Level up your patient care with AI: A conversation with Dr. Rebekah Browder

Dr. Gordon Barfield: welcome everyone to the presentation tonight we're really glad you're here um we have a treat for you tonight we've got Dr Rebecca Browder from Westport Connecticut um and she's going to be sharing some amazing information with us about how she utilizes digital tools as well as AI in a practice to level up her patient care and her comprehensive exams so welcome Rebecca

Dr. Rebecca Browder: thank you you so much so happy to be here virtually with all of you from all across the country

Dr. Gordon Barfield: again I'm Dr Gordon Barfield I'm a clinical manager over here at overjet I'm a licensed dentist as well as an orthodontist and I'm your host tonight so we're really glad you're here we're going to have a fun uh back and forth get some wonderful information from Dr Browder and before we do that though we do need to button up a couple of housekeeping tips uh if you could share for us Dr B hello there we go and then uh there we go the disclosures the fun stuff right the boring stuff before we get to the real fun stuff again guys I'm Dr Barfield I am a full-time employee of overjet Dr Browder nor her family members uh have any financial interest to disclose relating to the content of this particular presentation and Commercial support for this CE program is provided by overjet the activity is being jointly provided with C Zoom Partners LLC and members of CE Zoom planning committee have no relevant Financial Rel relevations to disclose I also wanted to uh tag on to what uh Tori said at the beginning we want to take your questions and answers uh at the end of the presentation if you'll hold those and either put them in the chat or the Q&A function that will be uh helpful for us and we'll have time to address those at the end of the presentation thank you so much so uh without any further Ado Dr Rebecca Browder Dr Browder tell us about yourself how did you get into Dentistry

Dr. Rebecca Browder: how did I get into Dentistry um so my journey into Dentistry is a little um bit of a Securus route I worked I went to college as a chemistry major decided I didn't want to be a chemist wanted to go abroad so I majored in French and Italian graduated with a degree in two languages I actually don't speak and then worked uh as a bartender in real estate and then onto marketing and advertising for about eight years before I had an appointment with a local dentist and I had an epiphany I was in the chair and I looked up and I thought I could do this uh and everything just clicked so I quit my job two months later I was in postback and I never looked back I I love every second of it so it took me a while to get here um but since that moment I I have absolutely adored it

Dr. Gordon Barfield: now now I know you but I didn't know a lot of that story that's incredibly impactful and wonderful uh I love the diversity in in your story tell me about your practice um what's happening up there in in Westport as your family practice

Dr. Rebecca Browder: oh so much it's so cool over here in Westport um so my practice is um about 50 years old I'm the fourth um owner of it and um I took over just before Co and it was actually my first full-time job I had been working part-time as I had a couple of children um and then this was my first full-time job and nine months into it um my um boss that I was working for decided he was going to relocate to Texas so he said hey I have an a buyer for the practice but would you like it so I said you know what let's do it let's go ahead and do it and so um I jumped on it we signed the deal in February of 2020 and then March 2020 we closed the office um and we were shut down for about two months but it gave me I actually loved that time it was so valuable for me because I didn't know what I was doing and it gave me this block of time to go in with no patience and really focus on the practice so the very first place that I started was it I don't know why I chose that but that for me just sounded like I needed to get kind of all of that I I knew from the beginning that I in computers and before AI was even a thing I knew it was going to be a big part of my practice so I started there and I started kind of getting my idea for what sort of X-rays I wanted did I want a cbct did I want a scanner and I started dipping my toes in the water um and so that's kind of where the practice started and then since that time every little part of technology or um AI or computer whatever that I had have put into the practice has only been advantageous for me and has only bettered the practice and now I'm a straightup addict like I'm I'm just a salesperson's dream you know they come to me and they're like hey we've got a new thing I'm like great I'll take two um and I try all of these things but they have just made the practice so much better so I am a full-time um family practitioner I see everybody and we do kind of a range of um comprehensive Dentistry um and with kind of more of a focus on preventative Dentistry really getting there and identifying Things Early um and then also a fun um focus on Cosmetics um but again all in a minimal kind of minimally invasive way so having all of this Tech allows me to do that

Dr. Gordon Barfield: I love that and you and I have talked often about technology and dentistry and where we think all this is headed and it really is um something that is going to bring to our practices the ability to do better quality dental care for our patients and at at the end of the day that sort of is the umbrella idea that we're talking about here right

Dr. Rebecca Browder: 100% when I was getting when I was going into dental school I knew that within Dentistry I had two focuses that I loved I loved um public health and I loved cosmetic dentistry and I was like that's going to be a hard thing to marry but I do feel like all of the um the tech and Ai and all of the um all of the things that have been developed with our help of computers and digital Dentistry are actually allowing us to get to a point where that's going to be a realization where we're going to be able to not only take care of our patients but also provide like beautiful artistic Restorations that we love so it's going to be great for them it's going to be fulfilling for us it's awesome

Dr. Gordon Barfield: sort of our Nirvana right

Dr. Rebecca Browder: exactly yeah happy campers

Dr. Gordon Barfield: and as a as a great segue um you know into what technology is actually bringing to our practices and then ultimately to our patients what's the starting point for for that right where where do we start there we don't just jump into well where here's our treatment plan and here's our treatment and out comes a beautiful aesthetic result there's a starting point somewhere right

