort of their homes, there are a lot of different ways for a dental practice to go digital.

With the advent of new technologies, dental practice owners may begin to feel the pressure as they pursue new patients, knowing that the practice down the street is high-tech and has the budget to do just that much more for the patient. One key differentiator might lie in AI. Tasks that were once arduous or time-consuming can now be tackled 2-fold with the help of AI.

“In the use of AI for imaging, measurement, and detection aids, this conceptual gap that we now have is that we have to think about our skills as a diagnostician that are enhanced by some of the AI components that we have,” Dr Scarlett says. “Therefore, [we have to consider] our treatment planning and acceptance of treatment planning. Before the patients might say, ‘Oh, you’re looking at this little mini x-ray that you took in my mouth and you’re holding it up to the box.’ You’re looking at that and you can’t convince the patient of what you’re seeing on this tiny little x-ray. When I put it on a computer screen and digitize it and show where it’s at on a giant TV screen, it’s easier to accept. I can show the patient and I’ve got an AI program that circles caries or puts a box where there is a loss of bone. The patient can see that and there’s more treatment acceptance. So does that change my treatment? Yes, absolutely.”

When patients feel like they’re a part of the conversation regarding their care and that they have the knowledge and information that AI can provide them, they may be more willing to accept treatment. Going digital is not just a matter of if anymore; it’s now a must in the ever-shifting landscape of dentistry. Not only can it improve patients’ experience, but it can also boost revenue, make the dental practice more marketable, and help a practice stack up in a competitive market.

“For the practitioner, digitizing brings more accuracy to clinical work and to administrative work. It also is a fantastic marketing tool because patients are looking for this as an option. It’s adding revenue, it’s increasing patient awareness, and It’s bringing new patients in while giving current patients a better, higher quality of standard of care,” Sigler says. “It’s a win-win for everybody, and it’s only going to continue improving with increased provider adoption.”

References

1. How sustainable is your dental workplace? Br Dent J. 2022;233(4):248-250. doi:10.1038/s41415-022-4935-x

2. Nock K. Tech Census 2023: looking at the state of dental technology today. Dental Products Report. July 1, 2023. Accessed August 3, 2023. https://www.dentalproductsreport.com/view/tech-census-2023-looking-at-the-state-of-dental-technology-today