In Conversation with Dr. Fabian Harders

“Digital health” has increasingly permeated into all aspects of medicine and health, including dentistry. Far from being isolated to the treatments provided, digitization has a top-down impact on all aspects of the dentist-patient relationship. It’s already transforming patient behaviors and their relationship to dentists and, indeed, all medical professionals. Dr. Fabian Harders, trainee orthodontist at Dr. Nesselrath & Kollegen, Ratingen, has unique insight on how digitization is driving the world of dentistry.

Our team at Zircon Medical recently hosted Dr. Harders on our podcast series to discuss the growing role of digitization in dentistry.

Introducing Dr. Fabian Harders, trainee orthodontist at Dr. Nesselrath & Kollegen, Ratingen

Dr. Fabian Harders is an trainee orthodontist at Dr. Nesselrath & Kollegen, an orthodontic clinic in Ratingen, Germany. He completed his dental education in Münster in 2018, and he’s currently undergoing further training as an orthodontic at Nesselrath & Kollegen. He has also recently completed a course on TMJ disorder and therapy.

Dr. Fabian Harders says he stumbled into dentistry accidentally after watching a friend’s father plied his trade at his dental clinic. He subsequently enrolled himself in dental school after graduation. However, it took a while to dawn on him that he was truly interested in orthodontics. He was particularly drawn to orthodontics because of the possibility of providing a dental experience from scratch.

Orthodontics gives Dr. Harders the chance to accompany a patient through several years and shape their future dental health instead of working on a single tooth. He’s also excited by the biomechanics involved in orthodontics, including the different bracket systems and wires. Although aligners have been gaining popularity recently, Dr. Harders is still more excited by lingual braces fixed to the back of the teeth.

Introduction to digitization in dentistry

According to Dr. Fabian Harders, digitization is a “macro trend” that everyone has encountered in some form. It may have started with people being able to count their steps, but it’s progressed enough that patients now conduct thorough research before consulting a dentist. He believes digitization has made patients more aware and conscious of their health and teeth than they were in the past.

Dr. Harders is particularly impressed by the move towards cellular or online appointments with dentists. Instead of going for initial consultations, patients can now consult their doctors over the internet, making in-person consultations redundant. However, Dr. Harders believes digitization is a broad area that’s transforming all aspects of healthcare for the better.

“I don’t think it's just a matter of making analog processes in dentistry digital,” he says. “Whether it's an impression that's no longer taken with an alginate or a silicone but with a scanner, or tele-prevention, education, or diagnostics.” Digitization in dentistry, according to Dr. Harders, is about using digital possibilities to bring all aspects of dental care into the 21st century.

Digitization and changing patient behaviors

#1. The patient is now at the center of the relationship

One of the most significant aspects of digitization is how it’s changing patient behaviors. A key component of digital services is that the customer is always placed at the center of the service. And this centralized focus on the patient experience now exists in all walks of life, whether it’s hailing a cab through Uber or shopping with Amazon.

Due to this larger trend, patients now expect a similar experience with healthcare and dentistry. Dentists now must place the patient and their experiences at the center of the relationship. Dr. Harders cautions against this thinking: “As a doctor, we are the center of everything. If a patient has a problem, he comes to us, and we offer him the solution.”

The aforementioned model of doctor-patient relationships no longer works because patients are now building an entire health network through independent internet research. The individual doctor is simply a small part of the patient’s health network. To move with the times, physicians and dentists must readjust their thinking to cater to the patient’s expectations while still steering them in the right direction. 

#2. The patient’s reliance on a single dentist will decrease

In the past, patients often stayed with their family dentist for decades. But digitization is making that less likely. Patients now choose multiple dentists and access to all their information from Google, so their reliance on one doctor will become negligible. This shift has already happened in other aspects of life. For example, patients now consider multiple shopping outlets to find what they’re looking for instead of limiting themselves.

