Episode #619: The Next Big Thing In Dentistry, With Dr. Christian Coachman & Philippe Salah

You don’t have 24/7 access to your patients’ mouths — until now! Today, Kirk Behrendt brings back Dr. Christian Coachman, founder of Digital Smile Design, and Philippe Salah, CEO of Dental Monitoring, to introduce a revolutionary system that will help you monitor your patients’ oral health in real time. With DM, you can optimize the care you give before, during, and after their time in your chair. Prevention and maintenance have never been easier! To learn more about the next big thing in dentistry, listen to Episode 619 of The Best Practices Show!

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Main Takeaways:

Remote dental care is possible and powerful.

Dental Monitoring cuts down wasted appointment time.

DM will detect problems much faster than standard appointments.

Using DM, you know exactly when and what treatment patients need.

Remote care is already the standard in medicine. Start using it in dentistry.

Quotes:

“When you are doing treatment for your patient, you never know what is happening when you don’t see your patient — when the patient is at home. And you all know, especially in orthodontics, that the clinical relevance, the clinical action, is happening outside your practice. [Dental Monitoring] brings you back necessary information to be able to drive the treatment in the best direction possible at every moment during the treatment. So, how does it work? It’s very simple. Your patient gets a smartphone. From that, we take several pictures — more than 100 pictures, automatically with our system, with a pretty cool way of taking them. From that, we use these pictures — taken by the smartphone, not your patient — and we triage lots of clinical notifications where we indicate to you, to the orthodontist, if there is some concern or great achievement that you want to communicate with the patient. Or maybe it will trigger an appointment. Or the opposite — it will trigger, ‘No need to see my patient.’ So, for the first time in dentistry, we really synchronize the delivery of care with the need of care. You see the patient as much as you need to see them, and at the right moment. Never less, never too much.” (3:53—5:11) -Philippe

“[Dental Monitoring is] like taking care of the patient before they are sitting in your chair, and after they are sitting in your dental chair. If you count all the hours that somebody lives in a full year, maybe the patient is one, two, or three hours in your dental chair during the whole year. So, you have all the other 365 times 24 hours where you’re not seeing what is happening in the patient’s mouth. That’s why I think remote care is so powerful. Everybody is already taking advantage of this in other areas with smartwatches, physically and even emotionally, sending information, sharing information with their physicians through devices. So, physicians can actually control what is happening in our body when we are not there with the physician.” (5:16—6:09) -Dr. Coachman

“When I started to work in the dental field, I was working in practices where lots of the patients coming in for the first appointment were not ready for the treatment. If it was an ortho treatment, they were too young. They were baby teeth, not ready for the treatment, or they get perio problems and they need to see their periodontist or their GP to be treated first. This was pretty inconvenient for the patient and a big waste of time for the orthodontist. Here, we fixed the problem. Now, before arriving at the clinic, we allow the doctor to get a pretty accurate screening of the patient prior to the first visit. And then, based on the result, the orthodontist, the specialist, or the GP will be able to qualify the patient and drive them in the right direction, ‘Yes, you can come to my practice. This is a good time to see you,’ or, ‘Maybe go see my colleague in another discipline that will help you first before you come to me.’” (6:22—7:19) -Philippe

“Let’s say you are [doing] an aligner treatment or braces treatment. When do you see your patient? You see them every six weeks, eight weeks, 12 weeks, 16 weeks. On what basis? What is the rationale behind that? The rationale for most orthodontists in that example is what we call their comfort zone. They feel comfortable that within the next six weeks nothing bad will happen. But, in fact, they never know. Most of the time, the patient arrives at the practice and it’s a surprise. It’s a good surprise, sometimes. Nothing bad happened, and everything is fine. The patient arrives, and you say to little Timmy, ‘You’re good, Timmy. You can go back home.’ Isn’t that a waste of time for Timmy and your practice? Or the opposite scenario. Timmy arrives [with five broken] brackets, and from a five-minute check appointment, it transforms to a 40-minute appointment. And then, stress comes to the practice. This is another scenario. Is it not a failing scenario again? I think these two scenarios, which are 99% of appointments, is not a good scenario for the orthodontist.” (7:23—8:33) -Philippe

“What is the chance, without a monitoring solution, that the patient is coming to your practice the exact day you need them to come? Very little chance. So, we make it happen [with Dental Monitoring]. Every week, the patient is taking a scan. Then, we needed artificial intelligence. We needed something to automate it because we knew that the orthodontist or the dentist will not look at the patient every single week. We needed to automate through artificial intelligence to screen at the medical device level that the accuracy of the records is sufficient for the dentist or the orthodontist to make a decision, ‘Do I need to see my patient? Do I need to act with him?’ This was the power we created.” (8:33—9:19) -Philippe

