Current state of dental informatics in the field of health information systems: a scoping review.

BACKGROUND: Over the past 50 years, dental informatics has developed significantly in the field of health information systems. Accordingly, several studies have been conducted on standardized clinical coding systems, data capture, and clinical data reuse in dentistry. METHODS: Based on the definition of health information systems, the literature search was divided into three specific sub-searches: "standardized clinical coding systems," "data capture," and "reuse of routine patient care data." PubMed and Web of Science were searched for peer-reviewed articles. The review was conducted following the PRISMA-ScR protocol. RESULTS: A total of 44 articles were identified for inclusion in the review. Of these, 15 were related to "standardized clinical coding systems," 15 to "data capture," and 14 to "reuse of routine patient care data." Articles related to standardized clinical coding systems focused on the design and/or development of proposed systems, on their evaluation and validation, on their adoption in academic settings, and on user perception. Articles related to data capture addressed the issue of data completeness, evaluated user interfaces and workflow integration, and proposed technical solutions. Finally, articles related to reuse of routine patient care data focused on clinical decision support systems centered on patient care, institutional or population-based health monitoring support systems, and clinical research. CONCLUSIONS: While the development of health information systems, and especially standardized clinical coding systems, has led to significant progress in research and quality measures, most reviewed articles were published in the US. Clinical decision support systems that reuse EDR data have been little studied. Likewise, few studies have examined the working environment of dental practitioners or the pedagogical value of using health information systems in dentistry.

Methodological challenges when performing a systematic review.

Well-conducted systematic reviews can provide a foundation upon which to base educational curricula, practice guidelines and healthcare policy. We aim to provide an overview of important methodological issues that need to be addressed during the five phases of performing a systematic review. 1. The specific problems to be addressed by the systematic review need to be formulated as clear, unambiguous and structured question/s. 2. Literature from multiple resources should be searched to avoid publication biases, as positive outcomes are more likely to be published than null/negative results. 3. The quality of selected articles should be assessed using a checklist, while the reliability of graders, as well as the quality of the checklist, needs to be established a priori. 4. Statistical heterogeneity needs to be assessed to determine if a meta-analysis is appropriate to pool the data. If not, a narrative synthesis of the evidence/overall findings needs to be performed within a clinical context.

Understanding dental CAD/CAM for restorations--the digital workflow from a mechanical engineering viewpoint.

As digital technology infiltrates every area of daily life, including the field of medicine, so it is increasingly being introduced into dental practice. Apart from chairside practice, computer-aided design/computer-aided manufacturing (CAD/CAM) solutions are available for creating inlays, crowns, fixed partial dentures (FPDs), implant abutments, and other dental prostheses. CAD/CAM dental solutions can be considered a chain of digital devices and software for the almost automatic design and creation of dental restorations. However, dentists who want to use the technology often do not have the time or knowledge to understand it. A basic knowledge of the CAD/CAM digital workflow for dental restorations can help dentists to grasp the technology and purchase a CAM/CAM system that meets the needs of their office. This article provides a computer-science and mechanical-engineering approach to the CAD/CAM digital workflow to help dentists understand the technology.

Are Electronic Health Records the Future of Dental Practice?

This article explores the opportunities and challenges for dentists in the transition to electronic health records (EHRs). Dentists have been slowed in the digital transition by lack of federal incentives and technical assistance. Now, however, changes in the practice of dentistry, including more integration with other health care providers, may propel them forward.

Legal Considerations for Electronic Health Records.

Electronic health record (EHR) solutions provide many potential benefits for dental practices, whether those programs run internally on a dental practice's computers or are cloud-based solutions. However, these programs also create new risks for a dental practice, which may be mitigated through due diligence and adequate contractual provisions to ensure protection for dentists. This article addresses the legal considerations associated with a dentist entering into a service contract with an EHR vendor.

The awareness and attitudes of students of one indian dental school toward information technology and its use to improve patient care.

