Episode 791: A.I. Is the Second Opinion You Need

 Kiera is joined by Mike Buckner of Pearl to continue their conversation about artificial intelligence in dentistry in a way that enhances treatment plans, patient care, and overall practice. Together, they discuss:

• Benefits of a clinician using A.I.

• Positive effects of A.I. on the patient and case acceptance

• A.I. as a second opinion to ensure standard of care

• How insurance companies are utilizing A.I.

• And more

Episode resources:

Learn about Pearl

DAT listeners, connect with Mike: [email protected] 

Listen to episode 712, The Immersion of A.I. in Dentistry

Reach out to Kiera: [email protected] 

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Transcript:

Kiera Dent (00:01.008)

Hello, Denali team listeners. This is Kira and today is an incredible day. I am so excited. I've got Mike Buckner with Pearl back on the podcast today. We are gonna dive into all the things AI. Mike, how you doing today?

 

Mike Buckner (00:13.842)

I'm doing great. Thank you. Happy New Year.

 

Kiera Dent (00:16.4)

Happy new year indeed, I know. I was so excited that when I saw you on the podcast lineup because I thought, okay. So I feel like when you and I first chatted, AI was new. I remember you and I talking about this and thinking all the different pieces. And I was like, Mike, AI is gonna take off. And now Pearl has expanded, other AI companies. But I mean, I think 2023, we saw the AI, I would say like wave is coming in and the different things people are doing. I mean, everything is using AI now.

 

All the platforms we're on are using AI. And so it's super cool. I hope people have gotten on the bandwagon with AI within dentistry, but Mike, kind of walk us through. I'm so excited. I know you have some new things, some new studies. You're always full of new things. But before we dive into that, kind of just for our listeners to know what exactly is Pearl. That way, before we dive into it, guys, it's all about AI, but I want Mike to at least tell you what Pearl is, and then we're gonna dive into all the stats and statistics around it all over.

 

Mike Buckner (01:11.518)

Yeah, so Pearl utilizes computer vision, artificial intelligence to provide a second opinion with your dental x-rays. So your 2D images, your bite wings, your PAs. And Pearl was the first company to bring in FDA cleared caries detection into dentistry in March of 2022. So it was really interesting watching this journey as we saw, you know,

 

AI started coming in, there was a lot of skepticism, there's a lot of people that were wondering, what is AI, is it going to replace a dentist? Why would I need artificial intelligence to do my job? There was a lot of misconceptions around that. And so as that came in, and especially with the FDA clearance, we saw a massive adoption of the early adopters that were kind of watching it from the sidelines and starting to get on board.

 

We saw that wave of early adopters and now kind of what we're seeing, that was early 2022. 2023 is when we really saw the adoption. So we had people that were kind of watching from afar that were now like, okay, now that there's, there's a few different companies that are providing artificial intelligence as a second read or a second opinion. Um, now it was kind of about making the decisions. And so what we saw was towards the end of 2023,

 

Kiera Dent (02:13.446)

Mm-hmm.

 

Mike Buckner (02:35.598)

It wasn't really and there was there was a dentist on a podcast and I'll You know, I'll give you the information of who exactly that was but he said, you know there's a lot of misconception around is AI here to replace the dentist and his response was It's not here to replace a dentist. However, the dentists that are utilizing artificial intelligence will

 

Kiera Dent (02:52.66)

Mmm.

 

Mike Buckner (03:02.962)

will fast replace those that are not, meaning they're the ones that are the forward thinkers. There's the patients now that are reaching out to us that are wanting to know where are doctors in the area that are utilizing artificial intelligence because the patients are now demanding it. So it really is kind of a mix of early adopters that are now getting on board and now the patients, the patient population that is now also in demand

 

Kiera Dent (03:20.804)

Right, right.

 

Mike Buckner (03:33.046)

to know what our doctors are doing in order to enhance the diagnosis in the practice.

 

Kiera Dent (03:33.89)

Yeah.

