Artificial Intelligence Its Uses and Application in Pediatric Dentistry: A Review

Point-of-care diagnostic devices for periodontitis - current trends and urgent need

Point of care (POC) diagnostic devices provide a method for rapid accurate identification of disease through analysis of biologically relevant substances. This review focuses on the utility of POC testing for early detection of periodontitis, a critical factor in treating the disease. Accessing the oral cavity for biological sampling is less invasive when compared to other internal test sites, and oral fluids contain biomarkers indicative of periodontitis. The ease of access makes the mouth an excellent target location for the development of POC devices. In this review, accepted standards in industry by which these devices must adhere, provided by the World Health Organization such as REASSURED and CLIA, are discussed. An overview is provided for many periodontal biomarkers currently being investigated as a means of predicting periodontal disease and its progression. POC devices currently being investigated for the identification and monitoring of periodontal disease such as paper-based and lab-on-a-chip based devices are outlined. Limitations of current POC devices on the market are provided and future directions in leveraging biomarkers as an adjunctive method for oral diagnosis along with AI-based analysis systems are discussed. Here, we present the ESSENCE sensor platform, which combines a porous non-planar electrode with enhanced shear flow to achieve unprecedented sensitivity and selectivity. The combination of the ESENCE chip with an automated platform allows us to meet the WHO's ASSURED criteria. This platform promises to be an exciting POC candidate for early detection of periodontitis.

YOLO-V5 based deep learning approach for tooth detection and segmentation on pediatric panoramic radiographs in mixed dentition

OBJECTIVES

In the interpretation of panoramic radiographs (PRs), the identification and numbering of teeth is an important part of the correct diagnosis. This study evaluates the effectiveness of YOLO-v5 in the automatic detection, segmentation, and numbering of deciduous and permanent teeth in mixed dentition pediatric patients based on PRs.

METHODS

A total of 3854 mixed pediatric patients PRs were labelled for deciduous and permanent teeth using the CranioCatch labeling program. The dataset was divided into three subsets: training (n = 3093, 80% of the total), validation (n = 387, 10% of the total) and test (n = 385, 10% of the total). An artificial intelligence (AI) algorithm using YOLO-v5 models were developed.

RESULTS

The sensitivity, precision, F-1 score, and mean average precision-0.5 (mAP-0.5) values were 0.99, 0.99, 0.99, and 0.98 respectively, to teeth detection. The sensitivity, precision, F-1 score, and mAP-0.5 values were 0.98, 0.98, 0.98, and 0.98, respectively, to teeth segmentation.

CONCLUSIONS

YOLO-v5 based models can have the potential to detect and enable the accurate segmentation of deciduous and permanent teeth using PRs of pediatric patients with mixed dentition.

The Implications of Artificial Intelligence in Pedodontics: A Scoping Review of Evidence-Based Literature

BACKGROUND

Artificial intelligence (AI) has emerged as a revolutionary technology with several applications across different dental fields, including pedodontics. This systematic review has the objective to catalog and explore the various uses of artificial intelligence in pediatric dentistry.

METHODS

A thorough exploration of scientific databases was carried out to identify studies addressing the usage of AI in pediatric dentistry until December 2023 in the Embase, Scopus, PubMed, and Web of Science databases by two researchers, S.L.R. and A.L.G.

RESULTS

From a pool of 1301 articles, only 64 met the predefined criteria and were considered for inclusion in this review. From the data retrieved, it was possible to provide a narrative discussion of the potential implications of AI in the specialized area of pediatric dentistry. The use of AI algorithms and machine learning techniques has shown promising results in several applications of daily dental pediatric practice, including the following: (1) assisting the diagnostic and recognizing processes of early signs of dental pathologies, (2) enhancing orthodontic diagnosis by automating cephalometric tracing and estimating growth and development, (3) assisting and educating children to develop appropriate behavior for dental hygiene.

CONCLUSION

AI holds significant potential in transforming clinical practice, improving patient outcomes, and elevating the standards of care in pediatric patients. Future directions may involve developing cloud-based platforms for data integration and sharing, leveraging large datasets for improved predictive results, and expanding AI applications for the pediatric population.

