I N F O R M AT I C S & TECHNOLOGY ABSTRACT

Background. Dental informatics is a rel-

atively new field that has significant poten-
tial for supporting clinical care. Most den-
COVER STORY tists are unaware of what dental infor-
matics is, what its goals are, what it has
Dental informatics achieved and how they can get involved in
it.
A cornerstone of dental Methods. The authors conducted a liter-
ature review and several round-table dis-
practice cussions with dental informatics experts
to discuss the preceding issues surrounding
dental informatics.
TITUS SCHLEYER, D.M.D., Ph.D.; HEIKO SPALLEK, Results. Dental informatics is the appli-
D.M.D., Ph.D. cation of computer and information sciences
to improve dental practice, research, educa-
tion and management. Numerous applica-
nformation technology, or IT, has transformed tions that support clinical care, education

I society and will continue to do so in the future.1 and research have been developed. Dental
The way in which children grow up, companies do informatics is beginning to exhibit the
business, people shop and communities socialize characteristics of a discipline: core litera-
has changed significantly since the beginning of ture, trained specialists and educational
the information revolution.2-8 That revolution also has programs.
made its mark in the dental profession. Almost 80 per- Conclusions. Dental informatics pre-
cent of dentists have computers in their offices, almost sents possible solutions to many long-
30 percent have access to the Internet, and an standing problems in dentistry, but it also
increasing number use a variety of other technologies, faces significant obstacles and challenges.
including digital intraoral cameras and Its maturation will depend as much on the
9 efforts of people as on the collective efforts
How can paperless patient records.
Given current technological trends, of the profession.
technological Practice Implications. Dental infor-
the number and magnitude of changes
advances be matics will produce an increasing number
brought about by IT and its potential
made most applications will only increase. We are of applications and tools for clinical prac-
useful for not far from the day when computers tice. Dentists must keep up with these
developments to make informed choices.
dental practice, will permeate virtually everything we
research and do, from how we read our morning
education? newspapers to how we make treatment
decisions for our patients.10
Within the next five years, experts
foresee the commercial availability of electronic paper and development of significant scale and
(paper that functions like a very high-resolution com- scope, their interests primarily are driven by
puter screen), a vast array of special-purpose computing the profit motive. Most innovations are pur-
appliances, autonomous software agents that enter into sued because they are expected to make
transactions on our behalf, an almost ubiquitous high- money. Other projects, which may be more
capacity networking infrastructure and personal digital important or significant but are not deemed
assistants that rival current desktop computers in per- as profitable, receive scant attention and
formance. resources. One example is the American
How can these technological advances be made most National Standards Institute, or ANSI,
useful for dental practice, research and education? Tech- standard digital imaging and communi-
nological innovation for the health care professions orig- cations in medicine, or DICOM, which
inates from a number of sources, such as the commercial defines a format for storage and exchange of
market, research and educational institutions, and digital images, including radiographic and
people. While companies collectively engage in research visible-light images. DICOM is the almost

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I N F O R M A T I C S & TECHNOLOGY

TABLE 1 become a cornerstone

of dental practice.
COMMMON ELEMENTS IN DEFINITIONS OF MEDICAL
INFORMATICS. WHAT IS DENTAL
INFORMATICS?
ELEMENT EXPLANATION