Dr. Harders believes that dentistry is headed in the same direction. If a patient doesn’t like the implant process in practice A, they can do their research to acquire more information and try out another clinic. The easy availability of information through online research and online forums enables patients to inform themselves when their experience isn’t optimal or lacking. This makes them more likely to find practices that can address the issue.

However, Dr. Harders draws a clear distinction between the desire for a better experience and “doctor hopping.” He describes doctor hopping as the act of bouncing from one physician to another because of chronic dissatisfaction. That’s entirely different from the legitimate desire to find a dentist who accurately addresses the patient’s unique concerns and goals. Digitization is making it harder for dentists to maintain or count on patient loyalty.

#3. The patient is more interested in learning about themselves, their health, and their teeth

Digitization is also making patients more interested in learning about themselves, their bodies, and their own teeth. They now have tools, technologies, and apps that track their vitals and present information in easily accessed graphical forms. This allows patients to better understand their health themselves without having to consult dentists all the time, which, in turn, makes them more interested in self-education.

Dr. Harders uses the example of Philips’ latest Sonicare toothbrush as an example. The new series of toothbrushes will use artificial intelligence to collect data while the patient is brushing via sensors and display the information in an app. As such, patients will come into their appointments with self-collected data with potential diagnoses, and dentists will have to actively consider that information while dealing with patients.

Digitization and data collection

Dr. Harders excited about the possibilities made available through online data collection. The introduction of the electronic patient file makes it possible to upload the patient’s data and medical history to the cloud, giving all dentists and health personnel centralized access to the patient’s relevant details. However, Dr. Harders is also excited about the patients’ ability to collect personal data, as illustrated previously.

Dr. Harders believes there’s a lot of data lying dormant that dentists and orthodontists aren’t yet using. The patients’ ability to collect information will also strengthen the dentists’ ability to treat them. The dentist will no longer be reliant on the information they collect in practice in one specific instance. Instead, they can collaborate with the patient to gain a detailed medical history over extended periods.

However, Dr. Harders anticipates a slight point of tension between the dentist’s recommendations and the patient’s self-collected data. Dentists can’t simply ignore the data collected by the patients or the proposed diagnosis. They’ll have to at least consider the data available in their apps while curating their treatment plans and making a diagnosis. As such, there will be an active exchange of information between the patient and the dentist.

Dr. Harders believes the trend of greater digitization will be followed by a growing unease with big data. We’re already seeing a global trend of skepticism with “big data,” an elusive term that indicates tech companies that indiscriminately gather the users’ information for uncertain purposes. Dr. Harders predicts a push-and-pull between the desire to embrace digitization and the unease with big data collection. 

“I think it’s important, when this becomes more of an issue in our country, that we receive support from the ministries, dental associations, and other institutions,” Dr. Harders says. “People need to understand that the data they collect is safe when they give it to us. We don't pass it on directly to just anyone.” He emphasizes the need for educational work to convince patients of the safety of data collection.

Digitization and orthodontics

Digitization has found immense popularity and success in orthodontic treatments, especially invisible aligners. Patients can now send videos or images of their teeth to highlight how their teeth are progressing, cutting out the need for constant follow-up sessions. However, Dr. Harders believes the prospect of eliminating the need for dental visits altogether is unlikely.

Dr. Harders always prefers seeing patients in person for their orthodontic treatments. He keeps a plaster model of the upper and lower jaws in his hands to plan the therapy. He believes physical check-ups for orthodontics are more tangible than looking at scans on the PC. While digitization can automate lots of processes, it can’t replace the need to work with people individually, especially for fixed braces and lingual braces.

“At most, you could use it to check in between,” Dr. Harders says. “Does the patient really have to come by in five days? Or is the wire between the teeth active enough to push the treatment back a few more days?” Similarly, he believes digitization will reduce the need for multiple sessions, but it won’t entirely remove the need for consultations, at least not anytime soon.

