Thank you for joining us for today's webinar, From Diagnosis to Using AI to Enhance the Patient Experience.

Today, we're going to talk about how better diagnostics can strengthen the entire process, from how we diagnose and treatment plan to how we present that treatment to our patients and ultimately help them achieve the best possible outcome.

I am very excited to have two incredible clinicians and educators with us today to share their perspectives. First, I'd like to welcome Doctor. Lou Graham. Doctor. Graham has more than thirty five years of clinical experience and is the founder and president of Catapical Education. He has been a leader in diagnostically driven dentistry and the integration of emerging technologies into clinical practice.

And joining us is doctor Melissa Harris, an internationally recognized clinician and educator and the CEO and cofounder of Ride Global. Doctor Harris has spent more than two decades teaching dentists around the world with a strong focus on clinical excellence, treatment planning, and helping dentists improve their practices.

So doctor Graham, why don't you start us off by giving us a little perspective on today's topic and what you'd like dentists to take away from this conversation.

I think the most important aspect in what Lincoln and I are gonna be sharing today is the more confident you are in your diagnostic ability.

That gives you that much more confidence in treatment planning, and that instills the trust of what your patients are gonna be looking towards you for. So I think one leads to the other and leads to the other. That would be my thought on today's course.

Excellent. And, doctor Harris, I'll turn it over to you to share your perspective on the conversation and what you think is most important when it comes to moving from diagnosis to that patient education?

So I think the the key thing is that you can't see what you don't know. So the first step of diagnosis is you have to have knowledge and you have to see. And what what do I mean by see? Like, when you buy a red Toyota, suddenly you see red Toyotas everywhere and the day before you bought it you saw none.

And it's not because they appeared. So step one of diagnosis is seeing, and that's like something that Pearl is helping tremendously with. If you don't see it, there is no diagnosis. So once you have a diagnosis, that's the potential for the patient, and there's a lot of things that can go wrong in the potential of the patient.

But once you have a potential for the patient, then you have to convert that patient somewhere towards the potential of the treatment that could be done. And so there's really two places there for a patient with significant demand and health problems to go to zero, which is one, you don't see it, so there's no potential, and then secondly, don't convert the patient or see any value in the treatment, and so nothing gets done.

Absolutely. Well, sixty five percent of patients are visual learners. So I'm looking forward to diving in. Without further ado, Doctor. Graham, we'll turn it over to you to get started. And Doctor. Lincoln, looking forward to hearing from you afterwards.

So my portion today really summarizes really my forty years in dentistry And that really traditional dental diagnostics really from the fifties was really all about guessing.

And guessing, as Lincoln just said, you gotta know what you're looking at in order to really treatment plan what's best for your patients.

So let's start today with understanding traditional dentistry. Traditional dentistry was really all about an explorer. Along came fluoride. And with the invention or introduction of fluoride, what happened was that our fissures, which used to be open holes, our occlusal fissures, they remineralized. And with remineralization, you would still get microleakage potentially then leading to the spread of decay in the dentin.

But an explorer became highly ineffective, and today, we still use explorers literally just picking at teeth.

So when you look at this image with two molars, forget the bicuspid, and you look at staining and absolutely no sticking, what's your treatment plan? And if you don't have more information, you're simply guessing. And explorers also equally don't have really great accuracy at even dentinal lesions if literally the fissures are just remineralized. So we've all gone in and dropped a bur in a fissure that we thought was a small decay, and there was a large hole. We've all been there. And that shows to you the lack of true diagnostic ability of a dental explorer.

Then we get to bitewings.

And when we look at bitewings for evaluating noncavitated early enamel lesions, the accuracy based on the literature is up to thirty percent. So, again, you're guessing when you're looking at a bitewing image. And equally important, even on a d one lesion that may not be capitated, the X rays really will not be that accurate to the point of about really forty five percent accuracy. So let's just take a typical case in my practice from a couple years ago.

I'm removing the occlusal composite, and maybe you see something on the mesial. But as soon as you drop in there and take out the occlusal composite, you see interproximal decay. Again, showing you the inaccuracy of bitewing images in general for early enamel lesions. And in this one, this was a d one lesion.

So, ultimately, we have to be diagnosing earlier for early enamel caries, and that's what I'm talking today about. We also have to diagnose better.

So these are absolutely two musts when we talk about being more preventive minded for all of our patients.

So when you now look at the studies with AI for early enamel lesions, the accuracy is between sixty six and eighty one percent.

