*Letter* **Recent Trends and Future Direction of Dental Research in the Digital Era**

**Tim Joda 1,\*, Michael M. Bornstein 2, Ronald E. Jung 3, Marco Ferrari 4, Tuomas Waltimo <sup>2</sup> and Nicola U. Zitzmann <sup>1</sup>**


Received: 4 March 2020; Accepted: 10 March 2020; Published: 18 March 2020

**Abstract:** The digital transformation in dental medicine, based on electronic health data information, is recognized as one of the major game-changers of the 21st century to tackle present and upcoming challenges in dental and oral healthcare. This opinion letter focuses on the estimated top five trends and innovations of this new digital era, with potential to decisively influence the direction of dental research: (1) rapid prototyping (RP), (2) augmented and virtual reality (AR/VR), (3) artificial intelligence (AI) and machine learning (ML), (4) personalized (dental) medicine, and (5) tele-healthcare. Digital dentistry requires managing expectations pragmatically and ensuring transparency for all stakeholders: patients, healthcare providers, university and research institutions, the medtech industry, insurance, public media, and state policy. It should not be claimed or implied that digital smart data technologies will replace humans providing dental expertise and the capacity for patient empathy. The dental team that controls digital applications remains the key and will continue to play the central role in treating patients. In this context, the latest trend word is created: augmented intelligence, e.g., the meaningful combination of digital applications paired with human qualities and abilities in order to achieve improved dental and oral healthcare, ensuring quality of life.

**Keywords:** digital transformation; rapid prototyping; augmented and virtual reality (AR/VR); artificial intelligence (AI); machine learning (ML); personalized dental medicine; tele-health; patient-centered outcomes

#### **1. Introduction**

Digital transformation is the ubiquitous catchword in a variety of business sectors, and (dental) medicine is no exception [1]. Continuous progress in information technology (IT) has made it possible to overcome the limitations and hurdles that existed in clinical and technological workflows just a few years ago [2]. In addition, social and cultural behaviors of civilized society in industrial countries have changed and fostered the trend of digitalization: urbanism, centralization, and mobility, permanent accessibility via smartphones and tablets combined with the internet of things (IoT), as well as convenience-driven markets striving for efficiency [3].

The implementation of digital tools and applications reveals novel options facing today's chief problems in healthcare, such as a demographic development of an aging population with an increased prevalence of chronic diseases and increased treatment costs over an individual's lifespan [4]. In dental medicine, several digital workflows for production processing have already been integrated into treatment protocols, especially in the rapidly growing branch of computer-aided design/computer-aided manufacturing (CAD/CAM) and rapid prototyping (RP) [5].

New possibilities have opened up for automated processing in radiological imaging using artificial intelligence (AI) and machine learning (ML). Moreover, augmented and virtual reality (AR/VR) is the technological basis for the superimposition of diverse imaging files creating virtual dental patients and non-invasive simulations comparing different outcomes prior to any clinical intervention. Increased IT-power has fostered these promising technologies, whose possible uses can only be assessed in the future [6]. Not all digital options are currently exhausted, and their (valuable) advantages are not completely understood. Basic science, clinical trials, and subsequently derived knowledge for innovative therapy protocols need to be re-directed towards patient-centered outcomes, enabling the linkage of oral and general health instead of merely industry-oriented investigations [7].

To sum up, unseen opportunities will arise due to digital transformation in oral healthcare and dental research. Therefore, this opinion letter highlights the estimated top five healthcare trends and innovations of the dawning digital era that might influence the direction of dental research and their stakeholders in the near future.

#### **2. Top Five Healthcare Trends and Innovations**

#### *2.1. Rapid Prototyping (RP)*

RP is a technique to quickly and automatically construct three-dimensional (3D) models of a final product or a part of a whole using 3D-printers. The additive manufacturing process allows inexpensive production of complex 3D-geometries from various materials and minimal material wastage [8]. However, while the future looks very promising from a technical and scientific point of view, it is not clear how RP and its products will be regulated. This uncertainty is problematic for the producing industry, healthcare provider, and patients as well.

