Danny Grannick explores how new technologies are impacting oral health and dentistry.
Whilst we have seen other areas of healthcare shift to being prevention-focused, some feel that dentistry has remained largely reactive. Many practitioners are using traditional methods to detect existing diseases and provide treatments when they occur rather than preventing these conditions in the first place.
US citizens currently spend a whopping $103bn on dental care treatments annually. In reality, if patients invested half of this money into a proper measure of their oral health, you could help them prevent certain diseases and reduce the need for severe (scary and often painful) operations. Doing this is in a dental practice’s interests, as it can help increase loyalty and trust in the service provided. Rather than being a body that is feared and avoided, dentists can be a leader in supporting a movement towards healthier lives. Insurance packages could become prevention packages with a combination of dental care check-ups to ensure a healthy state of the mouth, and oral health checkups, to investigate symptoms of potential diseases.
But just how can you correctly measure a patient's oral health? The answer lies with technology and science.
Patients know about gum disease, inflammation, and tooth loss; however, they rarely are aware of their oral microbiome. The oral microbiome is the community of microbes (bacteria, fungi, viruses) that live in the mouth. Oral health is affected by the balance of these microbes. There are over 750 types of microbes known to live in the mouth, and it’s essential to know which are good, which are bad, and how to treat them.
Good bacterial species produce vitamins such as vitamin B12 and K, while harmful species produce acids that erode your teeth. Oral health is affected by hygiene, genetics, lifestyle (stress and exercise), and specific foods and drinks in a diet (even some that are considered healthy can have a negative impact).
Before individuals could measure their sleep patterns, they would assume that sleep, stress, and body recovery were unrelated. Now, large tech brands offer sleep monitoring apps on mobile devices and watches. These allow users to track and understand sleeping stages such as deep, light, and REM.
The same occurs with oral health today, where professionals are now leveraging emerging technologies to study and analyse certain behaviours and their effects. Oral health providers can discover correlations between the bacteria in the mouth and diseases across the entire body. For example, growing research suggests that cognitive decline (including forms of Alzheimer's and other dementias) may link back to some of the same bacteria that cause gum disease.
Advances in technology within genomics, antimicrobials, robotics, and artificial intelligence, are transforming the ability to diagnose and prevent diseases. Integration of dental practices with medical teams, physicians, geneticists, and pharmaceutical scientists gives health specialists a holistic approach and the ability to connect diagnoses and discover causes and prevention possibilities before the diseases occur.
Technology is available to measure oral health by analysing the bacterial levels in a saliva sample. By understanding the microbes present, oral care providers can review an individual’s unique microbiome and provide personalized diet recommendations and risk potential. Microbiome testing methods range from qPCR to shotgun sequencing and metatranscriptomics. Here’s a quick summary of each:
qPCR: This is helpful in determining the quantity of genetic material; however, it requires the design of ‘primers’ to determine your target bacteria of interest. To design the correct primers to identify these microbes of interest, you must know what microbes will be present. Consequently, qPCR tests typically only detect a handful of microbes.
Shotgun sequencing: This looks at all the DNA in a saliva sample and can tell you which species are present, in what quantity, and the functions of each species.
Metatranscriptomic sequencing: Metatranscriptomics gives you the most detailed analysis of the microbiome and its activity by looking at the Ribonucleic acid (RNA) in the bacteria. However, it is costly and generates large datasets that can be difficult to interpret.
People who brush their teeth regularly can be confused about why they are experiencing bad breath, gum disease, and cavities. In bad breath, while brushing and flossing remove the sulphur compounds produced by bad bacteria, it may not remove the harmful bacteria themselves. Saliva plays an integral part in managing the bacteria level in one’s mouth. It keeps mouths hydrated and supports the removal of unwanted microbes and food particles by washing them away. It even has some antimicrobial properties.
You can separate oral health risk factors into behavioural risk factors, such as eating lots of sugar or carbohydrates, and clinical risk factors, including certain medications which create dry mouth and alter the pH of saliva, which affects overall oral health.
Oral health applications that distinguish behavioural and clinical risk factors allow patients to understand better why they experience symptoms. They can also receive recommendations like adding certain foods to their diet, switching toothpaste ingredients, or modifying lifestyle habits, like chewing xylitol gum to stimulate more saliva without increasing sugar levels.
When oral health screenings integrate with tele-dentistry and user-friendly apps, patients will receive results and consultations remotely. Health professionals can create patient profiles using AI predictive tools to simulate and analyse different potential risk scenarios. AI-powered predictive tools review genetic testing data, patient behaviour, patient history, and external factors to refine risk factors and provide behavioural and nutritional support unique to each patient.
Spending on dental care will increase by less than $70bn by 2027, compared with almost $140bn in projected spending in 2019. Technological advancements that help measure and educate oral health aid cost reductions by preventing more painful surgeries down the line. By encouraging your patients to measure their oral health, you can increase the number of clients that walk into your dentist, not in fear but gratitude. When you can provide a service to prevent diseases and react when a symptom does appear, patients will have more trust and may avoid severe illnesses that can cause harm elsewhere in the body.