Excerpts & Op-Ed

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By Dr. John Cutter, D.D.S.

Drag out your crystal ball and polish it up!
Now, tell me: Did you see online streaming replacing DVD’s?
Did you see Amazon or Alibaba replacing your favorite shopping mall?
Did you see SARS-CoV-2 being the biggest disruptor in your life to date? No.
It’s okay … neither did I.
The problem isn’t our crystal ball. The problem is how we have successfully adapted and responded to our present-future.
That last hyphenated word is no mistake. If you believe there are three, distinct dimensions of time (past; present; and future), I’ll wager you’re feeling overwhelmed, confused, and lost. There is only the past and the present-future because what you do this very moment in time affects every second that follows, particularly in your professional life and practice.
This is the universal constant of change. Buggy whip manufacturers were a thriving business model until Henry Ford’s Model T in 1908. Kodak was the leader in all things photographic until digital appeared. Today, it identifies its market principally as software. Even Procter and Gamble, which spent $7.32 billion in 2020 on advertising¹ alone, no longer sees its brand as soap and care
products, but rather personal empowerment. As Robin Lewis, co-author of The New Rules of Retail writes:

“To survive, indeed succeed today, embrace disruption, and adapt, adopt, or acquire the new models. Do not sit in death’s waiting room like the buggy whip makers.”²

Clearly, the past is now the past. It will do little good imagining ever returning to pre-Covid protocols and routines. So, if it’s time

to pawn our crystal ball, where do we look for answers, direction, and reassurance?

The last four years of my U.S. career was spent as a principal dentist for the NHANES program of the Centers for Disease Control and Prevention. The data we acquired in that program’s 50-year history has led to significant insights and changes in medicine and dentistry, improving legislative, community, and practice standards. ³ Today,
as one of five Co-Founders of the global oral health initiative, TeethCloud, which has recently admitted its 13th member nation, I enjoy interacting daily with dental clinicians, educators, and researchers who are dedicated in utilizing data collected from 100,000 study participants (11,000 in the Philippines⁴) to decrease oral health inequalities across the world. The ongoing conversations are exciting, enthusiastic, and determined! But, more importantly, the data is fast converging into trend identifications that will lead us through the pandemic landscape to shape us into more flexible and resilient healthcare providers.

Among those trends, several are key:

1. Interdisciplinary Healthcare Teams (IDHT’s) – This is medical-dental integration. Dentistry is essential. There are over 200 oral-systemic links that trace back to periodontitis, caries, and sleep apnea. Knowing Covid 19’s virion is resident in salivary gland endothelium⁵, we are among frontline professionals who must be responsible
for testing, tracking, and treating (vaccinating) these patients. Here too is the compelling argument of why your patient family needs to routinely see you, not just for emergency care. As Dr. Marc Cooper, President of MBC Consultants, recently put it, this is our “Big-Bang [moment]; and, not believing that it will happen is being asleep”.

2. Dental Informatics / Dental Data Science – From 1968 onward, we might have termed this the computerized dental practice. However, today it’s about going digital. It implies an imperative that must drive us away from antiquated, paper-based record keeping; fosters identifiable metrics for doctor, staff, and practice; and, most easily leads to a cloud-based neural network of peer-to-peer dental offices whose data can be instantly uploaded and statistically analyzed, both locally and globally. Invited to attend the deliberations of the ADA’s Subcommittees on Teledentistry and Informatics⁶, I can report that our industry is already formulating protocols and best practices in these applications. Consequently, I believe this area will soon become a newly recognized specialty. Can the dental IT assistant as an integral office team member be far behind?

3. Artificial Intelligence (AI) – Machine learning algorithms are transforming the way we practice from robotic arm implant placement to improved pathology identification from radiographs to self-monitoring healthcare applications. This is not dreamy forecasting. It is here now! Just read the recent articles by Alicia Webb and Shannon Sommers, both hygienists and rising stars
in dental informatics.⁷ Need more proof? Stakeholders across the dental spectrum have recently formed the Dental AI Council.⁸ As heralded this month in a Stanford University seminar, AI’s usage will explode in the next 24-36 months.

4. Teledentistry – Dr. Gerardo Legaspi, Director of
Philippine General Hospital, has informed me that
66% of all inbound potential admissions are now triaged by telehealth means. Moreover, twenty states in the U.S. cite 30-42% of their public health and private practitioners using teledentistry. While never meaning to replace the in-office head and neck exam, it will dimensionally speed and automate those initial clerical and clinical screening procedures that would have
otherwise taken up valuable time from your production schedules.

5. Changing Face of Medical/Dental Missions – As a recently invited guest to the World Federation of Public Health Associations (WFPHA)⁹, the days of tent pavilions and extracting teeth on basketball courts or parking lots must come to an end. Covid19 precautions and the inability of most missions to guarantee

adequate standards of infection control must now be replaced by providing awareness, education, homecare materials, baseline charting triage, and referral to dedicated points of care, whether that be community clinics, hospitals, or private practices. The data must also be collected which in turn will lead to significant legislation and marshalling of resources to increase positive outcomes.

6. Staff Is Essential – Those practices that supported their staff, expanded their duties, and added additional members have successfully negotiated 2020 far better than those who felt eliminating staff was a means to decrease overhead and recoup lost revenue. The concept of the solo dentist with merely “2-hands” in the operatory is a failing model. Doctors, you need at
minimum a chairside assistant; you need a dental hygienist; in fact, your hygienist needs a dental assistant; and, no, your receptionist cannot be permitted to hop from front office to operatory.

7. Patient-Centric Care – This is not a surrender of either whole-patient care or the integrity of your diagnostic and treatment planning skills. It does mean, however, that the transparency gained by the Covid pandemic has made the patient more aware of what the standard of care should be. Patients will not only be highly watchful of what you do and how you operate your practice, they will demand that it meets a higher level of compliance. Failing to listen, meet, or exceed the expectations of that importance will likely see patients who look elsewhere for care. So, trash the crystal ball! Follow the evidence-based data!
It’s time to adapt to the present-future and transform yourself and practice. Better yet, join with us and add your data to ours! Arguments that it can’t be done or doesn’t include you, simply locks dentistry’s cottage industry door and tells the national citizen you’re closed for business.

1 www.statista.com
2 www.therobinreport.com; 03-27-17
3 www.cdc.gov/nchs/nhanes/index.htm
4 www.dentalcharting.com
5 journals.sagepub.com/doi/full/10.1177/
6 Teledentistry Guidance (ada.org)
7 www.rdhmag.com/career-profession/article/14185563/artificial-
8 lilac-lynx-p6gt.squarespace.com/
9 www.wfpha.org