In dentistry, one of the main difficulties today is the choice of materials. Commercially available materials commonly used for RP are currently permitted for short to medium-term intraoral retention only and are, therefore, limited to temporary restorations and not yet intended for definitive dental reconstructions. RP offers great potential in dental technology for mass production of dental models, but also for the fabrication of implant surgical guides [9]. For those indications, prolonged intraoral retention is not required. From an economic point of view, a great advantage is the production in large quantities at the same time in a reproducible and standardized way. Another important area of application is the use of 3D-printed models in dental education based on CBCT or μCT. An initial study, however, has revealed that 3D-printed dental models can show changes in dimensional accuracy over periods of 4 weeks and longer. In this context, further investigations comparing different 3D-printers and material combinations are compellingly necessary for clarification [10].

In the near future, those material-related barriers and limitations will probably be broken down. Many research groups are focusing on the development of printable materials for dental reconstructions, such as zirconium dioxide (ZrO2) [11]. This different mode of fabrication of ZrO2 structures could allow us to realize totally innovative geometries with hollow bodies that might be used, for example, for time-dependent low-dose release of anti-inflammatory agents in implant dentistry [12]. A completely revolutionary aspect would be the synthesis of biomaterials to artificially create lost tooth structures using RP technology [13]. Instead of using a preformed dental tooth databank, a patient-specific digital dental dataset could be acquired at the time of growth completion and used for future dental reconstructions. Furthermore, the entire tooth can be duplicated to serve as an individualized implant. RP will most likely offer low-cost production and highly customized solutions in various fields of dental medicine that can be tailored to suit the specific needs of each patient.

#### *2.2. Augmented and Virtual Reality (AR*/*VR)*

AR is an interactive technology enhancing a real-world environment by computer-animated perceptual information. In other words, AR expands the real world with virtual content. In most cases, it is the superimposition of additional digital information on live images or videos. VR, in contrast, uses only artificial computerized scenarios without connection to reality [14]. Depending on the technique, every conceivable way of sensation can be used, mainly visual, auditory, and haptic, independently or in any combination [15]. Today, there is a rapidly increasing number of applications for AR/VR technologies in dental medicine as a whole, as well as many intriguing developments for both patients and healthcare providers [16–18].

AR/VR software allows users to superimpose virtually created visualizations onto recordings of the patient in natural motion. Any 3D-model, for instance, a prosthetic design of a possible reconstruction, can be augmented into the individual patient situation to simulate diverse, prospective outcomes in advance without invasive work steps [19]. These digital models can then be viewed in real-time and facilitate communication not only with the patient to demystify the complex treatment steps but also between dental professionals to make the treatment more predictable and efficient. In the future, the possibilities will continue to grow and help facilitate the dental routine. An interesting indication is the augmentation of CBCT-based virtual implant planning directly into the oral cavity or while using intraoral scanners (IOS), projection, and display of the optically detected area with AR glasses.

Another promising area of interest is the sector of dental education, transferring theoretical knowledge and practical exercises to offer interactive teaching with 24/7-access and objective evaluation. AR/VR-based motor skill training for tooth preparation especially facilitates efficient and autonomous learning for dental students. Initial studies have shown that AR/VR technologies stimulate more senses to learn meritoriously [20]. Moreover, in postgraduate education, challenging and complex clinical protocols can be trained in a complete virtual environment without risk or harm for real patients; additionally, specialists can continuously maintain their skills while training with AR/VR-simulations. Within a few years, AR/VR will have the potential to revolutionize dental education radically [21,22].

#### *2.3. Artificial Intelligence (AI) and Machine Learning (ML)*

AI (including ML) has already invaded and established itself in our daily lives, although in more subtle means, such as virtual assistants named "Siri" or "Alexa". The basis for AI is the increasing power of computers to think like and complete tasks currently performed by humans with greater speed, accuracy, and lower resource utilization [23,24]. Therefore, AI technology is perfect for work that requires the analysis and evaluation of large amounts of data. Repetitive activities are boring and tiring for humans in the long-run with increased risk of error, while AI-based applications do not show signs of fatigue. In contrast to humans, the artificial learning process results in constant better performance with increasing workload. Additionally, computers are not biased compared to humans, who come with innate biases and may judge things prematurely and differently from each other [25,26].

The most valuable indication for the use of AI and ML in dentistry is the entire field of diagnostic imaging in dento-maxillofacial radiology [27,28]. Currently, applications and research in AI purposes in dental radiology focus on automated localization of cephalometric landmarks, diagnosis of osteoporosis, classification/segmentation of maxillofacial cysts and/or tumors, and identification of periodontitis/periapical disease. Computer software analyzing radiographs has to be trained on huge datasets ("big data") to recognize meaningful patterns. The diagnostic performance of AI models varies among different algorithms used, is also dependent on the observers labeling the datasets, and it is still necessary to verify the generalizability and reliability of these models by using adequate, representative images. AI software must be able to understand new information presented by images as well as written text or spoken language with proper context. Finally, the software must be able to make intelligent decisions regarding this new information, and then, learn from mistakes to improve the decision-making for future processing [29].

