A practice-based study of the variation of diagnostics of dental caries in new and old patients of different ages

History and application of artificial neural networks in dentistry

Artificial intelligence (AI) is a commonly used term in daily life, and there are now two subconcepts that divide the entire range of meanings currently encompassed by the term. The coexistence of the concepts of strong and weak AI can be seen as a result of the recognition of the limits of mathematical and engineering concepts that have dominated the definition. This presentation reviewed the concept, history, and the current application of AI in daily life. Applications of AI are becoming a reality that is commonplace in all areas of modern human life. Efforts to develop robots controlled by AI have been continuously carried out to maximize human convenience. AI has also been applied in the medical decision-making process, and these AI systems can help nonspecialists to obtain expert-level information. Artificial neural networks are highly interconnected networks of computer processors inspired by biological nervous systems. These systems may help connect dental professionals all over the world. Currently, the use of AI is rapidly advancing beyond text-based, image-based dental practice. This presentation reviewed the history of artificial neural networks in the medical and dental fields, as well as current application in dentistry. As the use of AI in the entire medical field increases, the role of AI in dentistry will be greatly expanded. Currently, the use of AI is rapidly advancing beyond text-based, image-based dental practice. In addition to diagnosis of visually confirmed dental caries and impacted teeth, studies applying machine learning based on artificial neural networks to dental treatment through analysis of dental magnetic resonance imaging, computed tomography, and cephalometric radiography are actively underway, and some visible results are emerging at a rapid pace for commercialization.

A data-based study on survival of permanent molar restorations in adolescents

OBJECTIVE

The aim of this epidemiological, data-based survival study was to study the longevity of restorations in permanent molars of adolescents in the 1990 and 1995 birth cohorts during the period of 1992-2005 in the City of Vantaa, Finland.

MATERIALS AND METHODS

The dental records of 2975 (1990 cohort) and 3147 (the 1995 cohort) adolescents were analyzed. The longevity of restorations from their placement until replacement was illustrated using the Kaplan-Meier survival curves. The influence of the cohort, gender and caries risk on the survival rate was assessed using the Cox proportional hazards regression analysis.

RESULTS

A majority of the restorations were tooth-colored. The proportion of amalgam restorations was almost non-existent in both cohorts. The survival of tooth-colored restorations on the occlusal surfaces of molars was lower in the 1995 cohort compared to the 1990 cohort. The need of replacement of glass-ionomer restorations was twice that of composite restorations' hazard ratio 2.27 (1.62-3.16).

CONCLUSIONS

Composites are the most frequently used dental materials and have the longest survival times among adolescents. The survival of restorations per se is poorer in the more recent than in the earlier birth cohort.

Reusing electronic patient data for dental clinical research: a review of current status

OBJECTIVES

The reuse of electronic patient data collected during clinical care has received increased attention as a way to increase our evidence base. The purpose of this paper was to review studies reusing electronic patient data for dental research.

DATA SOURCES

1527 citations obtained by searching MEDLINE and Embase databases, hand-searching seven dental and informatics journals, and snowball sampling.

STUDY SELECTION

We included studies reusing electronic patient data for research on dental and craniofacial topics, alone or in combination with medical conditions, medications and outcomes. Studies using administrative or research databases and systematic reviews were excluded. Three reviewers extracted data independently and performed analysis jointly

RESULTS

The 60 studies reviewed covered epidemiological (32 studies), outcomes (16), health services research (10) and other (2) topics; were primarily retrospective (58 studies); varied significantly in sample size (9-153,619 patients) and follow-up period (1-12 years); often drew on other data sources in addition to electronic ones (25); but rarely tapped electronic dental record (EDR) data in private practices (3). Type of research was not associated with data sources used, but research topics/questions were. The most commonly reported advantages of reusing electronic data were being able to study large samples and saving time, while data quality and the inability to capture study-specific data were identified as major limitations.

CONCLUSIONS

Dental research reusing electronic patient data is nascent but accelerating. Future EDR design should focus on enhancing data quality, begin to integrate research data collection and implement interoperability with electronic medical records to facilitate oral-systemic investigations.

CLINICAL SIGNIFICANCE

Measuring and improving the quality of dental care requires that we begin to reuse electronic patient data collected in practice for clinical research. Practice data can potentially serve as a useful complement to data collected in traditional research studies.

Heavy consumption of dental services; a longitudinal cohort study among Finnish adults

Background

A reform to Dental Care legislation in 2002 abolished age limits restricting adults’ use of public dental services in Finland. In the Public Dental Service (PDS) unit of Espoo, the proportion of adult patients rose from 36% to 57%. The aim of this study was to investigate heavy use of dental services by adults and its determinants.

Methods

A longitudinal cohort study was undertaken based on a PDS patient register. Of all adults who attended the PDS in Espoo in 2004, those who had six or more visits (n=3,173) were assigned to the heavy user group and a comparison group of low users (n=22,820) had three or fewer dental visits. A sample of 320 patients was randomly selected from each group. Baseline information (year 2004) on age, sex, number and type of visit, oral health status and treatment provided was collected from treatment records. Each group was followed-up for five years and information on the number and types of visit was recorded for each year from 2005 to 2009.

Results

Most heavy users (61.6%) became low users and only 11.2% remained chronic heavy users. Most low users (91.0%) remained low users. For heavy users, the mean number of dental visits per year (3.0) during the follow-up period was significantly lower than initially in 2004 (8.3) (p<0.001) but 74.8% of heavy users had had emergency visits compared with 21.6% of the low users (p<0.001).

A third (33%) of the visitors in each group had no proper examination and treatment planning during the 5-year follow-up period and two or more examinations were provided to fewer than half of the heavy (46.1%) or low (46.5%) users.

The mean number of treating dentists was 5.7 for heavy users and 3.8 for low users (p<0.001).

Conclusions

Frequent emergency visits were characteristic of heavy users of dental services. Treatment planning was inadequate, probably partly due to the many dentists involved and too many patients requesting care. Better local management and continuous education are needed to ensure good quality adult dental care and to reduce heavy consumption.

Review of 36,537 patient records for tooth health and longevity of dental restorations

To develop an automatic system for utilizing electronic dental records, a data mining system to extract the diagnostic and treatment codes from the records for an intermediate file and automatic drawing of Kaplan-Meier-type survival curves was first created. Then this intermediate file was analyzed with SAS software for the scientific determination of Kaplan-Meier survival of tooth/surface-specific healthy time and survival of restorations in each permanent tooth, health center, and age cohort and also combined. All patients born in 1985, 1990 or 1995 in 28 health centers in Finland were analyzed. Patients classified as caries-active were those who had caries in any first permanent molar under the age of 8 years, while resistant patients did not have caries in these teeth before 10 years. In the younger age cohorts, a shortening of survival of caries-free teeth was seen. The shortest caries-free survival was seen in mandibular and maxillary molars in the youngest age cohort. Occlusal surfaces of molars determined their caries onsets and proximal caries occurred equally in molars, incisors and premolars, whereas canines or mandibular incisors did not have caries in these age cohorts. Caries-prone subjects had the shortest survival in all their teeth. The median longevity of all restorations was 11.7 years, with great variation between health centers and teeth. Because of the great variation between individual teeth, the tooth-specific approach seems appropriate in both caries epidemiology and material sciences.