Night Guard By iTero; Mammography By AI

Night Guard By iTero; Mammogram By AI


Leonard Zwelling

If you are at all interested in the future of dentistry, check out this web site (top url).

After about fifteen years of nightly wear and tear, my tooth-protecting night guard had worn a hole in itself. Or, more correctly, I wore the hole in it with my grinding. Grinding can be good as a career path. It’s really persistence and determination, two attributes required for success in academic medicine along with a strong stomach and a stronger ego. They say golfers grind when their game is not in top form, but they still manage to score well usually through getting up and down around the green after errant approach shots. But, grinding of your teeth when you sleep is not good, so a plastic insert that is fitted precisely for your bite is worn at night to protect the enamel and the gums, too.

When I acquired mine a long time ago, it was produced by me biting into a putty-like plastic mold that was then sent to a laboratory to manufacture the actual night guard. Now—welcome to the era of modern technology.

An Israeli company named iTero, which was purchased by Invisalign, has deposited the gunky tasting tooth molds into the dust bin of dental history.

Now the dentist uses a magic wand (actually a small computer-driven camera) to scan your teeth and your bite and deposit all the data into a computer. The dentist sees the image, but the important information is all zeros and ones. The image and its inherent computerized data are sent to California via email and the night guard will be mailed back in a few weeks. Mine came back in less than a week.

Consider the implications for medicine.

Images generated with routine x-rays, CT scanners, or MRI scanners are already digitized. Now all you need is the neural network-generated software to analyze the image and give you a diagnosis. In fact, it’s already happening in mammography as the second article describes.

The computers are going to get better and better at reading images as they are constantly learning how to perfect their skills through neural networks. And unlike radiologists, the computers never forget what they have learned.

Now, let’s take it another step.

What if patients could enter their own complaints, histories, and symptoms on laptops while they wait for the doctor, even at home, a week before the visit. These data would be analyzed by AI before the patient is even seen and forwarded to the patient’s doctor who could then concentrate his physical exam (some doctors still do this) and the associated laboratory tests and imaging around the differential diagnosis elicited by the data entered before the doctor even laid eyes on the patient. You don’t believe me? Try it yourself.

Use your own aches and pains or the symptoms of any recent patient and enter the information in Chat GPT. You will likely get a reasonable differential that could focus your thinking without eliminating the need for human contact between patient and doctor.

Now let’s take it further.

Suppose the entire genetic sequence of a patient’s DNA could be acquired before being seen by the doc. Oh, go ahead and add proteomics and epigenomics, too. Basically, it is feasible that a patient could have a sub-clinical autopsy before ever meeting her doctor. Then the doctor visit could be what it ought to be, an interchange between doctor and patient as to what the patient’s problems likely are and what the plan is to deal with them because the likely diagnoses have been ascertained, the proper tests have been ordered, the results have been analyzed, and treatment has been suggested by AI, MD.

Feeling threatened?

You shouldn’t be. Your work load is likely to go down and your patients can spend more quality time with the doctor and the doctor can spend less time with EPIC as the patient and physician extender can do the data entry.

My night guard is only the beginning of a new way to practice dentistry. Surely robots can be taught to fill teeth and even if that’s five years away, detecting the need for root canals and implants is likely to get better and better. Periodontists use CT scans now.

Similarly, the accuracy of diagnoses and subsequent precision of treatments in medicine is also likely to improve. After all, look what robots have done for surgery. That’s just the beginning.

Today I saw the future of dentistry. My guess is that the future of many medical procedures from mammography to colonoscopy will soon be ceded to machines. Can you imagine having extra time to actually talk to a patient instead of being a clerk? You will love it. So will the patients.

Did you know? Dr. Zwelling’s new book “Conflict of Interest” becomes available Spring 2023. Check for the latest on this book and information on how you can purchase a copy.

2 thoughts on “Night Guard By iTero; Mammography By AI”

  1. This is a timely article and reminder that artificial intelligence and robotic procedures will advance our care.
    Years ago, I had the opportunity to advise IBM on the development of their SUPER computer Watson and its future implications in medical care. At first, I felt threatened. But, now I understand that computer-designed diagnosis and treatment will be remarkably accurate. And, physicians can spend more time discussing options with patients, getting to know their socioeconomic situation and cultural context, and enjoying bedside manner again.
    Thanks for this interesting reflection!

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