BACKGROUND: Many obstacles need to be overcome if digital and electronic technologies are to be fully integrated in the operation of dental clinics in some countries. These obstacles may be physical, technical, or psychosocial barriers in the form of perceptions and attitudes related to software incompatibilities, patient privacy, and interference with the patient-practitioner relationship. The objectives of the study are to assess the perceptions of Indian dental students of one school toward the usefulness of digital technologies in improving dental practice; their willingness to use digital and electronic technologies; the perceived obstacles to the use of digital and electronic technologies in dental care setups; and their attitudes toward Internet privacy issues. METHODS: The study population consisted of 186 final year undergraduate dental students from the A. B. Shetty Memorial institute of Dental Sciences, Rajiv Gandhi University of Health Sciences, Mangalore, India. Survey data were analyzed descriptively . RESULTS: Most students indicated that information technology enhances patient satisfaction, the quality of dental record, diagnosis, treatment planning, and doctor-doctor communication. Cost of equipment and need for technical training were regarded as major obstacles by substantial proportions of respondents. DISCUSSION: Most dental students at our school feel that the information technology will support their decision making in diagnoses and devising effective treatment plans, which in turn increase patient satisfaction and quality of care. Students also perceived that lack of technical knowledge and the high cost of implementation are major barriers to developing information technology in India.

Electronic clinical records: having the right data to navigate through the perfect storm.

U.S. health care is converting from paper to digital information management. This conversion has passed the tipping point and is showing evidence of the benefits. Yet effective clinical information systems for dentistry have barely begun to be adopted. Dentistry is changing and the new practice models will require digital information management, as there is increasing pressure for evidence-based practice, continuity of care and demonstration of the quality of care resulting from these models.

How a modified approach to dental coding can benefit personal and professional development with improved clinical outcomes.

BACKGROUND: One disadvantage of the remarkable achievements in dentistry is that treatment options have never been more varied or confusing. This has made the concept of Evidenced Based Dentistry more applicable to modern dental practice. Despite merit in the concept whereby clinical decisions are guided by scientific evidence, there are problems with establishing a scientific base. This is no more challenging than in modern dentistry where the gap between rapidly developing products/procedures and its evidence base are widening. Furthermore, the burden of oral disease continues to remain high at the population level. These problems have prompted new approaches to enhancing research. AIM: The aim of this paper is to outline how a modified approach to dental coding may benefit clinical and population level research. METHODS AND MATERIALS: Using publically assessable data obtained from the Australian Chronic Disease Dental Scheme and item codes contained within the Australian Schedule of Dental Services and Glossary, a suggested approach to dental informatics is illustrated. RESULTS: A selection of item codes have been selected and expanded with the addition of suffixes. These suffixes provided circumstantial information that will assist in assessing clinical outcomes such as success rates and prognosis. CONCLUSION: The use of item codes in administering the CDDS yielded a large database of item codes. These codes are amenable to dental informatics which has been shown to enhance research at both the clinical and population level. This is a cost effective method to supplement existing research methods.

The oral-systemic personalized medicine model at Marshfield Clinic.

Periodontal disease and diabetes, two diseases that have achieved epidemic status, share a bidirectional relationship driven by micro-inflammatory processes. The present review frames the current understanding of the pathological processes that appear to link these diseases and advances the hypothesis that reversal of the epidemic is possible through application of interdisciplinary intervention and advancement of oral-systemic personalized medicine. An overview of how Marshfield Clinic's unique clinical, informatics and bio-repository resources and infrastructures are being aligned to advance oral-systemic personalized medicine is presented as an interventional model with the potential to reverse the epidemic trends seen for these two chronic diseases over the past several decades. The overall vision is to engineer a transformational shift in paradigm from 'personalized medicine' to 'personalized health'.

Cusp radius measurement through digital image analysis.

OBJECTIVE: Dental anatomy has been extensively described in numerous textbooks. Nevertheless, there are very few details about the value of the cusp radius of posterior teeth. This in vitro study used a laser profilometer to scan the occlusal surfaces of 21 molar teeth. MATERIALS AND METHODS: The images were analysed with µScan software and the approximate radius of curvature was measured. RESULTS: The values varied between 0.6-2.5 mm. The radius average value was 1.25 mm bucco-lingually and 1.61 mm mesio-distally. CONCLUSIONS: These findings might serve as a guide for different dental biomechanics studies and the conception, design and manufacturing of dental prosthetics.