Dr. Rebecca Browder: there's always a starting point yeah um and that I think it's different depending on how you practice um but I think the starting point for me is always Diagnostics um and that's kind of what this presentation is going to be about um getting all of that information together so that you can synthesize all of that information you can develop an appropriate treatment plan and then you can explain it to the patient because even if your treatment plan is improving Home Care you have to be able to explain that to the patient to educate them and allow them to become empowered so that they actually take action even if it's as simple as starting to floss more

Dr. Gordon Barfield: sure sure and and how does how does that uh that upleveling that we're talking about right for for that diagnosis and ultimately the plan sort of play out and where do we kind of start with that and why is that comprehens exam comprehensive exam so important to everything that we do

Dr. Rebecca Browder: all right so I'm I'm just going to go ahead and launch into some of the slides here to um answer that question if that works um so this first picture I took just as a joke but um it kind of represents how I felt um my patient saw me originally you know I I knew that I had studied for countless hours I knew that I had gone to school that I had gone to residency that I had passed my boards I knew that I was qualified to give them a treatment plan and I just assumed that they saw all of that great in me too so when I would go in and I would do my exams I would not really focus on trying to educate them or trying to show that side of me instead what I wanted to do is kind of focus on the patient and focus on my relationship with the patient so I would um oops sorry there we go um so I would go in and I would have more of a one-on-one conversation with the patient where I would ask them tell me about yourself how is little Timmy how's the the softball game going how are the kids acclimating to their third you know sibling or whatever it is and so the patients and I are forming this really great Bond and I'm thinking okay this is wonderful they're going to start to trust me um and that was true to a certain degree um but what they didn't know was that while I'm having this conversation with them I'm also going through and doing all of the things that we do during our exam so I'm examining their periodontal condition I'm looking for signs of inflammation and calculus I'm looking for you know signs of like implus do they have any sort of cancer that I can um identify I'm looking at their Restorations are these in uh good shape or do they need repair are they clenching are they grinding um were these bonded properly do we have leakage um all of those things I'm looking at their function so I'm looking to see okay do we have AB fractions do they put too much pressure again are they axer do they have an airway issue um are they brushing too hard whatever it might be and of course um not everybody but um most of us are are also looking at the Cosmetic aspect because if we can improve a smile aesthetically as well that's the cherry on top so I'm looking at their gingerful architecture I'm looking at their tooth shy and shape do they need whitening um all of those things so as I'm talking to them and getting to know the patient and forming that personal Bond all of this information is being processed in my head because I'm so smart I can multitask like that and I'm coming up and kind of uh creating their treatment plan and so I'll say okay you know it was a a great um great visit today uh this is what you're going to need you need four quads of SRP you're going to need Fluoride Varnish you four times a year six fillings to onlay one crown and you're going to need some alignment um then Sam will take care of you at the front desk so good to see you I'll see you next time great we love each other and I leave the room and so then I'll go over and okay hey um when's Jamie's next appointment and um I was always shocked I was like what do you mean they didn't schedule what do you mean she didn't make another appointment she's got so much going on how did she why did she not make another appointment and what I realized was that I was forming a really good bond with them but they weren't being educated or empowered to make that decision to exercise their autonomy as a patient and to feel invested in their care as far as they knew nothing hurt they didn't need any of this and I remembered back to a um Dental visit that I had before I had decided to become a dentist and it was at a chain dentist um and the woman that was my dentist was probably recently out of school but she was the first person to stand me up and have me look at my bite wings and she talked me through it and she might have been talking me through it because she was also you know kind of piecing things together herself but whatever it was it was so impactful for me because I oh oh that's why I need a filling okay great where do I sign and so I had her in the back of my head and I said all right you know like what do we do what can we do how can we get um our patients to that next step and so that's when I started to bring in digital scanning and AI the more I can um teach the patient the better when I first started talking to patients I would you know try to explain hey this is um you know perodontal condition this is the crown this is the root this is where your bone is and if the bacteria gets down the Bone's going to go and I'm pantomiming these things and the patient's like uh okay you know and then I'm trying to draw it and I'm not drawing it well and then I'm getting videos from you know spare club or or something like that but there's nothing that I found that's more impactful than being able to show the patient their own mouth doesn't matter if it's somebody else's mouth they need to see their mouth so in our office um we have a couple of different digital scanners that we use um but in our hygiene we do Wellness exams um as well as our um x-rays we usually alternate the six-month visit so one's going to be a wellness exam and one's going to be our x-rays um and so we'll use that and we combine that with our artificial intelligence and this is how we've been rolling it out for about the past year and it's just been awesome working with our patients um and so what we'll do is my my hygiene um it was difficult to get them on board because obviously you need buyin from your team in order to roll these things out into your practice and the last thing anybody wants to do is add more to their list of things to do within that hour appointment but once I started showing the team and showing the patients the value that was there the team was on board they loved it because not only um did it give patient value but it also allowed them to become much more involved in treatment planning now now with what they can see on the AI and with what they can see on our Wellness scans they're starting the treatment plan before I even get in there they know what we're looking for they're seeing um and it's standardized across all of my hygienist because here it is in different colors they can see all of this in black and white or red and blue or yellow and green whatever the color is um they're able to see all of that and so across all of my hygienist they're starting to standardize these treatment plans so I'm coming in and a lot of my work is done not only with having to come up with what the treatment plan is but also they've started mentioning these things and starting showing these things to the patient already so that when I come in they know they need to have the x-rays up they need to have overjet up and they need to have the most recent scan up and that's going to be my way I'm going to come in I'm going to look at it I'm going to get the information from them I'm going to do my exam and then I'm going to be able to tell the patient what I see so the first thing um that we always do like I said is we'll have overjet up um we'll have our itaro scan up and we'll take it from there and usually when we have the itaro scan up the first thing the patient always says is are my teeth that yellow um and I you know it's it's fun it's an icebreaker it's a nice way to make a joke and say oh yeah well you know it just sells whitening for us and no no no no your teeth aren't that yellow but I love that question because it's starting a conversation they're asking they're already discovering things about their teeth so now we have this reflection up there for them on a big screen that they can zoom in zoom out spin around and they're starting to become inquisitive and so I say okay you know what your teeth aren't really that yellow but let's take a look and I'll bring up this screen and I'll start to look um at all of the areas of the tooth and we'll go through all of those different areas that we that we were discussing before we'll go through their periodontal condition restorative functional occlusion and we'll show them what we see what that means and then what steps we can take to improve it and then whether or not they do it is up to them my job is not to make the decision that oh you know what they're not going to do whitening they're not going to do alignment they're not going to do an onlay they're not going to replace the fillings that's not my job my job is to say hey I'm educated in this this is what I identify this is the problems it can cause or is causing and this is the treatment that we can offer you from conservative to invasive this is what we have and now you're educated you're empowered you tell me how do you want to handle your mouth and so it's really been a wonderful conversation to the patient I'm still getting to hear about Timmy's t-ball game and everything but um now we're getting to have a different layer of trust and a different layer of Engagement from the patient that helps them become more empowered and more invested Ed in their care

