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Using AI for Good, Not Evil by Dr. Jeanette MacLean

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Categories: Practice Management, HR and Accounting;
Using AI for Good, Not Evil

by Dr. Jeanette MacLean

My thoughts on using artificial intelligence (AI) to interpret dental radiographs have changed dramatically over the past two years. My initial reaction was extremely negative. I assumed patients would be highly skeptical of AI and feared that some dentists might use it to “sell” dentistry or to over-treat.

Feedback from a colleague began to change my mind. Dr. Joshua Solomon practices pediatric dentistry in Northern California, serving a large population of parents working in Silicon Valley. He shared with me that his software-engineer-type parents trust his AI software’s opinion more than they trust his opinion as a board-certified pediatric dentist of more than 20 years.

A 2024 article in the Journal of the American Dental Association got the wheels in my head spinning in a different direction.1 The authors emphasized the need for modern caries management to shift from restoring cavities to “managing oral health and controlling oral caries throughout the lifespan through prevention and early intervention,” including system changes and technological adjuncts, such as artificial intelligence-supported algorithms, to endorse or support this model and track outcomes over time.

I started to wonder, what if we use AI as a tool for good, not evil? Meaning, what if we could use AI as a way to diagnose, treat, and monitor incipient caries lesions? I have been offering nonsurgical caries treatments like silver diamine fluoride (SDF) and resin infiltration to my patients for more than a decade, but I know not all providers offer these early interventions. I am hopeful that AI’s ability to highlight incipient caries lesions will help increase the adoption and utilization of nonsurgical caries management and discourage drilling into non-cavitated lesions.

I have been pleasantly surprised by the overwhelmingly positive response from our patients and parents to our new AI software. I frequently hear comments about how impressed they are with the technology or how cool they think it is. The response from our typically disinterested teenagers has been almost comical: when I mention “AI,” they suddenly perk up, turn in the dental chair to look at the monitor, and become actively engaged in a discussion of its findings.

The ability to export AI-interpreted images for patient education has been particularly helpful. When we have teenagers who drive themselves to their appointment or another parent with questions who didn’t come to their child’s appointment, the AI pictures are worth a thousand words.

So far, I’ve only experienced one parent who had a negative reaction to the AI images. She requested to see the original radiographs, citing fear that the AI was driving my diagnosis. I reassured her that it was merely enabling me to better illustrate my areas of concern in color rather than grayscale. I shared that insurance companies are using the same technology to protect against over-treatment. That changed her tune.

AI is not new in dentistry; it has been used for practice management, insurance verification, intraoral scanners, and CAD/CAM for years. AI use is pervasive amongst dental insurance companies and dental service organizations. AI can help expedite insurance claims, document bone levels, identify radiographic calculus, quantify the percentage of impaction for wisdom teeth, and much more.

Does this mean we will soon be replaced by robots? Of course not. As I tell my patients and their parents, we need to use our “actual intelligence” alongside “artificial intelligence.” A 2022 white paper from the American Dental Association provided an overview of AI, calling it a tool, not a replacement for professionals, that can enhance our human skills and intelligence.2 Our software, Overjet, sometimes misses lesions and gets false positives. I prefer to view the original image first, then view it with AI like an immediate second opinion or spellcheck.

Beyond its ability to support diagnosis and patient education, I have found our software helpful for identifying action items, such as when a patient is due for radiographs or sealants, and for untreated decay. It even prompts procedure codes for minimal interventions like SDF and Curodont. I also highly value its ability to help me and my partner remain consistent in our treatment planning. Admittedly, sometimes our tired eyes miss a lesion. AI helps catch conditions that could accidentally go undocumented or untreated.

A summary from the Veterans Health Administration’s First International Symposium on Artificial Intelligence in Dentistry highlighted, “Integrating AI into dental practice can improve diagnostic accuracy, streamline administrative processes, and enhance access to care. These tools offer substantial benefits for large health care systems, such as the Veterans Health Administration, including greater efficiency, personalization of treatment, and improved outcomes, particularly in underserved or resource-limited environments.”3

Like it or not, AI is here, and it is our future. We can choose to ignore it or we can embrace it and adapt to its strengths and limitations. You might even learn to love it, as I have.

 Case study:
A four-year-old patient presents with his mother for a second opinion exam. The mother of the child expresses concern for a surgical treatment plan presented by another pediatric dentist, since her child has no visible decay and is asymptomatic. Patient’s aunt, a dental hygienist who lives out of state, suggests they see me for a second opinion to determine whether a less invasive approach could be taken. The child’s mother had never heard of silver diamine fluoride but was extremely grateful for the nonsurgical option and agreed to have it applied the same day. Patient returns five months later, six months since his last prophy at the previous provider. New bite wings show that the incipient lesions are stable, and SDF is reapplied. Patient’s little sister is also seen for a new patient exam. Both parents attend this visit and express their extreme gratitude for the noninvasive treatment option I gave them, and state that they have been telling their friends with children about their experience.
Using AI for Good, Not Evil
Using AI for Good, Not Evil
Figs. 1a and 1b: Bitewing radiographs of a second opinion patient (DEXIS Titanium imaging).
Using AI for Good, Not Evil
Using AI for Good, Not Evil
Figs. 2a and 2b: Overjet identifies incipient caries lesions, highlighted in yellow. Surgical intervention is not indicated at this time. Nonsurgical treatment with silver diamine fluoride is offered and accepted by parent.
Using AI for Good, Not Evil
Using AI for Good, Not Evil
Figs. 3a and 3b: Five-month follow-up BWs (DEXIS Titanium imaging).
Using AI for Good, Not Evil
Using AI for Good, Not Evil
Figs. 4a and 4b: Overjet confirms the incipient lesions are stable after treatment with silver diamine fluoride (Advantage Arrest, Elevate Oral Care). The lesions between the mandibular right primary molars are no longer detectable.

References
1. Fontana M, Gonzalez-Cabezas C, Tenuta LMA. Evidence-based approaches and considerations for nonrestorative treatments within modern caries management: Integrating science into practice. J Am Dent Assoc. 2024 Dec;155(12):1000-1011. doi: 10.1016/j.adaj.2024.09.007. Epub 2024 Nov 2. PMID: 39488773.
2. Jagtap, Rohan. (2022). Dentistry - Overview of Artificial and Augmented Intelligence Uses in Dentistry.
3. DeNucci, Donald J. et al. Summary of the Veterans Health Administration’s First International Symposium on Artificial Intelligence in Dentistry. J Am Dent Assoc. 2025 August; 156(8): 649 – 657.

Author Bio
Dr. Jeanette MacLean Dr. Jeanette MacLean is a diplomate of the American Board of Pediatric Dentistry, fellow of the American Academy of Pediatric Dentistry, fellow of the Pierre Fauchard Academy, fellow of the American College of Dentists, fellow of the International College of Dentists, owner of Affiliated Children’s Dental Specialists in Glendale, Arizona, and mother of two. MacLean has become an internationally recognized advocate and expert on minimally invasive dentistry, appearing in newspapers, magazines, television, and continuing education lectures on this hot topic. Information: kidsteethandbraces.com
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