Exploring the prospects of artificial intelligence in transforming dental care for special needs groups: A Scoping Review

doi:10.21203/rs.3.rs-7578245/v1

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Exploring the prospects of artificial intelligence in transforming dental care for special needs groups: A Scoping Review

https://doi.org/10.21203/rs.3.rs-7578245/v1

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Introduction

The integration of Artificial Intelligence (AI) in various realms of dental practice has been ground-breaking. Their application in providing quality dental care to individuals with special needs has been scarcely explored and hold potential to be transformative. This Scoping review aims to evaluate the evidence on application of AI tools in special care dentistry, their prospects and challenges to their use.

Methods

A comprehensive review was carried with search strategy involved the use of the keywords along with Boolean operators: (“artificial intelligence”) AND (“Intellectual disability” OR “Physical disability” OR “Medically compromised” OR “Geriatric” OR “Elderly”) AND (“dentistry”). Databases searched included PubMed, Google scholar, Scopus and Web of Science, including studies that were available as full- text and published in English language. The study characteristics were evaluated for the AI tool used, special groups involved and the aspect of dental care.

Results

Five studies were included in the review, that studied AI tools used for diagnosis, treatment planning, patient risk prediction, surveillance and behaviour management of these groups, with one study of the five assessing the perception of dentists on their use. The AI tools exhibited high accuracy (88–95%) and user acceptance (> 85%) with most dentists (74.4%) recommending its use in special care dentistry.

Conclusions

This scoping review and evidence syntheses highlighted the potential of AI in enhancing dental care for those needing special care, while also indicating the research gap necessitating future studies that are scientifically robust and based on real- world applications.

Health sciences/Health care/Dentistry/Special care dentistry

Health sciences/Health care/Dentistry/Dental public health/Dental epidemiology

Artificial Intelligence

Elderly

Intellectual Disability

Persons with Disabilities

Modern day dentistry has been constantly evolving to extend quality oral care to individuals irrespective of their physical, mental, emotional and environmental limitations. The scope and access to Dental care is expanding with special priority to those requiring special care due to disability and restricted functionality. Special care dentistry caters to these vulnerable populations with dental care adapted to meet their specific oral health needs. Special care dentistry is defined by the International Association for Disability and oral Health as, “dentistry for individuals with a disability or activity restriction that directly or indirectly affects their oral health, within the personal and environmental context of the individual”.⁽¹⁾ Persons requiring special needs include physically and mentally challenged persons, immunocompromised persons, those with illnesses, prison inmates, homeless individuals and immigrants. Each of these diverse groups, need dental care modified to their complex circumstances. Despite the advancements, the groups needing special care face various challenges in the pursuit of quality dental care. From personal barriers to institutional, social and environmental barriers, constraints of different forms exist across countries to the access and utilization of dental care by these groups. Personal constraints include physical, psychological, cognitive and mental impairments that impede communication, delivery and acceptance of dental treatment.

Institutional and social barriers such as lack of policies, programmes, structural arrangements and lack of awareness regarding the dental needs of these groups. The overall dearth in dental personnel and dental care adapted to the requirements of special needs group, financial constraints and structural difficulty in integration of dental and medical care for such individuals are major drawbacks hindering the delivery of quality dental care.⁽²⁾

Although existing dental care systems have managed to superficially address these challenges, the need for incorporating systems that can comprehensively tackle the challenges along the dental care pathway to these groups are crucial. Conventional dental care has relied on early diagnosis, standardized treatment protocols and regular follow-ups that are subjective, susceptible to manual error and resource-intensive. In this regard, various measures and tools have been utilised to aid in the efficient delivery of dental care to the special needs population. One of the tools that has shown promising prospects is Artificial Intelligence (AI), with transformative and accurate outcomes that can be included in this realm.

The application of Artificial Intelligence (AI) in various aspects of dentistry has been explored and continues to be a major subject of interest for researchers. Its use ranges from diagnosis through precise radiographic and image analysis, planning treatment modalities and predicting treatment outcomes. It has been found to be of optimal significance in dental caries diagnosis,⁽³⁾ identifying severity of periodontal disease,⁽⁴⁾ orthodontic treatment planning,⁽⁵⁾ oral lesions diagnosis⁽⁶⁾ and automated designing of prosthodontic appliances.⁽⁷⁾ Beyond clinical procedures, AI has also been of considerable use in patient management, epidemiological analysis of dental diseases, disease risk prediction, risk prevention, dental education and feedback.^(8,9)

Even though the beneficial applications of AI have been widely used for the general population, its utilization for those populations needing special care is worth exploring. Individuals requiring special care encounter difficulties in terms of accessing, accepting and cooperating with conventional dental care due to rigid systems that do not adapt. AI tools are convenient solutions in resolving and simplifying these barriers. AI applications can be effectively utilised for precise diagnosis, behaviour management, tele dentistry for remote access and speech assistance in these groups of patients. The potential of AI to be tailored to specific requirements while expanding dental services to underserved groups makes it a pivotal addition in special care dentistry. However, there is a dearth of studies that explore the prospects of AI in special care dentistry necessitating research in this direction. This scoping review was conceptualized with the aim to address this research gap by analysing the artificial intelligence tools available for special needs groups, their application in special care dentistry, advantages and challenges to their use.