 

Kiera Dent (03:39.728)

Mm-hmm. Yeah, which is amazing because I think when people realize that it's just a tool just like x-rays were a tool I mean I could hear dentists probably in the past thinking about x-rays Coming in to replace them in their job. Like we just have to think about What we feel is normal is not actually normal there were adoptions into it There were changes into it and I think AI is the same and seeing it as a tool It's so much better. Like I had offices last year tell me that they were using Pearl

 

to actually train and onboard their new grad associates because it just helped them with diagnosis. And I like, to me, that resonated so much because literally as an assistant, like Mike, I'm gonna date myself real quick, which I feel like I'm still super young and hip, but I learned taking x-rays as a dental assistant on film. And I remember taking it on film and it was so hard for me to get the correct angulation, to get it in the right placement because you take the x-ray, you go process it, you see the results and I'm like, oh shoot, I missed it. I cone cut.

 

but I have no idea where my placement was. And so then when digital x-rays came out, I thought, oh my gosh, if people can't get good x-rays now, like you don't know how to take an x-ray because it was so much easier to get it. I could see that what I did wrong, I could get better x-rays more consistently. And I've thought about that kind of being with AI where it's not replacing you, but it's helping you see like what you would diagnose just with those 2D x-rays compared to what AI is seeing and how can you enhance your diagnosis to give better patient care all the way around. And for patients,

 

You better believe that they're smart. I mean, TikTok and all the different things, we're educating our population. Maybe also like making us a little more dumb too. Like I'm not sure which way we're gonna go, but we are educating and people are now expecting these things that I think we're gonna need to stay up with the trends a bit faster and more so, just with how quickly the population and social media and all those different things are really moving it around.

 

Mike Buckner (05:31.502)

Absolutely. There's really kind of two facets here that we need to look at when looking at artificial intelligence. And I think the one is, you know, the clinician, you know, utilizing artificial intelligence. What are the benefits and why would they need it, right? And how does it help the clinician? But at the same time, there's also a massive effect on the patient and the patient outcome and case acceptance. Because for a long time, we've had this issue.

 

of trust when it comes to treatment planning. And I know that most of the dentists out there don't have this issue because their patients trust them and they understand, they've built that relationship, they've done a really good job with that. But there are those patients that come into the practice and they're looking at the black and white images as the dentist is saying, okay, do you see this small little gray spot there? And the truth of the matter is their eyes have not been trained to view that. And sometimes it's obvious, but other times they're like, I don't see it.

 

Kiera Dent (06:04.518)

Right.

 

Mike Buckner (06:30.898)

I don't see what you're pointing out. I'm just going off of trust. But now with AI and having AI outline the exact area of decay and of disease on the tooth, of periapical radioleucensies, of bone loss, and showing those outlines on the x-ray, we're allowing the patient for the first time to truly see what we're seeing and what the clinician has been trained to see. So that's number one is allowing that patient to see it, understand it.

 

Kiera Dent (06:31.071)

Mm-hmm.

 

Kiera Dent (06:35.11)

Right.

 

Kiera Dent (06:53.625)

Mm-hmm.

 

Mike Buckner (07:00.522)

And we've seen a massive, a massive jump in case acceptance in the practices that utilize it where we see on average an increase of 25 to 30% case acceptance when the patient can see what's going on those x-rays. Now on the clinician side, absolutely. You brought up a point of, you know, dental students and associates and the benefit of utilizing it there. I just want to speak really quick to a case study that was done at, with UCLA.

 

Kiera Dent (07:15.297)

Mm-hmm.

 

Mike Buckner (07:29.006)

this last year in 2023. And this was really cool, but this was, there was 87 dental students that were basically completing caries detection competency exams. And as they were finishing up dental school and taking these exams, they ran a comparison with what the dental students were finding and the accuracy of what they were finding on the x-rays. And they also ran that in conjunction with Second Opinion, with Pearl Second Opinion. And,

 

Kiera Dent (07:56.913)

Mm-hmm.

