Digital Technology in Endodontic Practice

Digital Technology in Endodontic Practice

When I created the initial version of this website approximately 25 years ago, digital imaging techniques were relatively new and digital radiography was just beginning to receive wide acceptance. Focused field CBCT’s were not yet available and most full head digital imaging involved extremely expensive machines and relatively high exposures to patients. Contemporary imaging techniques have revolutionized dental imaging and if you are practicing Dentistry, you need to modernize your office.

Today there appears to be no reason why anyone should be using antiquated conventional film developing techniques when digital radiography offers much better images. Unlike conventional film, digital radiographs allow us to manipulate brightness contrast and use filters to further enhance the image.

In endodontics, there is a distinct advantage in having immediate images to check for working length and cone placement by shifting of the angle of beam without having to remove the sensor from the patient’s mouth. Digital radiographs also offer far greater efficiency of use and better options for the environment. Digital imaging also offers the ability to share data and images effortlessly with no cost. We know that better treatment is rendered when all parties involved in the treatment can communicate efficiently and minimize both exposure of the patient and cost of procedures. However, they have one drawback: they require the practice using them to be completely computerized, to have a local network and the appropriate backups and safeguards to preserve the data.

One byproduct of the recent Covid pandemic is the greater emphasis on interoffice communication using video conferencing to discuss shared cases. in my own practice I have begun to send short video messages to my referring dentists showing them all the images involved and explaining my rationale for treatment. When images are digitized, case presentation and interdisciplinary treatment can be optimized through collaborative treatment planning, with all parties involved being able to share images and formulate a treatment plan that best suits the patient’s needs.

Virtually all dental practices today are using some sort of software to manage their practices. The most efficient practices are ones in which there are two computers in each operatory, one for the assistant and a second for the dentist. The assistant computer is used for making chart notations and other specific information relayed to the assistant by  the dentist. The dentist’s computer can be used to activate radiography programs, access online website information, tooth atlases and illustrations, photos and x ray images that are used to educate patients and explain the prospective treatment.  Unlike conventional radiographs which are extremely small, digital radiographs and clinical photos can be enlarged sufficiently to allow patients to truly visualize and understand the dentist’s findings, recommendations and treatment results. Notations can be made directly  on the images, which not only is helpful to patients, it serves as an excellent record of what has been discussed with the patient, further legally safeguarding the clinician.

Digitization of an office involves a lot of planning, significant expense and particularly rigid adherence to securing data and performing proper backups. If you are considering replacing your existing software or moving to a more digital environment for your clinic, I strongly recommend that you consider putting two computers in each operatory to take full advantage of this technology.

Hardware failures will inevitably occur overtime and contingency plans must be made so that if this occurs, your office can be up and running quickly and without delay. That is why it’s important to have very good support locally and online from whichever hardware and software supplier you choose. You should ALWAYS be backing up your data either via remote internet connection (with alerts as necessary) AND a second physical hard drive taken home at the end of each day. You can NEVER have too many backups.

One other factor that is not frequently understood by older clinicians is the cost of moving from conventional records to digital records. Legacy clinicians who have many thousands of patients in their practice will need to eventually move these records to digital form, which frequently involves scanning of individual charts, documents and radiographs. This can be an extremely tedious and expensive procedure. That is why it is important for practices to initiate digitization as early as possible to avoid these costs.

In the past, practices were evaluated on the basis of perceived practice numbers and a percentage of goodwill. Today’s practice valuations rely on statistics and while goodwill may play a small part in the practice worth, ultimately it all comes down to what you can prove numerically in digital form with things like production numbers, number of patients, demographics, percentage of insurance based dentistry, etc. Although  the cost of moving to this kind of digitization may initially be large, failure to have this information available to today’s practice valuators means that your practice may be essentially worthless. It is only as valuable as you can prove with real numbers. Digitization of your practice now may be expensive but it may be the only way in which you can preserve the perceived value and justify the sale price when the time comes for you to sell.

The  website has been very fortunate in recognizing the need for both security and access . We have designed the site in such a way that both patients and clinicians can be confident that their information and interaction with the site is secure .

Allowing patients to register online as well as filling out medical and pain histories and consent forms, permits us to decongest the reception area. These forms can be filled out at home, at the patient’s leisure.

Once our referrals become aware of how easy it is to access the portal and refer a patient, their workload is reduced . Furthermore, their ability to access all of their patients data 24 hours a day allows them to check upcoming appointments, patient status, download chart notations that may have made and access any letters or reports that Dr. Kaufmann has created, as soon as they are generated.

One last consideration: In an online survey that I did about 10 years ago, very few dentists who answered the question said that they were using encrypted mail to send images, letters and reports via E mail. Recognizing that sending this kinds of information using conventional mail was a violation of PIPEDA (essentially equivalent to US HIPPA)  protocol, the CDA has since created a service to do this. Unfortunately, this involves generation of a zip file or sending of a key to the receiving party, which generates more work and decreases efficiency.

Our site has 128 bit encryption that allows referrals to SECURELY access this data WITHOUT the need for these extra steps. Although privacy concerns about Dentally relaed health data have not been an issue until now, it is possible that in the future Provincial Dental associations or Provincial Governments may prohibit the use of regular E mail for transmission of patient data. If so, having a way to effortlessly access patient data, correspondence, reports and images in a secure manner may become a necessity.