A beneficial AI system should realize all of this in about the same time that a human being can perform the given task. Up to now, applications of AI on a broad scale were not technically feasible or cost-effective, so the reality of AI has not yet matched the possibilities in routine dental applications [30], although the technical progress is exponential, and very soon, a large number of AI models will be developed for automated diagnostics of 3D-imaging identifying pathologies, prediction of disease risk, to propose potential therapeutic options, and to evaluate prognosis.

#### *2.4. Personalized (Dental) Medicine*

Electronic health records (eHR) with standardized diagnostics and generally accepted data formats are the mandatory door opener to personalized medicine and predictive models investigating a broader population. The structured assessment and systematic collection of patient information is an effective instrument in health economics [31]. Health data can be obtained from routine dental healthcare and clinical trials, as well as from diverse new sources, as IoT in general, and specifically, data on the social determinants of health [3].

The linkage of individual patient data gathered from various sources enables the diagnosis of rare diseases and completely novel strategies for research [32]. Examining large population-based patient cohorts could detect unidentified correlations of diseases and create prognostic models for new treatment concepts. The linkage of patient-level information to population-based citizen cohorts and biobanks provides the required reference of diagnostic and screening cutoffs that could identify new biomarkers through personalized health research [33].

eHR has great power for a change of research both ways. On the other side, the digitized transparent patient could be stigmatized and categorized by insurance companies, provoking adverse effects that have not yet been determined socially [3,6]. Therefore, linked biomedical data supporting register-based research pose several risks and methodological challenges for clinical research: appropriate security settings and the development of algorithms for statistical calculations, including interpretation of collected health data [34,35]. A generally accepted code of conduct has to be defined and established for the ethical and meaningful use of register-based patient data.

Overall, personalized medicine holds the key to unlocking a new frontier in dental research. Genomic sequencing, combined with the developments in medical imaging and regenerative technology, has redefined personalized medicine using novel molecular tools to perform patient-specific precision healthcare [36,37]. It has the potential to revolutionize healthcare using genomics information for individual biomarker identification [38]. The vision is an interdisciplinary approach to dental patient sample analysis, in which dentists, physicians, and nurses can collaborate to understand the inter-connectivity of disease in a cost-effective way [39].

#### *2.5. Tele-Healthcare*

Tele-healthcare enables a convenient way for patients to increase self-care while potentially reducing office visits and travel time [40]. Considering the growing number of the elderly population with reduced mobility and/or nursing home-stay, special-care patients, as well as people living in rural areas, these patient groups would benefit significantly from tele-dentistry [41,42]. Measures to be taken in case of dental trauma can be effectively communicated by telephone counselors and can be frequently used during out-of-office hours [43]. In general, it facilitates easier access to care and also represents a cost-reduced option for patients, as instead of expensive treatments, tele-dentistry shifts towards prevention practices and allows patients to consult with otherwise unavailable dental professionals, for example, using a live consult via video-streaming [44,45]. Nevertheless, it must be emphasized that tele-dentistry can never replace a real dentist; rather, it must be understood as an additional tool [30].

Today, tele-dentistry is only in an early start-up phase [46]. Early studies have mainly focused on specific and rare diseases that might require surgery, but there are findings that suggest that a teleradiology system in general dental practice could be helpful for the differential diagnosis of common lesions and may result in a reduction of unnecessary costs [47]. There is a fundamental need to regulate the expanding field of tele-healthcare, with guidelines to secure clinical quality standards. The legislation must be clearly defined and clarified for routine implementation of a national-wide tele-dentistry platform. The technical requirements must be met and security standards for sensitive patient information guaranteed, with well-defined regulatory affairs.