Universality Informatics is viewed as applicable to all activities

According to
in the domain, such as research, education and Merriam-Webster’s
patient care.
Collegiate Dictio-
Goal Most definitions cite the improvement of patient nary, informatics is
care as the goal of medical informatics.
derived from the
Science Informatics is a basic and an applied science; that is, term “information
a continuum spanning model formulation, system
development, system installation and the study of
science,” which is the
effects.15 collection, classifica-
Multidisciplinarity Aside from the domain (such as medicine or den-
tion, storage, re-
tistry), informatics is composed of several con- trieval and dissemi-
stituent disciplines, such as computer science,
information science, cognitive science and
nation of recorded
telecommunications.16 knowledge treated
both as a pure and
applied science.12
universal standard for managing images in clini- When applied to a specific domain, such as
cal medicine.11 Until recently, however, digital medicine, nursing or dentistry, information sci-
dental radiology system vendors have been slow ence becomes “informatics.” Existing definitions
to implement DICOM. One reason has been that of medical informatics13,14 share several common
dental extensions for DICOM are relatively new, elements15,16 (Table 1).
and many vendors may not realize the benefits of A simple, but cogent, definition of dental infor-
implementing DICOM. But more importantly, matics is “the application of computer and infor-
DICOM allows dentists to combine imaging mation science to improve dental practice, re-
devices and software from several vendors and, search, education and management,” which was
thus, removes the “lock-in” that vendors of propri- derived from an earlier definition that was coined
etary systems have enjoyed so far. in 1992.17
The commercial market has brought many A common misconception is that informatics is
innovations to the dental profession. But it is not the same as IT.18 Informatics is focused primarily
likely to address many fundamental problems— on research, development and evaluation of infor-
such as controlled vocabularies, open standards mation models and computing applications. IT, on
for exchanging patient information among practi- the other hand, is concerned with the implemen-
tioners, quality assurance for patient outcomes tation and application of computer technology and
and mechanisms to represent dental knowledge— telecommunications. Despite the larger concep-
any time soon. While academic and other institu- tual division, limited areas of overlap between
tions are working on some of these issues, one informatics and IT exist, such as custom develop-
obstacle to progress is the fact that the field of ment of software and evaluation of implemented
dental informatics is not very mature. systems.
Dental informatics combines dentistry and sev- Dental informatics can be considered a spe-
eral research disciplines, such as computer sci- cialty of medical informatics. A number of models,
ence and telecommunications. Because it is new, methods and applications can be shared, trans-
there is confusion relative to its definition, goals, ferred or both between the two disciplines. For
opportunities and achievements. Therefore, we instance, the National Library of Medicine’s, or
wrote this article to answer several questions: NLM’s, MEDLINE is the world’s largest biomed-
What is dental informatics? What are its goals? Is ical literature database and is equally applicable
it a discipline? What are its opportunities and to all health care disciplines. The same applies to
challenges? How can the practitioner get involved GenBank, a database of gene and protein se-
and stay up to date? We wrote this article to stim- quence information to which researchers from
ulate interest in this emerging field and help several domains contribute. Methods for building
readers understand how dental informatics can expert and decision-support systems, such as

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 I N F O R M A T I C S & TECHNOLOGY

neural and Bayesian networks, can be applied Table 2 offers a description of selected computer
across disciplines.19 Despite much common applications.19,25-43 The list is not inclusive, but
ground, there also are many aspects that set rather provides an overview of the breadth and
those informatics domains apart. For instance, depth of existing applications.
most design work that informs the development
IS DENTAL INFORMATICS A DISCIPLINE?
of computer-based medical records simply is not
applicable for computer-based dental records. Before we can answer the question of whether
Dentists collect, display and analyze data differ- dental informatics is a discipline, we should dis-
ently than do their medical counterparts. While cuss what features characterize a discipline.
the general medical and medication histories col- Requisite features are
lected by both physicians and dentists share da core of people who conduct research and pub-
many common elements, the dental history and lish in the discipline;
the oral health status have no equivalent in dan identifiable body of literature: books, jour-
medicine. As a consequence, developing, imple- nals and other publications;
menting and evaluating complete computer-based dprofessional societies and related activities,
dental records is both a challenge and an opportu- such as meetings and conferences;
nity for dental informatics, as are many other deducational programs leading to a certificate or
domain-specific aspects. advanced degree;
dfunded research programs.
WHAT ARE DENTAL INFORMATICS’ A core of people who conduct and publish re-
PRACTICAL GOALS?
search in dental informatics exists. An informal
The main goal of dental informatics is to improve review of the literature showed that since 1965
patient outcomes. Thus, the disci- approximately 3,500 authors have
pline must support and improve diag- published about 2,200 articles
nosis, treatment and prevention of Developing, related to dental informatics and
disease and traumatic injury; relieve implementing and computer applications in dentistry
pain; and preserve and improve oral evaluating complete in about 420 journals and conference
health. A secondary goal is to make computer-based proceedings. Journals with signifi-
the delivery of dental care more effi- cant numbers of informatics-related
dental records is
cient; for example, by maintaining or articles include Oral Surgery, Oral
improving cost-benefit ratios. Dental both a challenge and Medicine, Oral Pathology, Oral
informatics also must support re- an opportunity for Radiology and Endodontics; JADA;
search and education, and improve- dental informatics. Dentomaxillofacial Radiology; the
ments in these areas should, and Journal of Dental Education; and
often do, translate into improved the British Dental Journal. The
patient care. Journal of the American Medical Informatics
Informatics is key in helping practitioners Association and the International Journal of
solve clinical problems and keep current. Most Computerized Dentistry are more narrowly
educational programs still subscribe to the philo- focused. The first book on dental informatics was
sophy that everything dentists need to know can written in 1992 and provides a conceptual
be learned in dental school. The trend toward overview of the field.44 Other books, such as “The
problem-based learning and the development of Global Village of Dentistry”45 and “Imaging in
20-22
critical-thinking skills tells a different story. Esthetic Dentistry”46 provide more detailed looks
Dentists must be as familiar with the problem- at some application areas.
solving process as they are with the problem Currently, dental informatics has no main-
domain itself. Computers can help practitioners stream journal of its own, the emergence of
maintain their continuing competency, and many special-purpose journals (such as the Journal of
dentists already are using computers to keep Computerized Dentistry) notwithstanding. This is
abreast of new developments.23,24 appropriate considering that dental informatics is
Many examples of developments in dental in the early stages of development and that, at
informatics that have helped improve patient this time, it is more important to educate a broad
outcomes (or have the potential to do so if widely audience about the possibilities of dental infor-
used), education and research can be cited. matics than to provide a specialized forum for

