Leveraging artificial intelligence applications for better general dental practice efforts during COVID-19 pandemic: Engineer’s perspective
By Eng. (Professor) Mahesh Jayaweera and Dr. Hemantha Amarasinghe
General dental practice (GDP) covers a range of treatment options and procedures fundamental to protecting and maintaining a good standard of oral health. In the light of the COVID-19-rid bizarre situation, the GDP landscape worldwide has been crippled for many months. As such, the global population is deprived of proper dental healthcare that would otherwise be a privilege regularly. Nevertheless, dentists need to be proactive in providing dental healthcare to the general public under the new normal conditions. This precarious stance brings about many challenges before the dental fraternity (as seen in the figure alongside). It highlights the need for a novel, sustainable and efficient model that would help practice general dentistry with a slight risk of COVID-19 transmission via different modes. To this end, leveraging modern technology built around artificial intelligence (AI) is one of the most promising strategies for reshaping the landscape of dental healthcare. There are exciting possibilities ahead: AI architecture, big data analytics, and the use of the Internet of Things have gained popularity worldwide for dentists to interact with the general public while minimizing the risk of disease transmission. Such technologies leapfrog unprecedentedly in other sectors. Therefore, the emergence of the COVID-19 pandemic should be considered a blessing in disguise in GDP to bring about sustainable and efficient delivery of patient care. In this whole saga, engineers play a vital role with novel innovations, and dentists should take the fullest advantage of this pinnacle.
Digital and numerical applications built around AI for GDP:
Dentists must practice GDP in light of the COVID-19 pandemic to control the oral health burden. From today’s perspective, most of the personnel engaged in GDP are hesitant. As such, they speculate about practicing the oral care initiatives in a manner they did before the onset of the COVID-19 pandemic. One of the most significant issues is the inability to conduct screening and health promotion programs, leading to the possible higher transmission of the COVID-19 virus. Dentists and engineers can explore the possibilities of bringing in digital dentistry for their day-to-day work. In other words, many are in the process of transforming the conventional tasks into digitalization-centered efforts where many activities are done remotely or with a lesser exposure and minimal contact time. These efforts will reduce or completely shut the modes of airborne and fomite transmission of the COVID-19 virus resulted from aerosol-generating procedures.
In these efforts, one has to note that AI and big data analytics are at the forefront. AI is the computer's ability or a robot controlled by a computer to do tasks that humans usually do because they require human intelligence and discernment. Big data analytics is a complex process of examining big data to uncover information - such as hidden patterns, correlations, trends, and preferences in, say, screening patients. With a combination of these two disciplines, globally, people develop innovations that could help dentists carry on their work precisely, efficiently, and safely. The first part of the vital task in the digitalization process would be handling data stored in a secured computer cloud. Handling data is usually we do with the internet of things (IoT). The IoT refers to a system of interrelated, internet-connected objects that can collect and transfer data over a wireless network without human intervention. For example, look at your smartphone.
With these technologies, scientists have now come out with state-of-the-art technology-embedded products for dentists to explore. Some of them are intelligent toothbrushes, smart goggles with LED illumination and eyesight corrections, smart facemasks, AI-built spittoons with automated air suction device, robotic assistants, 3-D printing, intraoral cameras fitted with LIDAR sensors, graphene-built innovative masks for patients, bipolar ionization techniques, smart filtering devices with HEPA filters, and intelligent PPEs incorporated with nanomaterials, among others. These devices help dentists, particularly in educating the public, screening and diagnosis, and follow-up efforts, handling many people at a given time. One could note that some are already available in the global market, and others are under investigation. For example, one paper in Lancet Digital Health in March 2021 elaborates that 222 and 240 such devices were approved in the USA and Europe, respectively, as medical devices.
One has to be aware that with the emergence of new variants of concern of the COVID-19 virus globally, we notice some of the vital epidemiological parameters go from bad to worse: high infectivity, high transmission (reproduction number), increased severity, increased airborne time, and less efficacy against vaccines. Moreover, some of these critical epidemiological attributes instigating more and more case numbers per day with new variants worldwide are evident with the devastation of economies of many countries. In such circumstances, one cannot predict that the existing dental settings are safe to bring in mass population to GDP. In this context, the devices mentioned earlier play a vital role in eliminating the risk factor for those who work in such dental settings. We, therefore, believe that the future would not be that bleak with the adoption of digitalization efforts in dental clinics, particularly addressing public health issues.