#### **3. Conclusions**

The future direction of dental research should foster the linkage of oral and general health in order to focus on personalized medicine considering patient-centered outcomes. In this context, dental research must have an impact as a deliverable to society, not just research to churn out scientific publications but to truly change protocols applied in the clinic. Moreover, here, digitization with AI/ML and AR/VR represents the most promising tools for innovative research today. Furthermore, research in a digital era will also be more and more assessed in terms of "impact" as a deliverable good. Impact assessment is still very much debated by scientists, healthcare policy-makers, and politicians. Additionally, general public health societies are increasingly dependent on solid data sets, gaining knowledge to enable innovations and result in recommendations, guidelines, and healthcare policies of utmost importance. These are supposed to generate economic and social benefits on every and each level from an individual to a population. Scientists in dental medicine have also to be aware that funding might be increasingly dependent on the possibility to demonstrate an impact on a large scale. Thus, the use of impact assessments in the future will most likely serve the following two tasks: (1) demonstrating the value of research, and (2) increasing the value of research through a more effective way of financing research in order to have a societal impact [48,49].

For digital dentistry, this requires managing expectations pragmatically and ensuring transparency for all stakeholders: patients, healthcare providers, university and other research institutions, the medtech industry, insurance, public media, and state policy. It should not be claimed or implied that digital smart data technologies will replace humans who possess dental expertise and the capacity for patient empathy. Therefore, the dental team controlling the power of the digital toolbox is the key and will continue to play a central role in the patient's journey to receive the best possible individual treatment, and to provide emotional support. The collection, storage, and analysis of digitized biomedical patient data pose several challenges. In addition to technical aspects for the handling of huge amounts of data, considering internationally defined standards, an ethical and meaningful policy must ensure the protection of patient data for safety optimal impact.

Nowadays, the mixed term "augmented intelligence" is perhaps somewhat prematurely introduced in social media. However, the benefits of digital applications will complement human qualities and abilities in order to achieve improved and cost-efficient healthcare for patients. Augmented intelligence based on big data will help to reduce the incidence of misdiagnosis and offers more useful insights—quickly, accurately, and easily. This is all achievable without losing the human touch, improving the quality of life.

**Author Contributions:** Conceptualization, T.J.; Methodology, T.J. and N.U.Z.; Writing—Original Draft Preparation, T.J. and N.U.Z.; Writing—Review and Editing, M.M.B., R.E.J., M.F., and T.W.; Supervision, T.J.; Project Administration, T.J. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflict of interest.

#### **References**


#### *Int. J. Environ. Res. Public Health* **2020**, *17*, 1987


© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

International Journal of *Environmental Research and Public Health*

### *Letter* **Digital Oral Medicine for the Elderly**

#### **Christian E. Besimo \*, Nicola U. Zitzmann and Tim Joda**

Department of Reconstructive Dentistry, University Center for Dental Medicine Basel, University of Basel, 4058 Basel, Switzerland; n.zitzmann@unibas.ch (N.U.Z.); tim.joda@unibas.ch (T.J.)

**\*** Correspondence: christian.besimo@bluewin.ch; Tel.: +41-61-267-2632

Received: 16 February 2020; Accepted: 22 March 2020; Published: 25 March 2020

**Abstract:** Sustainable oral care of the elderly requires a holistic view of aging, which must extend far beyond the narrow field of dental expertise to help reduce the effects of sociobiological changes on oral health in good time. Digital technologies now extend into all aspects of daily life. This review summarizes the diverse digital opportunities that may help address the complex challenges in Gerodontology. Systemic patient management is at the center of these descriptions, while the application of digital tools for purely dental treatment protocols is deliberately avoided.

**Keywords:** oral medicine; oral healthcare; dentistry; gerodontology; elderly patient; digital transformation; big data; patient-centered outcomes

#### **1. Introduction**

The steady aging of human populations is a development that affects not only the industrialized world, but also emerging and developing countries. It is estimated that about half of all people who have ever lived to an age of 65 years old or older are alive today. We are living through an exponential population expansion and demographic transition. Therefore, it is necessary to understand the sociological and biological changes facing the elderly population and to master the current and future challenges in dental healthcare for aging patients [1].

This opinion letter, based on an ongoing evaluation of the sociodemographic changes due to aging, focuses on digital technologies, which could help deal with the complex challenges in oral medicine for the growing elderly.

#### **2. A Silent Revolution**

#### *2.1. Social Change*

Old age is changing fundamentally and to an extent that justifies the term 'social revolution', albeit one that is proceeding quietly. This change is characterized by the objective of being able to live in a self-determined manner and in a private environment for as long as possible, even when in need of healthcare. In this context, a transfer to a care institution is only foreseen in the case of an extreme emergency and to be delayed for as long as possible. This development will contribute to the progressive delaying of the fourth age, which is marked by the need for advanced assistance and care, and will further reduce the average length of stay in institutions. In Switzerland, individuals aged 65 years and older only stay in nursing homes for one year [2].