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I N F O R M A T I C S & TECHNOLOGY

TABLE 2

SELECTED COMPUTER APPLICATIONS IN CLINICAL CARE, EDUCATION

AND RESEARCH.
AREA APPLICATION DESCRIPTION

Clinical Care OralCDx25 Method for the screening of oral lesions that
involves a brush biopsy and computerized analysis
of the histologic slide, allows for screening of more
patients for premalignant or malignant lesions
earlier

Digital Equivalent to traditional film for many diagnostic

radiology26.27 and therapeutic tasks; advantages include reduced
radiation exposure for patients and dental
personnel, reduced development time, automation of
quality assurance processes and the potential for
immediate digital analysis

Tuned-aperture Example of a three-dimensional imaging modality;

computed applications include primary caries detection29 and
tomography28 assessing bone defects at implant sites30

Decision support Aid for dentists to make decisions about therapeutic

systems19,31 approaches or complex or rarely encountered
conditions; oral radiographic differential diagnosis,32
for instance, supports the diagnosis of radiographic
lesions

MEDLINE33 Database that makes a significant portion of the

dental literature accessible to practitioners to help
answer clinical questions

CEREC34 Fabrication of machine-milled crowns and bridges

during the course of an office visit

Dental practice Automation of many routine tasks in a dental office,

management such as electronic claims submission, scheduling
and financial management

Education Oral manifesta- Computer-assisted learning package on the oral

tions of human manifestations of human immunodeficiency virus of
immunodeficiency relevance to general dental practitioners
virus35

Dental diagnosis Interactive program to provide students or

and treatment36 practicing dentists an opportunity to develop and
practice their critical-thinking skills for diagnosis
and treatment

Simulations37-39 Educational programs designed to closely

approximate clinical situations for teaching,
continuing education or performance evaluation

Complete distance Integrated educational tracks, certificates or degrees

education offered at a distance
programs40

Research Data mining Analysis of large sets of data to generate new

tools41 knowledge or findings

Collaboratories42 Infrastructure to make it easier for large,

geographically distributed research groups to
work together

Computerized Complex analyses of research data

data analysis43

dental informatics researchers. Over the long integrated with those of several existing associa-
term, however, the development of a dedicated, tions, such as the American Dental Education
international and multidisciplinary dental infor- Association, or ADEA; the ADA; and the Amer-
matics journal should be considered. ican Medical Informatics Association, or AMIA. In
Currently, dental informatics has no dedicated most cases, a section or special interest group of
professional society. Rather, its activities are an association provides a forum for exchange be-