Roughly, the literature is showing getting close to eighty percent. Is AI perfect? No.

But, again, there's limitations with X rays, and those limitations lead to limitations with AI.

Even with a d one lesion, look at the difference. You get an eighty to ninety percent accuracy with AI versus no AI. So, again, incredibly enhanced diagnostics.

This is just from one of the many literature publications that I reviewed, and what it showed was for early enamel caries, sensors were less accurate than film and even phosphor plates. I know it's kinda shocking.

But when you add AI, you go from a fifteen percent in this study to a sixty six to eighty one percent.

And maybe, yes, you would capture all these incipient lesions yourself, but I will absolutely tell you we see day in and day out that we are missing these lesions in our practice.

What about dentin caries? Sensors go up to about forty five percent accuracy, but eighty to ninety percent when using an AI tool like Pearl.

So here's the latest update from Pearl when we're talking about e one and e two enamel lesions shown on your left of your screen.

Now what happens is when you take your images, an incipient lesion can be identified, and it will show you the percentage of demineralization roughly to the DEJ. Yes. I would absolutely tell you that it's always about twenty percent worse.

That's what the literature will say. So, again, this is an approximation based on X rays, but now Pearl is giving you a quantitative reading of the, literally, the degree of demineralization in incipient lesions. So now when you're treating patients with a peptide, a self assembling peptide, and you go back, you should be able to see these percentages actually increasing with remineralization or you could say decreasing. That's the idea. You wanna see remineralization.

And so when we're talking to our patients and also when we're looking at X rays, you look at an X-ray for five seconds. I mean, I know how this goes after forty years. You're walking into a hygiene op, and you've got literally an FMX or bite wings, and you're just scanning. Here's the difference.

When you look now with Pearl, and this is with tooth parts, you now can identify two caries lesions underneath those alloys, one incipient lesion, and then four areas of subgingival calculus. This is all boom right in front of you. Is it always accurate? No.

But what it is is far more accurate than what we can see with our naked eyes. So you just have to look at this, and I love the name second opinion. It's not saying a hundred percent yes. You still have a brain.

This is your intelligence. This is how we work together.

And the last product that I have been using over ten years, and now there's a new introduction of a new technology, is Transillumination.

You see that correctly. It is ninety nine percent accurate at reading early enamel lesions interproximally and more. But today, I'm gonna focus on early enamel lesions.

So what you're really doing is is you're taking a video and then capturing the image.

And the normal hydroxyapatite crystals are very translucent, and they will appear white.

Dentin will appear a little grayer.

So what you see circled now is a demineralization of the enamel structure and the photons that were literally have undergone scattering, and this results in a decline of optical characteristics of the enamel.

So this is where you get to this ninety nine percent accuracy.

And the reason is transillumination, again, no radiation. It's a near infrared technology.

It can show mineral loss as early as five percent. As early as five percent.

It also will show you the buccal lingual area interproximally. In other words, where is the demineralized area compared to an X-ray, which is thirty to sixty percent required demineralization in order for you to visualize it.

So the technology, and this is from Cabo's new DiagonoCam, which has three features. One is fluorescence. One is an HD camera, and this is transillumination. It's all built in with one system.

And so what you have is you have two fiber optic paddles.

They literally go down along the gumline. It's totally comfortable.

They emit a near infrared light about eight hundred and fifty nanometers, and it travels through the bone, through the tissue, and up to the tooth. And as it comes up through the tooth, you're seeing this image. That's exactly how it works. Takes literally about ten seconds to do a quadrant, maybe fifteen seconds.

But here's what you can see.

You can see early enamel breakdown.

This is the window for a self assembling peptide like Curonide.

So if you can detect lesions four times faster or four times more accurately prior to them hitting the DEJ, I feel this technology, which I've been using with a previous system, is indispensable.

What's also interesting is the limitations. There are definitely limitations.

And as the decay interproximally gets deeper, as is seen in d two, an X-ray is gonna be far more accurate in reading the information. The way I approach this really is the way the literature has approached this. I love this as an adjunct to bitewing X rays, but I will clearly tell you for my adolescents in my practice, my teenagers, very often, would just use transillumination and not X rays. But we live in an insurance driven world where where X rays are paid for, so I would always supplement follow-up with transillumination. So this is what happens. You're gonna use with Pearl or whatever AI system you're using.

You would then use transillumination to verify the findings from AI. So AI is gonna be far more accurate, and transillumination will confirm, I believe, the accuracy of AI.

