Dental software

Terminology

The term dental software defines software used in dentistry.

History

The history of the development of the dental software is brief. For the first time the computers have been used in the dental medicine in the 1960s[1]. Since then computers and information technologies spread progressively in the dental practice. According to Atkinson, J. in the year of 2000 85,1% of all dentists in the United States use computers[2].

Classification

There are many types of dental software, in dependence of the specific task, that they do to help the dental practice. One classification is given from Schleyer[3] and Kirsher[4]. They categorize three main categories of dental software: administrative, clinical, and for internet. The clinical category from other side is categorized in: electronic dental records, electronic dental designs, dental imaging software, and software used for diagnostics and treatment. Zimmerman[5] recognizes the following types of computer software, depending from their task: administration and management of patients documentation. electronic archives of the documentation. telecommunication computer - aided education computerizing instruments and techniques in the dental office software helping the clinical decision making. All classifications of dental software are relative, since there are software products, designed for realizing more than one task. A larger classification based on the specific task shows more types of tasks and software. This classification of dental software is:

• Dental administration management
• Dental practitioners records management
• Dental schedules and dental scheduling
• Patient dental records management
• Dental billing
• Dental imaging processing
• Dental diagnostics
• Dental treatment helping
• Computer aided dental education
• Software for usage of dental instruments and other techniques used in the dental practice

Dental administration management software

Different administrative and government institutions in the different countries of the world demand requirements to the dental practitioners. Such institutions may be health insurance companies, health booking offices, government registers and others. The dental administration management software is made to help both the administration workers and the dentists for meeting these requirements.

Dental practitioners records management software

The dental practitioners management software is a software most frequently used in dental clinics, or in hospitals, where more than one dental or medical practitioner works. The dental practitioners records management is mostly used from the administration and helps the users to effectively manage the records of the practitioners. There are many dental practitioners management software projects, available in the market. Examples of Dental Software Products, that support dental practitioners records management are:

Dental schedules managing software

The dental schedules managing software is designed to distribute the obligations of the dental practitioner in such a way, so no time both of the dentist and of the patients to be unnecessary lost.

Patient records management dental software

Patient records management dental software is used by the dentists in order to organize the records of the patients in their practice. The computer patients management software is used for collecting, managing, saving, and retrieving medical information for the patients, and for creating reports for the patients. Computers in the dentistry were first used to record dental archives[1] as an alternative of paper dental documentation. Later the term "computer based dental documentation" was replaced with the term "electronic patient record (EPR)" since the last better describes the method and the environment in which the patient record is being managed[6]. In 1991 in an official report of the Institute of Medicine of the National Academies in Washington, USA gives definitions about what functions must implement a computer based system for health documentation.

The American Dental Association (ADA) created Specification number 1000 and number 1004[8] concerning the structure and the content of the electronic health record. The medical data include identification and contact data, date of next visit, number of previous visits, anamnestic, clinical and paraclinical data, applied treatment, and treatment results data. Patient Records Management Dental Software is the most frequently used dental software. Many software products exist, however because of the requirement for not using list format only several will be listed.

Web based dental patients records management software is also been proposed. The web based records save the information for the patients in a central web server instead in the computer in the dental office[9].

Dental imaging processing software

The dental imaging processing software, or imaging software, defines software used for creating, processing, viewing and storing dental rentgenografic (X-Rays), intra and extra-oral images. Generally, dental imaging software is included in the product package of dental rentgenographic devices or can be purchased separately.

Most imaging software is DICOM ready or will be at an upgraded price.

There are several types of imaging software:

1. Manufacturer proprietary
2. Open hardware (not to be confused with open source)
3. Practice management linked

Manufacturer proprietary

There are many dental hardware manufacturers that produce their own imaging software. A few even have their own practice management (PM) solutions that integrate very tightly between the two products to produce a near seamless environment (which can fall under practice management linked- see below). All have their own database engines to help link and locate patient images, or they utilize a linked database structure from the PM software, which is known as bridging. In some cases, bridged imaging software cannot be utilized without the PM software operating in the background.

Manufacturer imaging software will have all the needed enhancements to make the X-Rays their product produces look the best. Generally, this sort of software comes free with the hardware and will have limited licensing usage or functionality unless an upgraded version is purchased. A couple of manufacturers will sell a full use, unlimited user license with their products.
Most software of this nature will only operate with the hardware manufacturer they were designed for and will accept very few outside vendors. Because of this, the dental provider is generally required to use the manufacturer's hardware and support.

Open hardware imaging

Some software vendors have created imaging software that will work with multiple hardware vendors and in some cases will produce derivative copies for manufacturers and PM vendors. Open Hardware Imaging (OHI) also focuses completely on the end result after taking an X-Ray or intra/extra-oral image, and that is image management and manipulation.

All OHI software requires the manufacturers software to be installed prior to usage. This insures the dental hardware's device software is operational and provides a default testing environment in the advent of a malfunction. It also provides a basis for the OHI software to obtain device settings.