 

Mike Buckner (07:58.726)

the AI system. What they found was, you know, the dental students, the sensitivity of what was seen on the x-rays was about 53%, you know, accuracy, specificity was about 50%. Accuracy, the overall accuracy was about 51%. Now, with the AI systems, they found that the sensitivity was around, you know, 90% accuracy, specificity was 96%, but the overall, I'm sorry, the overall accuracy was 94%.

 

Kiera Dent (08:14.226)

Wow.

 

Mike Buckner (08:28.29)

There's a massive, massive gap there. And so allowing these new associates coming into practices to have a tool not to replace, but just to allow that second opinion to ensure that the standard of care is set in the practice and that as things are flagged, it allows the clinicians to come together to view that and to either agree or disagree because it truly is a second opinion.

 

Kiera Dent (08:31.764)

Mm-hmm.

 

Kiera Dent (08:54.688)

Yeah, well, and I love that you have it as a second opinion. And I think like as clinicians, like at the end of the day, you are the dentist, you are the doctor, and you make final say. AI is just there as a tool to help you, just like x-rays are there as a tool to help you, just like if you use the diagodent, it's a tool to help you, but it's not going to replace the field, the seeing. I mean, I would never in my wildest dreams want to distrust AI.

 

just like you would never in your wildest dreams, just trust your hygienist. Like hygienists are there to tee it up and they're looking and they're seeing so much more that you're not seeing. But at the end of the day, you've got to make the clinical sound judgments because you ultimately know what that tooth needs. Because you're seeing it of what it really needs. But gosh, like I feel, I've always felt coming from the clinical background, coming from the different pieces that I have, that we are at such a unique space because reality is...

 

we can't see inside these teeth. Like they're just there. We have to try and figure it out. We have to try and figure out what's going on behind the scenes. And yet we're expected to guess is there decay there? How much decay is there? We're looking at this and trying to guess and figure it out. Where AI is just helping us be better with our estimating in something we really can't see. Like you cannot see in that tooth. And I've always thought like, we're really trying to play this puzzle game. So I think that that's such an interesting study.

 

to see how much better they were able to do with diagnosing. Now, I also think it could become a crutch and you then just rely solely on AI and you don't really like look at it and diagnose it. But I don't know, I'm just such pro. I think we've seen so many good things come from AI. Now, of course, like I'm curious because I think that I look at this and I asked you before and now we even have more information. I feel like with a side where a dentist could get kind of burned if they're not careful and adopt AI soon would be through insurance. What have you guys found with insurance using AI, Mike?

 

How are you seeing, because I guarantee you insurance companies are using AI that's going to cut down the cost of having to pay people. Insurance companies are really smart. They're brilliant businesses. How are we seeing kind of this effect play out into the insurance world?

 

Mike Buckner (10:53.214)

Yeah, you know, we've been keeping a close eye on that. And, you know, we have been focused on providing a tool for the clinicians to utilize this artificial intelligence as evidence for claims. So we've kind of designed our system around that and providing a PDF printout that has, you know, evidence for claims that can be submitted in with their insurance claims. And what we've seen, we actually did, we had a focus group that was

 

comprised of office managers that were utilizing Pearl to submit their evidence for claims. What we found was those practices that had a lot of denials, especially with SRPs, a lot of denials that were coming back. Once they started utilizing Pearl's evidence for claims and submitting those in, that their denial started to decrease. Because again, you're now outlining all of the measurements.

 

Kiera Dent (11:45.724)

bit.

 

Mike Buckner (11:49.314)

And as it's being submitted in, FDA cleared AI detections on the X-rays. We've seen a massive improvement there of offering that evidence for claims. Now, I think that it's still very early on with how it's being utilized with insurance companies. The path that Pearl is on right now is we are working towards, and that's really our goal this next year, is working towards almost providing, especially with clearinghouses,

 

almost providing like a stamp of approval, right? That says, okay, this has been, this claim or this X-ray has been, you know, highlighted and backed by AI showing that it matches what's being submitted in with the claim and getting to the point where we can just almost have that instantaneous stamp of approval and turning around those claims within a matter of days. So that's really where we're going, is trying to assist the dentist in providing the evidence.