Dr. Gordon Barfield: you mentioned that trust Factor that's a really important one for us isn't it

Dr. Rebecca Browder: yeah huge

Dr. Gordon Barfield: I think that um you know that's one of the real challenges we have in dentistry right uh with low case acceptance rates and we know what those are across the board um there's an opportunity for improvement there right if we can get to that trust factor that third point of the trust triangle we can have a uh an impact there and make a difference

Dr. Rebecca Browder: yeah 100% And that has made a difference for me um and I'll talk about this a little later kind of um the changes that we saw since we started implementing this process um in our treatment acceptance and the amount that we were able to produce and I wasn't changing the way that I practiced so much you know I didn't become really invasive or aggressive I didn't learn some new I didn't start placing you know all on X's I just started educating the patient for my bread andb butter dentistry and I was getting more accept acceptance and it ended up being better for the patient and better for our bottom line so having that trust where they're just you know it's a very vulnerable position to be in to lay back and open up and just say okay you do what you have to do you know now they know the why and they trust you even more it's a beautiful relationship Builder um so for us when we when I go in to see my patients as I said we'll have um our x-rays up um I'll look at our x-rays first I always like to treat my Ai and um my computers as ad junks to me they don't replace me there are going to be things that I pick up from my clinical experience um that uh might not be picked up on some of these things so I'm not off the hook entirely um but I'll go in I'll familiarize myself and then I'll bring up um the different aspects either in overjet or itaro and so the first thing that we're looking at here is just a little screen grab I think we have an updated one yeah just a little screen scen grab from one of my patients um and what we're seeing here this is before there was a new roll out recently what we're seeing here is on the top you'll see the date of the Paro chart so it's pulling in the information the clinical information from my um hygienist who recently parot tarted and it's telling me what teeth were identified as having um probing greater than four millimeters um and this is also then going in and they're looking at this patient and they identifying areas like we have on this lower left hand side here and identifying areas where there's little whisks of calculus they're identifying areas where we've have bone loss the nice thing that has changed with a recent update which I can show you on the next slide is that um we now have an area instead of just going from green to Red from 1 millimeter to 3 millimet we now have the two millimet um highlighted in yellow this has been super helpful for us as well especially with my hyen because it has been able to identify those people that are a little bit more at risk um and a little bit more we can be more proactive and preventative with them so that we're not waiting for this like egregious amount of bone loss before we realize oh you need SRP you know we're not waiting for them to get to a point where we now are we're reacting um retroactive or not retroactive we're reacting to them as opposed to being proactive um to the condition so I'm really loving this but so this is what I'll bring up first I'll look at areas where um the computer has measured from the um cemento enamel Junction down to the level of bone and then I'll go in and I'll probe around and I'll see sometimes what we'll see is that the um the bone on the Buckle is higher but we may have a bone drop on the lingual so we still have to go around and we still have to probe but this is a really great thing because it's so easy for me to visualize I have it up in the screen and I know okay I'm looking over and the greens I'll I'll go around but maybe I won't spend as much time there and I'm going to go and I'm going to confirm the findings that I see on here so I'm going to confirm do we have gingival inflammation or bone loss in the areas of 18 19 what do we have to do there do we have to do local SRP are we doing a gingivitis are we improving um home care and we're going to see them again in three months what sort of proactive step are we taking because clearly something's going on in their hygiene and additionally I love this because now that we're getting into we're going to be coming up on a year pretty soon we're going to be able to see this year-over-year so instead of being like I don't know I think you were three millimeters last year we're going to be able to see T of a millimeter changes and we're going to be able to again intervene before things have gotten worse before things have gotten terrible um and hopefully that's just as simple as um improving the home care and calling it a day but if we need to do do more hygiene or parodontal therapy there awesome all the better we're getting the patient what they need and showing the patient this awesome so great because then they get it they know it's not me they know it's not my hygienist who's like well you know I've never had a problem before you may never have had a problem before but you probably also didn't have this you didn't have this that was helping to identify issues and helping to um treat them so we'll look at the periodontal condition um on the ex Rays I'll look intraorally and then I'll bring up the scan again for them and I'll show them you know so commonly we have this um built up on our um lower anteriors and I love this particular patient because she walked in to my office and she has such a myriad of different conditions going on she needed an onlay she needed some filling she needed a little bit of this a little bit of that so it's really um she had all of this plaque built up and tartar around these lower interiors and to show them this picture oh my God worth a thousand words right you know like who's going to look at this and be like I'm good I'll keep my tartar thanks I'll see you never you know you just look at it and you're like e get it out get it out now I don't care what it is just get it out now um and so that's been super helpful right