608 JADA, Vol. 132, May 2001

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 I N F O R M A T I C S & TECHNOLOGY

tween members. Specialized conferences, such as United States have a department or section of
the Conference on Computers in Clinical Den- medical informatics. Conferences such as
tistry, those sponsored by ADEA, the Consortium Towards Electronic Patient Records and the
for Clinical Information Systems, and the Confer- AMIA’s fall symposium attract several thousand
ence on Computers in Dental Education and Prac- participants each year. Medical informatics
tice have been held in the past. Up until now, research is funded by programs of significant
these conferences have been arranged on an ad scale and scope at NLM, the National Cancer
hoc basis, and none has developed into a stable, Institute and the National Science Foundation, as
widely accepted scientific forum. well as by corporations and foundations.
The first educational programs leading to Dental informatics is a nascent discipline. To
advanced degrees in dental informatics were cre- what degree it can mature successfully depends
ated in 1996 in response to a request for applica- on its ability to take advantage of opportunities
tions issued by the National Institute of Dental and overcome some significant challenges.
and Craniofacial Research, or NIDCR, in coopera-
OPPORTUNITIES AND CHALLENGES
tion with NLM. A program at Columbia Univer-
sity and a joint program offered by the University Dentistry is an information-intensive activity,
of Pittsburgh and Temple University offer mas- and informatics by its very nature supports such
ter’s degrees through three-year and two-year activities well. IT already has significantly im-
programs, respectively. The philosophy of both proved our ability to store, access, manage, filter
training programs is grounded in the belief that and apply information. When one considers what
dental informatics is derived from medical infor- progress has been made in a myriad of aspects of
matics rather than a separate discipline.47 Thus, human life, it is not difficult to envision how den-
trainees complete a generalist education in tistry may be transformed by becoming infor-
medical informatics and specialize in dental matics-based.16 Ultimately, informatics done well
informatics. The programs graduated their first simply will let us concentrate on our jobs as
trainees in 2000. dental professionals by improving and main-
Anecdotal evidence suggests that dental infor- taining the oral health, and consequently the gen-
matics research receives only limited third-party eral health, of our patients. These new and pow-
funding, such as from the government, the mili- erful technologies will bring cultural changes to
tary, foundations and companies. NIDCR and the dental profession itself. The following are
NLM have funded very few grant applications in some opportunities and challenges that infor-
dental informatics, and some universities have matics places before us.
been and are receiving limited corporate support. dLongitudinal, lifetime, comprehensive
In contrast, programs sponsored by the European and patient-centered dental records. Den-
Union have resulted in significant funding in tistry is still largely a cottage industry. This situ-
dental informatics research in Europe. Much of ation expresses itself in the minimal degree to
the research in dental informatics at this time is which patient information is shared. Patient-
conducted as “unfunded” research by faculty at centered, rather than practice-centered, dental
dental schools and universities around the world. records can eliminate duplicate information
It is instructive to compare dental informatics gathering, provide a rich context through access
to its parent, medical informatics. The medical to prior diagnostic and treatment records, and
informatics research community is extremely allow the practitioner to concentrate on the
active. Medical informatics has its own literature problem at hand. The book “Futurize Your Enter-
that is segmented into topics such as biomedical prise”1 contains an excellent vision of how
engineering, biomedical computing, decision sup- patient-centered medical records can improve
port and education.48 Major informatics journals, health care. Several computer system vendors
such as MD Computing and the Journal of the offer precursors to such systems already today.49
American Medical Informatics Association, have dUniversally accessible patient records
existed since the early 1990s, and approximately that ensure privacy and confidentiality. As
140 books about medical informatics have been an increasing portion of patient-related informa-
published. Twelve medical informatics training tion is stored and transmitted digitally, dental
programs funded by NLM exist, and approxi- informatics has the responsibility to develop,
mately 30 of the 150 medical schools in the implement and monitor measures to keep it pri-

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I N F O R M A T I C S & TECHNOLOGY

