The Dangers of Status Quo

I’ve seen a lot in my years in this profession. I was lucky to have entered dentistry at the time I did. I love change, and I have been fortunate enough to see a lot of them in my career. There are always better ways to do things. Those processes are out there just waiting to be discovered or uncovered. Like valuable minerals trapped inside a mountain, they just take a spark of motivation and a lot of digging to get to the gold.

Younger doctors will probably laugh when they read this, but in my first couple of years in practice, I charted with a red and blue pencil on a paper chart. We used film and a chemical processor to take radiographs, and when they were dry, we would put them in a small coin envelope and write the date on the outside of it. My procedural chart notes were written by hand, and I was sure to use ink so there was no way they could be edited. I had to print when I wrote up notes, because my cursive is so abysmal that sometimes even I can’t read it. I didn’t have time to write up those notes during the day, so at the end of the workday, I would spend approximately 30 minutes at my desk doing my notes.

Those days were long, and looking back, they seem so tedious. Of course, at the time, they didn’t seem that way. Simply put, I didn’t know any better. That’s just the way it was, and I slogged along blissfully unaware of how great the future would be. So this month, because the focus of this issue of Dental Products Report is our Tech Census, let’s take a look at 4 things you should be using at this point along the dental timeline.

The things I’m mentioning here are what I think you should be using at minimum. I understand that acquiring and integrating technology requires an investment in capital and time, so my recommendations here are for things that have been available for a while, are easy to use, and won’t put a huge dent in your operating revenues while enhancing productivity and giving you better clinical outcomes.

Digital Charting and Recordkeeping

I’m sensing some eye rolls here, so please bear with me. I was peer review chair for the state of Missouri for approximately 25 years, and I also do expert witness work in the malpractice space. Because of my work in these areas, I’ve seen a lot of dental records in my career. I was constantly amazed by how many doctors were still using paper in their recordkeeping. Something to keep in mind if you ever end up in litigation: Perception by a jury is tremendously important. If your records look sloppy and unorganized, people may be inclined to assume the doctor is sloppy and unorganized, whether that’s true or not. I’ve also read records where the handwriting was worse than mine, and that is saying something. If your records cannot be understood, are sloppy, or are minimal, they could come back to haunt you.

Keeping all your clinical notes and charts digital is a tremendous time saver. Nothing is illegible, it’s hard to lose things, everything is in sequential order, and clicking a mouse is inordinately easier than coloring with that red and blue pencil. Knowing that charting, periodontal probing, and notes are instantly available and easy to use makes your day easier and less stressful.

Digital Radiography

American Dental Association statistics state that 90% of doctors are currently using digital radiography. That’s great news to me. My question is, why are there around 10% who are still holding out?

For those doctors, I have one thing to say. The 1990s just called, and they want their film back.

In all seriousness, in all my years talking with my peers, I’ve never had one person tell me that they got rid of their sensors and went back to film. Once you go digital, you’ll wonder why you waited so long.

Add to that the explosion the industry has seen with artificial intelligence (AI) in radiographic analysis. The number of users increases every month, and the more radiographs these systems see, the smarter and better they become. Of course, digital radiographs are necessary to use AI, so that’s one more reason to make the change from film. For those of you who are already on board with digital, you should be considering which AI system you want to implement.

Intraoral Cameras

For those of you who read this column regularly, you know how passionate I am about communicating visually with patients. It’s much easier for patients to comprehend their problems and understand treatment recommendations if they can see what those problems are.

The great news in this area is that the prices of intraoral cameras have fallen significantly in the past 5 to10 years. This allows the office looking to provide an image to use as a focus of communication with patients to purchase a camera for a few hundred dollars.

Two examples of very affordable intraoral cameras are the MouthWatch and the Shofu EyeCam. Both connect to a computer via a standard USB cord and are incredibly portable. However, the prices of these devices are low enough that buying a camera for every operatory can be accomplished without breaking the budget. The last time I checked, these 2 cameras were both under $300.

For offices that perform a lot of cosmetic or full-mouth reconstruction treatment, there are several cameras that provide stunning images in the higher price range. Every doctor has different wants or needs. The takeaway is that you should have an intraoral camera and use it regularly.

Soft Tissue Diode Lasers

This is another product category that has seen amazing progress coupled with astounding price drops since the product first came to market. It’s incredible to me that when I was a kid, lasers were things only superheroes used, and now I pick one up every day. When I bought my first laser, it cost approximately $35,000 and was approximately the size of a 2-drawer filing cabinet. Today, a laser with similar power and settings can be purchased in the same form factor as a powered toothbrush for less than $5000.

