October 19, 2016
You awaken in the middle of the night: that tooth that’s been a little sensitive lately is throbbing. By morning, you realize you have a real problem. So you head into the bathroom, plug your smart toothbrush into your smartphone—and when you put the brush in your mouth, it scans your teeth. The images automatically upload to the Cloud. They are analyzed by artificial intelligence, which finds a cavity in your aching tooth and a hairline crack in another molar. The scans and preliminary analysis are transmitted to your dentist, who then texts you to schedule an appointment.
Later that day, in the office, the dentist removes the decay that etched a cavity into your tooth—with a laser. It makes the procedure painless: there’s no need for novocaine. Much of the cracked tooth is removed and it will require a crown. Then an office technologist does a 3-D ultrasound of the two problem teeth—x-rays, like dental drills, have become a thing of the past—and transmits the scans to two separate devices.
One instantly mixes a “biologically active” restoration to fill the cavity, but it’s not the old-time silver mercury or white acrylic. It uses stem cells to rebuild the tooth’s dentin—the bony tissue that lies beneath the white enamel. A second machine, a 3-D printer, manufactures a cap for the other tooth while you wait, which your dentist pops right in without the need for adjustments because production has become so precise. These procedures that once required multiple visits are completed in just over an hour.
Sound like a scene out of Star Trek? It’s actually a peek into the future of dentistry, says Larry Emmott, a dentist and dental technology expert. “Much of this, I think, is possible within the lifetime of dentists practicing today.”
The digital revolution that is transforming every aspect of our world is also impacting dentistry and medicine in a multitude of ways, from electronic record-keeping and data analysis to new diagnostic tools, novel prevention methods—and revolutionary treatment options. “The future is wide open,” says Emmott.
Experts say that technological innovation will ultimately improve and broaden access to dental care, allowing for same-day care that translates to fewer office visits—making a healthy smile more affordable.
As more high-quality digital information becomes available to researchers, the potential for more precise diagnosis and treatment only continues to grow. Data including your age, medical and dental health history, as well as your genome, will, for example, allow dental professionals to pinpoint your susceptibility to various types of oral disease. In the near future, doctors and dentists will increasingly tailor treatment to your personal genetics, making choices reflecting what has proven most effective for your genome and your particular physiology. Or they may even decide how to best treat you based on the specific bacteria that’s causing your problem.
A significant part of this revolution is the ongoing development of diagnostic tools that are able to analyze our physical condition with ever-greater precision. That includes advanced digital imaging, like a currently available system called the Canary. During a three-second scan, an electric toothbrush-sized device emits pulsing red laser light; it may detect cracks and caries that are too small to show up on an x-ray. Another device, the “S-Ray,” ultrasonically maps both teeth and gums in 3-D to find cavities and disease. Upon approval from the U.S. Food and Drug Administration, experts think s-rays may be cheaper than x-rays. What’s more, neither of the two systems expose patients to harmful radiation.
Next-Generation Diagnosis and Treatment
Lasers are now being used in both diagnosis and treatment. Dentists are using “soft tissue lasers” for minor gum surgery—but down the road, they may hand these procedures over to computers. “Hard-tissue lasers” could ultimately replace whining high-speed dental drills, removing tooth decay with the aid of tiny, digitally-controlled mirrors. However, the hefty price tag on these devices will have to come down before they are widely used.
New breakthroughs are creating “biomaterials” to fill cavities. For example, a joint project between Harvard and the University of Nottingham has created a synthetic biomaterial that could essentially allow a cavity to heal itself, a development with the potential to greatly reduce tooth deterioration that leads to expensive, painful root canals.
Earlier detection of oral cancer—the sixth deadliest form of cancer—is now possible. The “VELscope” device uses CSI-style blue lights to pick up tissue changes that can’t be seen with the naked eye, highlighting potential problems that may call for a biopsy.
A more futuristic outlook could include nanobots. Some of these microscopic machines might restore or straighten teeth, deliver anesthesia during oral surgery, diagnose diabetes and other diseases, or treat oral cancer. Others may fight bacteria with products like a “wearable toothpaste” made of antimicrobial carbon nanotubes. But nanotech research is complex, and these developments lie far in the future, as human clinical trials would be necessary to determine both efficacy and safety.
Even with these advances, teeth will sometimes need to be replaced with a cap, crown or a bridge. Current technology uses Computer-Assisted Design/Computer-Assisted Manufacture (CAD/CAM) to mill a tooth from a 3-D scan. 3-D printing is the next phase, with a frenzy of research reaching for this Holy Grail. Some, like a group at the University of Groningen in the Netherlands, are working with recipes that could add tooth decay-fighting chemicals to 3-D printed teeth.
Other types of “bioprinting” are also on the horizon. A team at Wake Forest University in North Carolina has printed out human body parts from a mixture of live cells and gel that is laid down in layers to construct living human tissues. They successfully “built” a jawbone—and while use in patients is years away, such an innovation could benefit those who develop oral cancers.
Across the globe in Australia, periodontist Saso Ivanovski from Griffith University in Queensland has engineered replacements for eroded jaw bone and gum tissue from a patient’s own cells. Up until now, dental surgeons have had to remove bone and tissue from the hip or skull for restoration procedures. Pre-clinical trials will begin in 2017.
A host of dental care innovations focus on prevention. For example, manufacturers are now designing toothbrushes with all kinds of gizmos: cameras and location tracking technology that show you the parts of your mouth where you’re not brushing enough; a timer that keeps track of how long you brush and syncs with apps that keep you entertained for the two minutes you’re supposed to brush; and pressure sensors that warn if you’re brushing too hard. Other innovators are attempting to create sensors that could detect various diseases from saliva or mouth tissue, could monitor heart rate, detect blood alcohol levels—or sense bad breath.
A mouthpiece outfitted with a pH sensor could detect acidic saliva—a risk factor for tooth decay and gum disease—without having to send a sample to the lab and wait for results or pay costly fees. Testing chemicals in your breath could diagnose possible diabetes, which is not only a serious illness in its own right, but also exacerbates gum disease.
Democratizing Dental Care
Some advances will allow initial scanning to be done at home or at a community health clinic with a smartphone. These technologies will democratize dental care, allowing quick diagnosis of basic problems for people anywhere—even those who live in remote areas or in places where there are few dentists. Ultimately, someone living in a developing country could upload their information and get the same initial analysis as a New Yorker who sees a high-end Madison Avenue dentist.
With the advent of these techno-innovations, basic imaging and other diagnostics won’t need to be done by highly-trained professionals. Soon, technologists will become an integral part of a dental practice, and dentists will focus on the complex, difficult procedures that require their expertise. This should ultimately lower costs.
The future of dentistry looks very different than the practice of today: no drills, no injections, easier access, and shorter treatment time. Overall, there will be a greater emphasis on prevention that translates into fewer cavities and less periodontal disease. The predictions: dentistry will increasingly provide nice, white, healthy smiles.
As Emmott says, “The future is coming, and it will be amazing!”
Credit: Kenn Brown, Mondolithic Studios