So let me just really get to my other portion, and it's about Pearl and opportunities.

So in our morning, this is a Wednesday morning in December, And when you open your dashboard, which is what I call it, we have thirty eight opportunities here, and it ranges anywhere from periapical maintenance all the way to a crown.

And what I'm gonna focus on is incipient restorations.

When you click on incipient restorations, anybody who's coming in that day will appear in blue.

So now I'm just gonna go down to one patient, TA, and I click on TA, and the opportunity is periomaintenance, a predicted restoration, and a restoration which is incipient predicted four and five. Now I want you to look at this carefully.

It says restoration predicted number four and incipient lesion number four. I'm gonna show you why this is important because it's identifying two different diagnostics or diagnosis for one tooth. So you'll see why. So when you open up second opinion, what I love are the color icons.

And the color icons are alerting you to that AI has found something on that X-ray. So in this case, you're looking at a pink dot and an orange dot, which is progressive caries and incipient caries. When you look at this X-ray, you immediately are drawn to that wonderful composite, and you're thinking I'm gonna have to redo it. But what you often miss are the incipient lesions.

And I'll go back.

Would you have caught that? And if you would have caught it, great. But the whole idea is that we don't wanna be missing these patient after patient. Because what happens? You take another bitewing in a year, and now all of a sudden you see the lesion has advanced when we could have prevented literally that advancement by placing a self assembling peptide in this situation.

So now I'm gonna go to the second X-ray, which is what I wanna focus on. Again, a pink dot and an orange dot.

So now you see that tooth number four, it says caries has progressed where previously it was an incipient lesion.

This is AI interpreting it because of the overlap of the X-ray.

So you, as a dentist, have to evaluate when you're looking at an FMX or bitewings, which is your best image, and that best image is gonna be that most accurate for AI to diagnose. The issue is really bad X rays.

So what Pearl has done, which we've adopted in our practice, and I love this, is that it identifies the issues, which could be underexposure, overexposure, cone cuts, overlapping, missing root tips.

And their studies have shown this is gonna happen ten, fifteen, eighteen, twenty percent in practices. Getting a perfect FMX, I love that. But what I don't love is walking into a room with inadequate X rays.

So what Pearl has done, and I applaud them for this, is my assistant who's taken this FMX we don't take FMXs anymore. We use CBCTs for those. But even if it's a bitewing and a PA, it will identify what is wrong with that image, and my assistant or hygienist are gonna retake it so I don't have to walk in the room and ask them to retake it. And this is just two examples.

Root tips aren't there. Overlap, obviously, these are inadequate X rays. I don't wanna waste my time waiting for my hygienist to retake them or my assistant. All of this is just part of the AI revolution that's happening in our practices.

Ultimately, and this is my closing slide, the whole idea is minimizing the death cycle of a tooth.

And what do I mean by that?

If you can predictively see earlier changes, we have ways now of minimizing those early lesions so they don't progress to requiring the first filling, then the second filling, then a crown, then a root canal, then, obviously, that can all fail and, ultimately, an implant or a bridge or a partial.

The goal is avoiding the cycle. And the more we look at the future of preventive diagnostics and enhanced diagnostics, we'll be far more treating our patients, I think, in a far more effective manner.

This is when I turn it over to Lincoln. So thanks for listening, everybody.

Thank you so much, Lou. I I love these tools that we have to help us with seeing, with visualizing, and with educating the patient. And we're really seeking to solve two problems simultaneously.

The first problem is that the dentists themselves. So as dentists, we get the most confusing training that you can imagine. We get dental school telling us that we are a procedural profession, but procedures are bad.

Literally a lot of dental schools, even though dentistry is by nature a profession of doing procedures, at the same time we get told that if you do a procedure you're dooming the tooth. And then there is the idea that we should help people achieve good outcomes but also be minimally invasive and that we should focus on the patient but also tell them what to do. So it's very confusing and so part of the tools that we have now help us understand what needs to be done and help us. And not just us personally, but help dentists generally because more and more dentists graduate into a variety of different offices, groups, DSOs, all types of businesses.

And they vary so much that there needs to be a way to get a standard baseline. And in particular in a world where there are groups that have five hundred dentists or one thousand dentists, there needs to be some sort of tracking mechanism to keep track of things. But even if you can see something on an x-ray or you can, the patient can see it, you can see it, then where do we go from there? And now we have a second problem which is first of all we have to allow ourselves to be a proceduralist.

