Nexus - Millennium Issue     

Dental Informatics -
Its Importance in Dental Education

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Elise S. Eisenberg, D.D.S., M.A.
Director of Dental Informatics

The NYU College of Dentistry (NYUCD) is committed to the proposition that new information technology resources can make a powerful contribution to dental education and practice. These technologies -- known collectively as dental informatics because they combine dentistry with information technology -- use computers and other electronic processes in support of education, patient care, and research.

The American Association of Dental Schools (http://www.aads.jhu.edu) has aided the development of dental informatics through a variety of activities including forming an Information Technology Committee (1988), developing a strategic plan for dental informatics (1990), and participating in various information technology consortia. Dental schools -- NYUCD among them -- are looking at novel approaches to the incorporation of informatics into dental education.

Technology in the dental office has also increased dramatically in recent years, especially in the number of uses that incorporate full patient information and clinical technologies. These technologies include practice management programs, oral health records programs, intraoral technology, multimedia patient education, differential diagnosis and treatment programs, digital radiography, air abrasion, lasers, imaging, computer-assisted design and manufacturing (CAD/CAM) devices, computer-assisted anesthetic delivery systems, and electronic probes. Today, in fact, employing technology in the dental office is a basic part of the dentist's armamentarium, and students must be prepared to use this technology both for practice and for research.

Over the past several years, NYUCD has made great strides in increasing student access to technology-based learning formats. Students can access technology-based resources at the College from their homes or dorms, and many seminars and lectures are given using laptop computers. The remainder of this article provides an overview of the current status of dental informatics at NYU.

The Use of Informatics in Dental Education at NYUCD
The Intranet and the Internet
The academic portion of the NYUCD Intranet (accessible only from within NYU) is an impressive collection of information from all facets of the curriculum. It currently contains over 10,500 files, of which more than 2,000 are image files. The information found on the Intranet varies from course to course.

One can find course syllabi, lecture outlines, handouts, assignments, conference and seminar information, practice quizzes and tests, as well as answers to quizzes, tests, midterms and finals, announcements, patient case presentations, lecture slides, review slides, student group information, faculty information, and educational links.

One of the strengths of the Intranet, as a World Wide Web-based site, is the ability to link to areas that are within the NYUCD Intranet or the Internet. This is particularly valuable in view of a recommendation made by the Institute of Medicine in its report on the challenges facing dental education (Dental Education at the Crossroads, 1995). That recommendation spoke to improving the curriculum by integrating biomedical sciences and clinical sciences to provide clinically relevant experiences. The integration between disciplines is not always clear to students who are expected to form linkages and to make use of this information in their real-time encounters in the clinical management of patients. The Intranet becomes an ideal vehicle to link together relevant material, thereby facilitating the integration. As the Intranet continues to grow, so too will the connections between courses.

The World Wide Web is currently being used by faculty and students for reference and for the acquisition of information not yet available or developed at NYUCD. It also allows for collaboration between courses and schools, especially in the area of patient case information and slide review.

In addition to the use of the Intranet and the Internet, the College's academic divisions are using presentation software for select lectures and review in the areas described below.

Basic Sciences
Students in oral histology and embryology and in anatomy have been using CDs created by the basic science faculty for two years. The histology CDs contain slides and images that are not currently available in text format, and the anatomy CD contains a variety of photographic and other images and three-dimensional multimedia to help the student fully understand the anatomical relationships being studied. Both CDs are interactive and reinforce concepts presented in lectures.

Comprehensive Care, Applied Practice Administration, and Behavioral Sciences (CCAPA)
Senior students are learning the benefits of using a clinical management system. For a three-month period they have the opportunity to keep track of their own patients using a stand alone version of the Easy Dental clinical management system software program. Students are learning to run reports and make business decisions integral to private practice based on these reports. An added benefit is that students learn what to look for when selecting a clinical management system for their office.

Growth and Developmental Sciences
Orthodontics - Sixty predoctoral students were involved in a pilot study that had as a goal to understand diagnostic records and patient problems and to explain these problems with appropriate terminology using presentation software.
Postgraduate Orthodontics - For more than a year, the postgraduate orthodontics students have been using the clinical management system software program Ortho II to maintain patient records and to schedule appointments. An additional diagnostic program being used is OTP (Orthodontic Treatment Planning), which can perform cephalometric analysis and "morph" this analysis onto a photograph of a patient. Digitized photographs and X-rays of the patient are added to form a complete "paperless" file for each patient, resulting in a "paperless" office -- which is a goal of this program and a model for implementation in other areas.
Pediatric Dentistry - For part of the curriculum in both the predoctoral and postgraduate programs, the Pediatric Dentistry Department is using a multimedia CD produced at the University of North Carolina Dental School. An additional software program created at the University of Washington School of Dentistry assists students with diagnosis and treatment planning at the predoctoral level.

Restorative and Prosthodontic Sciences
Dr. Louis Blatterfein Department of Prosthodontics
has been using multimedia delivery of preclinical information for many years. Faculty in this department are in the process of moving both preclinical and clinical material into Web-based environments using advanced software products such as Macromedia's Director. CDs created with this technology have been used in selected lectures, with enthusiastic responses from the students.
Dr. Arthur Ashman
Department of Implant Dentistry has been using the software product Simplant to digitize CT scans. The software allows for viewing bone density and simulates implant placement, simulates sinus graft surgery, and can help determine how much graft material may be necessary prior to surgery.

Surgical Sciences
Dr. Ignatius N. and Sally Quartararo Department of Endodontics - Students in the third-year, predoctoral program and postgraduate endodontics program are reviewing how to do root canal therapy with the help of a commercially produced multimedia CD. The second-year predoctoral, preclinical endodontics course will be using this to supplement both lecture and lab material.
Periodontics - Students in the first-year predoctoral course use Web-based lecture and clinical simulation information, radiographic interpretation, and digitized videos of patient exams. The third-year, predoctoral course has used a multimedia CD from Procter and Gamble for take-home assignments. This CD simulates a patient exam with medical and dental history, intra- and extraoral examinations, images and X-rays, and questions for the student.
Dr. Anthony S. Mecca Department of Oral and Maxillofacial Surgery - This department has been very involved with Intranet development and multimedia presentations for lectures. Faculty in this area are in the process of creating a CD on pain and anxiety management.

The Future of Dental Informatics
It is predictable that informatics in the dental office will continue to grow beyond traditional practice management and clinical applications. Informatics will play a role in communication among dentists and with their patients. Some dentists are already using the Internet for communication with colleagues and patients via E-mail and the World Wide Web as well as online chats and teleconferencing. Dental education and continuing dental education will see an increase in the number of online courses offered. As more and more technology is incorporated into the dental office, dental education will have to keep pace by introducing informatics courses addressing this new technology. In short, as dental education enters the 21st century, the use of the Intranet, CDs, and other forms of computer-based learning in the curriculum will continue to grow at the same rate as the growth of information technology in all other parts of our lives.