“[Remote care] is not new technology for medical. If you have a cardiac problem, cardiologists now will give you some metrics with some monitoring devices, and they will track down your pills on your appointment based on the recording. They will see you as much as needed based on the recording, or as little as needed based on the recording. Diabetes problems are the same. You’ve now got probes that are constantly measuring where you are in terms of your glucose level and will adapt your treatment based on the monitoring solution. In dentistry, we deserve the same level of quality. We deserve the same level of standard. It’s a new standard of care, to bring as much care as needed or as little as needed. Don’t overtreat or undertreat. This is really the core value of DM. We never say to our dentist, ‘Don’t see your patient.’ We tell them, ‘See them better.’ Some of your patients, who are disasters, you will need to see them more. Luckily, most of your patients will be very good patients. Because of that, you will see them less. So, it’s really improving the quality of care, improving the quality of the perception of the dentist on the progress of the treatment they do.” (9:47—11:07) -Philippe

“I was blown away when I first saw this. What [DM] did is something very cool. If you start a first appointment and you scan your patient in your practice — so, you have a 3D model of the patient’s mouth — from that moment on, every time the patient scans their mouth with their phone, their technology, through those images, is able to adapt the original STL, the original intraoral scan with the pictures, and transform the STL into a new 3D model of the existing scenario. So, in the future, you’re going to scan your patient on the first appointment. From then on, you will not need to scan them anymore because 2D images will create 3D models of the existing situation of the patient. You can track orthodontics without having to scan the patient during treatment. The software will do that by itself.” (14:30—15:38) -Dr. Coachman

“We believe that we are a very good complement to intraoral scanners. It means you take an initial intraoral scan, but you know that during the life of a treatment you will need multiple intraoral scans. Let’s take a scenario. You’ve got an aligner treatment. You scan the first time. You provide this STL file to your manufacturer, whoever it is. This manufacturer will provide you with a first set of aligners. Very often, if it’s not all the time, you need to do a refinement. This refinement triggers two appointments, one appointment to take a new scan, then wait for the manufacturing of the additional aligner, and then bring the patient in again, deliver the aligners, and then you start with a new cycle. Now, we want to invent a new way of treating, which is, you scan the patient, as before, treatment plan, deliver the first set of aligners. And throughout the progress of the treatment, we identify when it’s going wrong, when there is untracking in a set of aligners, a misfitting, or whatever. And then, we will produce an STL file at that particular moment, send it directly to the manufacturer, which will produce the next set of aligners. And this next set of aligners will be delivered to the practice even before the patient is there. So, it means that when your patient is coming to your practice, you already have the next set of aligners.” (15:59—17:35) -Philippe

“The world where you produce 40 aligners through Beam, and then you produce another 30 through Beam, this world will disappear. You will produce aligners only on demand based on the tracking. So, as you understand, it’s better for the manufacturer. It’s better for the planet. It’s better for the patient. And obviously, the more the treatment is good, it’s better for the practice. So, everybody is winning by this new cycle, which is a more dynamic production of aligners. And this also works for braces. If you, for example, use custom braces where you want to adapt your wire remotely for SureSmile or LightForce, imagine the fact that you can have a dated scan throughout the treatment. You can adapt the treatment like this. If you want to do retainers, today, you have to ask the patient to come in, then hope that the patient will be coming back in the next few days to be sure that you can give them the retainers, and so on. Now, you don’t need to. Just ask the patient to scan. And when they come, you already have the retainer ready. So, it’s changing the way you interact with your patient, making it far more convenient for everybody, for all the stakeholders of the value chain and the treatment chain.” (18:44—20:11) -Philippe

“Bringing the patient in only when they need it, at the right moment, for the right reason, should be mandatory. It should be the new standard of care. Don’t ask little Timmy and his mom or father to waste an afternoon of their day for just, ‘Everything is good, Timmy. Come back next time.’ Or the opposite, where you stress your entire clinic because everything is a mess and you did not capture sufficiently early that Timmy was actually not a good patient, not complying, breaking everything in his mouth. You want to make sure that this is under control. And if you take an adult patient, what do they want? They want efficiency. Time is super valuable.” (22:04—22:54) -Philippe