Digitization and dental practices

Dr. Harders and his dental clinic have already digitized many of their analog processes. He has found that digitization allows dental practices to outsource a lot of the work to their patients. He cites the example of filling out the patient’s medical history. Most practices now have iPads in the waiting rooms, so the patient can fill it out to automatically upload it into the system. You don’t need assistants or human resources to upload the patient’s medical history.

Dr. Harders believes it’s even more efficient to have the patient fill out the medical history details before the appointment. The practice can send them the medical history form in advance to fill it out before their appointment, saving time and organization. Digital capacities and apps allow dental practices to outsource many similar tasks to patients without neglecting them. This allows the dental clinic to run more efficiently, free from the need for routine tasks.

Dr. Harders is also keen to see if larger practices start preparing their internal apps, which can potentially bind the patient even more strongly to the dental practice. As an example, Dr. Harders cites the use of apps for aftercare. Once the treatment is done, the app’s chatbot can ask the patient if they’re satisfied with the treatment or if they have any concerns. The questions can be automated, informing the relevant dentist only if the patient has a problem.

This gives patients a sense of security, making them feel that the dentist truly cares for them, without the physicians having to put in more work. Dr. Harders wants to implement similar techniques and applications in his dental clinic to optimize all processes. That’s a part of his 5-year plan to make the dental clinic more patient-oriented using digital tools and applications.

Dr. Fabian Harders aims to finish his training as a specialist dentist in the next year and get more involved with lingual braces, which he prefers over aligners, a fairly controversial preference in his opinion. You can find him at Dr. Nesselrath & Kollegen, in Ratingen, or over LinkedIn. You can also listen to Dr. Harders in our Zircon Medical podcast or continue reading for a detailed article on the growing role of digital health in dentistry.

Digital dentistry is an extremely broad term that encapsulates everything from telemedicine and visual consultations to artificial intelligence-guided treatments. In a previous article, we discussed the growing role of artificial intelligence in dentistry. While artificial intelligence is certainly an important component of digital dentistry, the term “digitization” is far broader, and its impact on dentistry is impossible to ignore. 

In this article, we explore the trends and factors driving the growth of digitization in dentistry.

Production of affordable in-house dental products

Traditionally, the production of dental hardware, such as prosthetics, has been outsourced to external dental laboratories, often located in low-cost countries. However, digital technologies and 3D printers, and CAD/CAM systems (computer-aided design/computer-aided manufacturing) allow dental practices to produce entry-level hardware in-house at a far more affordable rate. Furthermore, producing instant prosthetics also improves the patient experience, giving them access to instant restoration. This trend is likely to continue as dental practices forge stronger alliances with dental equipment and technology companies providing affordable printing tools.

Changing patient behaviors will necessitate digitization

Until recently, dentists benefited from loyal patients who had little-to-no access to information regarding dental possibilities. However, as the internet increases transparency regarding dental treatments, possibilities, innovations, and prices, patients have started bringing their own expectations to dental practices. As a result, dental practices will soon have no choice but to embrace new innovations if they want to retain their patients.

For example, dentists can no longer expect their patients to repeatedly visit the clinic over several months for implants when other practices can use advanced digital workflows to complete the implant process in one or two sessions. As patients become more aware of digitally-enhanced treatments and possibilities, dental practices face the choice of embracing innovation or losing their patients. 

Digital technologies will soon affect the entire dental workflow

At this point, it’s clear that digital technologies will soon be adopted into every stage of the dental workflow, from practice management to follow-up and aftercare. The specifics of digital implementation in the workflow will differ for most dental clinics, and it’s an incredibly broad subject that deserves individual attention. However, the following is just a small example of how digitization can affect the entire workflow.

Management

Management and administration software can collect, compile, store, and arrange patient information and medical history. Transferring the data from on-premise programs to the cloud also facilitates easy access and sharing of patient information.