You're a dentist, you're meant to be dentisting. And we're not physicians. Physicians are non surgical specialists, we are surgical specialists. And so there are unfortunately a bunch of people who don't like dentistry but are dentists and they spend a lot of time trying to undermine us.

And so that first of all is in our head. Psychologically, the biggest barrier to dentistry being done effectively, efficiently, and early enough to not be catastrophic is not the patient, it is the dentist. The dentist is the biggest barrier to treatment. And then after that, then we have the patient acceptance.

So how do we get from the diagnosis to the treatment?

And this doesn't change whether you are doing one single broken tooth, an incipient lesion, dealing with periodontal disease, it makes no difference. Now this is not a particularly nice photo. I have better photography. I took this a very long time ago, but it's very useful because the process that we use to talk about a single tooth should be the same as we talk about a complex treatment.

The number one thing that I have learnt in the last month is that since we're a child, we're trained that anytime someone asks a question, we give an answer. So we're trained to give answers. And and so then when patients come in, they ask questions, and then we give answers. But when you're trying to help someone see value, the very first thing that needs to be done is they need to feel understood.

People get things done or get procedures done or get services done or buy equipment or goods or consumables from people preferably who make them feel understood or who understand them. So if we have a tooth like this, a single tooth, you could, you know, obviously you don't even need Pearl for this one, but maybe for the tooth next door you do. But it will be very obvious that this tooth has a big hole. Yet there are so many people who will have a big hole like this and they will do nothing.

Dentist will do something very basic. Now when I show this to dentists around the world and we assume that the roots are okay, one hundred percent or ninety nine percent of dentists say if it was their tooth they would want ceramic.

And yet for a tooth like this, a vast majority of the time they're not going to get ceramic, they're going to get a large filling or a patch up. You can see this tooth has already patched three times. It has three fillings in it and it's broken. And so how does this disconnect occur between what dentists know is the right thing and what's actually being done? The first problem is the way we're trained at dental school. So we're trained to give options and options are not terrible, they're just not effective.

And whilst people will say, well, I need to have options because for informed consent and legal purposes, it's actually not true. So you don't need options for this. You need an effective conversation.

We now have the visualization that there's a problem and it might be the single broken teeth I show or it might be a patient who has twenty five caries lesions. So even if it's basic dentistry, it's going to be very expensive and they've come in thinking everything's fine and they had a check up two years ago with their old dentist before they moved to college and now suddenly you're going to sit there and go, you need twenty five fillings, and the patient is going to freak out.

And so, of course, what we do to try and soften that is we're being taught to give them options at dental school. And being taught options is like being taught hot cross buns as your first song. Okay? For those, I don't know if they in every place in North America, they have those little whistle things called a recorder.

But my children and even me, we all learn to play the recorder. It's the most annoying instrument except maybe a drum kit for a three year old. And we learn this very basic song. Now that's not teaching you to be a concert musician.

It's teaching you the very basics of music. And so giving people options is like learning hot cross buns or, you know, Mary Had a Little Lamb on the simplest tin whistle or recorder or a single handed short keyboard.

It's not horrible. It's just not good.

So when you give someone a lot of options, what you do is you confuse the patient.

And when you confuse people, they shut down. So if you've ever been overwhelmed, you will have shut down such that you don't want to make a decision. So the typical reaction to being overwhelmed or confused or overly stressed is a reaction that comes from an amygdala, which is fight, flight, or freeze. So if you confuse a patient they're going to get angry, they're going to run away, so I'll think about it and they'll leave, or most commonly they will just not make a decision, they'll do nothing.

And so giving people lots of options confuses people, it stresses people, and it should never really be done.

Now what doctors do, if you go to any doctor who's highly trained, so any specialist, orthopedic surgeon, your ophthalmologist, they don't actually give you many options, if any. They often look at what you have and then they make a recommendation. Now why do they do that? Because they're trained for twelve or fifteen years and as a dentist you're trained for four.

And they have done thousands and thousands of repetitions and also they treat a very narrow range of things. So as a dentist, you might actually do fifteen different procedures. And it might be that a specialist is an orthopedic surgeon who subspecialized in the knee joint reconstruction for NFL players, and that's all they do. And they prefer doing left knees.

They're a specialist in they're a subspecialist in one thing. Whereas as a general dentist, you're not a subspecialist.

