Episode 712: The Immersion of A.I. in Dentistry

 Kiera is joined by Mike Buckner of Pearl to talk about artificial intelligence in dentistry. They discuss how AI works in conjunction with dentists, the fears people have over AI utilization, how to publicize your use of AI in your practice, and more.

Then, they dive into how Pearl technology improves diagnoses and how your specific practice can sign up and benefit.

Episode resources:

Learn about Pearl

DAT listeners, connect with Mike: [email protected] 

Reach out to Kiera: [email protected] 

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Transcript:

[music]

0:00:05.8 Kiera Dent: Hey everyone. Welcome to the Dental A Team podcast. I'm your host, Kiera Dent. And I had this crazy idea that maybe I could combine a doctor and a team member's perspective, because let's face it, dentistry can be a challenging profession with those two perspectives. I've been a dental assistant, treatment coordinator, scheduler, filler, office manager, regional manager, practice owner, and I have a team of traveling consultants where we have traveled to over 165 different offices, coaching teams. Yep. We don't just understand you, we are you. Our mission is to positively impact the world of dental. And I believe that this podcast is the greatest way I can help elevate teams, grow VIP experiences, reduce stress, and create A teams. Welcome to the Dental A team podcast.

0:00:50.9 KD: Hello Dental A team listeners. This is Kiera, and you guys, I am so excited for the guests that I've got today, Mike Buckner with Pearl. I am obsessed with AI. I think it's gonna totally take over the industry in such a positive way, and I'm all about you guys being on the cutting edge, innovating, pivoting, because I believe that the best businesses and practices either innovate or die. And so I wanted Mike to come on talking about AI, it's, I mean, all of us are probably using ChatGPT right now. We've heard the pros and cons, AI in dentistry. Mike, welcome to the show today. How are you?

0:01:25.6 Mike Buckner: Thank you. I'm good. I love being on your show.

0:01:29.4 KD: Thank you. Well, I know you're hanging out in Orlando. Are you headed to a conference? Or Florida. I shouldn't assume Orlando. I assume everybody in Florida goes to Disney.

0:01:37.3 MB: I know.

0:01:37.7 KD: But maybe you're doing something different.

[chuckle]

0:01:39.8 MB: Little bit south, Fort Lauderdale, just here for some meetings, so...

0:01:44.5 KD: Awesome, awesome.

0:01:45.5 MB: Yeah, so I'm doing this from a hotel room.

[chuckle]

0:01:48.3 KD: Perfect. Well, I am glad that you took time out of your time, so thank you for being here. So let's talk, if people haven't heard of Pearl, what is Pearl? What is AI? How is AI coming into dentistry besides just writing our social media posts and newsletters? Which if you're not using AI for that, just do that. But how is the AI? What is Pearl? Kind of walk us through that.

0:02:08.9 MB: Great. So, gosh! AI is everywhere, everybody's talking about AI and I feel like I said this, let's say like six months ago, and it's just gotten worse because AI is, everyone freaked out when the Google co-founder guy, I'm sorry, I know it sounds really unprofessional, but he basically quit because he's like, I don't feel safe about the direction that AI is going. And that stirred a bunch of controversy and everyone's kind of freaking out, like, oh my gosh! AI, is it gonna take over dentistry? Is it gonna take over what the dentist does? As we introduce it into the practice, like, is it just gonna basically, you feed it X-rays and it's gonna come up with a diagnosis and you don't even need the dentist? And it's like, no, no, not at all.

0:02:57.3 MB: How we have designed Pearl and AI is, it is designed to work in conjunction with the dentist. So I guess the best way to maybe approach this is, I had, I was speaking with a dentist from Illinois and he said, okay, I've heard about AI. And to me, it just sounds like training wheels. It just sounds like why would I need this? I went to dental school, I know what I'm doing. I don't need the extra help. And so I shared with him something that I shared with you before. I shared with him what actually happened to my wife, now, not necessarily in dental, but the same kind of technology. So I had mentioned this earlier to you on a previous meeting, my wife, she's doing great. She finished her breast cancer treatments, just a couple months ago, but last year...

0:03:50.2 KD: That's awesome.

0:03:51.8 MB: She went in for a mammogram and she felt a lump. She went in for the mammogram and the oncologist basically said, okay, we know that there's a lump. The results from the mammogram show that there's something, but it's not typical to breast cancer. So if you want, we can do an ultrasound. So we did the ultrasound and the same results almost kind of came back. He says, all right, so there's something there, but from looking at it, it doesn't look typical to breast cancer. At this point, you've done the mammogram, you've done the ultrasound. We can watch it. Okay? And bring you back next year.