Dr. Gordon Barfield: you've seen patients like this like all the time

Dr. Rebecca Browder: yeah all the time um so this has been really effective for helping patients um buy into our par dtal treatment and also like I said just becoming more involved and invested at home they're you know picking up the floss a lot more they're getting a water pick and they're using it it's not like oh yeah I bought it but I don't use it they see it they get the need for it now and they're getting involved and they're using it and it's been huge for them

Dr. Gordon Barfield: I heard the someone said uh they don't really need to even know what bone loss is they can understand what color change is

Dr. Rebecca Browder: 100% yeah 100% and that's why I really love this new yellow too because it's like I said we're saying hey you're you might not need a deep cleaning now but we're starting to see some changes and we're starting to see that this is getting to a point where we don't want it to be we don't want it to progress so we're going to become a little bit more proactive and we're going to start with you um and so yeah they don't they don't necessarily need to know the biologic factors that are leading into it all they see is that color or all they see is that picture and it's it's super impactful for them

Dr. Gordon Barfield: love that

Dr. Rebecca Browder: sorry love that yeah yeah um so we'll go into restorative after that um you know the gums are our foundation so we always start there and then looking at the teeth um with this patient in particular on her right side we saw two areas um that were highlighted one for incipient carries and one for carries that were through the um the CJ so we were going to go ahead and treat that now with our incipient carries we have a couple of different ways we treat that it could be as simple as a fluoride varnish it could be something like curodont um or a resin infiltration anything like that so we start to look at this and then I love because our x-rays show us interproximal carries so well um I love um going and then comparing it with our itero and using our near infrared Imaging um and just seeing kind of how those two come together seeing it from a different angle and examining the patient and putting that all together because this in and I actually ended up going in in treating um and it was with the help of our our IO but um you know I might have missed it being an incipient on this X-ray and maybe wouldn't have looked so closely at it on my it tarot if I hadn't caught it here and sorry some of those are hard to see some of those are super hard to see and the same goes for accusal you know these bitewing x-rays aren't meant to diagnose accusal um and so sometimes I don't catch it sometimes I'm not even looking for an accusal the first week that I had AI in my practice um I think one of the first patients that I saw it on was a teenager or 20s something not a filling in his mouth beautiful teeth and um overjet picked up carries on number 30 and I was like okay you know I highly doubt it and I looked at the tooth and I was like the enamel looks intact maybe there's a little bit of shadowing under the enamel but like I'm not seeing anything bombed out but I decided to roll the dice and Trust the AI and I gave the patient a heads up I said hey this is not something that we typically um see on X-rays and this is a new program that I'm working with but I think that it's worth a look let me go in let me get you numb I'll start to go in and if I don't find anything I'll keep it really superficial and you know I said I I think I said I won't even charge you for it and the patient was on board and I opened it and boom dropped right into it and that that was it for me I was like sold I just paid for my you know I just paid for my membership off of the one filling and I never would have seen it before and practicing as a solo practitioner that's huge that's huge to have something that's going to be that second parabis um so I um see these I go and I compare it to what we have on our um itot we use that near infrared Imaging so on the upper right here you can see um areas of um we opened see it a little bit closer opened that up saw the Decay um and treated it and we were happy with that scroll over and on the uh upper left hand side for the patient number 15 it's got that huge amalgam and this is a wonderful case where the patient says I don't feel anything it's fine it's been there it's been there for 30 years we're good and this is where I'll take my um my tech and I'll say you know what it's not good it's not great this is going to be a problem for you I've seen it I know it's going to happen the literature supports it let's look at it together so I'll see this big silver um amalgum I'll see some of the demineralization areas some of the fracture areas I'll go back I compare it with the X-ray I see the areas of Decay on the misal and on the lingual sorry on the misal and on the D distl um and then we'll also start to see this is this particular um tooth but we're also able to see now in some of our x-rays with the new roll out other areas like is there periapical radiolucency is there Endo needed on this um how close is the proximity to the nerve are we concerned about that happening you can see the enamel and the um carries there um and then we'll go back and I'll say hey so this is what we have we have a tooth that right now is asymptomatic I see that there's some leeching going on I see that there are some fracture lines there's some demineralization and I know from the literature that cusps less than x number of millimeters 2 to 3 millim ERS are more prone to fracture so that's what I'm concerned about let's go and see the pressure you're putting on this tooth okay patient here's the pressure and so we see you're putting a lot of pressure here and a lot of pressure here on those remaining areas of enamel let's go back to the tooth you see how now do you see what I'm saying this tooth