Bola AI Keeps the Hygienist in Mind With Periodontal Charting

Image courtesy of bola.ai

“I need to do periodontal charting annually but don’t have time to do it? How can I do periodontal charting with my practice management software? How can I do a full periodontal charting without an assistant and maintain infection control?” These and other comments are consistently heard in practices across the country when it comes to hygienists completing the annual full periodontal charting. Hygienists understand the importance of full mouth periodontal charting including recording pocket depth, gingival margins, furcation involvement, mobility and assessing the clinical attachment loss, but they often don’t have reliable ways of entering the information. In the ideal world, every hygienist would have an assistant to help with charting, but ideal doesn’t exist in today’s fast paced, infection-controlled practices. There is voice-activated or other products available that work great for some, but others find them frustrating or difficult to use. There isn’t a system available that works for everyone.

Historically, computer voice-activated programs often require the computer to be trained to understand the user’s voice, don’t necessarily follow the typical hygienist’s way of charting, or understand the need for infection control maintenance. Until now.

Wouldn’t it be ideal to be able to complete a patient’s charting without having to touch the computer? Bola AI is a Massachusetts based company founded by MIT engineers that has developed a Voice-Assistant that uses artificial intelligence (AI) to complete a full periodontal charting without the need for additional expensive equipment. Bola AI does recommend purchasing an inexpensive microphone. The team of Bola AI engineers and dental professionals are reimagining the patient and provider experience for the electronic dental record. Their focus is eliminating the need for extra “hands'' to enter patient data into the digital clinical record. Utilizing artificial intelligence, Bola AI allows for cost savings while increasing practice productivity.

AI is defined by Webster's Dictionary as a branch of computer science that deals with the simulation of intelligent behavior in computers. Wikipedia defines artificial intelligence as any device that perceives its environment and takes actions that maximize its chance of successfully achieving its goals. AI includes machines or computers that can mimic cognitive functions that humans associate with the human mind, such as learning and problem solving. Many tools are used in AI including mathematical optimization, statistics, probability, linguistics, philosophy, and many other areas. Subfields of AI include:

• Machine learning. Machines using neural networks, physics, and statistics to find insights in data without being explicitly programmed to do so.
• Deep learning. This is the learning of complex patterns in large amounts of data. Think image and speech recognition.
• Cognitive computing. This aims to simulate human processes through image and speech interpretation and responding appropriately.
• Computer vision. This recognizes content in photos and videos.
• Natural language processing. This is the ability of computers to analyze and generate human speech.

Whether we realize it or not, we are using AI every day when we ask Google, Siri, or Alexa a question.

Although AI has had its share of ups and downs since the mid-1950s, recently medicine and dentistry have begun to see its importance in diagnosis and other avenues using sophisticated algorithms to provide better care for patients and resources for healthcare professionals. AI is being used in medicine in areas such as radiology, cancer diagnosis and screening, symptom checking, pharmaceutical innovation, genetic research, and targeted disease treatments. Within dentistry however, AI has so far had limited use, primarily in dental radiology and mainly in research settings. Acceptance of AI within dentistry has been limited due to data being locked in segregated and limited interoperable systems, measuring and validating results is not easily replicable, and the questions surrounding value, privacy concerns, and ethical or legal requirements. Yet, the benefit of using technology, especially AI in patient data entry, is all about saving time. The AI within Bola AI means that the system will understand any speaker, any accent, right out of the box. The system has been trained for thousands of variations of English speech. Utilizing AI means that the program is likely to understand the speaker and can make better inferences about what the speaker’s intentions are than older voice systems could. 

Bola AI has developed specific algorithms that bridge the divide between dental professionals and their practice management software programs. Currently Patterson’s Eaglesoft, Henry Schein’s Dentrix, and Curve are the dental practice management software that Bola can be utilized with, but more dental practice management software is coming on board in 2021. Bola AI allows dental professionals to interact with their software without touching the computer. It has been shown to reduce time for tasks while enabling providers to concentrate on patient care. Bola engineers started with the end in mind, focusing on what dental professionals wanted in a voice-activated program that requires no voice training, no user limitations, and no pre-set memorized vocabulary. Hygienists and dentists wanted a program that is HIPAA compliant, continuously upgrading, and that is a positive return on investment (ROI).

