by Namrata Nayyar, David M. Ojcius, Arthur A. Dugoni.
This commentary describes the changes taking place in #dentistry and speculates on improvements that could happen soon. Advances in health care will have an impact on the integration and delivery of oral care; conversely, there is growing acceptance that oral health impacts systemic health. Technological innovations are changing the face of medical care and are quickly becoming integrated into dentistry. Advances in novel antimicrobials, genomics, robotics and artificial intelligence are transforming our ability to diagnose and manage disease.
More than 10,000 years ago, a Sumerian found a better way. He invented the wheel, perhaps the world’s greatest single technological achievement. Since then, millions of individuals — some celebrated and some unknown, some by design and some by accident — have found a better way. Thomas Edison found a better way – the incandescent lamp; Henry Ford – the mass-produced automobile; Alexander Graham Bell – the telephone; Alan Turning – the computer; Bill Gates – Microsoft Windows; Steve Jobs – the iPhone and iPad. The desire and the motivation to find a better way are integral parts of human nature. We Americans are known for our “Yankee ingenuity.” We are a nation constantly striving to find, and sometimes obsessed with finding, a better way to do our jobs, teach our children, refine our goods, sell our products, interact with people, maintain our health, test our skills and stretch our endurance.
The history of dentistry is as ancient as the history of humanity and civilization.1 Dental treatment has come a long way from the earliest known evidence of dentistry in 7000 B.C. with the Indus Valley civilization to current approaches and diagnosis and treatment. Over the past seven decades, we’ve gone from ignorance to understanding because of the standards and quality of education, our clinical efforts and scientific research. From a primitive form of medicine, the incorporation of modern-age technologies into dentistry within the last 50 years has accelerated this transformation.
Oral health in the 21st century is not just a “drill-and-fill” routine. While earlier efforts in dentistry conformed to removal of diseased tissue and restoration of lost tooth structure, newer advances are emphasizing prediction and prevention of the disease process.
Within our lifetimes, a sea of change in the knowledge and perception of dental diseases has occurred. Historically, oral health has been separated, clinically and administratively, from the overall health care delivery system; in recent times, there has been a major effort to incorporate oral health in overall health care diagnosis.2 This is due to the realization that oral care is the gateway to prevention and early detection of many nonoral systemic ailments. In 2000, “A National Call To Action To Promote Oral Health,” published by the surgeon general, called for “changing the perception” of oral health as separate from overall health and charged oral health and other health professionals to partner in research, treatment and policy efforts.3
There is growing evidence that oral health plays a significant part in development of systemic diseases like cardiovascular disease, diabetes mellitus, various cancers and dementia.4,5 The surgeon general’s office will issue a 2020 report on oral health to show us how we’re doing and challenge us to new action.6
Although we live in one of the most technologically, medically and scientifically advanced societies, we clearly still have much work to do if we are to live up to our full potential. In this country, we still have more than 28 million citizens without health care coverage,7 two out of three adults without dental insurance,8 37,000 new cases of oral cancer each year7 and a continuing crisis in oral health.
As we move forward into an exciting decade of promise and change, we would like to encourage you — our best and brightest — to take on new challenges, to take some risks and to challenge the status quo.
As a society, we are in a flux due to the sweeping changes occurring in all aspects of life, including the health care industry, which will impact oral health as well. The emergence of new technologies, be it robotics, artificial intelligence, tissue and organ transplants, use of novel antimicrobials or even application of genomics to create personalized oral care, will have a lasting impact on patient care. The integration of dental practices with comprehensive medical teams — embedding dentists within a team of physicians, pharmaceutical providers along with geneticists — would be a first step toward providing comprehensive diagnosis and treatment for all patients.
An obvious area where medicine can influence delivery of oral care is in personalized dentistry. The increasing availability of genetic testing and genome sequencing data and their relative affordability have opened many possibilities for the identification of novel markers for oral diseases through genetic sequencing. The option exists for adapting preventive oral care targeting individuals with higher genetic susceptibility or predisposition to certain oral diseases. Because most oral conditions are a result of genetic and environmental factors, a risk profile combined with other tools could be a useful predictive tool, which could influence treatment procedures and preventive care. The American Dental Association announced general guidelines for the use of genetic testing in dental practice.9 So far, 13 genes have been identified as involved in the caries process, while 11 are implicated in the periodontal disease process. The day is not far when patients, alerted by the results from genetic tests for susceptibility genes, will bring the genetic analysis for counseling or treatment by oral health professionals.
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