0:04:34.4 KD: And forth watch it.

0:04:34.6 MB: Yeah. 'Cause I'm like, look, I've been in dental long enough that I know what watch it means, right? We're gonna watch it get there. We're gonna watch it get worse.

0:04:41.2 KD: Something is there, we just don't wanna tell you.

[chuckle]

0:04:43.7 MB: Yeah. And so he says, you can do a biopsy. And so we said, absolutely. Let's do a biopsy. We did the biopsy, and it came back stage two Invasive Ductal Carcinoma. And at that point, I was working with Pearl and my mind just all of a sudden, I was ticked, I was frustrated. I was really upset because we have the technology today to be able to avoid situations like this. And in fact, I went onto LinkedIn and I kind of, I was researching AI in mammography and I reached out to a CEO of a company that does this with mammograms out of France. And we talked and he says, "Mike, this happens so much." In fact, generally we find that about only six out of 10 cases are detected on a mammogram. And I've mentioned this to you before too, but the human eye can really only see or differentiate between 30 and 50 different shades of gray. And as my wife and I sat there and then looked at the results on the ultrasound and the mammogram, it's all black and white. They're pixels, black and white dots and pixels of different shades. And it's like, okay, we're relying on this, we're relying on human eyes to interpret this and leaving it up to human error.

0:06:03.4 MB: So I reached out to the CEO of this company over in France that does this. They actually are implementing AI with mammograms. And he said, "Mike, I don't know why, I don't know what the issue is, but in the, especially in the United States only," he says, "roughly around six out of 10 cases are detected on a mammogram." And that really kind of freaked me out.

0:06:26.0 KD: Yeah.

0:06:26.3 MB: And here's the thing, we're leaving this up to human interpretation. As I looked at the pixels, as we looked at the results from the mammogram and the ultrasound, these black and white pixels, we're leaving it up to human interpretation. And everyone practises dentistry differently. And especially if you show an X-ray, everyone's eyes will gravitate towards something different, maybe first, right? What do you look at first when you look at an x-ray? And so for me, I'm like, man, that shouldn't be an excuse. We have the technology. We have the ability to have AI help make sure that we are finding and tracking everything. Now, I will say, AI is not gonna be perfect. And the best example is if you go onto any of your photo, apps on your phone and you search anything, it's gonna pull up any, you type in dog and it'll pull up all the pictures of dogs, but there's probably gonna be a few that are incorrect. But as you look at it, you're like, oh, I can see why that would look like a dog. To the exact same reason, the dentist and AI need to work together to make sure that the dentist can look and say, oh, you know what? That's a false positive. Or, oh, I missed this thing over here, but it picked up these things that I didn't see before.

0:07:45.3 KD: Mike, this is such an interesting story and I appreciate you sharing and I'm so grateful your wife is doing well. I just think of like, how many things are we missing when we have the opportunity to see it? Put any of us in that situation, so your spouse, your significant other, your mom, your siblings, your sister, all of us have a female that we know, like shoot, six out of 10. I don't wanna be that other 40% that's missed because...

0:08:10.5 MB: Yeah.

0:08:10.6 KD: Think if we would've watched this for a year, your wife's now recovering, how much worse this could be of a situation because we chose not to use the tools and resources available. To me I feel like it would be like we have so many things right now. I wouldn't go put a band-aid on a broken leg today. I would not wrap it with a handkerchief today because we have better tools and technology. And so I feel like with AI, that's why I've been such a huge advocate for AI, for us using it, for us innovating, because I think it is here to stay at some level. It's definitely not perfect. It's getting better and better. I didn't know that Siri was AI and I use Siri all the time. It's one of those things that I just feel it will become commonplace for us in the future. Why not get on it now? Why not start learning from it now? Why not start having it help us? And Mike, I am curious because I think a lot of dentists potentially, I'm not a dentist, I'm trying to empathise, I know I might be as a dentist, so let's say hypothetical, AI was coming into a consulting company and it was about to expose everything that I've missed on my clients in the last five years. I might not want to pull in AI. And so I'm thinking of dentists of like, how scary. I think about myself, go put me at my dental office and have them take my x-rays, how many cavities are they gonna show up and I'll be like, ah, shoot. Keep the AI off. Right?

0:09:33.0 MB: Yeah.

0:09:33.8 KD: How do you overcome that fear? Because I think that that could be a real piece of, I don't wanna look dumb to my patients. I don't wanna admit that I missed this. I don't want them thinking that I'm one of that 40% of mammograms that misses it when we're educated, we're smart, we've been trained. How can you go about alleviating that fear? Because I think fear might hold a lot of doctors back.

