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Inside Dentistry

November/December 2009, Volume 5, Issue 10
Published by AEGIS Communications


Digital Lightning

Digital radiography has emerged as a powerful indicator of a clinically competent and business-efficient modern dental practice.

Rand T. Mattson, DDS

Just as film-based images gave dentistry many advantages in the late 1800s, digital radiography benefits the modern practice in ways that far exceed the scope of film dentistry. Not only does it enhance the clinical practice of dentistry, it also has a profound positive impact on the business of dentistry. Digital radiography has emerged as a powerful indicator of a clinically competent and business-efficient modern dental practice.

The business benefits of digital technologies are often times overlooked when tainted by the stumbling block of cost. Cost is an important factor in any practice-related discussion that becomes even more significant when considering the dentist who is near the end of their career. Because these dentists are closer to retiring, they are less likely to net a positive return on digital radiography investments. Many older dentists admit to being technophobic and resistant to new technology.

A potent advantage of digital radiology is time conservation. It is faster than film in every way.1 Patients have less chair time, work dependent on an image can proceed faster, staff time is conserved, images are viewed immediately allowing additional images if necessary, or even “image guiding” of a difficult surgery or confirmation of results. Everything related to images happens faster, which creates clinical efficiency and holds down practice costs.

Digital image quality is better than film in many ways.2 Digital gives more detail especially when viewed on a large monitor. The quality of digital images versus film is no longer an issue (Figure 1, Figure 2 and Figure 3).3 Details become more apparent and are easily shared with patients. Images that are not exposed properly can sometimes be manipulated and used without needing a retake. Color and magnification can be added for patient understanding. The public understands computers and is familiar with monitors. Digital images viewed on a monitor help to remove X-rays from the land of dental mystique into something familiar that encourages patient participation in their oral healthcare decisions.

Digital technology encourages dentists to take better images. Poor images (eg, cone cuts, blurriness, improper exposure, angulation errors, and images missing critical anatomy such as root tips and restoration margins) discovered 10 minutes after the fact are less likely to be corrected than a poor image seen immediately and while the sensor is still in place (Figure 4, Figure 5, and Figure 6). Immediate minor adjustments quickly correct most common technique errors. The “new,” technically correct, retaken image is achieved with less radiation than a single traditional film.

Organization is another strong benefit of digital technology. Coupled with a computerized chart, digital images are much less likely to be misfiled in the patient record. There are no more drawers full of lost X-rays and fewer films filed in the wrong chart.

A huge advantage of digital technology is immediate consults. Digital images showing radiographic concerns can be e-mailed to a specialist, allowing a brief consult to happen by phone so that many questions can be answered before a patient leaves the chair. Immediate consults save the practitioner both time and effort. They also deliver peace of mind to the patient who no longer has to wait and worry about consult results.

Digital technology also takes dentistry to a greener level. Digital radiology eliminates processing and developing chemicals, silver, mounts, and paper records. Many communities are awakening to the fact that environmental health and personal well-being are tied to the environment. Some consumer groups are demanding greener healthcare. Digital radiography is green, whereas film images are not.

Digital Paperless Integration

Many practices have the necessary components in place for a digital paperless practice but have not taken the final integration step. Published literature and the author’s conversations with industry professionals indicate that far fewer than 10% of dental practices are paperless.4 There is a certain comfort in holding a paper chart in hand. Going paperless is a measure that many practitioners agonize over, yet banks and credit card companies have been paperless for years. Paperless has been tried and proven in many businesses.

Success in paperless integration is accomplished by the combination of good infrastructure and a practice management system (PMS) that meets the practice’s needs. It is imperative to have wiring to all practice areas with a computer, as well as areas where digital images are taken and viewed. While easier in new constructions where access can be planned, it is still achievable in a finished site. Power and network cables available at each location where there is a computer is the minimum standard for any system.