vate. While no system is perfectly secure, a bal- administered by the ADA, as well as its prede-
ance between privacy and access must be cessor the ASC MD 156 Task Group on Dental
found.50,51 Informatics. Unfortunately, after seven years of
dSignificant reduction of practice manage- work, this effort has achieved little. Tangible
ment and administrative overhead. A signifi- products that have been developed include the
cant portion of health care expenditures go Concept Model for the Standard Computer-Based
toward administration. One of the greatest Oral Health Record56 and the Guidelines for the
sources of inefficiency has been the lack of shared Design of Educational Software.57 Neither of these
information by health care buyers, sellers and efforts has evolved into a widely accepted and
consumers.52 Well-integrated information systems applied standard, but progress may improve
can reduce this overhead significantly, through based on the recent formalization of the SCDI.
measures from autonomous supply ordering to Another challenge is to increase the quality
automated scheduling, billing and recall. and quantity of dental informatics research. The
dClinical care based on empirically deter- standards for investigation and scientific inquiry
mined best practices. Most patients in indus- in new disciplines develop over time, and dental
trialized countries already enjoy very high informatics is no exception. What passes for
standards of care. However, large variations in research and what does not is a subject of periodic
diagnosis and treatment decisions discussion in medical informatics
still exist.53,54 As more patients even today.15,58 The scarcity of people
become aware of the standard of Well-integrated formally trained in research
care, dentists will be forced to prove information methods and approaches and the
the quality of their care. While few systems can reduce dearth of interdisciplinary teams
dental treatments are based on overhead that can solve complex research
definitive clinical evidence obtained questions constrains the volume and
significantly, through
through randomized clinical trials, quality of research output. Support
outcomes data aggregated over large measures from for dental informatics research from
numbers of practices and patients autonomous supply grants, contracts and funding agen-
can help identify best practices. Since ordering to cies such as NIDCR or NLM is
many patients use the Internet to automated minute. The problem, however, is
access health-related information, scheduling, billing two-sided. The lack of qualified
valid and reliable information needs investigators in dental informatics
and recall.
to be available and recognizable as results in a scarcity of fundable
such.55 research proposals. Funding
How can the dental profession take advantage agencies, on the other hand, may not view dental
of these opportunities? A positive circumstance is informatics as a programmatic priority if demand
that dentistry as a profession is relatively unified. for research funding is not apparent.
The majority of U.S. dentists are members of the Dentistry is a relatively small segment of the
ADA. The ADA and other dental organizations, health care system. Thus, many companies are
such as the Academy of General Dentistry and hesitant to invest in research and development
the American College of Dentists, provide because the potential payoff is constrained by the
common ground and political clout on many small size of the market. Network externalities
important issues. Yet success in realizing the pre- also are a significant deterrent to investment.59
sent opportunities rests on significant innovation, Products or services, such as the telephone, that
research and development in informatics that become more valuable as more people use them
most likely will not come from central are said to benefit from network externalities. For
organizations. instance, when only a few practices can exchange
While it may seem difficult to forge a common patient information using computer-based patient
vision for informatics within the dental profes- records, or CPRs, the collective benefit is small.
sion, it is not impossible. One attempt at crafting When most practices use such interoperable
a long-term strategy is the development of stand- CPRs, however, the collective benefit is large.
ards related to dental informatics through the Globalization may improve this situation because
newly formed, ANSI-accredited Standards Com- it increases potential markets.
mittee on Dental Informatics, or SCDI, which is The growth of dental informatics also is ham-

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 I N F O R M A T I C S & TECHNOLOGY