doesn't need a filling this tooth needs an omel so now we have been proactive about treating the patient and we've done it in the right way and we've done it in a way that they have Buy in you know it's not like why did I get upsold from having a fine silver in to having an onlay you know and it's not overly aggressive because I don't have to do a full Crown once the tooth breaks I'm being conservative here I'm being proactive and I'm being conservative at the same time um which I think is is super important to the way that I practice um so after we look at our uh perodontal and our our restorative concerns then I'm going a little bit more and I'm saying okay let's round this picture out now what other functional issues are we having so we bring up her screen again again and I say okay you know I see here that you have um you've had Ortho before you have a um broken lingual wire we'll start looking at whether or not there's relapse I'll say okay I see over here you have something called abfractions we'll talk about how um lingual inclination can worsen those up fractions and how um alignment comes into play with that um we'll go down and we'll toggle to her screen and go to um our Stone image and we'll look at our where that we're having because this tooth is a little bit more facial and it's starting to get more wear because it's coming in contact with your um opposing teeth here and the the value of having teeth get into alignment so it's not having straight functional teeth because they're pretty um or not doing invis line or clar liners or traditional Orthodontics because it's pretty but it's actually for a reason straight teeth or healthy teeth for a reason because you're not going to have that extra wear you're not going to have that abration you're not going to have forces being put on a tooth that's detrimental to the tooth you're going to have everything where it should be forces dispersed as it should be and that's going to have the teeth last for a longer period of time and that's kind of how we explain it to our patients and being able to show this is really beneficial um and then last kind of my most favorite thing um we drift a little bit away from our AI um with this but it's also um really great in having these instruments and this um information these Diagnostics cohesively because we can figure out what's the best way to go about it from a cosmetic standpoint too um so lots of times when we'll have our itaro up um I'll be able to see the patient and I'm saying oh you've got beautiful teeth you've got beautiful um healthy teeth but um I noticed that they're a little bit it almost looks like you're hiding a little bit of your teeth and the patient will say say yeah you know I just don't like it and so we could hypothetically say you know what we're going to do 10 veneers up here but for this patient I said I think what you need is I think you just have a little bit of passive eruption what if we just do a quick gingivectomy and open that up a little bit um super nonivasive super easy and she was sold right there and this took 15 minutes and she's a patient for life like she was so pumped about it she sends us before and after pictures and she's like I love my new smile um so it allows us to communicate with a patient and give them these little things where it doesn't have to be a huge cosmetic overhaul but patients benefit from this you know not only is it going to remove some of that excess um uh some of that excess gingiva that may be causing a little bit of a plaque trap um but it's giving her a smile that's a little bit more H so love that um this was a patient that came in she had some concerns about uh tooth four and to three and four those crowns she didn't really like the the color of the crowns and as we got into it I was like H this is something where I think you could actually be really happy for who she is as a patient from changing her alignment was pretty good but we needed to change the shape of some of these teeth so we started to go through and I did a quick mockup and I said you know I think if we raise this we change the shape we make them a little bit bigger here we bring them out a little bit you're going to be a bit happier and she was sold too so we did end up doing um veneers on her mostly at itive which was also awesome as well um and she was just super pumped about it and so having these things having overjet having um my itot or you know I like I said I use a couple of different um scanners um having my cbct is another one having these things and being able to integrate them all together removes all of my guessing it removes my like second guessing and I don't know I think I'm just going to wait and watch watch because I don't know how this is going to plan out um it gets rid of all of that and it makes my treatment planning so much more a clearcut so you know it's standardizing everything now there's not one patient that gets this and somebody else that gets this my hygiene is all seeing the same thing like the comment before things are colorcoded you know it makes it pretty idiot proof um for those of us in the dental field and our patients so everybody's getting the same the P the hygienist no this is going to yield X treatment because this is what we're seeing um it's great with our um Insurance approvals because I love it I love it now I I wait for patients to receive a denial and I just I can't wait to write that narrative and put in like here's my x-rays here's my stuff from overjet that has everything Illustrated here's my intraoral photo detailing everything and it gets approved and it's kind of a hassle that we have to do that but the great thing about overjet one of the things that initially sold me um when I was considering um bringing on AI was the relationship that they have with the with the insurance companies and how um and I guess you can speak more to this um Dr B about how it works with insurance but we just don't we don't have an issue with it anymore