Diagnostics

Imaging technologies and software capture high-def x-rays and scans of the patients’ mouth and teeth to facilitate smoother diagnostics. Meanwhile, artificial intelligence-guided programs analyze the x-rays to identify warning signs, create detailed analysis, plan treatments with minimal dentist input, and predict post-treatment results with illustrations.

Planning

CAD/CAM systems can innovate and design customized dental prosthetics, such as crowns, bridges, and dentures, within minutes. Chairside milling and 3D printers allow dentists to complete the entire restoration or case in a single session instead of spacing it across multiple weeks.

Treatments

Advanced laser technologies help with crown lengthening, treating dental cavities, gingivectomy, extracting wisdom teeth, etc. Lasers can cut soft and hard tissues with greater ease and efficiency than manual tools while minimizing the side effects or risk of complications.

Follow-Up

Apps and chatbots can be used to provide recovery guidelines and check up on patients without the dentist’s active involvement. This significantly improves the patient experience while automating follow-ups.

Overview of technologies leading digitization in dentistry

Teledentistry

Teledentistry services, like The Teledenists, allow patients to access dental care and consultations without going to an actual dental clinic. The patient can capture images of their mouth or show their mouth via a camera to consult with a dentist. Teledentistry services shot up during the COVID-19 pandemic, allowing patients to consult dentists without stepping outside. Teledentistry can also be combined with VR/AR and other technologies for advanced diagnostics.

CAD/ CAM

Computer-assisted design and computer-assisted manufacture offer dentists affordable and simple means of printing dental prosthetics in their dental clinics. The dentist can essentially produce the prosthetics, like crowns and bridges, during the same session as the teeth preparation, providing immediate restoration. 3D printers with CAD/ CAM technologies can also provide complex orthodontics to start the process immediately without waiting weeks between sessions.

Intra-Oral Cameras

Intra-oral cameras allow dentists to examine the insides of the patient’s mouth without hand-held mirrors. They contain unique liquid lens technology that works like the human eye, providing stunning visuals without obstructions or blind spots. It also improves the patient experience because they don’t need to open their mouths as wide as they often do with hand-held mirrors. Intra-oral cameras allow dentists to diagnose conditions with greater accuracy.

Artificial Intelligence

Artificial intelligence will play an increased role in various phases of dentistry, especially diagnosis and planning. AI-drive programs and tools can already identify dental diseases, including periodontitis and dental cavities, with greater accuracy than dentists. This allows dentists to scan hundreds of x-rays at once and receive notifications about those exhibiting problems. Artificial intelligence can also be used to curate sophisticated treatment plans.

Augmented Reality

Augmented reality refers to technologies that provide a simulated prediction of an alternate reality or future possibilities. Dentists already use augmented reality while providing aligners — the software predicts how the patient’s teeth will look at various stages of the process. Over time, augmented reality will become even more integrated into dental practices, allowing patients to accurately see the results of their treatments beforehand.

Virtual Reality

Virtual reality technologies seal off the outside world and immerse the user in an alternate virtual world. Virtual reality cameras have found immense use in education, allowing dental students to virtually assist surgeons without actually being in an operating room. Experiments have also shown that virtual reality headsets can alleviate the patients’ anxieties during dental procedures by placing them in other virtual scenarios, distracting them from the treatment.

B2C Technologies

Smart technologies aren’t just being prepared for the benefit of dentists but also for patients. B2C dental technologies, like smart toothbrushes, have sensors that track the patient’s oral hygiene over extended periods, noting signs of plaque and cavities. The Kolibree smart electric toothbrush is sophisticated enough to inform the patient if they’re brushing incorrectly. These technologies capture vast amounts of data that dentists can use for optimal diagnosis and treatment planning.

There’s no doubt that digital technologies are rapidly gaining mainstream acceptance in dentistry. As more dental practices adapt to this changing landscape, it becomes more mainstream and inescapable. Digital solutions will inevitably disrupt the dental industry; the only question is whether you’ll swim with the tides.