Bridging to PM software is the most common way OHI can retrieve patient info for its own databases. Some PM vendors provide ways to integrate imaging into their software by use of creating toolbar buttons and other methods. This requires delving to the deep recesses of PM software and will be unique per brand. In the case the PM software doesn't have a direct bridge integration, the use of a data grabber or bridger is required.

Data grabbers or bridgers operate upon the displayed screens of the PM software. In most cases, the dental user is required to be in the patient information or the charting screen before the grabber can be used. This process generally works well, but once in awhile issues can develop such as patients with same names, the front office didn't input all the patient information correctly, or the use of middle initials/nicknames isn't properly defined in both software. Most of the time, these issues can be resolved with minimal fuss.

OHI software generally works off of their own database engines and therefore require their own database utilities. An advantage of this type of software is if one part of the system fails, such as the PM software, the practice can continue to work and take images, which is what is used most of the time.

Practice management linked

Practice management linked (PML) imaging software provides the tightest integration with PM vendors software. Because of this, patient images can be displayed in the patient charting screens. This generally doesn't combine the imaging and PM databases, but some vendors claim that is the case.
Most PML software is open to most hardware vendors though generally the biggest brand names are accepted. Some PML vendors will not work with certain dental hardware manufacturers because of various contractual matters or preferences. Some popular brands of PM software favor certain hardware that they prefer to sell and thus have adjusted their imaging to work well with those devices. For all intents and purposes, PML software behaves like OHI software and can be used with other PM vendors.

Dental diagnostics helping software

The software products are usually based on technologies, that try to simulate the human intellect, called artificial intelligence or AI. The expert systems designed to enhance the diagnostic process, are part of the dental expert systems software. Today for more appropriate definition is supposed to be decision support systems, or DSSs, and knowledge based systems(KBSs).

The only one software product, designed to help the dentists with the diagnostication of hard for diagnose placement diseases, that can be found in internet is the Diagnostic Helper Software: http://diagnostichelpersoftware.webs.com/

Dental treatment planning software

The usage of computer technologies for taking clinical decisions for the treatment of dental patients started at the end of the 1970s. The software products are usually based on technologies that try to simulate the human intellect, called artificial intelligence or AI. The expert systems designed to enhance the treatment process, by providing the dental practitioner with a treatment plan are dental expert systems software. Today for more appropriate definition is supposed to be decision support systems, or DSSs, and knowledge based systems(KBSs). Such software products are designed for the therapeutic dentistry[17], the prosthodontics[15, 16].

Dental internet and ethernet communication software

Telecommunication technologies found application in the medicine in the 1950s, which led to the defining of a new term "telemedicine". In 1997 Cook for first time uses the term "teledentistry"[11] and he defines it as the practice to be used videoconference technologies for diagnosis placement or consultations for the treatment from destination. Different variations of medical and dental data interchange using internet are developed[10]. It is expected this type of software to revolutionize the way for interchanging information between medical and dental practitioners. Today the teledentistry includes activities such as information interchange by phone lines, fax machines, and transfer of computer based documents by the use of internet. There are also special software products, designed specially for communication and information interchange between dentists, and software products specially designed to access dental information by the use of internet.

Computer-aided dental education

The computer-assisted education is an element from the remote education[12]. The term "electronic learning" or "e-learning" defines the usage of internet and multimedia in the educational course. Schleyer[13] describes the learning with the help of computer software as a means for overcoming the faults of the traditional forms of education. In 1997 Cook wrote about the usage of videoconference technologies by the means of their usage for dental education[11]. Today software for computer aided dental education are made for various dental specialities: orthodontics, dental imaging, endodontics, cariesology, oral pathology, pediatric dentistry, parodontology and prosthodontics[12, 13].

Software for usage of dental instruments

Instruments, used in dentistry, and needing software to operate are large number of models of digital rentgenography hardware, intraoral cameras, various diagnostic hardware products such as for early caries detection, parodontal probes, CAD/CAM systems[14].

Free dental software

There are several types of free dental software: shareware, freeware and open source dental software. Most frequently the free dental software is provided as shareware. This means, that the dental software license allows its usage only for evaluation purposes. These software products have limitations. However there is at least one freeware dental software project, which license allows it to be used free and for unlimited time from the dentists. It is localised at: http://freedental.webs.com/ There is a very well developed Open Source dental project, that can be found on: http://www.opendental.com/ However, even with open source, the open dental software is not absolutely free, because it uses third party intellectual properties, for which dentists have to pay for its usage.