Constructing and implementing a performance evaluation indicator set for artificial intelligence decision support systems in pediatric outpatient clinics: an observational study

Artificial intelligence (AI) decision support systems in pediatric healthcare have a complex application background. As an AI decision support system (AI-DSS) can be costly, once applied, it is crucial to focus on its performance, interpret its success, and then monitor and update it to ensure ongoing success consistently. Therefore, a set of evaluation indicators was explicitly developed for AI-DSS in pediatric healthcare, enabling continuous and systematic performance monitoring. The study unfolded in two stages. The first stage encompassed establishing the evaluation indicator set through a literature review, a focus group interview, and expert consultation using the Delphi method. In the second stage, weight analysis was conducted. Subjective weights were calculated based on expert opinions through analytic hierarchy process, while objective weights were determined using the entropy weight method. Subsequently, subject and object weights were synthesized to form the combined weight. In the two rounds of expert consultation, the authority coefficients were 0.834 and 0.846, Kendall's coordination coefficient was 0.135 in Round 1 and 0.312 in Round 2. The final evaluation indicator set has three first-class indicators, fifteen second-class indicators, and forty-seven third-class indicators. Indicator I-1(Organizational performance) carries the highest weight, followed by Indicator I-2(Societal performance) and Indicator I-3(User experience performance) in the objective and combined weights. Conversely, 'Societal performance' holds the most weight among the subjective weights, followed by 'Organizational performance' and 'User experience performance'. In this study, a comprehensive and specialized set of evaluation indicators for the AI-DSS in the pediatric outpatient clinic was established, and then implemented. Continuous evaluation still requires long-term data collection to optimize the weight proportions of the established indicators.

Decoding children dental health risks: a machine learning approach to identifying key influencing factors

Introduction and objectives

This study investigates key factors influencing dental caries risk in children aged 7 and under using machine learning techniques. By addressing dental caries' prevalence, it aims to enhance early identification and preventative strategies for high-risk individuals.

Methods

Data from clinical examinations of 356 children were analyzed using Logistic Regression, Decision Trees, and Random Forests models. These models assessed the influence of dietary habits, fluoride exposure, and socio-economic status on caries risk, emphasizing accuracy, precision, recall, F1 score, and AUC metrics.

Results

Poor oral hygiene, high sugary diet, and low fluoride exposure were identified as significant caries risk factors. The Random Forest model demonstrated superior performance, illustrating the potential of machine learning in complex health data analysis. Our SHAP analysis identified poor oral hygiene, high sugary diet, and low fluoride exposure as significant caries risk factors.

Conclusion

Machine learning effectively identifies and quantifies dental caries risk factors in children. This approach supports targeted interventions and preventive measures, improving pediatric dental health outcomes.

Clinical significance

By leveraging machine learning to pinpoint crucial caries risk factors, this research lays the groundwork for data-driven preventive strategies, potentially reducing caries prevalence and promoting better dental health in children.

Artificial Intelligence in Pediatric Emergency Medicine: Applications, Challenges, and Future Perspectives

The dawn of Artificial intelligence (AI) in healthcare stands as a milestone in medical innovation. Different medical fields are heavily involved, and pediatric emergency medicine is no exception. We conducted a narrative review structured in two parts. The first part explores the theoretical principles of AI, providing all the necessary background to feel confident with these new state-of-the-art tools. The second part presents an informative analysis of AI models in pediatric emergencies. We examined PubMed and Cochrane Library from inception up to April 2024. Key applications include triage optimization, predictive models for traumatic brain injury assessment, and computerized sepsis prediction systems. In each of these domains, AI models outperformed standard methods. The main barriers to a widespread adoption include technological challenges, but also ethical issues, age-related differences in data interpretation, and the paucity of comprehensive datasets in the pediatric context. Future feasible research directions should address the validation of models through prospective datasets with more numerous sample sizes of patients. Furthermore, our analysis shows that it is essential to tailor AI algorithms to specific medical needs. This requires a close partnership between clinicians and developers. Building a shared knowledge platform is therefore a key step.

