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Informatics in oral care.

Informatics is used in oral health care as an application of computer and information science to improve dental practice, research, education and management. (1) Dental informatics (DI) is a relatively new field that has significant potential for supporting clinical care. DI is beginning to exhibit the characteristics of a discipline: core literature, trained specialists and educational programs. (2)

Oral health care providers collect, display and analyze data differently than do their medical counterparts. While the general medical and medication histories collected by both physician and dental practices share many common elements, the dental history and the oral health status have no equivalent in medicine. As a consequence, developing, implementing and evaluating complete computer-based dental records represent both a challenge and an opportunity for DI, as do many other domain-specific aspects. (3)

DI combines dentistry and several disciplines, such as computer science and telecommunications. Limited areas of overlap exist between information technology (IT) and DI. For example, a DI team may conceptualize a computerized method to organize patient history archives and then seek the technical expertise of an IT team to help with software development. (4)

Scope of DI

Since oral health care is an information intensive science, almost every aspect of the field benefits from the application of computer and information sciences. The ubiquitous reach of today's computer networks indicates significant change: oral health care is not an isolated province of health care anymore. (5) Oral health care is now, more than ever, connected to a larger system of stakeholders, regulations, expectations, accountability and risk. The main goal of DI is to improve patient outcomes. A secondary goal is to make the delivery of oral health care more efficient; for example, by maintaining or improving cost-benefit ratios. (3)

Dental Education

In dental hygiene computer-assisted learning packages have been developed such as oral pathology, tooth anatomy, trauma, for general teaching and as interactive programs to provide students the ability to develop their critical thinking and decision making skills. (6)

Electronic Oral Health Records

Electronic oral health records (EOHR) are used in dental hygiene to provide patient care in accordance with individuals' health conditions and concurrently manage the resources needed to provide patient care. There have been many productions of the EOHR, with different approaches and different focuses, such as inclusion of dental history, oral status, treatment planning, progress notes, patient care database, medical alerts, clinical care guidelines, care modifiers and diagnostic decision support. (7)

Construction of Tooth Restorations

Computer-aided design/computer-aided manufacturing (CAD/CAM) technology is widely used today to generate tooth-colored restorations that are bonded to front and back teeth. CAD/CAM can be used for making restorations chairside in the dental office or for fabricating restorations in a dental laboratory. (7)

Computer Video-Imaging

This technology morphs the picture of the patient's face to show how restorations, braces or surgery will change the jaw, cheekbones and teeth.

Digital X-ray Imaging

The advancements in digital radiography are really a break-through in the field of dentistry. (8) The most significant advantages of digital imaging are computer-aided image interpretation and image enhancement, in addition to the obvious options of standardized image archiving and image retrieval. (9)


The term "teledentistry" is defined as "the use of information technology and telecommunications for dental care, consultation, education, and public awareness in the same manner as telehealth and telemedicine." (10) Teledentistry can extend advanced care to patient populations at a reasonable cost through their health care providers, as well as ease the problem of a shortage of specialized dental consultants and professional isolation in rural areas. (11)

Meanwhile, the research agenda of DI is continually evolving. (2) Figure 1 includes a few of the research areas being addressed.

Focus On Patient Care

DI has the potential to improve the effectiveness, efficiency and overall quality of care that oral health professionals are able to provide to patients. Figure 2 lists several elements of patient care that are enhanced through DI. (12)

Practice of Informatics in Oral Health Care

DI has the potential to transform how oral health practitioners care for their patients by helping them address many obstacles. Practitioners could integrate information technology into practice by educating themselves about all of their technology options using unbiased reviews on websites and in journals, information from colleagues and continuing education courses. (6) They could also use these resources to evaluate which technologies would best complement the dental team's current workflow. While there are no shortcuts to integrating technology into a dental practice, when done thoughtfully, informatics allows the dental team to concentrate on what they do best: deliver patient care. (4)

The success of DI requires the expertise of a broad range of professionals. There is no need to have a computer science degree to get involved in DI. People who have contributed to the advancement of DI come from a wide variety of fields including research, education, bioinformatics, computer science, library and information sciences --and oral health care. (5)

Resources for Dental Informatics

Currently, DI has no mainstream journal or dedicated professional society of its own. Rather, a variety of professional organizations have developed DI programs. For example, the American Dental Association (ADA) dedicates one day of its annual conference to the latest technologies for dentists. The American Dental Education Association (ADEA) hosts an annual session dedicated to informatics. And the American Medical Informatics Association (AMIA) holds an annual symposium that includes presentations on DI.