pered because many of its benefits are hard to Association and the British Medical Journal are
measure, and achieving them requires significant good sources for keeping up with general medical
upfront and ongoing investments. For instance, informatics developments.
the quantifiable benefits of a computer system for Meetings and conferences. Venues for infor-
billing and electronic claims submission include matics-related topics are the ADA’s technology
time and money saved in preparing claims, days, the ADEA’s annual session and AMIA’s fall
reduced claim and payment turnaround, and symposium.
improved management of accounts receivable. Standards activities, society activities,
The advantages of installing a CPR, on the other university committees and vendor focus
hand, are much harder to define and measure. groups. The ADA-administered SCDI is an excel-
Evaluating the return on investment, however, is lent way for dentists to get involved in setting the
fraught with difficulties not only in dental infor- standards for tomorrow’s IT applications in den-
matics. Nobel Prize–winning economist Robert tistry. Local and regional dental societies, univer-
Solow said that we see computers everywhere sities and vendors increasingly maintain com-
except in the productivity statistics. Productivity mittees or advisory boards to help shape their
growth has slowed every decade from the 1960s strategies for IT, and they often offer interested
until the mid-1990s, while investments in IT have dentists a chance to get involved.
grown dramatically. This phenomenon has been Computer courses. Colleges and universities
termed the “productivity paradox.” offer introductory and advanced
However, the dramatic contribution The growth of courses in information systems, pro-
of computers to the rising produc- dental informatics is gramming and databases. Many
tivity since 1995 may indicate that companies offer courses on specific
hampered, in part,
we have reached a turning point.60 applications, such as desktop produc-
Since health care in general and den- because many of its tivity and graphics programs. Pro-
tistry in particular still lag in the use benefits are hard grams for bachelor’s or master’s
of computers, most benefits still are to measure, and degrees in a variety of computer-
to come. achieving them related areas also are available, and
The current situation simply may requires significant some of the necessary courses can be
be symptomatic of a profession find- taken through distance learning
upfront and
ing its way in informatics. An en- programs.
couraging sign is the significant and ongoing investments. Communities. The Dental Infor-
increasing interest of many influen- matics Section of ADEA and the
tial stakeholders in dentistry. Hopefully, this Dental Informatics Working Group of AMIA allow
interest can be channeled into concerted action people interested in dental informatics to net-
that benefits all of dentistry. Success, however, work. Both groups maintain Internet discussion
also is predicated on the level of involvement of lists that include members from all over the
each practitioner. The next section highlights world. Joining these communities is free for mem-
some opportunities. bers of the respective organizations.
Dental informatics degree programs. Two
HOW CAN YOU GET INVOLVED IN DENTAL
INFORMATICS? dedicated postgraduate programs in dental infor-
matics currently exist.61,62 Both are appropriate
Getting involved in and staying up to date on for people interested in having a research career
dental informatics is not as easy as joining a pro- in dental informatics. The opportunities available
fessional society and subscribing to its journal. today make this an option particularly attractive
There are, however, a few options. for dentists who would like to participate in
Articles on dental informatics in major shaping the development of dental informatics.
dental journals. Journals in which articles It is safe to assume that the sources of informa-
about dental informatics appear periodically tion and the opportunities for interested dentists
include JADA, the Journal of Dental Education, to get involved will only multiply in the future.
Quintessence International and the Journal of
CONCLUSION
Computerized Dentistry. The Journal of the
American Medical Informatics Association, MD “There is nothing more difficult to take in hand,
Computing, the Journal of the American Medical more perilous to conduct, or more uncertain in its

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I N F O R M A T I C S & TECHNOLOGY