0:09:56.3 MB: Yes. And to that point, the exact conversation that I was having with this dentist who was asking me about AI and where it was going, I said, okay, so let's just say for example that I didn't see, or we didn't do the biopsy and we just kind of closed our eyes and pretended like it wasn't there. Or, you know what, I don't want to know about it because maybe that'll mean that it's not there and it doesn't exist. But here's the thing, whether you know about it or not, they're your patients. You've taken the x-rays, you are liable. And what we're seeing more and more are these law firms that are literally chasing after dental patients, marketing to the dental patients saying, has your dentist ever missed a cavity? Has your dentist ever misdiagnosed periodontal disease or didn't diagnose X, Y and Z? Because if so, click here and we will go after your dentist and sue them and get money from them. It's sickening. But this is happening more and more.

0:10:57.6 MB: So it's like, whether you know about it or not, whether you found it or not, you are liable. It is there, and it's better to know. And here's what AI will do. It's not gonna say, hey, we want you to call all these patients back and say, hey, we totally missed something and we screwed up. Why don't you come into practise? No. But rather as these patients are coming back into the practise, we can have AI basically look at your schedule every day and organise and prioritise and basically colour code the appointments on the schedule of those patients that are coming back into your practise saying, "Hey, here's one. John right here at 10 o'clock, AI detected something that was never presented. So for the hygienist, make sure that we're checking between 19 and 20, AI's picked up something there. So just double check." It's not saying that, "Hey, this is how you should treat it and this is what you should diag... " It's not diagnosing it, it's just rather kind of highlighting it, saying AI is detecting or predicting that there could be something here. We wanna work together with you and make sure you check this out.

0:12:02.7 KD: And I think that that's such an important note. One, I love it because it does make chart prepping and diagnosing easier. Having a second set of eyes. I can't tell you how many dentists tell me, I'm so thankful for my hygienist teeing up treatment and looking at it with me. They're not diagnosing, they're co-diagnosing with me because I'm running in for an exam. I've got three minutes and I gotta get back to that patient. I'm running behind. We miss things. That's human nature. There's nothing wrong with it.

0:12:26.9 MB: Totally.

0:12:27.1 KD: All of us do that. I miss things with clients. I went into an office I've been seeing for five years and I found out that they were mis-billing. And I'm like, how did I miss this? I am really good at this. I know what I should look for and I missed that.

0:12:38.3 MB: Yeah.

0:12:38.9 KD: Those things are scary. That's human nature. We can't catch everything. And so realising that we're humans, but also realising that we've got tools to help us out. And I think some good verbiage that you guys can use for your patients is, they're not... If they ask, why was this not diagnosed six months ago? Say, we have great technology. Like today, we now know that this is where it's at. It's not saying that it was there last time. I don't have to confess that it was there last time. I can say, today, we now know that there is treatment here that we need to get taken care of. And the great news is, this is how we can take care of it. We think in our minds like, "Oh my gosh, I didn't diagnose this." Think back though. I just wanna put this into perspective. And I know this for a fact 'cause I've worked with plenty of new doctors. I worked at Midwestern, lots of new grads out there. How many of you, your first year of doing dentistry, you did dentistry, and you see those patients come back six months to 12 months later and you're like, "Oh my gosh, I did that?" Or, "Oh my gosh, I missed that?"

0:13:37.0 KD: You didn't then tell them, "Hey, I did terrible dentistry on you." You say, "Oh, we have this little spot, we're gonna get it taken care of." I think if you can think about it the same way, patients aren't coming in here with chainsaws and being angry at you and telling you you're a terrible dentist. We just now have a new tool to help them and help you co-diagnose. So I think almost use AI as a co-diagnosis, and something I had not thought of until now. Mike, on our last podcast, I was geeking out, we podcasted maybe six, eight months ago. I had not heard of AI in dentistry. And I'm like, "What? Tell me more. This is so crazy, cool." And I asked you, do you think insurances are using this? And it was like, "For sure they're going to start." So in that same vein, I guarantee you dentists, insurances are gonna start coming at you, saying things to you, showing that you're missing things or whatnot. Because I guarantee the insurance companies are already using AI. And so for us as private practice and for dental practices, let's get on board.

0:14:38.7 KD: Let's start using it. Let's start having tools in our practice. And I'm not saying that you have to, but I think it's going to come, it's going to come change your practice. Why not start using it now? So just a couple of thoughts. I really feel it's such a great co-diagnoser with you, just like your hygienist is, and it will just make it easier for you, make it easier for associate doctors coming in, make it easier for patients to see it. But it's not the end all be all. You are the dentist, you are the clinician. And just like X-rays aren't the end all be all, you still need to confirm that they're accurate, same thing with AI would be my guess. Mike, any thoughts on that?