Dental software versus special dental formats

Parallel with the development of the dental software many software products, that are not originally created as medical or dental software were adjusted to work for dental purposes. In many cases these adjustments were successful. For example patient database software in many dental offices were replaced by software products for general database management, such as Microsoft Access, Microsoft Excel, the legally free distributed Open Office variations of the above. Access and Excel files, structured according to the need of the patient management(defining fields as Patient Name, Ambulatory Number, Diagnose, etc.) in many cases are sufficient to represent functional, secure, powerful and intuitive for usage patients database, powerful concurrence of the expensive dental patient management software products. The disability of the text processing software to write the numbers of the dental teeth graphically(and thus unable to write and print dental patient reports) was overcame by the creation of dental fonts, that can be used in Microsoft Word and legally free text processing software products, such as Open Office Write and Abi Word. Readily made forms for dental patient report writing and printing appeared to be sufficient for the generation(by the dental practitioner, not automatically) dental patient records and their printing. Dental schedules management software can in a high degree be replaced with standard schedule management software projects, created for schedule management for general purposes, some of which can legally be downloaded for free. For processing of dental images were used many software products for genetral image processing, such as Adobe Photoshop, Irfwan View and others. Processing dental images with software products for general pictures processing proved to be powerful, easy to use, reliable, and much cheaper(in some cases free). Dental treatment planning software was "replaced" with legally scanned and legally purchased via internet books over the treatment topic, opened with ebooks opening software and shortcuts, designed to open the book on specific pages. For calculating hard to be calculated dental bills were used specially adjusted Microsoft Excell Sheets, instead of Dental Biling Softare. Many dentists are successful in receiving computer aided dental education without the usage of software for this purpose, by finding and purchasing ebooks, lectures from the websites of medical universities, browsing the Medline MEDLINE and other medical and dental databases, using usual email clients for communication via email and materials interchange via email, using internet explorer and other web browsers for participating in dental forums, and using e-learning, that do not require the purchasing of software. So far now the only type of dental software, for which special formats are not effective enough is the diagnostics helping software.

Recommendations for choosing software for the dental practice

For choosing the best management software for their practice, the dentists should have many things in mind, but the most important is whether the software fulfills the specific need of the dental practitioner. Another important advice to be considered the usage of special format and degree in which the special format will satisfy the practitioner's requirements. Dental imaging software has several factors to consider as well and is dependent upon the dentist's needs or wants. Some imaging software is proprietary and will accept very few outside hardware vendors, yet will produce good images for diagnosis. Others are more open and will work with a wide array of hardware and will have good image quality as well. Another factor is integration with the practice management software and how well it can incorporate patient info into itself.

References

1. Delrose, D.C. et R.W. Steinberg. The clinical significance of the dental patient record. -J.Am.Dent.Assoc., 131, 2000, Suppl., 57-60.
2. Atkinson, J. et al. Electronic patient records for dental schoolclinics: more than paperless systems. - J.Dent. Educ., 66, 2002, Vol. 5, 634 - 642.
3. Schleyer, T., H. Spallek et M. H. Torres-Urquidy. A profile of current Internet users in dentistry.
4. Kirshner, . The role of information technology and informatics research in the dentist-patient relationship. - Adv. Dent. Res., 17, 2003, Vol. 12, 77 - 81.
5. Zimmerman, J. L., M. J. Ball et S. P. Petrovski. Computers in dentistry. Dent. Clin. North Am., 30, 1986, Vol. 10, 739 - 743.
6. Heid, D. W., J. Chasteen et A. W. Forrey. The electronic oral health record. - J. Contemp. Dent. Pract., 3, 2002, Vol 1, 43 - 54.

7. Dick, R. S. et E. B. Steen. Committee on Improving the Patient Record. An Essential Technology for Health Care. Washington, National Academies Press, 1991.

8. ADA Specification 1004: Computer Software Performance for Dental Practice Software. New York: American National Standards Institute, 2001: http://www.ada.org/prof/resources/standarts/informatics_reports.asp

9. Schleyer, T. et V. Rado-Dasari. Computer basedoral health records on the World Wide Web. - Quintessence Int., 30, 1999, Vol.7, 451 - 460.

10.Schleyer, T. Digital dentistry in the computer age. - J. Am. Dent, Assoc., 130, 1999, Vol.12, 1713-1720.

11.Chen, J. et al. Teledentistry and its use in dental education. - J. Am. Dent. Assoc., 134, 2003, Vol. 3, 342 - 346.

12.Eaton, K. A., et M. Hammick. Distance learning materials for dentists - a users guide to quality. - Br.Dent.J., 194, 2003, Vol.5, 253 - 256.

13.Schleyer, T. et L. A. Johnson. Evaluation of educational software - J. Dent. Educ., 67, 2003, Vol.11, 1221 - 1228.

14.Hurston - Anderson, L. Integrated office technology: how technology can help improve officeefficiency. - J. Am. Dent. Assoc., 135, 2004, Vol.10, 18 - 22.

15.Beaumont, A. J. Jr. Microcomputer aided removable parture denture design. - J. Prosthet. Dent., 62, 1989, Vol.5, 551 - 556.

16.Davenport, J. C., P. Hammond et F. J. Fitzpatrick. Computerized design of removable partial dentures: a knowledge based system for the future. - Dent. Update, 20, 1993, Vol.5, 221 - 226.

17.Duncan R. C. et al. Using computer to diagnose and plan treatment of approximal caries. Detected in radiographs. - J. Am. Dent. Assoc., 126, 1995, Vol.7, 873 - 882.