Introduction- Data visualization in dentistry
“Data visualization” is daily use concept having paramount importance and flexibility, with its
applications ranging from fields encompassing everything between business and science. It uses
visually precise and informative tools such as graphs, plots, charts, images and figures that can
be depicted by the use of visualizing softwares (Meloncon and Warner, 2017, Midway, 2020).
1. The plan regarding the design of the visualization should be first
devised. The visualization should show as much data as is possible,
i.e. it should be "rich" in information, so that it can provide greater
understanding of the certainity of the estimate.
2. Adoption of the best software to draw the visualization is a
critical step. The tools of the software should be sufficient enough
to depict all information.
3. Correct "geometry" should be chosen by considering the data
being depicted. The decision is usually made in accordance with
"data-ink ratio". Types of geometries are; (a) amounts/comparisons,
(b) composition/proportions, (c) distributions, (d) relationships
4. The use of color is usually promoted and research states that
using color makes the visualizations more memorable and
meaningful. For example, use of seven or more colors was rated
best. Color, of course, represents information.
5. Including any relevant metric of uncertainity is also promoted.
Research states that failure to include uncertainity in a visual can be
misleading.
6. An approach termed as "small multiples" further enhances the
effectivity of a visual, it is also referred to as "paneling" or
"faceting". The visual/figure is repeated to highlight differences in
the provided data.
7. Models should be distinguished from the data. And the model
should be explained in the figure caption or referenced elsewhere in
the document so that the reader can find complete details on what
the visual model is representing.
8. Consider the necessity of including an infographic. But one msut
not include it every time, even though they have the highest
"memorability score".
9. Get an independent figure review from colleagues, peers or
people external to the study review
Figure 1: Data visualization is a means of transforming abstract data into physical visions,
which helps primarily in gaining attention of viewers and readers when presenting scientific or
business-related work, as humans are more visually oriented (Qin et al., 2020). The above figure
provides a summary of “principles of effective data visualizations”; (1) richness of information
(Hehman and Xie, 2021); (2) adoption of most suitable software (O'Donoghue et al., 2018); (3)
use of correct geometry and decision regarding data-ink ratio (Tufte, 2001); (4) use of color
(Borkin et al., 2013); (5) inclusion of “uncertainty”; (6) use of “paneling (small multiples)”
(Tufte, 2001); (7) models should be distinguishable from data; (8) inclusion of infographics-
decision making; (9) getting a review of visualization. Figure is adapted from (Midway, 2020).
Data, whether it is medical, dental, scientific or business related, has been declared as “the new
oil” (Economist, 2017). But if we focus just on the healthcare (medical and dental) field, it is
easily observable that collection and storage of data has only been recently acknowledged as a
possibility to facilitate a better, safer, more reliable, affordable and accessible care (Joda et al.,
2019). Further narrowing of focus, just on the field of dentistry, reveals that dentistry has lagged
behind in the adoption of data-driven technologies and thus visualization of data is only a recent
trend both in practical and research field. The total global health data in 2020 had an estimated
volume of 2,314 exabytes (1 exabyte = 10 18 bytes), which has increased in vast amount in
comparison to 153 exabytes of 2013 (Statistica, 2018). This health data is further expected to
increase extensively due to the widespread use of mobile phones, ubiquitous sensors and camera
(Rizzatti, 2016). Data acquisition and storage is central in facilitating quality, accessibility, and
equity of oral and dental care in decades to come. Adoption of such data-driven technologies and
the ultimate data visualization step is set to metamorphose the field of dentistry into “data
dentistry”, where decision making steps will base on the already acquired data, which is thought
to further promote the dissemination of data-driven applications (Schwendicke and Krois, 2022).
Examples of Data Visualization in Dental Literature
According to research, since 2020, human medical knowledge doubles every 73 days, due to
which dental professions also face an unprecedented information overload and thus find ways to
manage and visualize these loads of information (Corish, 2018, Densen, 2011). A research study
conducted by Nieminen and Vähänikkilä (2020) is an excellent piece of work that depicts the
importance of data visualization and analysis techniques in the field of dentistry (Nieminen and
Vähänikkilä, 2020). This study lists other researches that have used data visualization
techniques, such as; a bibliometric study on dental journals which estimates the availability of
statistical information within pedriatic dentistry conducted by Yang et al. (Needleman and
Niederman, 2001), improvement in split-mouth study design and analysis was carried out by
Lesaffre et al. (Lesaffre et al., 2007), etc. A comparison between different studies has been put
forth for the comprehension of statistical data analysis and visualization methods employed in
dentistry. The study also reports on various methods that are currently being used in statistical
dental data visualization, which include, bar diagrams, histograms, box plots, Chi-square test,
variance analysis, regression models etc. (Nieminen and Vähänikkilä, 2020). Various data
management and visualization techniques including text mining, network visualization and big
data management techniques may help in analyzing and summarizing the exponentially growing
knowledge in the field of dentistry. The American Academy of Restorative Dentistry has devised
and later implemented a strategy to cope with dental information overload. The Academy
publishes an annual review of selected scientific literature that focuses on seven different areas.