Enhancing clinical skills in pediatric trainees: a comparative study of ChatGPT-assisted and traditional teaching methods

BACKGROUND

As artificial intelligence (AI) increasingly integrates into medical education, its specific impact on the development of clinical skills among pediatric trainees needs detailed investigation. Pediatric training presents unique challenges which AI tools like ChatGPT may be well-suited to address.

OBJECTIVE

This study evaluates the effectiveness of ChatGPT-assisted instruction versus traditional teaching methods on pediatric trainees' clinical skills performance.

METHODS

A cohort of pediatric trainees (n = 77) was randomly assigned to two groups; one underwent ChatGPT-assisted training, while the other received conventional instruction over a period of two weeks. Performance was assessed using theoretical knowledge exams and Mini-Clinical Evaluation Exercises (Mini-CEX), with particular attention to professional conduct, clinical judgment, patient communication, and overall clinical skills. Trainees' acceptance and satisfaction with the AI-assisted method were evaluated through a structured survey.

RESULTS

Both groups performed similarly in theoretical exams, indicating no significant difference (p > 0.05). However, the ChatGPT-assisted group showed a statistically significant improvement in Mini-CEX scores (p < 0.05), particularly in patient communication and clinical judgment. The AI-teaching approach received positive feedback from the majority of trainees, highlighting the perceived benefits in interactive learning and skill acquisition.

CONCLUSION

ChatGPT-assisted instruction did not affect theoretical knowledge acquisition but did enhance practical clinical skills among pediatric trainees. The positive reception of the AI-based method suggests that it has the potential to complement and augment traditional training approaches in pediatric education. These promising results warrant further exploration into the broader applications of AI in medical education scenarios.

Novel AI-based tool for primary tooth segmentation on CBCT using convolutional neural networks: A validation study

BACKGROUND

Primary teeth segmentation on cone beam computed tomography (CBCT) scans is essential for paediatric treatment planning. Conventional methods, however, are time-consuming and necessitate advanced expertise.

AIM

The aim of this study was to validate an artificial intelligence (AI) cloud-based platform for automated segmentation (AS) of primary teeth on CBCT. Its accuracy, time efficiency, and consistency were compared with manual segmentation (MS).

DESIGN

A dataset comprising 402 primary teeth (37 CBCT scans) was retrospectively retrieved from two CBCT devices. Primary teeth were manually segmented using a cloud-based platform representing the ground truth, whereas AS was performed on the same platform. To assess the AI tool's performance, voxel- and surface-based metrics were employed to compare MS and AS methods. Additionally, segmentation time was recorded for each method, and intra-class correlation coefficient (ICC) assessed consistency between them.

RESULTS

AS revealed high performance in segmenting primary teeth with high accuracy (98 ± 1%) and dice similarity coefficient (DSC; 95 ± 2%). Moreover, it was 35 times faster than the manual approach with an average time of 24 s. Both MS and AS demonstrated excellent consistency (ICC = 0.99 and 1, respectively).

CONCLUSION

The platform demonstrated expert-level accuracy, and time-efficient and consistent segmentation of primary teeth on CBCT scans, serving treatment planning in children.

Acceptance of voice assistant technology in dental practice: A cross sectional study with dentists and validation using structural equation modeling

