CATEGORY 102 AUSTRALASIAN DENTIST ARTIFICIAL INTELLIGENCE If you set out to design a disease to expose the weaknesses of modern dental diagnostics, you would struggle to do better than periodontitis. It is one of the most common chronic diseases in Australia, with national oral health surveys finding moderate or severe periodontitis in close to one in three adults, up from one in four a decade earlier. Yet it remains persistently underdiagnosed in routine care. In the previous article, we argued that dentistry asks too much of unaided human perception. Periodontitis is the clearest case study of what happens when it does. Periodontitis is not rare, and its consequences are not minor. Yet it remains one of dentistry’s most underdiagnosed conditions. A disease that hides in plain sight Periodontitis rarely announces itself. Bone loss is painless. Bleeding is easily dismissed. The disease can progress for years before a patient notices recession, tooth mobility, an abscess or pain, and by then the window for simple, effective intervention has narrowed. The stakes extend well beyond the mouth. Periodontitis is associated with diabetes, cardiovascular disease, cognitive impairment and other systemic conditions, making late detection a whole-of-health problem, not just a dental one. The measurement problem Consider what a comprehensive periodontalassessmentrequires:probingsixsites around every tooth while recording pocket depths, recession and bleeding on probing, as well as assessing furcation involvement and mobility. For a full dentition, this amounts to up to 364 individual measurements of probing depths, recession and furcation involvement, collected by hand and requiring 20 to 30 minutes of chair time. For patients, this can be quite uncomfortable: probing inflamed tissues can cause discomfort or even pain and bleeding, which is why many patients are reluctant to undergo it regularly. Probing is also technique-sensitive: force, angulation and tissue inflammation can easily shift a reading by a millimetre or even more, and two clinicians measuring the same site will often disagree. Although this may not sound like much, it matters when the thresholds separating disease stages can depend on differences of just one or two millimetres. Radiographic assessment has its own version of the problem. Judging bone levels by eye is subject to the same inter-examiner variability documented throughout dental imaging, not to mention the variability in the quality of the available radiographic data. Under the time pressure of routine care, the predictable happens: comprehensive charting is abbreviated, deferred, or reserved for patients already showing obvious signs. None of this reflects a lack of skill or care. It reflects a model that depends on a lengthy, invasive manual assessment being performed consistently and comprehensively, for every patient, at every visit. The result is a striking diagnostic gap. An estimated three in four patients with periodontitis do not know they have it, and the average delay from disease onset to diagnosis approaches five years. Where diagnosis breaks down: The case of periodontal disease By Khoa Le and Professor Axel Spahr Axel Spahr Khoa Le Key insight: The underdiagnosis of periodontitis is not a competence problem, it is a systems problem. When detection depends on timeintensive manual assessment under clinical pressure, inconsistency is built into the system. Veneer Placement Instrument amalgadent.com.au ● Autoclavable handle ● Two size suction tips ● Autoclavable tips ● Transparent silicone tips ● 3 mm lightguide tips ● Easy to hold ergonomic handle ● Firmly holds upper & lower veneers ● Silicone tips are reusable ● Hold and tack cure veneer with one instrument VAC-TAK™
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