 

Kiera Dent (12:43.259)

Okay.

 

Mike Buckner (12:47.778)

turning around those claims faster and just making the whole process a lot easier.

 

Kiera Dent (12:53.908)

Yeah, which I think is really fun to hear how it's actually playing out and to hear that this is making the team's lives easier. I mean, I can't imagine as an office manager having the ability to just have it quickly stamp out, say that this is what they saw. It's a backing. I mean, I got so sick of denials, Mike. I can't even tell you how annoying denials are. And to have a way to really just change that and to not have as many denials in the practice, I think is a beautiful thing that we should embrace.

 

So I'm curious though, Mike, can you explain how does AI actually work? I'm hearing we're using it for insurance, we're able to use it as a second tool, like a second opinion. I mean, especially, I was just thinking, how nice would that be for also solo doctors who don't have another dentist in the practice to bounce ideas off of, this AI is kind of becoming your second person of, let's check this x-ray, what do you see? You have someone in the practice that can be there with you in theory to help you. I think about like new grads and people saying, oh, I can't afford AI. And I think

 

How could you afford not to have AI? It's helping you diagnose even more than what you were seeing and have the patients not just go on your, you know, like 50 shades of gray and like, oh, can you kind of squint and see how there's this little triangle that they really have no clue and they're just trusting us. But like, can you see this? This is what these things are throwing, pulling through, AI is doing this. To me, I feel like it's a no brainer. So how does the AI actually work through Pearl and how do offices actually implement this?

 

Mike Buckner (14:17.002)

Yes. So, so there's really two parts to that. Um, w there's a lot of different branches of artificial intelligence. You know, there's, there's a computer vision, there's AI that, that utilizes text and information processing. And really the one that we're focused on is computer vision, breaking down the pixels on the digital X-rays pixel by pixel to really kind of put some, some definition around, you know, what is, what is considered carries, right?

 

because, and I mentioned this on an earlier podcast with you, where, you know, the human eye can really only see and differentiate between 30 and 50 different shades and tones of gray. But with AI and artificial intelligence, it's able to really expand that to about 500 to 700. And so you're now able to see things. And the benefit of artificial intelligence too is that it does not fatigue, you know, it doesn't, it's going to perform the same as you know,

 

Kiera Dent (14:46.689)

Mm-hmm.

 

Kiera Dent (15:02.937)

Mm-hmm.

 

Kiera Dent (15:12.345)

Right.

 

Mike Buckner (15:14.81)

Eight o'clock on Monday is five o'clock on a Friday when you've had a long week. Um, and so, you know, to, to the benefit pros and cons, it, it doesn't have that bias, right? So it's going to provide the same kind of information every time. Now, how this works, let me get back to that question. Um, we, we actually have kind of two different offerings and the first offering, which really is kind of the engine that drives everything.

 

Kiera Dent (15:18.042)

Mm-hmm.

 

Kiera Dent (15:27.205)

Yeah.

 

Mike Buckner (15:41.494)

is what we call second opinion. And that offers a real time read on x-rays that are taken, showing all of the overlay with the colors, showing the different parts of the tooth, where the dentin and the enamel lie, where they start and end, where the decay progresses or protrudes into each of those different layers, and breaking that down by percentages, saying 15% of the decay is in the dentin and 13% is in the cementum, and really giving that kind of definition.

 

So that's second opinion. And then we also offer kind of our premium package, which we call practice intelligence, because we know that there's a lot of information that's found on those digital X-rays as it's ran through artificial intelligence. Now, when we can compare that with what's in the practice management software, so that we can say, all right, here's what the AI found. Now let's actually see what you have treatment planned, and we're gonna do that actually for the last 18 months of all your X-rays.

 

Kiera Dent (16:18.122)

Mm-hmm.

 

Mike Buckner (16:40.578)

So we're gonna do a historical analysis. We're gonna run them all through AI. We're gonna then find what AI found versus what you treatment planned so that we can for the first time really provide that data and information around what your outstanding opportunity, or in other words, potentially undiagnosed opportunity is in the practice. Now, I just wanna follow up because sometimes people are like, well,

 

Kiera Dent (17:04.997)

Yeah.