Comparing potential early caries assessment methods for teledentistry.

BACKGROUND: Optical caries detection has the potential to be incorporated in telehealth medicine for preventive dental screening. The objective of this study was to evaluate and compare visible and near infrared detection methods for identifying early non-cavitated ex vivo occlusal demineralization. METHODS: Six blinded examiners were used to compare the accuracy of the following three examinations in detecting occlusal demineralization: Midwest Caries ID (MID), visual photographic examination (CAM) and Cross Polarization Optical Coherence Tomography (CP-OCT). For each diagnostic method, two examiners assessed the extracted tooth samples 1-2 weeks apart. Teeth were then sectioned and lesion depth was confirmed (n = 42) by a blinded histological examination using a glycol based caries indicator dye. The sensitivity (Sen), specificity (Sp), Intraclass Correlation Coefficient (ICC), and Area under the Receiver Operator Curve (AUC) were calculated. RESULTS: For detecting any demineralization versus sound pit and fissure enamel, the mean Sen/Sp found was 46.9/85.0 for MID, 80.5/52.5 for CAM, and 83.4/45.0 for CP-OCT. For detecting non-cavitated demineralization that progressed into the dentin, the mean Sen/Sp found was 17.3/88.0 for MID, 48.0/57.8 for CAM, and 44.2/72.7 for CP-OCT. AUC values were statistically significant (P < 0.05) in three out of four examiner assessments when MID and CP-OCT were used to detect any demineralization. AUC values were significant for a single CAM examination. When assessing deeper non-cavitated lesions, none of the assessment methods were able to yield AUC values that were significantly different than a random 'coin flip' test. When examining reliability, MID demonstrated the highest ICC score (0.83) and CP-OCT had the lowest (0.49). CONCLUSION: Although MID and CP-OCT were useful in detecting the presence of demineralization, examiners were not able to utilize these devices to adequately assess the depth of the demineralization. This study found that MID and CP-OCT did not have markedly superior diagnostic values from simple CAM assessment for use in teledentistry.

An initial, qualitative investigation of patient-centered education in dentistry.

Patient education plays an important role in the delivery of dental care. Current evidence suggests that the emergence of the Internet and other electronic resources are significantly influencing how patients learn about their healthcare. We conducted a qualitative inquiry using a combination of interviews with patients and clinicians, and direct observation of patient education episodes, to begin identifying requirements for customized, patient-centered approaches to education at the point of care. Most patients in our study felt comfortable with the amount and method of education during the dental visit, but 38% sought additional information on the Internet. Dentists and their team members provided patient education mostly verbally, supported by media such as radiographs, images and models. Electronic means, especially the Internet, were little used. Patient education occupied a significant portion of the time of initial comprehensive examination (29%) and routine (7%) dental visits. A deeper understanding of patient knowledge deficits and information needs will be needed to design effective educational interventions. Patient education should be meaningfully integrated into the workflow shared by dentists, their team members and patients, in order to maximize its outcomes.

Accessing the best available evidence.

UNLABELLED: This narrative review aims to highlight sources of the best available evidence and describe primary clinical trials currently taking place in primary dental care across the United Kingdom which will add to the evidence base. CLINICAL RELEVANCE: To provide evidence-based dental care, dental professionals have to integrate the best available evidence, their clinical experience and their patients' values; this paper should help to identify user-friendly sources of the best available evidence.

Knowledge management systems for oral health in developing and developed countries.

Knowledge management systems utilize information technology to manage knowledge in organizations with the purpose of creating, supporting, storing and disseminating information. These systems have been around for decades, but have significantly changed over time in complexity and features with the evolution of information technology and the Internet. With the development of these new technologies, the concept of knowledge management has thrived and has had significant impact on the way in which knowledge is accumulated, stored and accessed. This article will describe the historical development of knowledge management systems in oral health, illustrate the technology using examples and explore the future use of these systems with emerging technologies such as Google Wave®. One example of how knowledge management systems may affect the quality of dental education is the DentEd project, where a collaborative website was developed to coordinate dental school visitations and collection of reports from working groups, leading to several important publications. MEDLINE is another example of an effective knowledge management system in health care, providing access to health care-related scientific literature, which is highly organized under the auspices of the United States National Library of Medicine. Another and very differently organized example of an effective knowledge management system is Wikipedia, which is a free, web-based, collaborative, multilingual encyclopedia project supported by a nonprofit foundation. The final example of an effective knowledge management system is all of the social media, including Facebook and Twitter. These tools have proven very powerful in organizing and collaborating. In conclusion, the development of new technologies and the Internet have changed the way in which information is developed and accessed. This development is still ongoing and only the future will reveal how this will continue to change.