You are a specialist in one part of the body, but you are doing many things. And so because we lack training, we kind of fumble around in the dark for many years and this makes it difficult for us to make a recommendation. And also because of the way we're trained to give options and this big fear of being paternalistic and telling people what to do, we're trained at dental school not to make recommendations or tell the patient what to do. Of course the problem goes that if you end up in front of the dental board or in court, no one will really care what options you gave the patient.

They will care was the thing that the patient chose to do the right thing and did it give them a good result that met their expectations? And if the answer to that is no, then it won't really matter which options you give. So on the basis that you will be held one hundred percent responsible for your options, you should make a recommendation. Now making recommendations is very, very comforting because people are often very anxious when they come to a dentist.

And if you want to increase anxiety, give people a lot of things to think about. So even if you are going to give options, it must be very simple, very clear, and it must be like two. So then I guess the question is, how do you get rid of options?

You get rid of options by asking questions, And this takes a lot of practice. If you have more than one option, you haven't asked enough questions. So if a patient came in and you take the x rays and no one can see anything, know, pointing at an x-ray with a pointer when it doesn't have Pearl is a complete waste of time because the patient will agree with you to make you go away but they can't actually see anything. So Pearl is showing them everything, the photos are showing them everything, your transillumination is showing people things. You have all of these tools, okay, but now you have to convert the patient. And if you just tell the patient, hey, you need twenty five fillings or you need four quadrants of gum disease and no one's ever mentioned this before, what you do is you tip that patient into shock.

They go into the grieving process and then part of the grieving process is denial, anger, bargaining, depression, acceptance. We've obviously patients deny that they need treatment many times. We've had patients get angry when we recommend it. So how do we transition a patient from what they have to what they desire to do without having shock.

The first thing you do is you want to start asking questions about what they are trying to achieve, which has nothing to do with what they've got.

So when you want to start working with a patient, you don't start with what they've got. You start with what does this patient want? You can get a lot more health outcomes done if the patient's focus is on what they want to achieve, not what they have. If you focus too much on what they have, they can get quite depressed and down, and then they're even less likely to do something.

Now we don't go, do you want to have teeth without a whole bunch of holes in them? Because that's not really that motivating. The sorts of questions that really get people to move forward is, what's your long term plan with your mouth? People don't think long term unless you ask them.

How long do you want your teeth to last? As dentists we think these questions are really obvious and we tend not to ask them because in our mind everyone wants to keep their teeth for their whole life. But it's not true.

Some people don't care, some people do. If they don't care, you're wasting your time. If they do, then you're not. But more importantly, the question itself gets them to start thinking about it. So then you might double tap the patient. You go, how long do you want your teeth to last? And then follow it up with, does it matter to you if you end up with dentures one day?

Most people now don't want dentures unless they have to, so they want to avoid it. And so really you're going, is this an outcome that's acceptable to you? You're showing them different pictures of the future.

And the patient will then start to guide you to what they do want. So they'll often go, No, I don't want to lose my teeth and I don't want dentures. Okay, so now we're getting somewhere and then you can start to go, Can you function okay? But obviously you don't say, Can you function? You're going to ask them, Is your chewing Okay? And then if you see on the Pearl, you look at your Pearl radiographs and you go, oh look, there's lesions everywhere, you could start to ask things, would it be a problem if you started getting food stuck between your teeth or if you started getting pain every time you ate chicken. Because an interproximal lesion, if left, that's what happens.

So people won't care about if you say, oh, if you don't fix your teeth, I'm going to threaten you with bad outcomes. What you're saying to them is, would this be a problem for you? I'm not invested in this, I don't care either way, but for you, if you started to get food stuck between your teeth every time you ate chicken and it started to ache, would that affect your life? And then you can focus on what they like to eat and bring their attention, okay, this person really likes eating barbecue in Texas. We know that brisket is really good at sticking between teeth, okay, this is going to impact their brisket eating lifestyle. And so what I'm doing is I'm focusing the questions on the patient's individual needs.

Then the patient can say, No, I would hate it if I had bits breaking off my teeth, I had food getting stuck there, I started getting pain when I eat, that would annoy me. And then you could go, If you smile and there's black holes showing in your back teeth, would that bother you or are you totally cool with it? You might think, Oh, well that's such an obvious question. No question's too obvious when you are working with a patient. And so if you look at what I'm doing, I'm asking questions that focus on function. I'm asking questions that focus on cosmetics, and then I might ask one that focuses on cost. You know, do you want to fix these problems that I'm starting to see sooner when they're less expensive?