These areas namely are; (i) prosthodontics; (ii) periodontics; (iii) dental materials; (iv) occlusion
and temporomandibular disorders; (v) sleep disordered breathing; (vi) oral medicine; and (vii)
oral and maxillofacial surgery and dental caries (Donovan et al., 2018). The authors Kolahi,
Dunning and Rossomando have used “mapping techniques” to visualize dental research data to
depict the “scientific landscape of dental literature of 2018” (Kolahi et al., 2019). Through the
use of mapping, the authors intend to make the data more manageable and practically useful for
busy dental professions. The online search engines of PubMed and Web of Science were
searched for dental articles of 2018 to find out and enlist the topics of dental literature. The
extracted dental literature was further analyzed on the basis of country of origin, publishing
journal, funding agencies, articles being open access or not and their keywords.
Figure 2: Major topics of discussion in 2018 dental articles (Kolahi et al., 2019).
Figure 3: Co-authorship network visualization among 2018 dental articles (Kolahi et al., 2019).
Another recent study conducted by Dental Clinics at the University of Michigan is a good
example of use of data visualization techniques in respect to patients’ appointment attendance
and characteristics of failed appointments (Weber et al., 2021). This study used Tableau
software, which uses the principles of machine learning (ML). This software can be used to
“map” the provided data set, which in this case, was from the electronic dental records, financial
systems, learning management systems and student records data warehouses of The University
of Michigan, School of Dentistry. Tableau integrates and analyzes data and provides R statistical
tools (Harrison et al., 2020, R Core Team, 2019, Wickham et al., 2019) for data visualization.
There were four (4) categories of appointment cancellations statuses, with patients who do not
call in with any reason, patients cancelling within 48 hrs or less time, patients who cancel due to
‘other’ reasons, such as, due to sickness or weather and appointment cancellation by the school
itself. Through employing data visualization techniques, authors of this study found out
“patients’ previous attendance records” to be a deciding factor, whether the patients will attend
their next appointment or not. Also, patients who were ‘scared’ of their dental appointments
made up 62% of those patients who reported ‘no problem’ as a result of their appointment.
Patients who were 65 years of age were more likely to attend their appointments. Also a positive
correlation was observed when the patients were reminded of their appointments through email
or text messages (Weber et al., 2021).
Figure 4: Age data visualization; representing the most failed and most attended appointments
in Weber et al. study. (Weber et al., 2021)
Figure 5: “Failure-to-attend (FTA)” data visualization; FTA rates among patients who did not
respond to the question about their level of anxiety about dental visits (Weber et al., 2021).
Another research conducted by Pritchett et al. (2018) gives a more detailed view of analysis and
visualization of dental data (Pritchett et al., 2018). The authors of this study have employed
simple analytic techniques that can be used to extract important information related to patient
demographics, patterns of attendance (DNA-did not attend rates etc.), measuring equity of access
and many other factors. The research study focuses on patterns that data analysis and
visualization techniques can be used to convert raw, disorganized data into informative and
structured particulars that can further be used for decision making and improvement of dental
practices. The study utilizes EXACT (Software of Excellence) with additional help from ONS
(Office of National Statistics). The data visualization in this particular study carried out
Newcastle Dental Hospital concluded by the addition of certain recommendations in their
system, which mainly include sending reminder letters to attendees, introducing longer opening
hours to increase flexibility of appointments and prompting patients of a specific age group to
undergo screening tests for oral cancer.
Figure 6: Net number of new patients per year (Pritchett et al., 2018).
Figure 7: Number of female and male patients by year of last visit (Pritchett et al., 2018).