Voice assistant technologies (VAT) has been part of our daily lives, as a virtual assistant to complete requested tasks. The integration of VAT in dental offices has the potential to augment productivity and hygiene practices. Prior to the adoption of such innovations in dental settings, it is crucial to evaluate their applicability. This study aims to assess dentists' perceptions and the factors influencing their intention to use VAT in a clinical setting. A survey and research model were designed based on an extended Unified Theory of Acceptance and Use of Technology (UTAUT). The survey was sent to 7,544 Ohio-licensed dentists through email. The data was analyzed and reported using descriptive statistics, model reliability testing, and partial least squares regression (PLSR) to explain dentists' behavioral intention (BI) to use VAT. In total, 257 participants completed the survey. The model accounted for 74.2% of the variance in BI to use VAT. Performance expectancy and perceived enjoyment had significant positive influence on BI to use VAT. Perceived risk had significant negative influence on BI to use VAT. Self-efficacy had significantly influenced perceived enjoyment, accounting for 35.5% of the variance of perceived enjoyment. This investigation reveals that performance efficiency and user enjoyment are key determinants in dentists' decision to adopt VAT. Concerns regarding the privacy of VAT also play a crucial role in its acceptance. This study represents the first documented inquiry into dentists' reception of VAT, laying groundwork for future research and implementation strategies.

Dental education and practice: past, present, and future trends

This position paper explores the historical transitions and current trends in dental education and practice and attempts to predict the future. Dental education and practice landscape, especially after the COVID-19 epidemic, are at a crossroads. Four fundamental forces are shaping the future: the escalating cost of education, the laicization of dental care, the corporatization of dental care, and technological advances. Dental education will likely include individualized, competency-based, asynchronous, hybrid, face-to-face, and virtual education with different start and end points for students. Dental practice, similarly, will be hybrid, with both face-to-face and virtual opportunities for patient care. Artificial intelligence will drive efficiencies in diagnosis, treatment, and office management.

Accuracy of Artificial Intelligence Models in Dental Implant Fixture Identification and Classification from Radiographs: A Systematic Review

Background and Objectives: The availability of multiple dental implant systems makes it difficult for the treating dentist to identify and classify the implant in case of inaccessibility or loss of previous records. Artificial intelligence (AI) is reported to have a high success rate in medical image classification and is effectively used in this area. Studies have reported improved implant classification and identification accuracy when AI is used with trained dental professionals. This systematic review aims to analyze various studies discussing the accuracy of AI tools in implant identification and classification. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were followed, and the study was registered with the International Prospective Register of Systematic Reviews (PROSPERO). The focused PICO question for the current study was "What is the accuracy (outcome) of artificial intelligence tools (Intervention) in detecting and/or classifying the type of dental implant (Participant/population) using X-ray images?" Web of Science, Scopus, MEDLINE-PubMed, and Cochrane were searched systematically to collect the relevant published literature. The search strings were based on the formulated PICO question. The article search was conducted in January 2024 using the Boolean operators and truncation. The search was limited to articles published in English in the last 15 years (January 2008 to December 2023). The quality of all the selected articles was critically analyzed using the Quality Assessment and Diagnostic Accuracy Tool (QUADAS-2). Results: Twenty-one articles were selected for qualitative analysis based on predetermined selection criteria. Study characteristics were tabulated in a self-designed table. Out of the 21 studies evaluated, 14 were found to be at risk of bias, with high or unclear risk in one or more domains. The remaining seven studies, however, had a low risk of bias. The overall accuracy of AI models in implant detection and identification ranged from a low of 67% to as high as 98.5%. Most included studies reported mean accuracy levels above 90%. Conclusions: The articles in the present review provide considerable evidence to validate that AI tools have high accuracy in identifying and classifying dental implant systems using 2-dimensional X-ray images. These outcomes are vital for clinical diagnosis and treatment planning by trained dental professionals to enhance patient treatment outcomes.

Artificial intelligence chatbots and large language models in dental education: Worldwide survey of educators

INTRODUCTION

Interest is growing in the potential of artificial intelligence (AI) chatbots and large language models like OpenAI's ChatGPT and Google's Gemini, particularly in dental education. To explore dental educators' perceptions of AI chatbots and large language models, specifically their potential benefits and challenges for dental education.

MATERIALS AND METHODS

A global cross-sectional survey was conducted in May-June 2023 using a 31-item online-questionnaire to assess dental educators' perceptions of AI chatbots like ChatGPT and their influence on dental education. Dental educators, representing diverse backgrounds, were asked about their use of AI, its perceived impact, barriers to using chatbots, and the future role of AI in this field.

