The Single Most Problematic Issue In Dentistry That You Likely Have Not Thought About

Dr. Bryan Laskin

As dentists and, by default, leaders in a dental practice, we get inundated with urgent issues all day, every day. There is always someone on the team whose morale seems low, a patient that is upset, a lab case that is late, a sick kid at home, or a slow month to turn around. So, in the dayto-day battle of delivering the highest quality care for our patients and providing the best home life for our teams and our families, it is difficult, if not impossible, to take a step back and examine the most important issues affecting the oral health of our patients (and therefore the financial health of our practices).

I would like to propose to you what I believe to be the single most problematic issue in dentistry that you likely have not thought of and the significantly impactful solutions we have to directly address this issue.

At first glance, the issue that is choking our offices, harming patient care, and blocking innovation in dentistry may seem boring or not as destructive as it truly is. But allow me to point out some of the horrific realities that are a direct result of this obstruction to quality care:

More than 2 million dental-related issues in the US end up in hospital emergency room visits, costing American patients a useless $2 billion annually (P. Owens, R. Manski, A. Weiss, Emergency Department Visits Involving Dental Conditions, 2018, Healthcare. Cost and Utilization Project, Agency for Healthcare Research and Quality, August 2021)

For millions of patients, their electronic Personal Health Information (ePHI), including critical information, such as medical history data, is locked from being written into the dental practice “Practice Management System” (PMDS) - literally putting their lives at risk.

In the typical Dental Service Organization (DSO) using a cloudbased PMS, due to no fault of their own, anyone at the corporate center likely has access to all of the ePHI of every patient that is seen in any of the hundreds of offices that that DSO operates.

If you added up all the crucial information that we, as dentists, get from the innumerable and valuable datasets that are transferred over the broad information exchange networks that our friends in medicine leverage to improve the care of their patients, it would add up to the impressive, depressing number zero.

Therefore, it may be obvious that what I think is the biggest problem in dentistry, that shockingly no one is talking about, is the lack of data interoperability.

If you haven’t been exposed to the term before, interoperability is the ability of computers or software to exchange information. Have you ever thought about who actually owns all that information that you input into your PMS every day that likely sits in a server in a closet in your office? Allow me to answer this question, as it turns out it is a significant factor in our discussion about interoperability.

As far as I am aware (and I have researched this topic extensively; however, I am a dentist… not an attorney), the patient legally owns their own ePHI within your PMS. You, as the dentist of record, are a steward of this important resource of the patient. So why, then, is it impossible to transfer the patient records between us? The answer is that PMSs have been acting like this data is theirs, essentially creating a prison of this information that prevents patient care in the interest of keeping you hostage to their archaic systems.

If this seems controversial or accusatorial, I only point out this reality because it is important to clearly understand the blockages in order to directly address the problem and why there has been recent regulation that “forces” a solution. That regulation is the 2016 21st Century Cures Act, which carries a provision that went into effect late last year (10/6/22, to be exact) called the “Information Blocking Rule,” designed to specifically address the issue of lack of interoperability in healthcare.

If, at this point you are thinking, “why have I never heard about this before”, don’t feel bad. Actually, when I met the prior head of the Department of Health and Human Services late last year, she also had NO idea how bad things were in dentistry. Being in the narrow lane of “dental data information exchange” that I am currently working in, I often find myself as the sole dentist at an innovative health care conference. In fact, last year, I was excited to see a dental school classmate of mine on the casino floor of a Las Vegas hotel and called out, “Wow! It’s great to see another dentist at this conference!”. Turns out he was having a weekend partying with his friends…

At every single one of the healthcare conferences I attend, there are three connected issues that take over the majority of the panel discussions; data interoperability, regulation compliance (HIPAA and the Cures Act, primarily), and patient care. Of these topics, in dentistry, we have completely ignored the discussion on data interoperability for far too long.

Here is one, simple example of how the lack of interoperability fundamentally changes the quality of care that we accept as “normal today.” Let’s say a patient, named Lisa, moved from Oklahoma to your town and presented to you as a new patient with pain in the lower left. What would you do? Likely, take a radiograph, right?

Let’s stop there. Why don’t you pull up Lisa's medical history, compare what she filled out in your practice with what is on record with her physician and review her medical and dental history, including the prior treatment in the lower left with radiographs? That, surely, would be very helpful. It just isn’t possible because of our lack of interoperability.

So, we take a radiograph (panorex, CT or PA? Really, we don’t know because, well, you know…). Then you test Lisa’s teeth and determine that there is a failing root canal on tooth #19. There is no obvious issue with the endo or restoration of the tooth. So, what is the treatment plan?

Turns out, if you had called the prior dentist or had access to the dental records, you would have found out that when the endo was done on tooth #19, there was a hairline fracture noted on the pulpal floor of the tooth. If you were like me, you would have likely punted to the endodontist to make this decision, who would have treatment planned to redo the endo, and Lisa would go through multiple rounds of treatment, costs, and discomfort, only to lose the tooth quickly thereafter.

And we haven’t even discussed the lack of information that gets transferred from my office to the endo office.

So, what can be done about this problem? The answer is creating Standards and technology that align the profession and create secure, yet simple ways to transfer our patients’ data (remember… it is THEIR data). That work is currently going on at the ADA, Dental Standards Institute (DSI) Standards Development Organizations, as well as at innovative technology companies (that you may not have heard of yet) that are creating the network that will facilitate the reality of secure, open interoperability of Connected Dentistry®, connecting dentistry, as well as connecting dentistry to medicine.

There is a lot of work to be done, for sure, but we are making rapid progress toward solutions. Solutions you will likely be hearing a lot about in the coming months and years.

If you would like to be involved in helping address the issue of dental interoperability, as an advocate of the mission, or actively involved in Standards development, feel free to reach out to me or any other ADA Standards Committee member.

We, in dentistry, are starting to focus on medical/dental integration, trying to connect the dots in everything from sleep issues to diabetes/periodontal disease connection. However, we cannot have medical/dental integration without both medical/dental interoperability, as well as collaboration with our physician friends.

So, please join me in attending a healthcare conference that is not “dental specific.”It is not just an eye-opening experience, but one that I firmly believe will allow dentistry to lead the way to better healthcare.

Dr. Bryan Laskin is on a mission to reduce the stress of both dental teams and patients by upgrading care through innovation, education, and Standardization. Creator of Upgrade Dental, Digital Nitrous, OperaDDS, co-founder of Toothapps, as well as author of the Amazon best-selling book “The Patient First Manifesto," and host of "The Patient First Podcast," Dr. Laskin excels at helping others integrate technology and teamwork into their practices.

Dr. Laskin serves as CEO and Chairman of the Board of Dental Standards Institute, as well as Co-Chair for American Dental Association SCDI Workgroups focused on innovation and patient advocacy and serves as counsel for the most innovative companies in dentistry. bryan@toothapps.com