Dr. Gordon Barfield: well I think what's what's happening there really the power is in trying to measure with the same ruler that the insurers are are measuring with right so they're utilizing AI uh most of the big ones are and um we may as well get on the same page and use the same rulers right it's objective information that we're taking out the sub some of the subjectivity in dentistry which is one of our big big challenges uh and so I I think that ultimately it's good for patients it's good for payers overall they see some cost Savings in it that that way so and you know bringing us to Center bringing us closer to a a centered truth if you will and I think that's really what it's all about yeah ask you something Dr B if you had to if you had to put a summary statement on the power of digital technology and tools as well as Ai and what it is bringing to the overall exam and diagnosis process what would you say to that what's the power in it for you

Dr. Rebecca Browder: um so one I think it's an inevitability as we were talking about before there's no escaping it it's only just going to keep coming um and embracing that for me giving me this information has allowed me to move forward with such confidence um and as a single practitioner that's huge because I don't have somebody I can go to and be like hey what do you think about this what would you do in this scenario um and so having all of this information has taken the guest workk out of Dentistry you know we always say it's the practice of Dentistry this lessens that a little bit more it takes away um some of the subjectivity it takes away some of the um questions about how something is going to proceed I have data now and with data I can make decisions um it's no longer my opinion you know it's no longer um what I want to do this is what's recommended this is the condition that you have this is what's recommended um and that's super ow ing I think not only from a um the standpoint of the entire team because all of my team is on board with this all of my team is understanding how it plays in um but also with the patient and it's to your point it's getting to the right place we want to be in dentistry nobody you know the vast majority of us want to practice ethically we want to go home and not be nervous about did we do something that we shouldn't have done or did we not treat something we should have treated and this gives me that peace of mind I'm able to go in and I'm able to know with a lot more certainty than I had previously what the conditions are what needs to be treated when why and how and now the patient knows it too and it's shared responsibility and so I could never and I emphasize never go back this is as vital to me as practicing with loops like I could never practice without this um and I don't and if you look at my stats probably if you were to pull up my account I bet you we look at this with every single not only do I look at it um when patients are in for Hygiene when I'm treatment planning but when I have a patient come in for restorative I pull it off automatically again because I want to see exactly where I'm drilling where do I have to be how deep do I have to be what do I have to watch out for um it's just it's invaluable information

Dr. Gordon Barfield: amazing amazing that this has been fantastic for me I've enjoyed listening to you this is and I haven't had an opportunity to spend quite this much time with you before and I love it it's it's very empowering actually and we're we're getting in a ton of really really good questions you're going to love some of these um so let's tell people how to first and foremost how to get their c credit I think that's going to be an important one before we jump into the Q&A here this evening yeah okay what you guys are going to want to do there is log in to e zoom and then scroll down until you see the green verify button that uh cor corresponds to this particular course and then enter the word smile and you take a short three question evaluation that we've got prepared for you and you you'll get your credit in in that fashion you could also um scan the QR code here so we'll leave that up for a moment as we begin to uh field some of these questions the first one Dr B that comes in um what do you do when patients want to take pictures of the scans as well as the x-rays to possibly shop around

Dr. Rebecca Browder: let them let them let them shop around yeah let them let them shop around if they're gonna sh so for me I love when people go to get second opinions because chances are they're probably gonna the vast majority of times those people whoever they went to they come back they come back and if it's only if they're only in it for the money then um I haven't done my job at a practitioner I think maybe I haven't educated them enough maybe I haven't made them find the value or conversely do I have to look at my financing options you know am I am I dropping the ball in that respect um but for me the more information the better the more empowered the patient the more educated the patient the better so give them the information let them take the pictures let them shop it around what's the worst that could happen you know they come back and they're like oh yeah turns out you were right great

Dr. Gordon Barfield: um I also want to mention that um because it is giftgiving season um this is important that uh with this QR code tonight anybody that uses this QR code and then uh gets a demo off of this QR code you're going to get a $50 gift card to Amazon which is going to be really beneficial because it's gift giving season and that's my gift to you guys just kidding it's not from me but um do it it's valuable and just for a little Clarity on that one we want to advance that slide one because this particular QR code is going to C zoom and I think there you go Dr B that QR code is the one that um has to do with the Amazon okay um second question what does the color red or yellow mean one is Decay but what is the other and I think that the question is getting at what is the yellow color uh in in the carries finding

Dr. Rebecca Browder: yeah that's just incipient carries so that means that the Decay is visible in the enamel has not crossed over to the um cementum yet and so for that we tend to be a little bit more preventative in our treatment um sometimes um it's it can depend on the angulation of the film itself like in this particular case that I showed where I saw incipient carries um but then when I looked on um when I happened to look over at my um digital scan I was like you know what I'm going to go for it um and so the carries ended up it did reach through the CJ but so yellow is for incipient carries red is for something that goes through the CJ so that can be a nice delineation for you when you're coming up with your treatment plan are you going to be more conservative and treat with Fluoride Varnish every three or six months are you going to do a resin filtration or are you going to go in and actually break too structure and go in and do a a filling there