It is important to recognize the goal-oriented willingness and the high degree of creativity that senior citizens, either currently working or retired, display in their third age (traditionally 65–80 years old). However, these factors do not allow for any reliable prognoses regarding changes in lifestyles in old age and force the professional groups, institutions, and organizations concerned with aging to continually adapt their strategies and concepts [2]. This awareness has also reached the political arena in Switzerland, so that in future, there will be a growing reluctance to plan new inpatient care places and priority will be given to outpatient care in terms of cost-effectiveness [3,4].

#### *2.2. Consequences for Health*

The biological limit for life expectancy at birth and after reaching the age of 65 is still not predictable. Medical advances, healthy nutrition, good education, and improving working conditions continue to favor an increasingly longer third age and will reduce the risk and duration of the fourth age [2].

The preventive and restorative success of dentistry have led to people with an increasing number of teeth (including implant-supported reconstructions). However, despite their knowledge of the importance of regular dental check-ups for oral and general health, the elderly will inevitably gradually withdraw from this care, beginning between the ages of 60 and 65 [5]. The risk of psychosocial (loneliness, poverty) and medical problems (multimorbidity, polypharmacy), which increase with age, play a central role in withdrawing from care with major consequences for dental and oral health in the long term. Oral diseases do not only occur in old age when the need for help and care begins, but much earlier, because the social and biological factors mentioned above increasingly affect the resources needed to maintain oral hygiene and to receive regular care from the personal dental team. Even if the fourth age is delayed, the oral health issues still inevitably arise, and are then complicated further by the additional comorbidities of aging [6].

Facing these complex challenges, it is important for dentists to learn to perceive the human being holistically—in her or his entirety—and to establish a close network with other medical disciplines, institutions, organizations, authorities, and relatives who are concerned with the care of aging people. It is important to be aware that the range of stakeholders involved is growing and becoming more volatile, as the shift from inpatient to outpatient care increases [7,8].

#### **3. Digital Opportunities**

People participating in the digital community generate a rapidly growing amount of data every day. This is also increasingly true for senior citizens. Scientific use of this data offers the opportunity to gain a deeper and more dynamic insight into the lifestyle of aging people, for example, through analyzing digital shopping activities and payment transactions. This could allow a better and more up-to-date understanding of the changing lifestyles of the elderly. It is conceivable that algorithms could be developed that can identify sociobiological threats at an early stage by monitoring changes in behavior. Such algorithms would also be important for the dental care of aging people and thus for oral health. This would be one of several opportunities to achieve a paradigm shift in geriatric dentistry and to promote preventive rather than palliative care concepts that are still predominant [9,10].

#### *3.1. In Frigo Veritas (The Truth Lies in the Fridge)*

The *"In Frigo Veritas*" study conducted in Geneva in the 1990s demonstrated that the contents of the refrigerators of senior citizens was associated with the likelihood of hospitalization in the following month (11). Monitoring the nutritional provisions available to an elderly individual could therefore identify those at risk early. The use of shopping lists of food products, which are already electronically recorded today with the help of customer cards, could be considered here. This data alone would already allow individual conclusions to be drawn about the quantity, quality, and course of food. A link to intelligent refrigerator systems that can document the consumption and replenishment of food would also be conceivable. This would allow continuous conclusions to be drawn in real time on the nutritional situation and thus the morbidity risk in an out-of-home care setting [11]. This application could also be used in dentistry for therapeutic decision making or for the ongoing assessment of the care capacity of aging people threatened by sociobiological risks. In addition, nutritional counselling and guidance, supported by nutritional algorithms, could be carried out in a simplified, individualized and continuous manner, before, during, and/or after dental interventions such as tooth extractions or the insertion of fixed and removable dentures [12].

#### *3.2. Intelligent, Individually Usable Systems*

The personal health data generated in medicine, including dentistry, or by intelligent systems suitable for everyday use, such as smartphones, watches or other devices, open up a wide range of application options that will go far beyond the recording of acute emergency situations in in-home and out-of-home care settings. On the one hand, the cumulative use of medically relevant data does not only offer significantly expanded perspectives for research, but also for patient care. Today, it is already feasible to record vital data in real time using the aforementioned intelligent everyday systems. It can be assumed that the availability and variety of such systems will continuously increase in the near future and will also be usefully applied in dentistry [13,14].