Search strategy and selection criteria

The search strategy involved the use of the keywords along with Boolean operators: (“artificial intelligence”) AND (“Intellectual disability” OR “Physical disability” OR “Medically compromised” OR “Geriatric” OR “Elderly”) AND (“dentistry”). Databases searched included PubMed, Google scholar, Scopus and Web of Science. Studies from 2015 onwards were included keeping in mind the novelty of the intervention and the rapid updates in the field of AI. The review included original studies, reviews and qualitative research. Full-text articles available in English language only were included. Further, manual search was also conducted for related studies. Those studies that were published in other languages without translations to english, studies irrelevant to the scope of this review and that where full text was unavailable were excluded.

The keyword search across databases resulted in 447 studies. Of these 89 duplicates were removed resulting in 388 studies. Following the title and abstract screening, 294 studies were eliminated with 94 studies remaining. Those studies not complying with the inclusion criteria, lacking full text, published in languages other than English and irrelevant to the scope of this review were removed further, resulting in total of 5 studies that were included in the final narrative review. The domain of AI application in special care dentistry is an emerging field that has largely been unexplored. Hence the search resulted in lack of sufficient relevant studies in this specific area of focus. Nonetheless in the discussion, use of AI in healthcare of special needs groups has been extrapolated to provide context for its dental application. Of the five studies assessed four were on the direct application of AI in different populations needing special care ^{(10, 11, 12, 13)} and one study on the perception of dentists regarding their use in these groups.⁽¹⁴⁾ Of the studies included, one was a systematic review,⁽¹⁰⁾ two were cross-sectional studies,^{(11, 14)} one pilot study⁽¹³⁾ and one mini review.⁽¹²⁾ The studies assessed several special groups such as persons with disabilities,^{(12, 14)} intellectual disabilities,^{(11, 12)} elderly population⁽¹³⁾ and institutionalized persons.^{(12, 13)} The AI tools and systems that were evaluated include Machine Learning (ML),⁽¹⁰⁾ Deep Learning (DL),⁽¹⁰⁾ Reinforcement Learning (RL)⁽¹⁰⁾ and Reinforcement (R),⁽¹⁰⁾ AI tools used for image analysis,⁽¹²⁾ screening of gingival diseases⁽¹³⁾ and for measuring emotional changes.⁽¹¹⁾ One of the studies analysed the patient acceptance,⁽¹³⁾ another study checked for cooperation of the users⁽¹¹⁾ and one determined the perception of dentists on its use.⁽¹⁴⁾ All the five studies found the AI tools and systems were effective in their tasks for use among special care groups with a patient satisfaction of above 85% found in one study.⁽¹²⁾ Dentists who used AI for clinical dental practice in case of special needs groups were highly favourable (74.4%) for recommending its use and 59.2% used AI tools in their special care dental practice.⁽¹⁴⁾

This review found that the application of AI tools in behaviour management, diagnosis, risk prediction, surveillance of oral health, clinical examination was effective with good acceptance of its use among both patients and dentists. Although few studies were available that studied the direct application of AI, the studies assessed various special groups. Majority of the applications of AI in special care groups were in the fields of screening, diagnosis and behaviour management.

AI for diagnosis of dental diseases

Individuals requiring special care often present with overtly sensitive responses, fearfulness, anxiety and limited cooperation to dental procedures including examination, that hinder the diagnostic accuracy of dentists⁽¹⁵⁾. These factors along with the clinicians training in handling these circumstances make the early detection of dental caries and other dental diseases challenging. Use of imaging, radiographic analysis and clinical examination for diagnosis being time and cost intensive can further be an impediment in case of this population for accurate diagnosis. AI tools with their promising prospects have shown high accuracy and user acceptance in diagnosis of dental diseases.⁽¹²⁾

AI tools have shown capabilities to detect incipient dental caries, DentalMonitoring, overjet and Diagnocat are some AI tools that have shown accurate diagnosis at par with clinicians’ diagnosis.⁽¹²⁾Convolutional Neural Networks (CNN) exhibited greater speed of dental caries diagnosis, and higher sensitivity and specificity in diagnosing other dental diseases such as oral precancerous lesions, tooth fracture, periodontal diseases as compared to dentists.(16) Other tools such as GumAI, have shown high sensitivity in diagnosis of gingivitis among elderly population. With 100% user acceptance of the tool, its ease of use has been well established among elderly to improve their gingival health. ⁽¹³⁾ The large and diverse training datasets used for AI aid in better accuracy of the diagnosis, it also provide objective analysis without any bias as opposed to a clinician.⁽³⁾ These factors provide a unique edge to AI tools in case of special needs groups for accurate and quick diagnosis of dental diseases. However, considering these positive outcomes future studies on large populations of different special needs groups and validation of these tools are essential to improve their reliability for real world usage.

