Dental Robots in Pediatric Dentistry – A Futuristic Dream Come to Tangible Reality!!!

Pediatric dentistry is not just a ‘Cinderella of all Dental Disciplines’ or ‘Jack of all and Master of None.’ It is all about new inventions, strategies and technologies which embraced the domain of Pediatric dental specialty. Robots are automatically controlled machines which perform human task thereby reducing the stress and fatigue of the person and also reduces time. Robots have been used efficiently in all fields of mankind. ‘Human Health Science’ is also engulfed by robots and even encroached upon the ‘Dental Specialty.’ Literature exhibits application of robots in different dental specialties like oral surgery, prosthodontics, oral implantology and endodontics. There is paucity of information available pertaining to utilization of dental robots in the arena of Pediatric Dentistry. Therefore, the present research review article was designed and drafted to briefly discuss about development of pediatric dental robots and its advantages, limitations and future directions for further improvement in the technological era.

Keywords: Augmented Reality; Artificial Intelligence; Dental Robots; Pediatric Dentistry; Virtual Reality.

The present era of mankind is engulfed with tremendous advancements in the science and technology and trying to conquer Moon and Mars. It is not too far man to establish livelihood in these planets. To overcome the daily fatigue, man power, human task force and stress, scientists invented an automatic machine called ‘Robot’. The Robot performs the tasks as humans do and has been encroached upon different fields of modern life [1]. The fascinating fact about robot is that medical science shows enormous applications of robots including the dental science. In the medical specialty health care robots are used for various medical purposes like catheter removal/insertion, vaccinations, electroencephalogram, IV removal/start, oxygen tube insertion, changing dressings and blood tests. Pertaining to dentistry, robots have been tried in Oral Implantology, Oral surgery, endodontics and prosthodontics [2].

Humanoid/Human like robots have been popularly used in the medical sector to provide cognitive-behavioral assistance to the patients. In recent years, research on humanoid robots helping to support elderly people has increased [3] In addition to this even pediatric patient require such behavioral guidance during treatment. Moreover, robots may help in the education of children with chronic health problems or special needs such as autism, in the development children’s skills, in encouraging children to acquire healthy behaviors, and to make children more comfortable and used as a techno-psychological distraction technique [4,5]. However, there are paucity of research studies on application humanoid robots in the management of children in the medical and dental field.

Development of Pediatric Dental Robots

Although application of robots for medical care reflects like a ‘fiction’ or a ‘futuristic dream,’ but in fewer countries like in Japan, the scenario is entirely different. In the dental specialty pertaining to children, the improvements in the technology resulted in development and testing of social robots and human like/Humanoid robots in managing children [6].

In Japan, a Japanese robot technology company named ‘Tmsuk’, has invented a ‘child robot’ that provides training assistance for new budding dentists engaged with pediatric care. Through the use of crystal (piezo) technology and proportional pressure regulators, these dental robots provide accurate responses to child behaviors for dentists training to become pediatric dentists. This robot acts as a training tool, and is useful for those working to become dental assistants, oral surgeons, and other specialty dentists by providing them with a testing device to track biological responses in children. Moreover, the robot is designed to mimic children’s behavior, providing reactions that are realistic to children and how they respond to various treatments [7,8]. These robots have various advantages and facilitate in the task of future dentists as mentioned in the Table 1.

‘Tmsuk Robot’ has been designed to be durable and long-lasting, ensuring its affordability for dental professionals. Schools, organizations and institutions working with graduate students can ensure a better future for pediatric dentistry through the expanse and development of pediatric robots. By practicing on pediatric robots, future dentists will be able to ensure that they can respond to emergency situations and uncooperative child behaviours better before interacting with living patients [8].

Use of Social Robots in Behavior Guidance of Children

It is well known fact that children have more affinity towards robots due to their fascinating outlook and get attracted more quickly with robots. Using the same theme, recently a novel robot has been invented. It is a programmable, autonomous humanoid robot and named it as ‘NAO’. The NAO robot being a social and humanoid robot has been used for various purposes including education and therapy [9-12]. The NAO robot can be used as an educator and as well as a peer of children. It has been used in the classroom to teach new words to children between 3 and 6 years old, to assist in speech therapy, to adapt children to learn a second language in kindergartens, to improve the efficacy of nutritional education, and to deliver motivational interviews [13-16]. The NAO robot has mostly been used to improve social behavior and to improve the quality of life in children with autism, and to screen for autism in toddlers and it is evident in the literature.

