Ethics In AI-Powered Orthodontic Diagnostics

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The rapid diffusion of artificial intelligence in different walks of life has made life easier. While the process of automation continues to stun users, certain aspects need to be taken care of. AI brings a lot to the table and seems to work seamlessly but there is one significant challenge in its worldwide implementation i.e., ethics.

Ethics In Healthcare

Healthcare is a sensitive field where the patient submits himself to the wisdom and intention of the doctor. As healthcare providers, doctors are entitled to always work in the favor of the patient. The four main ethical principles that every healthcare professional (dentist/physician/surgeon) must follow in daily practice include:

  • Beneficence: Always act for the benefit of the patient.
  • Nonmaleficence: Not to consciously harm the patient.
  • Autonomy: The patient has the right to decide.
  • Justice: Fair and equitable treatment for all patients.

All these considerations stand valid in orthodontic diagnosis and treatment planning. Most dentists and general physicians learn about ethical considerations informally. However, modern research promotes a more active approach to teaching ethics to healthcare professionals. This emphasis highlights the importance of ethics in healthcare.

Ethical Implementation In EHealth

The advent of COVID-19 changed the outlook of health professionals and the system itself. The dynamics of patient attendance changed and doctors were forced to shift to telehealth services. Even in telehealth, ethical considerations are as important. As per a discussion paper, healthcare professionals must take responsibility for eHealth services and should work to preserve patients’ integrity, autonomy, and dignity.

Principles Of Ethical AI In Orthodontics

AI has shown promising results in improving orthodontics and can potentially revolutionize the field. However, the incorporation of artificial intelligence and machine learning in sensitive fields like orthodontics raises ethical concerns. Orthodontic patients provide multiple radiographs and photographs to the orthodontic clinic. Therefore, the protection of data is binding on the orthodontist.

Implementing AI in healthcare calls for special considerations. Keeping in view the rapid expansion of the large language model (LLM) tools, the World Health Organization advises caution in the use of artificial intelligence in orthodontics. LLMs like ChatGPT4.0, Llama, Bard, Bert, etc. are being extensively used in diagnostic decisions and patient awareness. Reports show that rigorous oversight is required in AI implementation because:

  • The data for AI training can lead to imbalances in equity and potentially generate misleading information.
  • LLMs may be trained on non-consented data.
  • Language models can be misused to create disinformation.
  • The responses generated by AI can be incorrect.
  • Patient safety and protection can be at stake if proper steps are not taken

By not providing the optimum treatment, AI can raise ethical issues and may even harm the patients. Thus, it is imperative to follow the principles of ethical AI in orthodontic diagnostics:

Ensure Well Being Of The Patient

AI systems must ensure the social well-being of the patient. With AI, this aspect can be improved greatly. Generally, orthodontists carry out extensive landmark identification on cephalometric radiographs. AI tools with extensive machine learning can identify anatomic anomalies that the human eye may miss. This identification can enhance the diagnosis and allow the provision of a better treatment plan.

Avoid Bias

Bias is an unavoidable dilemma in the medical field. Human choice is prone to unfair bias. However, the AI-powered system should not discriminate against individuals based on socioeconomic status, race, color, religion, etc. This principle must be specially considered because there is a high risk of bias incorporation. As AI algorithms are developed and trained only on data from a certain population group, unfair bias is possible. Thus, AI training should be done on a diverse set of data to minimize bias. Moreover, advanced AI algorithms should identify bias in human research/data and provide solutions for it.

Be Safe And Reliable

In the modern world, numerous diagnostic devices use AI to work. Modern orthodontists use intraoral scanners to record oral impressions. Most commercially available intraoral scanners are AI-powered which not only helps in digital cast development but also aids in the fabrication of clear aligners. AI systems must ensure that the exposure to waves (microwaves, X-rays, etc.) is safe for the patient and that the extraction of the data is reliable for diagnostic/fabrication purposes.

Ensure Data Security And Privacy

Keeping patient data safe and private is the greatest concern for AI systems. Most advanced AI systems provide dedicated data management and governance systems. With the help of encryptions and security maneuvers, AI should ensure the data safety of every patient.

Be Transparent

Numerous AI-powered programs suffer from a “black box” effect. It’s so-called because the system’s processing to reach a specific prediction or output is kept hidden from the user. Thus, the AI system must provide clarity for the advised logic of the model. This is crucial for trust-building.

Be Easily Governable

When dealing with the human body, there is never a hundred percent outcome. Unwanted consequences are a part of most of the dental and medical procedures. Therefore, the AI system must be governable so the orthodontist can make amendments to the treatment plan (at any time) according to the unintended changes.

Be Accountable

Accountability is another major challenge faced by AI incorporation. When getting help (in diagnosis and treatment plan) from a computer, there is no one accountable for errors. Therefore, AI program developers must provide opportunities for feedback and appeal. The system must be under the control of an appropriate human direction, so there is someone accountable for all the actions.

Offers Autonomy

The orthodontic AI system must respect human values and allow patients the right to autonomy and freedom. It should be free of any unfair and unjust action and allow the patient to choose what’s best for him.

Final Word

Ethics is an essential component of healthcare. Modern reports emphasize the need for formal training of healthcare professionals regarding ethical issues. WHO advises the implementation of ethical AI in healthcare and orthodontics. As per the principles of ethical AI in orthodontics, the AI system must ensure the well-being of the patient at all costs. The algorithms should minimize bias and ensure the provision of equity in orthodontic treatment. Automated data extraction should be safe and reliable and the system must guarantee robust data security and privacy. The AI algorithms must be transparent and easily governable so the orthodontist can make up for any unforeseen/unwanted changes. The AI and machine learning system must be under human direction and there has to be someone accountable. The designed AI system should offer the patients autonomy and the freedom to choose their desired treatment strategy.

References

  1. Varkey, B. (2021). Principles of clinical ethics and their application to practice. Medical Principles and Practice, 30(1), 17-28.
  2. Knight, S., & Papanikitas, A. (2020). Teaching and learning ethics in healthcare. Clinical education for the health professions: theory and practice, 1-19.
  3. Skär, L., & Söderberg, S. (2018). The importance of ethical aspects when implementing eHealth services in healthcare: a discussion paper. Journal of advanced nursing, 74(5), 1043-1050.
  4. https://www.who.int/news/item/16-05-2023-who-calls-for-safe-and-ethical-ai-for-health

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