Plausible services that would link up general public remotely:
We have elaborated devices and gadgets that are useful in GDP. However, in our opinion, they are to be utilized once the patients visit the clinics. Besides, there are methods by which dentists could provide their services remotely. Indeed, it does not mean that we can do everything remotely; however, we can control dental visits, and dentists can link up with patients through online modes. For example, in screening patients, one can use software developed by using machine learning and deep learning algorithms. What is imperative first is data gathering and their subsequent mining. Nowadays, numerous software applications in the global market help dentists collate patient’s data. For example, telemedicine and telehealth have been top-rated tools. Telemedicine is exchanging medical information from one location to another using electronic communication, which improves patient health status. Telemedicine has multiple applications and can be used for different services that include wireless tools, email, two-way video, smartphones, and other methods of telecommunications technologies.
Telehealth refers to electronic information and telecommunications technologies to support predominantly patient and professional health-related education, public health, and health administration. Technologies include videoconferencing, the internet, store-and-forward imaging, streaming media, and terrestrial and wireless communications. Nowadays, we have better tools for diagnosing diseases against signs and symptoms of patients, more precisely with the machine and deep learning algorithms than humans do. For example, convolution artificial neural network-based algorithms aid more precision analysis of X-rays, better than human interventions. Moreover, machine learning algorithms help decide the levels to which a dentist should diagnose a specific problem, among many. For example, in oral cancer diagnosis, such algorithms are in use effectively.
To this end, another important aspect is the data handling and storage and data mining facilities. For this purpose, there have been many developments with cloud computing and data mining algorithms. A key benefit of cloud-based services to dentists is that they allow fast implementation of programs exceptionally well in developing patient databases, interchanging observations among other colleagues, prompt diagnosis because they need not procure additional hardware. In addition, such facilities are essential tools for big data analytics of paramount importance for trend analysis, pattern recognition, risk analysis, etc. For successful implementation, of course, dentists must have higher bandwidths for big data handling and facilities of IoT. There have been numerous companies that provide such services to dentists in the US; however, in the developing world, such facilities are relatively poor; hence, it is very vital at this hour to bring down such facilities. Governments should pay attention to establishing such facilities in the health sector.
Challenges and pitfalls against digitalization:
From today’s perspective, yes, dentists have been confronted with many challenges in setting up, operationalizing, training, maintaining, and repairing such facilities. There have been public and private–sector involvements in providing such services in many countries, but, sometimes, their reliable service is questionable. Affordability for such novel systems, particularly in developing countries, is another hindrance. Another aspect worth mentioning is that the lack of coordination with professional fraternities who have sound knowledge of such digitalization landscapes. Inadequate knowledge on such novel developments also prevents many dentists from embracing such technologies. Governmental support in many countries also seems to be very poor. It needs a driving force to establish such beneficial culture and social etiquettes in government-driven clinics in the foreseeable future. Adding to the list are the rigorous approval procedures required for such devices in certain countries. Undeniably, patient data storage becomes an issue in terms of ethics and privacy. Some do not like to expose private data to others. In many countries, legal aspects covering the ethical and privacy issues are not yet fully developed and may not be in sight soon.
Standard dashboards need to be worked out to succeed in efficient and effective data sharing among all stakeholders. In addition, dentists should work out data-sharing policies among their colleagues. For example, international funders such as Wellcome Trust and the Bill & Milinda Gates Foundations have mandated that funding recipients share data from research related to COVID-19 as soon as the study is complete, regardless of the publication status. However, in every country, the challenges of data sharing persist to a different degree. These include complexities of getting consent, lack of data management capacities, delayed publishing, sometimes data cooking incidences, and other formats.
Of course, from today’s perspective, many challenges have to be confronted. Still, we are confident that dentists will conquer them and boldly adopt effective and efficient dental practices built around smart dental etiquettes. We all await patiently until this optimistic dream comes true in the foreseeable future.
Eng. (Professor) Mahesh Jayaweera
B.Sc. (Civil Eng), Ph.D. (Env Eng)
Professor, Department of Civil Engineering,
University of Moratuwa
Chartered Engineer, Member of IESL, IWA, SLAAS-Section C, and SLAAS-Chair of Committee for the popularization of Science
Dr. Hemantha Amarasinghe
B.DS. (Sri Lanka), MSc, MD (Comm. Dentistry), FDSRCPS (Glasgow)
Cancer Epidemiologist & Consultant in Dental Public Health Oral Health Unit, Family Health Bureau, Ministry of Health, Colombo