Continuing dental education programs across the United States provide a variety of courses focusing on DI. The Dental Informatics Online Community (DIOC) is a National Library of Medicine funded project to create an open, worldwide research community for people interested in DI. (5) The DIOC offers literature to enhance research and practice, a supportive community to seek feedback and collaboration and announcements of meetings and conferences. (5)


The growth of information technology innovations such as high-capacity digital networks, powerful computer hardware and software, high-resolution digital image compression, the Internet and very high data speeds enabling faster image transmission has reshaped our lives already. The question is to what degree it will reshape oral health care. Many dental hygienists are still unaware of the informatics field and its growing importance to practice, research and education. Putting the theories and concepts of informatics into practice requires minimal effort and significant investment. However, if implemented and used optimally, DI will change the delivery and efficiency of oral health care.

Sajeesh Kumar, PhD, is an associate professor in the Department of Health Informatics and Information Management, University of Tennessee Health Science Center-Memphis. His research focuses on design and development of dental informatics, teledentistry technology and health informatics technology evaluation.

Nancy J. Williams, RDH, EdD, is professor, Department of Dental Hygiene at University of Tennessee Health Science Center-Memphis. She recently began collaboration with the Department of Health Informatics and Information Management (HUM) as she and several of her graduate students share an interest in HUM topics as they related to dental hygiene graduate education and practice.


(1.) Schleyer T. Dental informatics: an emerging biomedical informatics discipline. J Dent Educ. 2003; 67(11): 1193-1200.

(2.) Schleyer T. Dental informatics: a work in progress. Adv Dent Res. 2003; 17:9-15.

(3.) Schleyer T, Spallek H. Dental informatics: a cornerstone of dental practice. J Am Dent Assoc. 2001; 132: 605-13.

(4.) Schleyer T, Spallek H, Bartling WC, Corby P. The technologically well-equipped dental office. J Am Dent Assoc. 2003; 134:30-41.

(5.) Dental Informatics Online Community. The virtual, global community for anyone interested in dental informatics. Available at: www. Accessed Mar. 23, 2016.

(6.) Buchanan JA. Use of simulation technology in dental education. J Dent Educ. 2001; 65(11): 1225-31.

(7.) Heid DW. The electronic oral health record. J Contemp Dent Prac. 2002; 3(1):1-13.

(8.) Van Der Stelt PF. Filmless imaging, the uses of digital radiography in dental practice. J Am Dent Assoc. 2005; 136(10): 1379-87.

(9.) Nair MK, Nair UP. Digital and advanced imaging in endodontics: a review. J Endod. 2007; 33(1): 1-6.

(10.) Clark GT. Teledentistry: what is it now, and what will it be tomorrow? J Calif Dent Assoc. 2000; 28(2): 121-7.

(11.) Daniel SJ, Kumar S, Wu L. Teledentistry: clinical outcomes, utilization and costs. J Dent Hyg. 2013; 87(6): 345-52.

(12.) Feuerstein P. Can Technology help dentists deliver better patient care? J Am Dent Assoc. 2004;135: 11S-16S.

By Sajeesh Kumar PhD and Nancy J. Williams, RDH, EdD
Figure 1. List of research areas being
addressed through DI (2)


* Universally accessible electronic patient oral health
records and medical history

* Effective and efficient user input and output
devices more suitable for chairside computing

* Validated, integrated decision-support systems

* Teledentistry


* Educational software

* Multimedia laboratories that include virtual reality
simulators for preclinical training

* Distance education programs


* Geographic information systems for dental
epidemiology studies

* Standardized knowledge representations and
controlled vocabularies for diagnosis, treatment, etc.

* Computerized data mining tools and analysis

* Bioinformatics methods and approaches for genetic


* Integrated information systems that automate routine
tasks and reduce administrative overhead

* Administration systems for dental schools to assess
quality assurance and streamline accreditation

Figure 2. Elements of patient care
enhanced through DI (12)


* Electronic insurance claims

* Electronic prescriptions

* Recall tracking


* Universally accessible electronic patient oral health records and
medical history

* Medical alert systems

* Increased patient involvement in managing their wellness and
making health care decisions


* Validated, integrated decision-support systems

* Digital radiography

* Effective and efficient user input and output devices more
suitable for chairside computing


* Educational software and materials

* Intraoral camera

* Patient specific risk assessment and instructions
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Author:Kumar, Sajeesh; Williams, Nancy J.
Date:May 1, 2016
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