“I love to take myself as an example. I’ve got four kids, myself, and my wife. My wife, I don’t have to take care of her. But for my four kids and myself — if I had to see the orthodontist of my kids every six weeks, you imagine four kids, I would be dead like more days going to the orthodontist than taking the days off. And if I speak for myself, I love the fact that my dentist is using DM to see if everything is fine. Do I need cleanings? Do I need plaque removal, etc.? Everything is fine. I don’t need to come. He charges me, no problem. And then, the next time I need to do my cleaning, I go at the right moment. It’s better for my life, better for the orthodontist, for the dentist, for whoever wants it. It’s the way it should be.” (22:55—23:50) -Philippe

“Why should we live in a world where we are fixing the problem instead of living in a world where the appliance is actually produced and generated dynamically based on what the patient and the treatment needs at that particular moment? It wastes time for the doctors and the patients, and is a big, big, big manufacturing headache for the manufacturers. All this should be disappearing.” (32:38—33:06) -Philippe

“We know that there is no treatment in dentistry which is just one time. Every dental treatment has multiple visits, multiple checkups, and needs maintenance. And so, there are multiple ways to synchronize the delivery of care with the need of care. Let me give you an example. We work in elderly homes where we help elderly people scan their mouths. They take pictures of their dentures, and then the dentist evaluates, ‘Do I need to change the denture? Do I need to act on these elderly people who are suffering?’ because there is an abscess, and nobody at the care home has seen it, and they are actually suffering. All this, we believe that it should be a standard of care. Do we need to take a DM scan every week? Absolutely not. Of course not. But should we scan every elderly person once every three months, once every six months, to make sure that our elderly people are good? I think so.” (35:43—36:54) -Philippe

“Most periodontists know that they need to fix the behavior before actually going to perio treatment. Otherwise, it’s a failing scenario. So, could we not monitor the patient for a period of three to six months, seeing if the perio is stabilized before we go to the perio treatment? Implants, the healing process. Wouldn’t it be great to see every three days, automatically, AI-driven, if the healing process is good? Is it not a better service? Maybe there is not much of a problem. But would the patient not feel super good that the dentist is capable of detecting if there is inflammation? It does not prevent the patient from coming to the dentist or to need the care, but it gives sufficient information to avoid problems and to make the patient feel good. So, there are tons of applications [for Dental Monitoring].” (37:52—38:50) -Philippe

“Too many things in dentistry are not standardized. Too many things in dentistry are not protocolized, not systematized, are not organized as we see in medicine — diagnosis, treatment planning, and treatment follow-up. There’s so much dentistry needs to evolve, and technology will transform this world.” (40:01—40:26) -Dr. Coachman

Snippets:

0:00 Introduction.

1:36 Philippe’s background.

3:06 How Dental Monitoring works.

9:23 A better way to see patients.

11:08 The technology behind DM.

20:12 Problems that DM solves.

23:51 The evolution of the DM super system.

30:13 The future of DM and dentistry.

34:38 Synchronizing delivery of care with need of care.

38:59 Last thoughts.

42:29 More about DM and how to get in touch with Philippe.

Dr. Christian Coachman Bio:

Combining his advanced skills, experience, and technology solutions, Dr. Christian Coachman pioneered the Digital Smile Design methodology and founded Digital Smile Design company (DSD). Since its inception, thousands of dentists worldwide have attended DSD courses and workshops, such as the renowned DSD Residency program.

Dr. Coachman is the developer of worldwide, well-known concepts such as the Digital Smile Design, the Pink Hybrid Implant Restoration, the Digital Planning Center, Emotional Dentistry, Interdisciplinary Treatment Simulation, and Digital Smile Donator. He regularly consults for dental industry companies, developing products, implementing concepts, and marketing strategies, such as the Facially Driven Digital Orthodontic Workflow developed in collaboration with Invisalign, Align Technology.

Dr. Coachman has lectured and published internationally in the fields of esthetic and digital dentistry, dental photography, oral rehabilitation, dental ceramics, implants, and communication strategies and marketing in dentistry.

Philippe Salah Bio:

Philippe Salah received his MS degree in bioinformatics and his PhD in biophysics from the prestigious École Polytechnique in Paris, France. He has traveled and worked in Europe, the US, Africa, Asia, and the Middle East.

In 2007, after graduating, Philippe fell in love with orthodontics after partnering with a renowned French orthodontist to build Harmony, a fully customized digital orthodontics solution. In 2011, Harmony was purchased by American Orthodontics, the world’s largest privately held manufacturer of orthodontic appliances.

By 2014, Philippe had realized that Artificial Intelligence was the next frontier in medical care. He brought together a team of engineers and orthodontists and created Dental Monitoring, the world’s first AI-based system for treatment monitoring, practice management, and patient communication.