Dentist — tasks, one by one

Reading dental X-rays

This is where AI has entered dentistry most clearly. The US regulator has cleared software that marks suspected decay on bitewing X-rays, and in the manufacturer's reader study the 13 dentists found more decay with it than without (sensitivity 57.9% unaided, 76.2% aided) at a small cost in false alarms. The clearance itself says the tool gives additional information for the dentist and is not a replacement for the dentist's review — and Singapore's law counts radiographic work as part of the practice of dentistry.

The performance figures come from the manufacturer's own submission, on 352 images, and describe readers in a study rather than dentists in practice. A clearance shows the tool may be sold for this use, not how many practices use it.

Diagnosing and planning treatment

The cleared AI tool is explicit that it assists only in detection, not interpretation or diagnosis, that it should not be the sole decision-making tool for diagnosis or treatment, and that the final clinical determination is the treating clinician's. In Singapore only a registered dentist with a practising certificate may practise dentistry, which includes the treatment of any disease of the teeth or jaws.

These are the conditions of one tool's clearance and one country's licensing law; they fix who is responsible, not how much a dentist relies on the tool in practice.

Carrying out treatment

Precise hand work on a moving, conscious patient is far from what current machines do in routine practice, and Singapore's law reserves any procedure on the teeth or jaws, and giving the anaesthetic for it, to registered dentists. Digital scanning and milling have changed how crowns are made; they have not moved the treatment itself out of the dentist's hands.

This rests on the law and the state of the technology rather than on a record of how treatment is delivered, and robotic assistance exists for some specialised procedures such as implant placement.

Charting and clinical records

Software that numbers teeth and marks findings on X-rays feeds the chart directly, and voice and language tools can draft visit notes. The record still has to be checked by the dentist who is responsible for it; the cleared tool, for example, makes the dentist responsible for reviewing its outlines and correcting them.

This rests on the capability of the tools rather than on a record of how widely they are used for charting.

Explaining and reassuring

Marked-up X-rays can make findings easier to show a patient, but consent to treatment and helping a frightened patient through it depend on the dentist in the room. Patients also have to trust that the treatment recommended is in their interest, which is a relationship rather than a readout.

This rests on the nature of the work rather than on a record, and it would change if patients came to accept treatment plans explained by software without a dentist present.

Supervising the dental team

Singapore's law makes it a condition of registration for several groups of oral health therapists that they practise only under the supervision of a registered dentist. As more of the routine work is spread across the team and its tools, the dentist's role as the one who answers for it stays.

The supervision condition applies to some categories of therapist and has exceptions, including public service; other countries organise the dental team differently.