And when I say less expensive, you know, a few hundred dollars a tooth. Or would you like to wait until they are really urgent and you can't put them off but then it'll be three thousand dollars a tooth.

So now I'm showing the patient that treating, doing all of these fillings now is not the most expensive option. It's the cheap option. We can get confused when a patient says, I'm concerned about cost.

Because we're so afraid of the patients complaining about cost. If someone says, I'm concerned about cost, we tend to run away and fear ourselves. But if someone says, I'm concerned about cost, you go, excellent. So what we will do is we'll work out a way to get these twenty five fillings done sooner that we're showing you on the Pearl x-ray because if we leave them, the cost will go up about ten times.

Certainly for me, I'm quite comfortable having a conversation about financing dentistry because I know that for them to do a payment plan, even if they pay interest, will be much less expensive. But the root canal interest rate is about one thousand percent. What does that mean? A filling's three hundred bucks.

If they need root canal therapy and a crown, it's three thousand bucks. So it's like ten times or one thousand percent more expensive to let things get worse. Now what you're doing is by asking the questions, you're guiding the patient to giving answers. So this patient has now said they don't want to have dentures, they don't want to lose their teeth, they don't want ugly black holes between their teeth and they don't want their brisket to get stuck between their teeth and they would rather keep the cost down.

And so now because of all those questions, if a patient's got a whole bunch of small interproximal lesions, go, okay, well to allow you to keep chewing and not get food stuck and not get discomfort and keep your costs lower, I would recommend we fix or repair. We don't even need to say filling or crown or anything.

We would repair these teeth. And if you can afford to we'll do them all at once. My treatment coordinator will help you work through the costings on that. If we can't find a way for you to do them all at once we'll start with the urgent ones and work through it. Now the patient has literally told us they want treatment.

If you have two options though, and one of them is expensive, the expensive one is always the correct one. So if you're planting a pot plant in the garden, you need a shovel, okay? You're never ever going to consider a bulldozer.

But if you want to build a three acre pond on your horse ranch, you're never going to consider a shovel. Well, you'll have the option of the shovel or the bulldozer, okay? But everyone wants to do the bulldozer because that's the right option. And so when you have two options and one of them's expensive, it's always the correct one. And so you should be recommending the expensive one as the correct option.

If it wasn't the correct option, you wouldn't offer it. You can do a distal occlusal filling or you can do a full mouth rehabilitation. No one says that, okay? But where they will give two options, where one is expensive, is when three cusps have broken off the tooth. Now clearly the correct answer for three cusps have fallen off and there's a crack in the last one, is an entire ceramic or gold restoration.

But many dentists will then offer a second option, which is a big filling.

Now the ceramic restoration or the indirect restoration will be much more expensive, and it is the correct option for the tooth. One hundred percent of dentists agree with this. And the only reason you're offering a five surface filling is because you're concerned about the cost and the patient being able to afford it. So what that means is if you have two options that you're giving the patient and one of them is expensive, you should say, if you can afford it, I recommend you do this. And what's interesting is when you start saying that, the number of patients who accept the ideal treatment goes up dramatically. And there's two very important things about ideal treatment.

The first one is that ideal treatment is more enjoyable to do and it's generally easier. It's often easier to do an onlay than a five surface filling.

And ideal treatment is correctly paid. So to do a very small filling doesn't take very long and it's not much effort, so the fee is correct for the job. But to do a five surface filling with replacing four cusps is a low fee, very complex procedure that's very tiring, which doesn't make you feel good. And so a portion of our burnout comes from doing compromised treatment that's badly.

Another option would be, crown lengthening is a simple procedure that most dentists can learn. If you do crown lengthening you get paid for it. And then when you go to do the crown it's really easy. But many of us do sub gingival crowns, which is the incorrect treatment for a deep, deep margin, which means we don't get paid for the crown lengthening and then we struggle for forty five minutes longer and it's really stressful and we run late and there's blood everywhere and our impression or our scans suck.

We get this problem where professionally it's less enjoyable.

It's professionally less ideal.

We get paid an amount that's not commensurate with the complexity and the difficulty of the task, and it makes us sad. Like no one likes doing compromised dentistry. So that's just a few things, and then of course we have internal barriers. I won't talk on this much longer, this is a full two day course, but internally we're often fighting our own battle with the cost of treatment.

So the person most afraid with costs in the room is not the patient, it's the dentist. We often are afraid of long appointments that are two plus hours, and will the patient cope with it? We often are sitting there worried for expensive treatments about our own ability to deliver, and then we start worrying about failure at dentistry. Dental school we get taught fear of failure, perfectionism, and we often look at complex cases and we're worried about getting sued or getting complaints.