AI for behaviour management

Studies have found that special care groups, especially persons with intellectual disabilities often exhibit anxious and uncooperative behaviour during dental procedures.⁽¹⁷⁾ Although sedation and general anesthesia have been the main stay of management in these cases, AI offers a formidable alternative that needs further analysis. AI combined with virtual reality (VR) provide virtual simulations that can serve as distraction or means to reduce anxiety of special care groups prior to and during dental treatments. Integrating AI with VR, enabling it to change the virtual simulation based on emotional changes in the patient was found to induce greater cooperation by persons with mental disorders during dental procedure. Reduction in anxiety scores from 2.93 to 0.17 was noted with the Venham anxiety and behaviour scale while Frankl behaviour rating scale showed improved in behaviour of these individuals with the use of AI and VR.⁽¹¹⁾ Studies have found that the use of VR in pain and anxiety management corresponds with the theory of gate- control,⁽¹⁸⁾ when coupled with AI it can modulate the virtual settings in accordance of the patient’s emotional state permitting stable behaviour control during dental procedures.

AI for communication assistance

Speech and language impairments in those with intellectual disabilities, autistic individuals, elderly populations are a major constraint in not only accessing but also in effectively communicating during dental visits. Various conversational agents powered with AI have shown to enable persons with cognitive difficulties in effective communication, health management and carrying out daily activities.(19) Through AI enabled personalized delivery of health educational content, elaborate oral hygiene information can be transformed by natural language processing (NLP) into easy to understand instruction for better compliance.(20) Although studies have determined that AI- based chatbots showed promising results in promoting good health practices among general population,⁽²¹⁾ their adaptation for individuals with special needs require various considerations. The direct application of AI in addressing communication constraints for simplifying dental treatment procedures among special needs groups needs furthers research.

AI for treatment planning

In case of individuals with special care needs, their medical history, response to dental treatment, level of understanding, oral hygiene practices and clinical conditions need to be taken into consideration to devise a tailored dental treatment plan.⁽²²⁾ The process being resource and time consuming, dentist’s experience and clinical acumen are critical to making the decision. Including AI tools for dental treatment planning facilitate objective and personalized decisions based on the patient’s requirements. With the aid of AI algorithms rapid planning can be undertaken along with features such as predictive analytics that help prioritize specific treatments based on risk of developing dental diseases.⁽²³⁾ Studies have shown that AI applications such as Previsoft, Overjet allow for risk characterization of patients based on dental conditions aiding in treatment planning suitably.⁽¹²⁾ The scope of incorporating AI tools such as these to deliver personalized, swift and simplified dental treatment plan confirming to the special needs of these groups should be explored.

AI for remote consultation

The availability of dental specialists providing dental care to special care group of patients is scarce and hence access to dental care may be limited. Additionally, financial constraints, logistic barriers and caregiver’s limitations can hinder access to dental care.⁽²⁴⁾ Tele dentistry and remote dental consultation powered with AI can overcome these barriers in diagnosis and treatment planning of dental diseases. Tools such as Apple Tree Dental that provides mobile supported tele dentistry have simplified timely dental care for persons with disabilities limited by accessibility concerns.⁽¹²⁾ Including AI with such tools should be studied further to enhance diagnosis and treatment planning with image analysis and risk prediction of users.

Dentist’s perception of adopting AI in special care dentistry

The perception, attitude and awareness of dentists regarding AI in providing dental care to the special needs groups is critical to understand the shortcomings and potential that need to be harnessed further. Hence this review also included a study conducted to assess the perception of dentists. Barnawi et al., in their study conducted among dentists of Saudi Arabia found that 59.2% of the dentists incorporated AI in clinical dental practice.⁽¹⁴⁾ The study further found that majority application of AI was in treatment planning (43.7%). More than half the study participants had positive perception of AI in special care dentistry. Previous training in AI was one the strongest predictor of its use. The study implied that developing standard AI framework and training dental practitioners in its use could help improvise its adoption in special care dentistry.