0:15:14.9 MB: Yeah, and I would also say like what does that say to your patients? Right? Like there was a dentist who wanted to sign up with Pearl, and then he said, "Hey, can you check and see are there any other dentists that are using Pearl within a 100 mile radius?" And I'm like, "Well, why?" And he's like, "Because that's huge. I want to use this as a big marketing piece to say like, hey, we are using state-of-the-art technology to make sure that we are providing you the best oral care and we're using best technology to do so." And another point that I just wanted to share too is there's a new concept, and I'm not a dentist, but there is a concept that I kind of went down a rabbit hole studying too, where when it comes to looking at and reading X-rays, there reaches a point after about 20 X-rays, your eyes, it kind of just starts to blend together.

0:16:11.9 MB: And I talk to doctors all the time that are like, "Oh, maybe I don't feel like I miss things." And then I get them, you know, once they turn Pearl on and they're like, "Mike, it's almost embarrassing how much we miss." And it's like, "Yeah, but here's the thing, is we're all human." We have the technology now to avoid that. And I think we all can agree that when we come in fresh on a Monday morning and we're looking at X-rays, it's gonna be very different than when we should have left the practice at noon on a Friday and it's 5:30 and we're still treating patients...

[laughter]

0:16:39.4 MB: And we're like, "Okay, come on, let's go."

0:16:41.5 KD: So note to all listeners.

0:16:43.3 MB: Right? Like put these X-rays, the amount of X-rays. [chuckle]

0:16:44.6 KD: Right? Like note to all listeners, schedule your dental appointments at 8:00 AM Monday morning if you want the healthiest mouth. If you don't wanna have a darn thing diagnosed, surely do like Friday afternoons. Like absolutely. I'm just kidding, doctors, I'm just teasing you.

0:16:57.9 MB: Yeah.

0:16:58.4 KD: But it's true. It's decision fatigue. You get fatigued as human beings. And it's just natural. We are way more fresh the first day we go to the gym than after our muscles are fatigued. Everything about us fatigued. So why not give yourself some space and grace? That's freaking genius of that doctor to use it. And Mike, as you were saying that, it just made me think of, how many things were we scared of to incorporate into dentistry? Think back to when the first X-rays were done and then going to digital X-ray. Do you guys know how much you saw on digital X-ray compared to those little film and you were like squinting and hoping and praying you could see it on those film boxes. Think about how crowns we always sent them to the mill, or to the... I just go straight to mill 'cause that's what we do now. To the lab, like we never, ever would think that a machine can make a better crown than a lab.

0:17:47.7 KD: That was preposterous. And that's just been since I've been in dentistry in the last 10 years. It's crazy to see the things that we first abhor and think are crazy to where we embrace them and they become everything. I guarantee you dentists, when they first started using gloves thought it was preposterous. We do not need to use gloves. Now if a dentist came to me to put their fingers in my mouth bare skin, disgusting. That just doesn't happen anymore. And so I think that this is something new. It's new, it feels scary, but it's so crazy cool the things we can do for our teams, for our people, for our patients and just be able to do and provide better dentistry, better care for our patients. Why would we not, I think is always my question with AI.

0:18:31.4 MB: Absolutely. So many practices are so busy. We are running from operatory to operatory, and we have the technology to make your lives better and to improve the dentist day-to-day and to improve overall oral health. And I'm excited to see where it goes. AI is here to stay.

0:18:55.3 KD: AI is so cool. I always wondered what would take down Google. I always wondered, 'cause like Google came, the internet came and that was a big thing that disrupted our lives for the better. And of course like bad things have come from it, but so much goodness has come from it. Same thing with AI. There will be bad things, there will be corrupt things, there will be great things, but it's here. This took down Google, and Google I don't think wants to admit that. I used to have Google as one of our top standards and now I've put ChatGPT for innovate or die. They are the standard of innovation. And Google hung out too long not wanting to innovate. And I say like, let's not be that practice. So Mike, explain to me how this works. So from what I understand is, we take the X-rays just like normal and then Pearl is almost like an overlay. I think back to like film projectors and you put the film down. That's what I feel like, it's not really how it is, but it's like this overlay that goes on it. And then it shows us where the cementum is, the dentin, it shows the pocket depths, like how deep it is, it shows the decay. Is that correct, this is basically how it works? Like we're not using Pearl to take X-rays with, we're using Pearl as an overlay onto the x-rays to start to show them to patients. Is that how this works? Like how does AI actually work?