Lasers can make everyday operative and surgical tasks easier and faster. One of the best things about them is that laser wounds heal incredibly fast and with minimal, if any, postoperative pain. They also rarely require sutures, even for large areas. A diode laser has an affinity for hemoglobin, which creates immediate hemostasis. This allows the doctor to work in a practically bloodless field. Being able to see the field while reducing the need for chemical hemostatic agents and sutures means more clinical efficiency, fewer postoperative visits, and fewer postoperative calls from patients.

Although retraction cord is still an option, I rarely use it anymore. I can create clear, clean views of my margins in approximately 1 minute using a diode laser and sometimes by adding VOCO Retraction Paste into the mix.

Diode lasers are a critical part of my clinical armamentarium. A day rarely goes by when I don’t pick one up for a procedure. When you consider the tremendous benefits, ease of use, and low price tag for many of these units, it’s hard to find a reason not to own one.

Future Considerations

Let’s take a quick look at some technologies with either less time on the market or a higher price tag. If you already have the 4 things I discussed previously, this is where I’d direct your interest.

Artificial Intelligence

I won’t cover this in-depth because I’ve written on this subject recently. Let me just state that this is a technology that is now ready for prime time. Users are finding AI critical to help increase diagnostic accuracy and productivity. Having an objective “second opinion” always available to point out areas of interest is a game changer for the profession. As more features are added by the vendors and the products mature, they will continue to be game changers for doctors who embrace them.

Digital Intraoral Scanners

This is another product category that has seen amazing progress in both features and lower prices. At this point, there is a scanner for every budget. Many offices, mine included, cannot imagine being without it.

Add to this the fact that an intraoral scanner is the entryway to a truly digital workflow. If you have not yet purchased a scanner and are looking to improve both your workflows and your clinical outcomes, this should be on your short list of technologies to invest in.

The devices can be used for fixed and removable prosthetics, orthodontics, diagnosis, and even hygiene, making them universal must-haves for practices. This is a technology that has a model with the right features for any office, no matter the budget. They save time and improve clinical results, and patients are fascinated by the technology.

In-Office Milling

Whether you are interested in same-day dentistry, improving results, or controlling costs, in-office milling has something to offer you. Today’s mills can create results previously thought to only come from a skilled laboratory technician with years of experience. We installed the DGSHAPE DWX-42W in our office more than 2 years ago, and I am still amazed at the results it creates.

When you combine the results with the lineup of materials you can select for your patients, in-office milling has tons to offer. The materials have a proven track record of success. That means that things you mill today have the longevity you expect from something created in a laboratory. There is also the fact that many laboratories are now milling most of their restorations. That translates to having the quality of materials you can purchase for your office match that of the same materials being used by dental laboratories around the world.

Milling in our office has improved efficiency, which our patients love, and given us the results we demand as clinicians.

3D Printing

Behold the next wave in the world of dental technology. The next 18 months are going to see in-office 3D printing take the industry by storm. For the past 3 to 4 months, I’ve been up to my elbows in the world of 3D printing, and I can tell you that from what I’ve seen behind the curtains, you are going to be thrilled.

Workflows are going to be changed for the better as we eliminate steps in our processes that are rapidly becoming unnecessary or redundant. Cloud-based design systems that use AI to help create all kinds of dental devices are on the horizon. Imagine diagnosing the need for an implant on Monday morning and performing the placement on Tuesday morning with precision and confidence and with a guide printed to your specifications right in your office. Then imagine placing a transitional removable partial with the pontic custom-designed to create the tissue contours exactly as you, the doctor, want them—also printed in your office.

Plaster and stone will rapidly become “remember when” materials as we move to virtual design using models that exist only in the design software. Occlusal guards, bleaching trays, interim partials, full dentures, and more will be delivered, sometimes within hours, to happy patients.

Wrapping Up

Our profession has become a moving sidewalk of progress. It seems that the only way to make sure you stay current is by constantly moving forward. Of course, I appreciate the fact that offices are always walking the tightrope of investment in technology vs maintaining profitability. However, in my career, I’ve seen doctors wait too long to pull the trigger. By not embracing the future, doctors are often overwhelmed by how much it will cost to invest in several new things at once. The best way to avoid this is to implement a policy of a technology budget. This allows you to set aside a specific amount of money every month knowing that at some point, those savings will be used to bring in new technology or to replace legacy systems.

The good news is that technology can decrease stress, streamline workflows, and give you amazing clinical outcomes. If you have not yet implemented the 4 must-haves I listed here, I highly advise you to do so. Then implement a technology budget and begin the process of saving to invest in even more cutting-edge products.

I’ve been lucky enough to have lived through this tremendous time of advancements in dentistry, and my perspective tells me that things are only going to get better. Even though I’m closer to the end of my career than I am to the beginning, I believe I was born right on time. See you next month.