 

Mike Buckner (17:08.718)

How am I supposed to tell the patient, hey, sorry, we forgot something or we missed something, right? But it's a matter of knowing what patients are coming in that week and getting that view to say, okay, they're coming in on Tuesday. Their last set of x-rays showed these things, but you only treatment plan this. So it's allowing the team, it's changing your morning huddle. It's allowing the team to really hone in and know where they need to be looking, where they need new x-rays, and to compare that.

 

Kiera Dent (17:11.27)

Yeah.

 

Mike Buckner (17:36.862)

with the percentages to say, okay, it was 15% in the dentin last time, where is it now? Has it progressed? So that's the practice intelligence.

 

Kiera Dent (17:43.324)

Mm-hmm. Yeah.

 

which I think both of them sound incredible to me. I think the thought of having a second opinion just is like, why not? And if you don't like it, you don't have to continue using it. It's very simple. It's an overlay over your x-rays. It's very easy to use. It's very simple for the patient to see. And I will tell you as a treatment coordinator, and I think I'm a darn good treatment coordinator, if you were to put me up against the best of the best, I think I could rally. And yet the thought of just having this as a tool and a resource.

 

slam dunk cases, you don't have to have a cura dent as your treatment coordinator anymore. You can have someone who's maybe not as confident presenting treatment plans and still be able to close because it's no longer about the person presenting and how good are they, it's more here's the facts. Let's help you say yes to this because here's the facts. Of course we're going to get you healthy. And I agree with you. I mean, let's just think guys, whether you chose to diagnose it or not, the decay is still there. And we're not here to say, oh my gosh, these doctors didn't do their work.

 

Dentist, please tell me, can I get an amen on this? Cause I know all of you can say this, your work that you did your first year out of school compared to where you are today, you kind of cringe a little bit and you think, oh my gosh, I did that, I missed that. That's called being a human. And so there's no judgment, there's no fault on that. And your patients with AI, they don't need to know that we missed this 16, 18 months ago. There's no need for them to know that. All it is, is we now know today that there's decay. That's it.

 

That's all it is. It's not going back and back, oh my gosh, we went back in the archives and hey, you didn't get this diagnosed. It's none of that. And I think it's all perspective of how you present it. You can tell someone they look good in an outfit or that they don't look good in the outfit and both ways can either make friends or make enemies. Just like you can present treatment and make friends or make enemies with how you do it. But the goal is never to make you feel incompetent or to make you ever look incompetent because you're a human. And guess what? Humans miss things and that's okay.

 

Kiera Dent (19:39.78)

And so just using it as a tool, I just think how cool is it that you have a gold mine of treatment in your practice that you can now present and then also get cases accepted easier. I love the historical analysis. Like go back in time, find it, because especially like I just had, we have a doctor mastermind group that we were, that we do every single month. Mike, you were a speaker and they loved you. But at that one, they were talking about how their schedules are kind of empty right now. And some offices are really struggling with empty schedules. And I just think, well, why not pull through the treatment that's available?

 

and then let's strategically call certain patients and get them back in on the schedule to fill our books as well. So, so many reasons I am huge Pearl fan. I talk about you guys every time I speak because I just think it's a way to enhance your treatment plan, enhance your patient care, enhance your overall practice like ability, make it to where not every dentist is diagnosing differently, make it to where the hygienist have an easier way to tee up treatment. Like it becomes the equalizer amongst practices to use it.

 

Do I think in the future that this could become a PBM like they did in that in, you know, pharmacy? Absolutely, guys. But let's be smart and let's be on the bandwagon first and let's prevent it and let's use it in our practices because who knows when that'll come in? I guarantee you people will be using it for different reasons. Why not use it now and let's make it great and prepare for it when it comes later on. So those are my thoughts. I'm a huge believer in it. I think we should do it. I think every like if I owned a practice, I would be implementing Pearl or some AI just so that way we were.