0:20:11.1 MB: Yes. So with your digital images and your x-rays, as soon as that x-ray is taken, in real time basically we pull that image file, run it through our AI servers, and then it's hosted on Pearl's, in the cloud on Pearl site, you will be able to go, all HIPAA compliant, but you'll be able to see the x-ray with all of the annotations, with all of the highlights and the measurements and how far into the dentin and the cementum showing the different colors and everything else. We're not necessarily writing over your X-ray, we are taking a copy of that. We are showing you all of the detections on top of that. It's housed in the cloud, so you can have it up on multiple monitors in your practice. And yeah, having that work real time is huge.

0:21:00.5 KD: It's incredible. And when I've looked at pictures of this, I use them now in my presentations of how do you get higher case acceptance? How do you get more patient buy-in? This is how you do it because they see it. It's so crazy cool. And then Mike, I think there's something also very interesting that offices who sign up with Pearl actually get to have a historical data analysis where we go back in time and show on your x-rays of what treatment is available. So I always love things that give me an immediate ROI, that's something I really love and I look for in business. And how crazy cool to look over the last 12 months and see all the treatment undiagnosed. Not to say that you did something wrong, but to then put forward those notes, like to be able to track it for you when those patients come in to be able to better diagnose on them in the future. So how exactly does it work? I sign up, I'm interested in joining. How does this exactly work? Mike, can you walk me through the process?

0:21:55.8 MB: Absolutely. So what we do is, we basically will go back and we'll scan the last 18 months of all of your images, all your x-rays. We allow that process just depending on the size of your practice, how many images there are, could be anywhere from 60,000 to 80,000 x-rays that we're running through our processors. We do have hard costs. The processing time on all of those, we allow about three weeks or so, three to four weeks to process all those just depending on the volume. And then once that's all ready...

0:22:28.5 KD: Isn't that's so cool though? Can you just pause, 80,000 x-rays can be looked at, screened and run through a software in three weeks. It'll get faster than that in the future, but like 80,000 images viewed in under three weeks. That's just insane to me of what AI can do. It's crazy cool.

0:22:45.8 MB: Yeah, and most of the time a little bit faster than that, and then we basically just, we connect with your team. We have a comprehensive report showing you all of the undiagnosed opportunity in each of the different categories. All of your scaling candidates, your endo candidates, restorations, restoration replacements. And we put that into, you know, an AI driven schedule. We have various lists that you can then go in and be very intentional on which patients you're getting back into the practice rather than just filling it with a prophy, we wanna be very intentional in getting the right patients back in, especially for the busy practices that might not have a lot of extra openings.

0:23:28.8 KD: So cool. So I am definitely a huge fan of AI. My team knows that I expect us to use AI. I'm like, why not? [chuckle] It was funny, something came through with AI and I looked at our marketer and I said, did you write this or did ChatGPT? And she was like, what? Are you saying I can't write this good? And she's like, it did come from ChatGPT. But I am such a fan of it. I think it's so crazy cool. Pearl is awesome. There are other companies. I just really have loved Pearl and have heard great, great experiences from our clients who have used them. So Mike, I know you take great care of our Dental A Team people who come in. What's the best way for them to get connected? If they wanna see a demo, like why not just see what it's about, is really I think the best thing to do right now. So how can they get connected with you as a Dental A Team person coming to Pearl?

0:24:16.5 MB: Absolutely. So I would say there's two ways. One, especially for our Dental A Team members, just send me an email, [email protected], send me an email. I will get you connected. You can also go onto our website, hellopearl.com and click there to register for a demo and we'll get you set up with someone who can walk you through it. But yeah, reach out to me, I'd be more than happy to help out.

0:24:41.9 KD: That's awesome. Like Mike said earlier, it's not training wheels for a dentist, it's helping you see what 40% of other clinicians, like if we're gonna go back to that mammogram, aren't seeing, and if I had an opportunity to get an edge 40% better than the rest of my colleagues, why would I not wanna take advantage of that? So I would just say, guys, try it out. I think it's super awesome. AI is so cool. Mike, thanks for being here. Thanks for hanging out with me. I know you're in Florida, so thanks for giving up some time. It was truly a pleasure and I appreciate it.

0:25:12.8 MB: Absolutely. Thanks for having me on as always. And love your group, love your community. We're here to help you if there's anything we can do.

0:25:19.7 KD: Awesome. All right guys, as always, thanks for listening and I'll catch you next time on The Dental A Team podcast.

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0:25:28.2 KD: And that wraps it up for another episode of the Dental A Team podcast. Thank you so much for listening and we'll talk to you next time.