Dr. Gordon Barfield: yeah that's that's uh that's spot on I love this next question I think this is a really crucial one for us uh as as Community leaders does it seem that all these improvements with AI make less of a need for a dentist in every dental office

Dr. Rebecca Browder: it may seem that way but no um I I'm I think we are one of the few maybe not the few but you know everybody's getting that question now all of the artists and writers and um people are are stressed because their jobs are being taken over by chat GPT or something like that this cannot replace us at this moment in time I don't know what the future but at this moment in time this is an adjunct to the way that I practice this is additional information for me as much as X-rays were um so this is all clinical information this is all data that I am then taking I am synthesizing I am figuring out what is the correct treatment option for the patient here so maybe at some point we're going to have a bunch of robots that can synthesize this for us and then do the restoration for us but I don't think it's coming anytime soon um and then I also think that going back to our conversation before with trust this builds trust this um a patient is going to be much less likely to move forward with treatment if they don't know why or to move forward they're not even going to floss if they don't know why you know nobody does that stuff unless that's there's something in it for them um so I think this AI is definitely not in a position to do anything but be additive to our ability as clinicians to be the best clinicians we can be and to be to be even better than AI alone

Dr. Gordon Barfield: yeah I totally agree with that and I think one of the important Concepts sort of to bring out in in this discussion is that um this AI is not a diagnosis making machine a diagnosis can only be made by a dentist uh and it can't make a treatment plan for you it can't do the dental exams this is another set of eyes it's no different in my view than things like Loops you mentioned loops and explore your tactile sense in your hands an airwater syringe an x-ray itself this is just another tool for helping you in making that accurate assessment for the patient and then ultimately your diagnosis that you are responsible for making so I think that's important to know um a couple that are linked here how good is the AI at recognizing recurrent carries around a restoration and the second question that links to that is can this detect cavities underneath Restorations

Dr. Rebecca Browder: yes um so yes it can detect cavities under Restorations yes it can detect recurrent Decay um and this is where to your point before where this is a diagnostic tool um this is not um identifying carries what it's identifying is a change in the density of the tooth it is then my job as a clinician to go in and say okay is that a liner under that filling is that why there's a a radiolucency there is there um is there you know a layer of bond there is that what that radiolucency is is it just the anatomy of the tooth is there a mesial concavity there is there cervical burnout um so yes it is great at detecting I can't remember from back when I um signed up but there's some some statistic about the Shades of Gray that the AI can see that we can't see necessarily on our monitors where it's picking up that variation of stage of the gray picking up the discrepancies between it and that's what it's identifying so it's not telling you you have active Decay it's telling you look over here there's an area here that is less dense than we think it should be and then you go in and you decide what you want to do with it but it's great at picking up those areas

Dr. Gordon Barfield: next question um comes in any instances where AI detected something but it actually wasn't there in other words there was a an artificial intelligence intelligence detection on an x-ray or a finding on an X-ray and when you looked at it clinically it just wasn't there you examined the tooth you used all the other tools that we know to use in examining a tooth and the finding just wasn't there does that happen all the time and here's what I mean by it

Dr. Rebecca Browder: um so the interproximal uh lesions very rarely does it happen there but where it does happen where I do find it is let's say there's been um some incisal wear on a k9 the AI will pick up there you'll get a big red spot right at the tip of the canine and after going through a while I know these certain areas where it's just going to be areas of wear or it's going to be um a change in the anatomy of the tooth um so there there are times when you're going to disregard some of the information that's presented for you but again this goes back to being a diagnostic tool this is showing you areas to watch out for areas to look for it's your job as a clinician to then go and make that change so it's bringing up this area on this K9 so it may not be Decay but it's my job to look and go see that canine and realize that this patient either has an airway issue or a bruxing issue and needs a night guard or a sleep Appliance or something like that so it's useful in diagnosing not just carries it's useful in diagnosing all you know the tooth structure should be there it knows what tooth structure should be there so why isn't it there and let's figure out that the only other area I see sometimes is like cervical burnout usually on the dists of the upper first MERS but again that's a pretty isolated case where I've just been able to see that and usually I'll see it on one film and not on the other um but overall for the interproximal lesions that we're looking at for our bread and butter Dentistry what we're thinking this would be most useful for it's pretty spot-on for me

Dr. Gordon Barfield: um how much extra time did it take to implement this AI during hygiene appointments wondering how to implement smooth smoothly without overwhelming the patient with too much information without having ample time to explain it that's a great question isn't it

Dr. Rebecca Browder: that is a great question and that is a that's more of a question about how you want to practice um so what I mean by that is as far as implementing overjet super simple so you take your X-ray and then within like 90 seconds or something like that it's up on your portal on overjet so as long as you have that ability to look at the internet in your op uh with the patient or um you know if there's computer at internet in the op it's as simple as the looking at the x-rays the way you normally would but now they are um now they're annotated for you um so it has actually cut down my time where I have to go in and diagnose because I don't have to go in and look at my x-rays and play with the grayscale and bring out my magnifying glass I do a quick scan of my x-rays and I bring up and I look at overjet and I see if there was anything that I missed and then from there depending on how much I need to explain to the patient I can I can spend more time I tend to spend more time with my patients that's the way my practice is but on days where we have three hygiene there and we're kind of going going going um we may just take a take a snapshot with our um patient software and text it over to them um but usually we just SE the patient we'll say hey you want to see it here it is simple simple so I think that this actually takes away a lot of the time of needing to explain for me cut down