#### *3.3. Stop Walking When Talking*

Nowadays, electronic pedometers are used to obtain discounts from health insurance companies. Similarly, we are already able to analyze gait regularity and thus the risk of falls among older people in specialized mobility centers, with or without multitasking, and to draw conclusions about diseases, side effects of medication, and cognitive performance [15]. The transfer of such systems to shoe insoles, for example, not only has the potential to obtain and link incomparably more empirical data on gait safety in elderly people living in a private household, but also to monitor their mobility in real time. In this context, the effects of therapeutic interventions on gait safety, such as those that aim to optimize occlusion, could be dynamically monitored [16].

#### **4. Interdisciplinary Networking**

As mentioned previously, the (dental) medical care of aging people living in private households is faced with growing interdisciplinary challenges. On the one hand, healthcare providers have to establish a network to harness the knowledge of the various disciplines by means of suitable digital systems to make it not only accessible for interdisciplinary research, but also clinically usable under growing organizational and legal requirements. On the other hand, everyday clinical practice requires dynamic, real-time networking among the growing number of stakeholders in the care of the elderly, which will increase significantly and become more volatile as outpatient care expands. Here, intelligent tools are needed that enable compatible, rapid, and secure interdisciplinary data exchange on a patient-by-patient basis to support individually tailored decision-making based on algorithms [17].

Finally, it is expected that routine sequencing of the genome in the case of disease will become established within the next five to ten years, as the costs of this procedure have been significantly reduced from \$100,000 to \$1000 over the last 20 years [18]. This should also contribute to the individualization of prevention, diagnostics, and therapy in dentistry, especially for older people with increasing psychosocial and medical risks. The latter could possibly be detected earlier and counteracted more effectively [19].

#### **5. Ethical and Legal Responsibilities**

We have learned from the hitherto short history of the digitalization of our world that this development is accelerating at a breathtaking rate. This calls for an urgent and internationally valid regulation for the protection of personal data of individuals, while enabling the exchange of personal information between stakeholders for the benefit of the individual. This has been pioneered by the basic data protection regulation of the European Union [20]. Such a set of rules must compensate for the existing socio-economic asymmetry of a data-driven economy, which ensures the right to a copy of personal data and thus digital self-determination. However, the right to a copy of personal data also requires the development of cooperatively managed databases that are able to manage the digital information in a fiduciary capacity and in a comparable way to financial institutions. In this way, it would be ensured that people could come into possession of all their health-related data to use these

under regulated conditions for their own benefit or to make data available to research and thus to the community [21].

In addition, society must ensure that (dental) medicine, which is increasingly controlled by guidelines and algorithms, does not lose sight of the individual person. It is true that large amounts of data can increase the reliability of answers to individual questions. Nevertheless, it remains to be hoped that big data will not lead to further commercialization or industrialization of medicine, and thus, neglect the healing power of a systemic doctor-patient relationship, but rather that it will nurture this relationship [22,23].

#### **6. Conclusions**

The global demographic change is characterized by an exponential population expansion and sociobiological transition towards a growing number of older patients. Sustainable oral healthcare of the elderly must comprise a holistic view of aging, far beyond the narrow field of dental diagnostics and modernized treatment protocols. Digital health data generated in dental medicine, or by daily used systems, such as smartphones, tablets, and watches, open up a wide range of application options in (oral) healthcare to master the complex challenges in Gerodontology. Scientific use of this data offers broad insights into the lifestyle of aging patients for the early identification of social threats and changing behaviors.

Medical and dental healthcare providers have to establish an interdisciplinary network using these digital systems for routine clinical practice. Smart digital applications are needed, which enable compatible, rapid, and secure interdisciplinary data exchange on a patient-by-patient level to support individually tailored decision-making based on the knowledge of all stakeholders in the care of the elderly in in-home and out-of-home care settings. The digital transformation has the opportunity to achieve a paradigm shift in geriatric dentistry and to promote preventive rather than palliative healthcare concepts.

**Author Contributions:** Conceptualization, C.E.B. and T.J.; methodology, C.E.B. and T.J.; writing—original draft preparation, C.E.B.; writing—review and editing, T.J. and N.U.Z.; supervision, T.J.; project administration, T.J. All authors have read and agreed to the published version of the manuscript.

**Funding:** This research received no external funding.

**Conflicts of Interest:** The authors declare no conflicts of interest.

#### **References**


© 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).

International Journal of *Environmental Research and Public Health*
