Ethics
Balancing Intuition and Technology: Ethical Considerations for AI in Dental Practice By Robert D. Stevenson Sr., DDS, FAGD, FACD, FICD, FPFA, FAAHD
This column is a collaboration between AGD and the American College of Dentists.
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s artificial intelligence (AI) technology becomes increasingly integrated into dental practices, dentists like Amanda Jones, DMD, find themselves navigating new ethical and professional challenges. Jones sits at her office computer, her brow furrowed in concentration. An emergency patient waits in the next room, and the diagnostic software on her screen recommends extraction of a grossly carious, painful tooth. Despite the software’s recommendation, Jones, a recent graduate, believes the tooth is restorable. She faces a dilemma: Should she trust her intuition or the judgment of the computer program? Our society has become captivated with the possibilities of AI. Generative AI has shown its value in creating documents, images and video. The technology is also making inroads into the practice of dentistry, with the promise of improved diagnostic accuracy, streamlined operations and enhanced administrative management. Studies show that AI’s accuracy in identifying caries, periapical radiolucencies and bone loss may equal or exceed that of the average dentist.1,2 Generative AI can be valuable administratively as a tool for claims submission, marketing and treatment planning. It can also aid in evaluating contracts. Generative AI will also provide an executive summary of articles in dental journals that busy dentists can’t seem to get to otherwise. Predictive AI is a new application of AI to healthcare. Predictive AI can evaluate patterns and predict possible outcomes based on the patterns it discerns. Besides obvious business and investment applications, it has the potential to predict possible outcomes, particularly in disease progression such as precancerous lesions. It may also help in establishing prognoses for treatment of intraoral diseases, implant placement and other processes.
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AGD IMPACT
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While AI offers many benefits, it also raises important ethical questions that must be addressed. Data privacy and security are high on the list for dentists. The current models of AI are trained to recognize patterns in words or images. As a platform is exposed to more samples, its accuracy increases. Bear in mind that the dentist has the ultimate responsibility for securing protected health information when using AI; this responsibility must not be entrusted to the software alone. An AI system is no better than the data it has reviewed. Methods must be developed to ensure AI is exposed to diverse patient groups to minimize biases that could lead to inaccurate diagnoses. A prudent dentist should be prepared to critically evaluate output from the tools he or she uses; there is no substitute for critical thinking in dental care. As dentists use these tools, they must be aware of the limitations of computer learning and be prepared to evaluate the responses they receive from their software. Eric S. Swirksy, in the Journal of the American College of Dentists, notes that “the words ‘bias,’ ‘disparities’ and ‘algorithm’ do not appear in American Dental Association (ADA) Principles of Ethics & Code of Conduct, but they do not need to.”3 The American College of Dentists’ (ACD) “Ethics Handbook for Dentistry” also applies but does not specifically address AI. Each of the five principles in the ADA Code has application to AI. Even if one is not an ADA member, the legal system expects that each dentist should abide by these principles. The principle of stewardship, as described by the ACD, describes the responsibility as a member of the dental profession to safeguard the standards and reputation of the dental profession, including one’s colleagues.4 The principle of autonomy applies to the choices the dentist makes as well as to empowering the patient to participate in treatment decisions. Data privacy is an essential element of autonomy, and respect for the patient’s preferences about diagnostic processes and treatment are crucial. For instance, if an AI system recommends a treatment that conflicts with a patient’s preferences, how should a dentist navigate this situation while respecting the patient’s autonomy? Nonmaleficence is honored as the practitioner critically assesses the options provided by his or her electronic consultant. If critical thinking and professional clinical judgment are discarded, the inherent risk of unwanted outcomes leading to harm increases. Protocols should be developed to ensure that the dentist’s professional judgment is respected and takes precedence over artificial opinions. Beneficence is at the heart of all dental treatment. Competence is a key part of providing appropriate care; it develops through experience, focused continuing education and training in new methods of technology. The dental team, under guidance of the dentist, should be well informed. The principle of justice focuses on minimizing biases and promoting fairness in clinical decisions. Bailey states that “AI-driven interventions should improve equity and not worsen existing disparities.”5 Justice, in tandem with veracity, suggests that the provider be transparent and honest about the tools used in diagnosis and treatment-planning if the patient expresses an interest. Justice also demands the use of critical thinking in clinical decisions. Veracity calls for the clinician to be honest with patients and honest with themself. The limitations of artificial decision-making