Acquiring the right hardware is the next step. Your PMS provider or a local specialist is often a great place to start. The selection of the right server is based on the size of your system and the number of users. A server with multiple discs and redundant power supplies can avert the problems of less sophisticated systems. Back-up hardware is also essential. Every practice should have multiple redundant back-ups which include off-site data storage. What may seem like overkill in the beginning can be precisely what saves the day in the face of a loss of data.

A common pitfall in the effort to go paperless is purchasing hardware and systems without a solid plan for integration. Efforts that do not include staff input and proper training are plagued with problems. The first day of implementation begs for a major staff rebellion and significant stress. Nominal preparation can avert the problems of poor planning and allow practitioners to not only survive but thrive. A successful, low-stress incorporation of digital into a paperless practice can be achieved by following these common-sense steps:

Engage the staff in the selection of a digital imaging system. Decide the best fit for the PMS and practice style. A staff that has input into the process is much less likely to drag their feet and sabotage the integration process.

Evaluate your hardware. Look at your current hardware and additional hardware you need to make the digital and paperless transition. This is a quality-and-quantity discussion. All hardware needs to meet the new system specifications (quality) and hardware needs to be available wherever the digital/paperless systems will be used (quantity).

Create your digital business plan. How will insurance claims be submitted, on paper or electronically? Plan how to scan paper communications and film radiographs into your PMS. How will you communicate with other professionals, electronically or on paper? All of these questions should be answered before a digital or paperless transition.

Train your staff on the new system. The most common mistake dental practices make when purchasing technology is failing to offer adequate training. A properly trained staff will quickly see the benefit of digital radiography and anticipate the transition to paperless integration.

Ensure that each paperless element functions flawlessly by itself. Does the PMS and paperless charting work for the practice? Does the digital system integrate into the electronic chart? Does everyone understand each system and have enough knowledge to make them work? Is the digital system working—does it capture all of the necessary images without any concerns and integrate them into the PMS? Make sure the answer is “yes” to each of these questions before proceeding to the next step.

Set a conversion date and implement the plan. This is the day you “pull the trigger” and convert to a digital paperless practice. When you plan properly and all of the component systems are functioning smoothly, integrating digital or converting to paperless is easy.

Huddle daily. Huddles are critical to a smooth transition. They reduce stress and increase efficiency because they provide a forum where problems are identified and solved, and tips and tricks for the new systems are shared. Huddles keep everyone standardized in their performance on new systems. They also help offices to determine areas where more training is needed and when comfort levels and competency has been achieved.

Look ahead. Finally, once you have accomplished your integration goals and office competency is achieved with a new technology, add the next technology in your plan.

Conclusion

Digital’s time arrived years ago, as has the prospect of the paperless practice. Together they typify a modern, efficient practice. Synergizing these two technologies creates digital lightning which amplifies the best features of each component. Together, they carry dentistry to new levels of clinical care and efficiency.

References

1. Kantor ML. Dental digital radiography. J Am Dent Assoc. 2005;136(10):1358-1360.

2. Emmott L. 6 Benefits of the technology. Dental Products Report. Available at: http://www.dentalproductsreport.com/articles/show/dpr0108_emmott_digital-radiography-part1. Accessed November/December 12, 2009.

3. Farman AG, Levato CM, Scarfe WC. How going digital will affect the dental office. J Am Dent Assoc. 2008;139(Suppl 3):14S-19S.

4. Schleyer TKL, Thyvalikakath TP, Spallek H, et al. Clinical computing in general dentistry. J Am Med Inform Assoc. 2006;13:344-352.

About the Author

Rand T. Mattson, DDS
Rock Run Dental
Roy, Utah


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Image Gallery

Figure 1  Large digital images show more detail than traditional radiographs.

Figure 1

Figure 2  Digital image quality exceeds film images.

Figure 2

Figure 3  Digital image quality exceeds film images.

Figure 3

Figure 4  Digital sensors come in a variety of convenient sizes which approximate traditional film sizes.

Figure 4

Figure 5  Images taken with hard digital sensors eliminate artifacts common in film and plate images.

Figure 5

Figure 6  Comparison plate sensor image with significant clutter.

Figure 6