success, than to take the lead in 16. Schleyer T. Digital dentistry in the computer age. JADA
1999;130:1713-20.
the introduction of a new order 17. Eisner J. The future of dental informatics. Eur J Dent Educ
of things.” Niccolò Machiavelli’s 1999;3(suppl 1):61-9.
18. Silverstein S. What is medical informatics, and why is it an
words describe the challenge to important specialty? Available at: “members.aol.com/ informatic-
dental informatics well. Com- smdsmd”. Accessed Dec. 5, 2000.
19. White SC. Decision-support systems in dentistry. J Dent Educ
puter technology has reshaped 1996;60(1):47-63.
our lives already. The question Dr. Schleyer is an asso-
20. Barrows HS. The essentials of problem-based learning. J Dent
ciate professor and the
Educ 1998;62(9):630-3.
is to what degree it will reshape chair, Department of
21. Fincham AG, Baehner R, Chai Y, et al. Problem-based learning at
dentistry. The ubiquitous reach Dental Informatics,
the University of Southern California School of Dentistry. J Dent Educ
Temple University
1997;61(5):417-25.
of today’s computer networks School of Dentistry,
22. Schilling K, Ginn DS, Mickelson P, Roth LH. Integration of infor-
presages significant change: 3223 N. Broad St., TU
mation-seeking skills and activities into a problem-based curriculum.
600-00, Philadelphia,
Bull Med Libr Assoc 1995;83(2):176-83.
dentistry is not an isolated Pa. 19140, e-mail
23. Kalkwarf KL. How the licensure process will evolve. JADA
province of health care anymore. “Titus@DENTAL. 1999;130:1737-42.
Temple.edu”. Address
24. Schleyer T, Forrest J, Kenney R, Dodell D, Dovgy N. Is the
We are now, more than ever, reprint requests to Dr.
Internet useful for clinical practice? JADA 1999;130:1501-11.
connected to a larger system of Schleyer.
25. Sciubba JJ. Improving detection of precancerous and cancerous
oral lesions. JADA 1999;130:1445-7.
stakeholders, regulations, expec- 26. Kademi JA. Direct digital radiography: preliminary review of
tations, accountability and risk. three FDA-approved systems. J Calif Dent Assoc 1994;22:48-56.
27. Versteeg KH, Sanderink GCH, van Ginkel EC, van der Stelt PF.
The road to clinical practice that is invisibly Estimating distances on direct digital images and conventional radio-
and seamlessly supported by informatics will be graphs. JADA 1997;128:439-43.
28. Webber RL, Horton RA, Tyndall DA, Ludlow JB. Tuned-aperture
nothing short of arduous. Putting the theories computed tomography (TACT): theory and application for three-dimen-
and concepts of informatics into practice requires sional dento-alveolar imaging. Dentomaxillofac Radiol 1997;26(1):
53-62.
significant effort and investment. Many projects 29. Tyndall DA, Clifton TL, Webber RL, Ludlow JB, Horton RA.
on this road will fail. Dentistry, however, should TACT imaging of primary caries. Oral Surg Oral Med Oral Pathol Oral
Radiol Endod 1997;84(2):214-25.
learn from the failures as much as it does from 30. Horton RA, Ludlow JB, Webber RL, Gates W, Nason RH Jr.,
the successes. Only then will we realize the Reboussin D. Detection of peri-implant bone changes with axial
tomosynthesis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod
promise of informatics. ■ 1996;81:124-9.
31. Wagner IV, Schneider W. Computer based decision support in
dentistry. J Dent Educ 1991;55(4):263-7.
Dr. Spallek is an assistant professor, Department of Dental Infor- 32. White S. ORAD for the Web: ORAD Version 2.0. Available at:
matics, Temple University, Philadelphia. “www.dent.ucla.edu/cgi-bin/orad/orad.pl”. Accessed Dec. 5, 2000.
33. Ahluwalia KP, Lang WP. Accessing MEDLINE from the dental
The authors thank Drs. Roger Kenney, Hikmet Umar and Humberto office. JADA 1996;127:510-6.
Torres and several other colleagues in dental informatics for their 34. Mormann WH, Schug J. Grinding precision and accuracy of fit of
thoughts and insights that contributed to this manuscript. The authors CEREC 2 CAD-CAM inlays. JADA 1997;128:47-54.
also thank the reviewers for their helpful comments. 35. Porter SR, Telford A, Chandler K, et al. Computer assisted
learning (CAL) of oral manifestations of HIV disease. Br Dent J 1996;
1. Siegel D. Futurize your enterprise: Business strategy in the age of 5(181):173-7.
the E-customer. New York: John Wiley & Sons; 1999. 36. Clancy J, Johnson L, Finkelstein M, Lilly G. Dental diagnosis and
2. Tapscott D. Growing up digital. New York: McGraw-Hill; 1998. treatment (DDx & Tx): interactive videodisc patient simulations for
3. Martin C. Net future. New York: McGraw-Hill; 1999. dental education. Comput Methods Programs Biomed 1990;33(1):21-6.
4. Hamel G, Prahalad CK. Competing for the future. Boston: Harvard 37. Johnson LA, Wohlgemuth B, Cameron CA, et al. Dental Interac-
Business School Press; 1994. tive Simulations Corporation (DISC): simulations for education, contin-
5. NUA Ltd. NUA Internet survey: ecommerce statistics. Available uing education, and assessment. J Dent Educ 1998;62(11):919-28.
at: “www.nua.ie/surveys/index.cgi?f=FS&cat_id=14”. Accessed Dec. 5, 38. Dentsim. Home page. Available at: “www.denx.com”. Accessed
2000. March 27, 2001.
6. Jupiter. Research overview. Jupiter Communications Inc. Avail- 39. Johnson LA, Cunningham MA, Finkelstein MW, Hand JS. Geri-
able at: “www.jup.com/jupiter/research/research.jsp”. Accessed Dec. 5, atric patient simulations for dental hygiene. J Dent Educ
2000. 1997;61(8):667-77.
7. CyberAtlas. CyberAtlas: latest market research. Internet.com Inc. 40. Smith TA, Raybould TP, Hardison J. A distance learning program
Available at: “cyberatlas.internet.com”. Accessed Dec. 5, 2000. in advanced general dentistry. J Dent Educ 1998;62(12):975-84.
8. Dyson E. Release 2.0: A design for living in the digital age. New 41. Swanson DR, Smalheiser NR. An interactive system for finding
York: Broadway Books; 1997. complementary literatures: a stimulus to scientific discovery. Artif
9. American Dental Association Survey Center. 1997 Survey of cur- Intell 1997;91:183-203.
rent issues in dentistry: Dentists’ computer use. Chicago: American 42. Kouzes RT, Myers JD, Wulf WA. Collaboratories: doing science on
Dental Association; 1998. the Internet. Computer 1996;29(8):40-6.
10. Hedberg SR. Like oxygen, researchers think computers will be 43. Sertgoz A. Finite element analysis study of the effect of super-
everywhere. IEEE Intell Syst 2000;15(3):2-6. structure material on stress distribution in an implant-supported fixed
11. Farr C. Digital dentistry in the 21st century. Dent Today prosthesis. Int J Prosthodont 1997;10(1):19-27.
2000;19(6):96-101. 44. Abbey L, Zimmerman J. Dental informatics. New York: Springer
12. Merriam-Webster Online. Informatics. Available at: “www. Verlag; 1992.
m-w.com”. Accessed March 26, 2001. 45. Schleyer T, Spallek H, Spallek G. The global village of dentistry:
13. Hasman A. Challenges for medical informatics in the 21st cen- Internet, intranet, online services for dental professionals. Berlin:
tury. Int J Med Inf 1997;44(1):1-7. Quintessence; 1998.
14. Patel VL, Kaufman DR. Medical informatics and the science of 46. Goldstein C, Goldstein R, Garber D. Imaging in estethic dentistry.
cognition. J Am Med Inform Assoc 1998;5(6):493-502. Berlin: Quintessence; 1998.
15. Friedman CP. Where’s the science in medical informatics? J Am 47. Masys DR, Brennan PF, Ozbolt JG, Corn M, Shortliffe EH. Are
Med Inform Assoc 1995;2(1):65-7.