Dr. Gordon Barfield: uh Don says is a cone beam in the office necessary for the AI to work do we need to have a 3D on his

Dr. Rebecca Browder: no not for me um I you can um mention anything different I don't use the cone beam um with overjet um I use my cone Beam for more aesthetic cases larger cases when I'm marrying it with a with an iaro scan um but for not for overjet for me

Dr. Gordon Barfield: right current practice uh we're not reading 3D data yet you guys can imagine that that will come with time but we are still living largely in a 2d Dental world uh so so uh 2D at the at the moment but 3D is being worked on and in the future that certainly will be be a part of what uh we're doing it'll be a part of d more more and more in dentistry as we go along how much does overjet cost is it a monthly subscription the the cost depends upon a number of factors depending upon the size of your your practice your organization features that you get um so if you want to know that specifically I think the best thing to do is to reach out maybe with a demo with one of the account Executives they can give you the specific details on that but there are tiers for it and yes it's typically a month L subscription

Dr. Rebecca Browder: and worth every penny might I add

Dr. Gordon Barfield: make sure that we got all of these questions here these are great questions guys we really appreciate these and we also appreciate everyone for being here this evening uh make sure that you get a screen clip on the QR code scan the QR code there and if you do sign up for a demo we're sending out a $50 Amazon gift card for you okay good good I think we've got them here any other questions we'd love to take those as we have just a few more minutes this evening I hope this has been beneficial for you all I know it's been fun for me uh getting to hear about Dr Browder and her her amazingly diverse entry into Dentistry as well as how she practices is uh something I would never Tire of

Dr. Rebecca Browder: I'm sure that's not true but thank you so much for having me it's been a real pleasure um I am a bit of a fan girl for um over I'm I love Tech in general but um I'm a bit of a fan girl for overjet so it's a real pleasure for sure for sure

Dr. Gordon Barfield: let's see maybe one more thank you Lauren she's a great webinar thank you so much thank you all for being here really appreciate it to all of you guys I know you're spending time here after probably a long day at work and I remember during my practicing days one of the last things that I wanted to do was to take my dinner time out and watch a CE webinar to get my credits at the end of the year but it is necessary and uh thank you guys for being here we had a really good group tonight it was a a a pretty large group uh Heidi says this presumes that we have digital scanning and digital x-rays question mark

Dr. Rebecca Browder: So for me um I used the the two are kind of separate um I do have digital X-rays and I assume that you would need that um for for overjet to work the digital scanning you don't need you don't need to have it um it's really beneficial but you don't need to to work together with the two I do but they don't need to work together

Dr. Gordon Barfield: that's right Heidi the uh the overjet platform uh needs digital radiography right uh it's as simple as you take your x-rays in your normal workflow and in nearly real time and Dr B you can comment on this uh the x-rays show up within the overjet platform with the artificial um intelligence overlays on them it happens very quickly on in an automated fashion in the background while you're working

Dr. Rebecca Browder: yeah super seamless whenever we've gone in um as usually as soon as they take the x-rays and come get me I think it's within 90 seconds or something like that we've never tested it um but there's never really been an issue where I went on and I was like come on it's still loading they're there oh do do we have one more minute I forgot to talk about my other favorite thing um about overjet is that when we first when I first brought it on um it goes back through all of your x-rays for the last 18 months and it's starts to identify everything so there's a patient dashboard for everyone you're seeing that day um and so it will say like hey you saw this patient 10 months ago or something and you missed something you missed SRP or they need second stage SRP or you missed a pero exam you coded as a regular exam or you miscoded this or you should have done you know um you you're missed recurrent Decay here all of these things so for me that's awesome because we use that in our morning huddles where we go in and we're not saying like well we've got to squeeze out an extra $2,000 today we're looking at hey where did we miss something clinically what does the patient actually need and that's how we're generating our production and just by doing this within I think I can't remember if it was the last year or um when we started doing the itaro and the um overjet our production without changing really anything else increased by 200,000 so like we it's just so seamless to get this information and use it to drive your practice without feeling salesy without feeling like you're pressuring people you're diagnosing you're giving information and they're taking it and it's just it's been a really seamless kind of natural organic way for us to increase um our increase our production which has been a huge awesome benefit

Dr. Gordon Barfield: obviously that that's very powerful statement because really what we're we're after is we're after the opportunities that we have missed and we know that we all miss these things and we miss them regularly that's the truth of clinical Dentistry right it is we are going to miss things we're busy we're challenged we have lots of things going on in the office uh and I I'm I'm shocked at the things that I have missed in a 33e clinical career the the number is immense and this is about making sure that we capture those opportunities in the best way that we can do that not necessarily about the production values that may happen to come along with that

Dr. Rebecca Browder: yeah yeah

Dr. Gordon Barfield: well thank you all so much for the time this evening we really do appreciate it and thank you Dr Browder for spending some time with us this evening uh I know you had a full clinical day and we really appreciate you being here thank you so appreciate it I appreciate it thank you all