RESULTS

428 dental educators (survey views = 1516; response rate = 28%) with a median [25/75th percentiles] age of 45 [37, 56] and 16 [8, 25] years of experience participated, with the majority from the Americas (54%), followed by Europe (26%) and Asia (10%). Thirty-one percent of respondents already use AI tools, with 64% recognising their potential in dental education. Perception of AI's potential impact on dental education varied by region, with Africa (4[4-5]), Asia (4[4-5]), and the Americas (4[3-5]) perceiving more potential than Europe (3[3-4]). Educators stated that AI chatbots could enhance knowledge acquisition (74.3%), research (68.5%), and clinical decision-making (63.6%) but expressed concern about AI's potential to reduce human interaction (53.9%). Dental educators' chief concerns centred around the absence of clear guidelines and training for using AI chatbots.

CONCLUSION

A positive yet cautious view towards AI chatbot integration in dental curricula is prevalent, underscoring the need for clear implementation guidelines.

Fully automated deep learning approach to dental development assessment in panoramic radiographs

BACKGROUND

Dental development assessment is an important factor in dental age estimation and dental maturity evaluation. This study aimed to develop and evaluate the performance of an automated dental development staging system based on Demirjian's method using deep learning.

METHODS

The study included 5133 anonymous panoramic radiographs obtained from the Department of Pediatric Dentistry database at Seoul National University Dental Hospital between 2020 and 2021. The proposed methodology involves a three-step procedure for dental staging: detection, segmentation, and classification. The panoramic data were randomly divided into training and validating sets (8:2), and YOLOv5, U-Net, and EfficientNet were trained and employed for each stage. The models' performance, along with the Grad-CAM analysis of EfficientNet, was evaluated.

RESULTS

The mean average precision (mAP) was 0.995 for detection, and the segmentation achieved an accuracy of 0.978. The classification performance showed F1 scores of 69.23, 80.67, 84.97, and 90.81 for the Incisor, Canine, Premolar, and Molar models, respectively. In the Grad-CAM analysis, the classification model focused on the apical portion of the developing tooth, a crucial feature for staging according to Demirjian's method.

CONCLUSIONS

These results indicate that the proposed deep learning approach for automated dental staging can serve as a supportive tool for dentists, facilitating rapid and objective dental age estimation and dental maturity evaluation.

Accuracy and Completeness of ChatGPT-Generated Information on Interceptive Orthodontics: A Multicenter Collaborative Study

Background: this study aims to investigate the accuracy and completeness of ChatGPT in answering questions and solving clinical scenarios of interceptive orthodontics. Materials and Methods: ten specialized orthodontists from ten Italian postgraduate orthodontics schools developed 21 clinical open-ended questions encompassing all of the subspecialities of interceptive orthodontics and 7 comprehensive clinical cases. Questions and scenarios were inputted into ChatGPT4, and the resulting answers were evaluated by the researchers using predefined accuracy (range 1-6) and completeness (range 1-3) Likert scales. Results: For the open-ended questions, the overall median score was 4.9/6 for the accuracy and 2.4/3 for completeness. In addition, the reviewers rated the accuracy of open-ended answers as entirely correct (score 6 on Likert scale) in 40.5% of cases and completeness as entirely correct (score 3 n Likert scale) in 50.5% of cases. As for the clinical cases, the overall median score was 4.9/6 for accuracy and 2.5/3 for completeness. Overall, the reviewers rated the accuracy of clinical case answers as entirely correct in 46% of cases and the completeness of clinical case answers as entirely correct in 54.3% of cases. Conclusions: The results showed a high level of accuracy and completeness in AI responses and a great ability to solve difficult clinical cases, but the answers were not 100% accurate and complete. ChatGPT is not yet sophisticated enough to replace the intellectual work of human beings.