Esthetic considerations for the treatment of the edentulous maxilla based on current informatic alternatives: a case report.

This report presents a protocol used to transfer the virtual treatment plan data to the surgical and prosthetic reality and its clinical application, bone site augmentation with computer-custom milled bovine bone graft blocks to their ideal architecture form, implant insertion based on image-guided stent fabrication, and the restorative manufacturing process through computed tomography-based software programs and navigation systems and the computer-aided design and manufacturing techniques for the treatment of the edentulous maxilla.

Translating periodontal data to knowledge in a learning health system.

BACKGROUND: A learning health system (LHS) is a health system in which patients and clinicians work together to choose care on the basis of best evidence and to drive discovery as a natural outgrowth of every clinical encounter to ensure the right care at the right time. An LHS for dentistry is now feasible, as an increased number of oral health care encounters are captured in electronic health records (EHRs). METHODS: The authors used EHRs data to track periodontal health outcomes at 3 large dental institutions. The 2 outcomes of interest were a new periodontitis case (for patients who had not received a diagnosis of periodontitis previously) and tooth loss due to progression of periodontal disease. RESULTS: The authors assessed a total of 494,272 examinations (new periodontitis outcome: n = 168,442; new tooth loss outcome: n = 325,830), representing a total of 194,984 patients. Dynamic dashboards displaying performance on both measures over time allow users to compare demographic and risk factors for patients. The incidence of new periodontitis and tooth loss was 4.3% and 1.2%, respectively. CONCLUSIONS: Periodontal disease, diagnosis, prevention, and treatment are particularly well suited for an LHS model. The results showed the feasibility of automated extraction and interpretation of critical data elements from the EHRs. The 2 outcome measures are being implemented as part of a dental LHS. The authors are using this knowledge to target the main drivers of poorer periodontal outcomes in a specific patient population, and they continue to use clinical health data for the purpose of learning and improvement. PRACTICAL IMPLICATIONS: Dental institutions of any size can conduct contemporaneous self-evaluation and immediately implement targeted strategies to improve oral health outcomes.

Advancing oral medicine through informatics and information technology: a proposed framework and strategy.

The implementation of information technology in healthcare is a significant focus for many nations around the world. However, information technology support for clinical care, research and education in oral medicine is currently poorly developed. This situation hampers our ability to transform oral medicine into a 'learning healthcare discipline' in which the divide between clinical practice and research is diminished and, ultimately, eliminated. This paper reviews the needs of and requirements for information technology support of oral medicine and proposes an agenda designed to meet those needs. For oral medicine, this agenda includes analyzing and reviewing current clinical and documentation practices, working toward progressively standardizing clinical data, and helping define requirements for oral medicine systems. IT professionals can contribute by conducting baseline studies about the use of electronic systems, helping develop controlled vocabularies and ontologies, and designing, implementing, and evaluating novel systems centered on the needs of clinicians, researchers and educators. Successfully advancing IT support for oral medicine will require close coordination and collaboration among oral medicine professionals, information technology professionals, system vendors, and funding agencies. If current barriers and obstacles are overcome, practice and research in oral medicine stand ready to derive significant benefits from the application of information technology.

Validity of an information and communication technology system for data capture in epidemiological studies.