But most importantly, we often reject offering a patient treatment so that they can't reject us. So we'll often give someone a compromise or not tell them the truth about what we're seeing or we'll downplay, a Pearl shows them it's a nightmare and we downplay it because we don't want the patient to be upset or to reject us or to be sad. So if you start going into a range of questions then what you do is if you ask the right questions you lead the patient to the treatment plan and the patient is basically saying I would like treatment. And if the patient says I'm not interested, then save yourself some time and don't worry too much.

Because offering a patient treatment that doesn't want it and they're not ready, particularly complex treatments like you can lead a horse to water, but you can't make it drink. And if you try and hold the horse's head under the water to make it drink, you just kill the horse. So with our patients, we have first to learn a discipline over ourselves, and then we can lead the patient to the treatment, and then we kind of get rid of that whole fight and tension that goes on. Now I think we have some questions now.

So I think Sheila or Kim is gonna join us and Lou, and we'll get in some questions. So Lou has told us the science of how we can see things and I've talked about how you can get the patient to actually do them. So Sheila, some questions at us.

Thank you, Doctor. Graham and Doctor. Harris for sharing such valuable insights on diagnosis and case acceptance. And what I appreciated most is how you both aligned on the common goal, is helping patients accept the care they need, especially when we can intervene earlier with treatment that's less invasive and less costly.

I think that's where Pearl AI can also be very helpful. It gives the clinical team that additional set of eyes, not to replace clinical judgment, but to help validate what we're seeing, increasing that diagnostic confidence as well as making case presentation much easier for the patient to understand. Doctor. Graham, your discussion on the circle of death really resonated with me.

As clinicians, we understand the potential consequences of disease progression that patients may not see like you were discussing, Doctor. Harris. And our job is to help them understand those risks and ideally prevent them. And Doctor.

Harris, your point about not overwhelming patients with too many options really stood out. Sometimes more choices are actually creating uncertainty and the patient leaves without moving forward, which is the worst possible outcome. So thank you both so much for being here today. Let's jump into some of the questions.

So, doctor Graham, how have advances in diagnostic technology, including the AI, changed your approach to the diagnosis when it comes to workflow, timing, and and you were talking a little about accuracy. How does one take the information from today and adopt that into their workflow tomorrow?

So I think to answer your question and to absolutely support what Lincoln was talking about, What goes on in initial exam should also be going on in different ways in a recall exam. There's always gotta be consistency.

That would absolutely be my number one. For my initial exams, I need information.

So for example, when I shifted to diagonal dentin in late 90s and other technologies, let's just say for caries, I knew confidently what I was treatment planning, and it was important for me to truly explain that to the patient and as Lincoln just said for them to want it. Today's exam in my practice, Sheila, is a total different exam than it was ten years ago.

We we take bitewings. We take a standard CBCT based on whether there's a TMJ issue or none.

We do a digital scan. So this way, my full hour is understanding a patient's medical and dental history, their risks. And by understanding their risks and the information that I can extrapolate in my examination, it allows me to minimize a dental surprise. It allows me to maximize what I think the correct treatment is, which is exactly what Lincoln was talking about.

Excellent. And doctor Harris, what do you think clinicians get wrong most when presenting their treatment? And and how do they build more trust with their patients? I liked when you talked about, you know, what kind of food and and do you wanna get brisket stuck? And it sounds like you're really getting behind the eyes of the patient. So what would you say to clinicians that they can take away from this webinar and put into practice tomorrow?

The best way to have a patient say, I'll think about it, is to confuse them. So that's by far and away. And then the second best way is to shock them.

Now you confuse people by giving them options, and every single dentist in the world's been taught options at dental school. This is not because it's good, it's because it's just the basic.

So there's like three levels to delivering treatment plans. Level one is give people enough options and hope one of them sticks. And basically the patient will choose the option that kind of fits with what they're thinking money wise, even though we never talked about money. The second level is a person educates the patient.

And we love education, okay, because education makes the person speaking feel good. You know, it's great to educate, strokes your own ego. Unfortunately education is logical and people don't buy for logical reasons and dentistry is a purchase. So the last part is understanding.

And understanding when you understand someone, you actually talk you actually say a lot less, and really experienced clinicians do this without thinking about it. But you'll notice very experienced clinicians, their consults are like two minutes.