 

Consistently diagnosing. I love that you talked about the human fatigue because it's real. I remember my x-rays and my dentistry Like assisting wise I was way better on Monday and Tuesday after I got into the rhythm Like think about coming back off of vacation. I was a junk assistant for about two days Just try to get back into the ring of it and to realize like AI doesn't ever sleep. It doesn't need a break It doesn't need to eat. It's consistently putting out the same results every time

 

I just think it gives you a leg up and ace in your hand with minimal effort on your

 

Kiera Dent (22:24.781)

Mm-hmm.

 

Kiera Dent (22:41.521)

Yeah.

 

Kiera Dent (23:01.831)

Yeah.

 

Kiera Dent (23:08.721)

Mm-hmm.

 

Kiera Dent (23:24.315)

Yeah.

 

Kiera Dent (23:40.555)

Oh.

 

Kiera Dent (24:05.16)

I mean, that's an FMX mic. I was like just doing quickly counting up an FMX and I'm like, you know, you got your 20 right there easily. And doctors, I know when you get out of that exam or out of that treatment room, me as an assistant, I'm like, hurry it up and get back here. So you've got your assistants, you've got your hygienists all pressuring you to get back to the room and to get the exams done, you got to bust a move and get in there quickly, do a quick gloss, do your exam, do a thorough exam and then move on.

 

that is high pressure, high stakes. Why not? I just think if I could get a leg up and be able to do it easier and better for my patients, why not? So that's why I'm obsessed with you guys, Mike. I think you guys just have a great platform. I know a ton of our practices have used you guys, have had really great success. It really has become something where the diagnosing becomes easier. I think not even just the diagnosing, because I feel like dentists do pretty darn well on diagnosing. I think for some, they are a little more shy to diagnose, and that's okay.

 

But what I think is really awesome is it just gives the confidence that what I'm seeing a patient's going to see and I don't have to try and convince them that what I'm telling them is true. It's here backing me up. And it is saying that what I'm seeing is what that's seeing and it's two opinions right there. So I think that just gives confidence to dentists as well. So for me, I'm like, if I could make my life easier, I could get more confidence and I could get more yeses with less effort in my exams.

 

Yes, I would definitely say yes. So Mike, if people are interested, they want to, because you guys, again, you don't need, you can try it out if you hate it. You don't have to continue on, but I think it's at least worthwhile to try and just see what your case acceptance is, what your denials, if you can reduce those denials, all of that. If you can have greater case acceptance, why not? So Mike, how do they connect with Pearl? How can they try this out? How can they see if it'd be a good fit for them in their practice?

 

Kiera Dent (26:30.152)

Cool, yeah, and they take great care of our Dental League team listeners, so be sure to tell them you heard about it here. That way you guys can meet. I know they've got some good things for our Dental League team listeners there, but truly so many practices love it. You can try the demo, you can test it out, you can see what it would look like, but I just think it's a worthwhile thing. So Mike, how long is the demo? Because I know people are really picky on their time. How long does a demo with Pearl actually take?

 

Kiera Dent (27:02.67)

Mm-hmm.

 

Kiera Dent (27:19.119)

Awesome.

 

Kiera Dent (27:24.136)

Cool. And I was just thinking guys for 20 minutes, that's what I was trying to point out. 20 minutes will get you higher case acceptance. It will get you more like easier diagnosis, get your whole team calibrate on those diagnoses. To me, it just seems like, why not? So I think like, hey, if I was going to implement anything in 2024, I definitely would be considering AI. You guys have seen it take off. It's everywhere. You might as well get on the bandwagon in my opinion and be a first adopter because I think those early adopters are going to have.

 

better success, easier, and your patients are just gonna have a better diagnosis longterm. So Mike, thanks for being here. I appreciate you guys so much. I truly appreciate you.

 

Kiera Dent (28:03.568)

Of course. All right. And for all of you listening, be sure to reach out. Let me know how we can help you. Hello at thedentaleateam.com. Reach out to Pearl, go on over there, see what it's like. And as always, thanks for listening. I'll catch you next time on the Dental Late Team podcast.