AI in assistive technologies with potential for application in special care dentistry

The scope of AI in assistive healthcare technology has been studied and it has shown various applications. Their use has been majorly included in assistive functions such as aids for navigating, language assistance, cognitive support.⁽²⁵⁾ Integrating AI Internet of Things can further enhance their usability in persons needing special care. Wearable smart devices that monitor health parameters can aid in medical and behavioural management during dental visits. Another assistive technology Environmental Control System (ECS) facilitate physically or intellectually disabled persons to manage and interact with their environment. Integrating AI and ECS to examine behavioural and emotional changes that enable altering the dental clinic 6environment accordingly could ease anxiety of such patients during dental visits.⁽²⁶⁾

Challenges and ethical considerations

Considering application of most AI tools involve input of private data and data on personal health, ethical and safety concerns are certain. Integration of AI necessitates procedures such as data anonymization of personal data of users and algorithmic transparency to ascertain the functioning of AI systems are ethical and safe. Compliance of such systems with regional and international regulations such as Digital Personal Data Protection Act, General Data Protection Regulation (GDPR) are essential for ethical and safe performance of AI tools

Limitations and recommendations

The findings of this review highlight the varied potential of AI in transforming oral care delivery for those with special needs. However, the limitations of this review need careful acknowledgement in analysing these results. The dearth of scientifically robust studies in this context not only raises the need for more studies in this area but also studies with larger populations, varied special needs groups and rigorous study design, examining long- term outcomes. AI tools evaluated in the included studies were diverse hampering comparison and lacked external validation among larger special needs groups. The real-world application of these tools and applications have been scarcely studied, raising concerns on their clinical and practical utility. Studies also need to explore the impact of AI tools in special care dentistry on the oral health related quality of life of these individuals. With evidence on AI in dentistry evolving there is a need to broaden the scope of research to application of AI in special care dentistry.

This narrative review was able to highlight the large research gap in the application of AI in special cared dentistry. While the review examined the prospects of AI tools in revolutionizing dental care for those with special needs, it also reveals the need for research on their practical application. These vulnerable populations need customized dental care and AI can serve as a catalyst in transforming dentistry in this aspect.

DATA AVAILABILITY

No datasets were generated or analysed during the current study.

Ethics approval and consent to participate Not applicable.

CONFLICT OF INTEREST

The authors declare that they have no conflict of interest.

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Table 1: Characteristics of the included studies that describe the role of AI in different groups needing special care

Author and year	Study design	Population considered	Artificial intelligence tool analysed	Area of interest	Conclusion
Tiwari et al., 2023	Systematic review	Underserved communities (including elderly persons, head and neck cancer patients, COVID-19 patients)	AI models such as Machine Learning (ML), Deep Learning (DL), R(Reinforcement) and RL (Reinforcement learning)	Oral, head and neck surveillance	AI tools in smart devices effective in remote oral health surveillance of underserved communities
Al Kheraif et al., 2023	Cross-sectional study	Individuals with mental disabilities (Including cerebral palsy and Down’s syndrome)	AI-powered tool linked to Galvanic Skin Response (GSR) that measured emotional arousal during dental treatment coupled with use of Virtual Reality (VR)	Anxiety, behaviour and level of cooperation in the study population	Effective in behaviour management of those with mental disabilities in dental setup
Drafta et al., 2025	Mini review	Vulnerable communities (Rural population, elderly, persons with disabilities, individuals with mental disorders, institutionalized persons, low- resource underserved population)	AI tool for intraoral image analysis AI based tool for analysis of smartphone images Oral screening using AI based tool (Logy AI)	Diagnostic potential Patient risk prediction Automated workflow planning	88-95% diagnostic accuracy High patient satisfaction over 85%
Chau et al., 2025	Pilot study	Elderly population in day- care centres	GumAI, a mobile health AI tool for gingivitis screening	Diagnostic accuracy of gingivitis Acceptance of the tool among users	High sensitivity and moderate specificity of the tool in comparison with the diagnostic performance of Periodontists.
Barnawi et al., 2025	Cross- sectional study	Perception of dentists in treating persons with disabilities	AI tool application in various aspects of clinical dentistry	Clinical examination Management of oral complications Invasive dental procedures Case history taking Non- invasive procedure Behavioural training Health education Medical diagnosis Diagnostic tests Treatment planning	74.4% of the dentists favoured recommending AI use in clinical dental practice of persons with disabilities

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You are reading this latest preprint version

Exploring the prospects of artificial intelligence in transforming dental care for special needs groups: A Scoping Review

Status:

Version 1

Abstract

Introduction

Methods

Results

Conclusions

Introduction

Methods

Results

Discussion

AI for diagnosis of dental diseases

AI for behaviour management

AI for communication assistance

AI for treatment planning

AI for remote consultation

Dentist’s perception of adopting AI in special care dentistry

AI in assistive technologies with potential for application in special care dentistry

Challenges and ethical considerations

Limitations and recommendations

Conclusion

Declarations

References

Table 1

Chart

Additional Declarations

Supplementary Files

Status:

Version 1