And they go in and they go, missus Brown, how can I help you? And she goes, Doctor, my teeth are short and it makes me embarrassed when I smile. He said, Would you like me to fix that for you? Cool.

Okay. Is it the right time? And will it fit within your budget? Notice I haven't talked about the dentistry at all yet, just would you like me to fix it?

Is it the right time? Is it within your budget? So understanding rather than overwhelming and probably have a cut off that you don't give a treatment plan on the first day. So most practises, if you give a treatment plan over six thousand dollars on the first day, it's between four and six.

The patient's gonna say no. They're going to be shocked and not come back. So big treatment plans need to be delivered at a second or third visit.

Yeah. That's interesting because a lot of times people think, I may never see them again. I have to give them the entire treatment plan. Right?

And and I think that could be very overwhelming for a patient. I like how you talked about really understanding what they're here for. Right? We have our visions and we have our diagnosis and we're ready to go.

We're ready to explain to the patient, but being able to understand what that patient came in for and what they want out of that visit. Doctor. Graham, I'm curious to hear your thoughts when clinicians have said, you know, I've been using my own eyes for a very long time. I don't need any help with diagnostics and AI.

I'm concerned it could take my job or decrease my ability to diagnose in the future. So what are your thoughts on that question?

Okay.

First off, we are still human beings. And when I say that, no human being is perfect. No AI is perfect. Let's be clear here, Sheila, on that.

AI is an adjunctive opportunity to assist you in getting to the best diagnosis. You we all know that we only see so many shades of gray.

AI can see ten times the shades of gray. So we're taking a limited science in two d imaging, and what we're doing is we're extrapolating as much correct information as we can.

That's the idea. I just read an article where radiologists evaluating, like, I believe, pancreatic cancer, AI is so much better at evaluating it than a radiologist. Radiologist, and that was data driven. So I would say use AI as a adjunctive tool. Welcome it. It will only make you better. It will certainly not make you worse, Sheila.

Excellent. Well, as far as questions, that's the only questions we have for today. But looking forward to hearing more from both of you. And, just wanted to turn it back over to each of you to give final thoughts.

Lincoln, do you wanna start?

Sure. Look, think that I think that standardized testing of any sort that removes subjectivity is useful. Even if the treatment plan varies dramatically off the back end of it. It's very nice that no matter who looks at the x-ray, the diagnosis of what there is consistent whether it's one person over here or another person over here.

So that standardisation is incredibly useful, particularly given that the fastest growing part of healthcare right now is the consolidation of individual practises into DSOs, the fastest growing part of healthcare in the world. And that means that when you look at the x-ray you see the same thing that the last dentist saw. Whether you agree with the dentist or not isn't completely different, but that's so be super useful. I can't see how having consistent imaging will ever take anyone's job away.

If anything, it'll make us busier. I mean, the the history of the world shows that the more you can see, the more you end up doing. So that's that's not going to take our jobs away. The single thing like AI recording I went to a doctor recently and the AI voice recorder sat there.

It was a medical doctor. And he was actually listening to me instead of writing notes the whole appointment. And it was incredible. I connected with the doctor the best I'd ever connected.

And that's not gonna decrease the amount of doctor visits I have. It'll increase it. And I got a full hour of his time instead of half an hour of him typing. So AI frees us to focus on what we should be, which is connecting and caring as humans.

And to add to that, I couldn't agree more.

And I think that dentists today, Sheila, have to ask themselves, can they be a better dentist? In other words, with more information, you can have more predictive outcomes. And that's the whole thing. You want predictive outcomes.

And then secondly, I think we're entering into a whole new era of really much more about preventive and predictive data than being a dentist. Routinely, all we're doing is reacting to data. We see a cavity, we react. We see bone loss, we react.

I think with future salivary testing, genetic testing, all of this is gonna be exploding into what we would call minimally invasive predictive dentistry.

If you're a dentist, this can really uplift your practice, and I think it's really exciting to see what we're gonna be doing with Total Body Solutions and Predictive Solutions. So, you know, I graduated dental school in the eighties, and I look at it as an archaic time compared to today. That's how I would describe it.

Well, excellent. Again, I just wanted to thank both of you today for sharing all of your information, your knowledge, and these key takeaways from this webinar are so valuable for a clinician from day one all the way to I don't know how many days it is for you, Lou, but I won't mention that. So anyway, thank you again for joining us, and we look forward to seeing you on more web.

And that's a wrap.

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