The year ahead
Things are forever changing, hopefully for the better, but changing nonetheless
I’m rarely one for resolutions but I do think about what may happen in the year to come. We have had a significant change to the NHS fees and items recently. It feels a little early to assess the impact of that. There are other changes which we should consider in the year ahead.
Digital radiography and photography are well-established in our environment. Digital dentistry is becoming a major factor for laboratories and practices. It is moving from specialist clinics into the mainstream. Scanners are a major expense, but costs are reducing. The quality, performance and user interfaces are improving. The digital workflow is a common topic of CPD and conversation in clinics. Milling and 3D printing are becoming more frequent in laboratories and even clinics themselves. Most of the workflow is still dictated by the interaction with lab work. However, there are certainly benefits in monitoring hard tissues with regular scanning. PSD now accepts – and expects – scans or pictures of models: paying the same fees.
The likely future is incorporating digitisation into all our working patterns and interactions with other professionals for referrals, approvals, payments and lab work. It cuts material costs and simplifies cross-infection protocols.
I suspect digital milling and 3D printing will reduce the ‘mess’ in traditionally dusty and plaster-covered laboratories. How long will it take for the economics to balance in favour of mass use of digital workflow? I think, currently, costs are still prohibitive for general NHS use but there will come a tipping point. Especially, if the lack of technicians can be mitigated using digital means. Perhaps in-practice use of digital manufacture may help this? I am concerned how that fits with the GDC and medical devices being produced by a non-GDC registered technician (although if it is the dentist, they are a registrant).
The other major benefit is the reduction of a postal/pick-up stage from clinic to lab. At the moment, there is a lot of chatter around ‘sustainable’ and ‘green’ dentistry. Emailing a lab all the data required to produce an appliance or device must be ‘greener’ than a man in a van running around practices. I have seen posts about utilising re-usable aspirator tips, impression trays and other items. I understand the rationale for it; we used to reuse all of these in my working lifetime.
How long will it be before our waste production problems overtake infection control worries to reduce single-use items? We’ve seen the other extreme in the move to LDUs, washer disinfectors and a drive to mass use of single-use everything. Now, is the tide turning?
The flip side of this ‘green drive’ is the use of huge quantities of digital data we need to store and back up. Digital radiographs and photo files are big enough.
Add to that routine scanning for patients, children with orthodontic needs, non-carious tooth surface loss mapping, plus all that lab work entails; our servers will be straining. Then there’s that cloud; you know, the one we pay for but have no idea where it is. That takes a lot of power and cooling to keep things properly looked after; not so green in terms of energy usage.
The other thing about data storage, is people seem to be desperate to get a hold of it these days, by fair means and foul. How long it will be until our cyber security comes under significant challenge? In my own practice, we don’t keep any financial data, but I suspect that may have to change in time. At that point, we may become a bigger target for hackers. Or maybe we just haven’t got to the top of their list yet? I won’t say this too loudly, but if my very expensive cyber security does get hacked by a super-smart and fiendish teenager from another state and they ask for a ransom, my insurers will probably pay out, if they’re not unreasonable. Unfortunately, insurers often have get-out clauses for these costs unless your systems are watertight. This could become a cost of business. Perhaps, it may not even be a teenager but a highly developed AI ‘bot’ extracting a few thousand pounds and staying under the AI police’s radar.
That may be fanciful, but it does bring me to the next big thing: AI. How can AI affect dentistry? I am certain it will. However, I am not sure what it can bring to us. Not being incredibly technically minded, I’m not the person to ask. What I do think is that dentistry, by the nature of fee per item and tooth surface notation, in NHS or private care, has created a huge amount of data. AI works best when it has lots of data and outcomes to feed the learning process. At this stage, I think it will have its biggest effect on our care, by reinforcing or improving our diagnostic and treatment planning processes.
I think it will be many years before there are automated systems that can do what we do. I doubt they will be technically proficient enough to take our place in my working lifetime, perhaps even in my lifetime. However, there will be elements of the learning which will impact our processes – and sooner than we think. The question is, who will pay for it? Not the NHS, even if they thought they could save money in the long run. I think it will be up to manufacturers of materials and, perhaps, entrepreneurs setting up websites to provide AI-generated guidance at a cost. As long as we have a world-leading facility like the SDCEP, I don’t see that being utilised often in this part of the world.
So, much to look forward to, to incorporate or to view from afar. Things are forever changing, hopefully for the better, but changing nonetheless.
Arthur Dent is a practising NHS dentist in Scotland. Have a comment or question for Arthur? Email arthurdent@sdmag.co.uk
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