The Belgian National Institute of Health Insurance is implementing an oral health data registration and surveillance system. This study aimed to develop and validate a system of electronic data capture for oral health surveys at a national level - Oral Survey-B - and to identify the advantages and disadvantages of the electronic system in comparison with the traditional handwritten data capture. Six series of full-mouth recordings simulating the clinical examination of 6 patients were set up in a Powerpoint presentation. The validation was undertaken by 52 general practitioners. A randomized one-period crossover design was used with two formats of data capture, i.e. electronic followed by handwritten or handwritten followed by electronic system. Further, 6 benchmarked handwritten forms were transferred to the electronic format. For the electronic data capture, 86.5% of the practitioners had a correct completion rate of ≥95%. The corresponding value for the handwritten data capture and transfer was 78.8% (p = 0.25, McNemar test). The overall accuracy of forms without any error was 73.4% for the electronic and 62.5% for the handwritten data capture (p < 0.001, signed-rank test). Significantly lower percentages of errors and less time were observed for the electronic data capture (p < 0.001, signed-rank test). Practitioners considered the electronic data capture as being much more difficult to carry out (p < 0.001). As information technology has turned into an ever more necessary working tool in epidemiology, there should be an important potential for uptake of further improvements in electronic data capture in the future.

Using natural language processing to enable in-depth analysis of clinical messages posted to an Internet mailing list: a feasibility study.

BACKGROUND: An Internet mailing list may be characterized as a virtual community of practice that serves as an information hub with easy access to expert advice and opportunities for social networking. We are interested in mining messages posted to a list for dental practitioners to identify clinical topics. Once we understand the topical domain, we can study dentists' real information needs and the nature of their shared expertise, and can avoid delivering useless content at the point of care in future informatics applications. However, a necessary first step involves developing procedures to identify messages that are worth studying given our resources for planned, labor-intensive research. OBJECTIVES: The primary objective of this study was to develop a workflow for finding a manageable number of clinically relevant messages from a much larger corpus of messages posted to an Internet mailing list, and to demonstrate the potential usefulness of our procedures for investigators by retrieving a set of messages tailored to the research question of a qualitative research team. METHODS: We mined 14,576 messages posted to an Internet mailing list from April 2008 to May 2009. The list has about 450 subscribers, mostly dentists from North America interested in clinical practice. After extensive preprocessing, we used the Natural Language Toolkit to identify clinical phrases and keywords in the messages. Two academic dentists classified collocated phrases in an iterative, consensus-based process to describe the topics discussed by dental practitioners who subscribe to the list. We then consulted with qualitative researchers regarding their research question to develop a plan for targeted retrieval. We used selected phrases and keywords as search strings to identify clinically relevant messages and delivered the messages in a reusable database. RESULTS: About half of the subscribers (245/450, 54.4%) posted messages. Natural language processing (NLP) yielded 279,193 clinically relevant tokens or processed words (19% of all tokens). Of these, 2.02% (5634 unique tokens) represent the vocabulary for dental practitioners. Based on pointwise mutual information score and clinical relevance, 325 collocated phrases (eg, fistula filled obturation and herpes zoster) with 108 keywords (eg, mercury) were classified into 13 broad categories with subcategories. In the demonstration, we identified 305 relevant messages (2.1% of all messages) over 10 selected categories with instances of collocated phrases, and 299 messages (2.1%) with instances of phrases or keywords for the category systemic disease. CONCLUSIONS: A workflow with a sequence of machine-based steps and human classification of NLP-discovered phrases can support researchers who need to identify relevant messages in a much larger corpus. Discovered phrases and keywords are useful search strings to aid targeted retrieval. We demonstrate the potential value of our procedures for qualitative researchers by retrieving a manageable set of messages concerning systemic and oral disease.

Three-dimensional portable document format: a simple way to present 3-dimensional data in an electronic publication.

Three-dimensional (3D) models of teeth and soft and hard tissues are tessellated surfaces used for diagnosis, treatment planning, appliance fabrication, outcome evaluation, and research. In scientific publications or communications with colleagues, these 3D data are often reduced to 2-dimensional pictures or need special software for visualization. The portable document format (PDF) offers a simple way to interactively display 3D surface data without additional software other than a recent version of Adobe Reader (Adobe, San Jose, Calif). The purposes of this article were to give an example of how 3D data and their analyses can be interactively displayed in 3 dimensions in electronic publications, and to show how they can be exported from any software for diagnostic reports and communications among colleagues.