As a subscription service, Bola AI can provide the practice with opportunities for growth. Bola AI is affordably priced per location with no support or training fees. Unlike other subscription services the price is per location, not provider. With a 5-minute set up time, ease of use, and a 99% speech recognition accuracy, effective and efficient periodontal charting can be installed on the same day.

With increased infection control procedures following COVID-19 protocols, breaking the chain of infection prevention has become increasingly important. Patients are asking questions and teams need to be aware that what they do within the operatory is being scrutinized and examined more than ever in the COVID-19 treatment world. At the height of the pandemic, in a study that was published in the Emerging Infections Disease Journal, scientists in Wuhan, China, discovered that 75% of keyboards and mice had traces of coronavirus on them, more traces than doorknobs and trash cans.

Utilizing appropriate personal protective equipment (PPE) in the operatory, whether for aerosol or non-aerosol generating procedures, dental team members face numerous challenges. Even before COVID-19, a hygienist was challenged to record a full periodontal charting within the allotted appointment time ranging from 45 to 60 minutes. Some practices allow a floating assistant to support the hygienist in accomplishing the recording, but most hygienists go it on their own. The hygienist without an assistant often will do a partial recording of only probing depths and bleeding points and will be unable to complete the full periodontal charting, which falls below the standard of dental hygiene care. During beta testing, Bola AI performed a procedure time analysis of periodontal charting with and without an assistant and using the appropriate PPE. It was discovered that unassisted, in order for a hygienist to accomplish the full and accurate periodontal charting, it takes 10 minutes and 40 seconds and uses 1 set of PPE but 2 sets of gloves. Utilizing an assistant, time decreased to 7 minutes and 20 seconds, however 2 sets of PPE and 2 people were needed. With Bola AI, time decreased to 7 minutes but only 1 person and 1 set of PPE were utilized. Following beta testing, a national dental service organization (DSO) utilized Bola AI to complete additional time studies while recording periodontal charting for recare and new patients. Recare charting decreased from 6 minutes, 30 seconds to 3 minutes while new patient charting decreased from 9 minutes 56 seconds to 7 minutes 20 seconds. The average full and accurate periodontal charting time for all patients in the DSO was 5 minutes. Maintaining effective infection control, controlling PPE costs, and accomplishing the periodontal standard of care, Bola AI can benefit the practice’s ROI (return on investment) within 3 weeks.

Using Bola AI’s Charting Assistant, the hygienist can record the complete periodontal charting in the same manner as if they were dictating to an assistant. For example, one could record “For tooth #14 4,2,3,3,2,4, bleeding on distal, recession 1, mobility 0.” No special equipment required, however

Bola recommends a $20 lapel microphone that can be purchased on Amazon because most operatory computers don’t have audio. The Bola AI program is downloaded onto the computer and works directly with the practice’s current practice management software. When providing third party insurers information regarding the American Dental Association’s CDT code D4346, a complete periodontal chart is required. Using Bola helps in obtaining the required information. Third party insurers are now also requesting full and accurate periodontal charting and imaging when submitting for quadrant or 1 to 3 teeth scaling and periodontal surgery. Having a system that is easy to use and accomplishes the needed information in less time, is a benefit to the patient and practice.

With 75% of adults exhibiting some form of periodontal disease while only 16% are fully periodontally charted annually, utilizing systems that allow dental professionals the ability to perform required tasks in less time and with less money is essential. Patients want and seek out dental practices that utilize technology while maintaining the appropriate infection prevention protocols. Additional studies have demonstrated that utilizing a charting assistant can increase patient case acceptance by 30% and SRP production by 145% since implementing Bola AI. The Bola Charting Assistant can create a Periodontal Index (PI) which represents the number of periodontal pockets over the number of bleeding points. By presenting the patient with this PI, the patient can understand their periodontal health similar to how a medical professional educates the patient about their blood pressure or cholesterol numbers.

The team of engineers and healthcare professionals at Bola AI are reinventing the patient and provider experience. They are building the ultimate AI-Voice Assistant for the electronic dental and medical record. They understand the inefficiencies created by the digitalization of healthcare and are committed to making technology work for healthcare, not the other way around. Moving beyond the current COVID-19 world, using the periodontal charting assistant is only 1 part of their motivation to create an entire “touchless” patient record experience while improving infection control and saving PPE resources and money. By creating the touchless environment, dental professionals can spend more time on the important components of treating patients.