Current Progress and Challenges of Using Artificial Intelligence in Clinical Dentistry-A Narrative Review

The concept of machines learning and acting like humans is what is meant by the phrase "artificial intelligence" (AI). Several branches of dentistry are increasingly relying on artificial intelligence (AI) tools. The literature usually focuses on AI models. These AI models have been used to detect and diagnose a wide range of conditions, including, but not limited to, dental caries, vertical root fractures, apical lesions, diseases of the salivary glands, maxillary sinusitis, maxillofacial cysts, cervical lymph node metastasis, osteoporosis, cancerous lesions, alveolar bone loss, the need for orthodontic extractions or treatments, cephalometric analysis, age and gender determination, and more. The primary contemporary applications of AI in the dental field are in undergraduate teaching and research. Before these methods can be used in everyday dentistry, however, the underlying technology and user interfaces need to be refined.

Transforming Dental Caries Diagnosis Through Artificial Intelligence-Based Techniques

Diagnosing dental caries plays a pivotal role in preventing and treating tooth decay. However, traditional methods of diagnosing caries often fall short in accuracy and efficiency. Despite the endorsement of radiography as a diagnostic tool, the identification of dental caries through radiographic images can be influenced by individual interpretation. Incorporating artificial intelligence (AI) into diagnosing dental caries holds significant promise, potentially enhancing the precision and efficiency of diagnoses. This review introduces the fundamental concepts of AI, including machine learning and deep learning algorithms, and emphasizes their relevance and potential contributions to the diagnosis of dental caries. It further explains the process of gathering and pre-processing radiography data for AI examination. Additionally, AI techniques for dental caries diagnosis are explored, focusing on image processing, analysis, and classification models for predicting caries risk and severity. Deep learning applications in dental caries diagnosis using convolutional neural networks are presented. Furthermore, the integration of AI systems into dental practice is discussed, including the challenges and considerations for implementation as well as ethical and legal aspects. The breadth of AI technologies and their prospective utility in clinical scenarios for diagnosing dental caries from dental radiographs is presented. This review outlines the advancements of AI and its potential in revolutionizing dental caries diagnosis, encouraging further research and development in this rapidly evolving field.

Evaluation of Attitudes and Perceptions in Students about the Use of Artificial Intelligence in Dentistry

BACKGROUND

The implementation of artificial intelligence brings with it a great change in health care, however, there is a discrepancy about the perceptions and attitudes that dental students present towards these new technologies.

METHODS

The study design was observational, descriptive, and cross-sectional. A total of 200 dental students who met the inclusion criteria were surveyed online. For the qualitative variables, descriptive statistical measures were obtained, such as absolute and relative frequencies. For the comparison of the main variables with the type of educational institution, sex and level of education, the chi-square test or Fisher's exact test was used according to the established assumptions with a level of statistical significance of p < 0.05 and a confidence level of 95%.

RESULTS

The results indicated that 86% of the students surveyed agreed that artificial intelligence will lead to great advances in dentistry. However, 45% of the participants disagreed that artificial intelligence would replace dentists in the future. In addition, the respondents agreed that the use of artificial intelligence should be part of undergraduate and postgraduate studies with 67% and 72% agreement rates respectively.

CONCLUSION

The attitudes and perceptions of the students indicate that 86% agreed that artificial intelligence will lead to great advances in dentistry. This suggests a bright future for the relationship between dentists and artificial intelligence.

ChatGPT in Dentistry: A Comprehensive Review

Chat generative pre-trained transformer (ChatGPT) is an artificial intelligence chatbot that uses natural language processing that can respond to human input in a conversational manner. ChatGPT has numerous applications in the health care system including dentistry; it is used in diagnoses and for assessing disease risk and scheduling appointments. It also has a role in scientific research. In the dental field, it has provided many benefits such as detecting dental and maxillofacial abnormalities on panoramic radiographs and identifying different dental restorations. Therefore, it helps in decreasing the workload. But even with these benefits, one should take into consideration the risks and limitations of this chatbot. Few articles mentioned the use of ChatGPT in dentistry. This comprehensive review represents data collected from 66 relevant articles using PubMed and Google Scholar as databases. This review aims to discuss all relevant published articles on the use of ChatGPT in dentistry.