Rise of the machines

Shaun Sellars continues his series on ethical dilemmas in dentistry which appears in every second issue of the BDJ.

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The current trend for 'do-it-yourself orthodontics' appears to be inescapable. A growing number of companies are attempting to cut out the middle man by selling the dream of straight teeth to their customers. This has naturally, and rightly, been decried in dental circles.

This column isn't about that. It's about what might be next.

Direct to consumer orthodontics has come about through advances in technology which allow the vast majority of this complex treatment to be fully, or mostly automated. The patient may never see a dentist.

If orthodontics, one of the most complex forms of dental treatment, is susceptible to deskilling and digital redundancy, where will that leave the rest of the profession in the future?

We're already seeing scanners, milling machines and 3D printers enter into practice. The technology is there for AI-assisted note-taking. As patients' ability to control their treatment increases, where does that leave the general dentist?

Imagine a scenario in the not too distant future where we have an accurate and reliable way to detect caries using a handheld device, much like current 3D scanners. Add in a little machine learning and these devices could soon become better at detecting dental disease than any dentist. From this, it's a relatively simple step to suggest treatment options.

So far so good. Improved diagnostics and better outcomes for patients. This may well be something that a large group of the profession can get behind. As time goes by this technology naturally becomes more affordable and smaller. More dentists will have access to it. But what happens when it's so easy to use, that you don't need to be a dentist to do it.

Eventually, someone comes up with the idea of integrating this into a toothbrush. Every day, patients can assess the health of their mouth directly whenever they want. They can tell if they need to see a dentist and get tips on how to look after their teeth themselves. They can cut out the middle man. The silicon dentist in their toothbrush tells them that they need to see the flesh and bones dentist in the surgery. It even books you an appointment and suggests what treatment you may want to opt for.

This may seem far off, but it wasn't that long ago that if you wanted to take a picture, you had to have a dedicated camera. Technology is adapting faster than many of us can take in. These changes are going to bring about new ethical dilemmas and concerns which we should all be involved in tackling. Not least of these is how far do we let this go? Are we happy letting computers dictate our choices of treatment, and what happens when those computers are advanced enough to carry that treatment out? To sift through this we need to be able to accurately predict the future or be involved in shaping it. Sitting back and letting it happen isn't an option.

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Sellars, S. Rise of the machines. Br Dent J 227, 947 (2019). https://doi.org/10.1038/s41415-019-1051-7

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    • Stephen Hancocks OBE

    British Dental Journal (2020)

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