The NAO has been used as a guide, to distract and encourage children during their dental treatment and studied in numerous research studies to evaluate the development of adaptive behaviors in children [17,18]. Socially assistive robots have the ability to assist to ease the procedures in order to reduce children’s anxiety and distress during their hospital visits. The same robot has been used in dentistry for reducing dental fear and anxiety of children (Table 2). The distraction method is a psychological behavioral method used to distract the perception of pain to an alternative stimulus [19]. Various methods and tools are used for distraction, from simple interventions to advanced techniques and methods like ‘virtual reality.’ Literature shows fewer studies in which humanoid robots were used as a distraction tool in medical procedures. Beran et al programmed a robot to distract children during vaccinations [17]. Later Ali et al used robot-based distraction therapy in children undergoing intravenous insertion [18]. However, studies on the use of robots to reduce dental anxiety are not tried. Recently only one study performed by Kasimoglu and colleagues (2023) from Turkey used NAO robot for distraction of pediatric patients during dental treatment [5]. Apart from this single study no other study has been conducted about the use of humanoid robots in pediatric dentistry. In this study, authors observed that 6-10-year-old children who had dental treatment with the NAO felt happier and had lower pulse rates compared to the control group children. The children in the Robot group exhibited more adaptive behaviors than the control group in both age groups. Therefore, finally authors concluded that better results could be obtained in younger children by performing the dental treatment after a familiarization session with the NAO robot [5].

‘Virtual reality’ is one among the innovative technology and has been increasingly used in pediatric dentistry to reduce anxiety and pain during local anesthesia or painful procedures like extraction [15-23]. However, compared to virtual reality, humanoid robots, which are complex technology products, can affect pain perception and dental anxiety more effectively than virtual reality because they can be both visually and audibly distract children and socially interactive with children [20-23].

Table 2: Research Studies on Application of Robots in the Domain of Pediatric Dentistry

As technology is advancing in rocket speed, the manual work force will also get modifying in every field of human life in the future. The mental and physical strain burden put on the pediatric dentist due to long hours of managing the child patient may compromise the quality of service rendered by the doctor. Therefore, it is essential that a system capable of physical manipulation that is powered by an intelligent program is required which acts as an ideal assistant to the dentist for carrying out technique sensitive procedures. In conjunction with artificial intelligence, robot enhanced pediatric dentist provides useful purpose in data management, diagnosis, treatment planning and student education [1-10].

There are robots with different applications which attract the attention of children, train them and support them with cognitive-behavioral interventions e.g., managing illnesses by promoting the correct behavior in those children with chronic health conditions, helping to distract children undergoing acute medical procedures or during vaccinations or comforting them as a friend [11-18]. However, among the many hurdles faced by the dream of turning robotics in dentistry into a tangible reality is the extreme cost and bureaucratic resistance. In addition, not every dentist and not all institutions or dental clinics can afford or use these robots [20-23].

In Japan, the first kind of robot called ‘Robin’ has been designed for children by scientists, engineers, and pediatric psychologists and to be used in pediatric dental practices. This robot utilizes peer-to-peer interactions and engages children in various active distraction techniques and physical activities. It also teaches children coping mechanisms to help reduce their stress and anxiety related to dental procedures. In addition, this robot also uses child-friendly terms and visuals to explain dental procedures and prepares children for the actual treatment [13-20]. This robot is proven to increase the children’s collaboration with the doctor and other clinical staff, thus ultimately saving their valuable time. Because of robot’s charming character by creating a welcoming atmosphere in every dental practice resulting in a successful patient visit and increasing the likelihood of the patient returning. Moreover, dental clinics can experience improved customer satisfaction, improved social media presence, an increased number of new customers, and higher retention rates of patients.

Robots have shown promising results in other fields of mankind and enormously used for education purposes.  Robotic-assisted treatment strategies are already taking place in many surgical health centers, with satisfactory outcome. The development and application of this technology in the domain of pediatric dentistry has many unbelievable tasks meant both for pediatric dentists and their pediatric clients. Therefore, the idea of robots helping all pediatric dental fraternity is not too far off from tangible reality.