612 JADA, Vol. 132, May 2001

Copyright ©1998-2001 American Dental Association. All rights reserved.
 I N F O R M A T I C S & TECHNOLOGY

medical informatics and nursing informatics distinct disciplines? The model for the standard computer-based oral health record. J Am Coll
1999 ACMI debate. J Am Med Inform Assoc 2000;7(3):304-12. Dent 1995;62(4):30-2.
48. Morris TA, McCain KW. The structure of medical informatics 57. Johnson L, Schleyer T. Development of standards for the design
journal literature. J Am Med Inform Assoc 1998;5(5):448-66. of educational software. Quintessence Int 1999;30(11):763-8.
49. Goedert J. Do-it-yourself online records. Health Data Manag 58. Patel VL, Kaufman DR. Science and practice: a case for medical
1999;7:28-9. informatics as a local science of design. J Am Med Inform Assoc
50. Hudak J. Emergency care. CIO Magazine. Nov. 11 1999;Web 1998;5(6):489-92.
business section 2:34-36. 59. Katz M, Shapiro C. Network externalities, competition, and com-
51. Masys DR, Baker DB. Patient-centered access to secure systems patibility. Am Econ Rev 2000;75(3):424-40.
online (PCASSO): a secure approach to clinical data access via the 60. Sichel D. Computers and aggregate economic growth: an update.
World Wide Web. Proc AMIA Annu Fall Symp 1997;17(3):340-3. Business Econ 1999;34(2):18-24.
52. Reep JA, Lohman P. Market forces and the environment. MD 61. Temple University School of Dentistry. Dental informatics post-
Comput 1999;16(5):38-9. graduate program. Available at: “www.temple.edu/dentistry/di/pro-
53. Bader JD, Shugars DA. Variation, treatment outcomes, and prac- grams/pg”. Accessed Dec. 5, 2000.
tice guidelines in dental practice. J Dent Educ 1995;59(1):61-95. 62. Columbia University School of Dental and Oral Surgery. Dental
54. Bader JD, Shugars DA. Variation in dentists’ clinical decisions. J informatics fellowship. Available at: “cpmcnet.columbia.edu/dental/
Public Health Dent 1995;55(3):181-8. Dental_Fellows.html”. Accessed Dec. 5, 2000.
55. Gregory-Mead B. Patients and the Internet: guidance for evi-
dence-based choices. J Am Coll Dent 1999;66(2):46-50.
56. Diehl M. Developing the American Dental Association concept

JADA, Vol. 132, May 2001 613

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