A retrospective study launched recently across two hospitals in UK that provide pediatric dental
treatment under general anaesthetic (DGA) employ bar plot data visualization to understand and
determine children’s attendance and experience of preventative interventions and operative
treatments including restorations and extractions with their primary care dentist (PCD) in the 12
months before and after their caries management (Large et al., 2021). Through this study, it was
found that attendance for examination was significantly reduced from 85% (pre-DGA) to 57.5%
(post-DGA). This shortfall of examination attendances places high caries risk children in further
danger as it is already well-known that children who are undergoing DGA experience for caries
management are a high caries risk group. Dental research is sparse in this particular field and the
existing literature depicts that high caries risk children show an irregular dental appointment
attendance trend and most probably only show up when experiencing pain. This further points
out to the fact that preventative measurements still lag and caries cannot be prevented in full
measure. The bar plots in this study help visualize the described situation with quantitative data
that makes the findings more impactful.
Figure 8: Age distribution of the sample (Large et al., 2021).
Figure 9: Treatment and attendance 12 months pre-DGA (Large et al., 2021).
Figure 10: Treatment and attendance 12 months post-DGA (Large et al., 2021).
Another research study conducted by Billings et al. uses data visualization techniques to
determine differences between teeth/site specific effects of cigarette smoking on periodontium
with those people who have never smoked. These patterns were visually ascertained by using
contour maps. This research study showed that molars in mesio-lingual (ML) and disto-lingual
(DL) sites were most affected. The participants of the study who were still smoking at the time of
study being carried out had their interproximal sites of most posterior teeth affected (Billings et
al., 2021).
:
Figure 11: Contour mapping identifies patterns and dramatically visualizes the substantial
periodontal site-specific differences. Current smokers had more affected teeth and/or
periodontal sites with a different contour pattern than never-smokers (Billings et al., 2021).
Future of Dental Data Visualization
Most of present dental studies that utilize data visualization tools use statistical formulae and
plots to quantitatively depict their data’s worth. The modern world has gone through immense
amount of advancement in terms of data-driven technologies and applications. It would not be
wrong to say that presently we have data-driven technologies embedded in every aspect of our
lives. And it is also similar for medical and dental fields, despite the fact that these disciplines
initially lagged in the adoption of such technologies. The introduction of artificial intelligence
(AI), sensors (such as wearables, ingestibles or implantables), social media, clinical data and
electronic health records (eHR) are prompting the inception of a new era of medical and dental
fields in terms of data visualization. The healthcare data is increasing exponentially and is
expected to reach a limit where just the use of simple plotting and mapping data visualization
techniques may not be sufficient to comprehend this data that is out pouring through many
channels including professional routine care, and other social determinants of health, which
further include sources, such as, Internet of Things (IoT), social media posts of patients, surveys
and questionnaires conducted via patient support groups etc. (Joda et al., 2019)
The future of data visualization in dentistry is seen in the context of artificially intelligence (AI)
which has found many applications and benefits and is prompting healthcare facilities
(medical/dental) to take up such softwares and techniques (Schwendicke et al., 2020). Use of AI
softwares and data visualization techniques can make the mining, mapping and extraction of
dental data easier and more feasible. Furthermore, AI data visualization allows the integration of
heterogenous data domains (e.g. patient’s history, socio-demographic and economic data,
clinical, imagery, biomolecular data, social network data etc.). By integrating data from various
domains and levels, AI allows to grasp the multi-level interaction of such data (Schwendicke et
al., 2020, Standards and Technology, 2019). AI may also provide many advantages in the field of
medical/dental data storage, which is usually unstructured and disorganized. AI’s introduction in
medical and dental field promises to make healthcare more participatory and interactive,
especially if the patients consent to provide their data routinely, e.g., by using wearables.
Continuous sharing of medical/dental data between attending physicians/dentists and their
respective patients will promote self-monitoring and self-management among patients and
reduce the workload of healthcare faculties. This will further drive a deeper understanding of the
drivers and processes underlying health and disease (Schwendicke et al., 2020). Augmented
reality with data visualization in dentistry is being used in implant placing step in oral surgery
and orthognathic surgeries. More recently, it has also been used in dental fields of orthodontia,
endodontia and restorative dentistry (Kwon et al., 2018, Llena et al., 2018).
Conclusion- Challenges & Future Approaches
The current and futuristic use of data visualization in dentistry is challenged in many aspects.
The first being that data sharing, storage and use are challenged in dental research and practice.
At this stage, patient’s legal and moral rights are challenged in context to their access to their
personal data and to decide on its use. The stored data might be used in other purposes, such as,
for commercial purposes, for risk assessments by health insurance companies etc. Research also
states that dental data may be manipulated or falsified in some of the cases. Furthermore, it is
difficult for data visualization techniques to make a strong impression on the healthcare system,
whether it be medicine or dentistry, because physicians and dentists are yet not fully qualified to
adopt these technologies or use such softwares. This factor majorly limits the widespread
application of data visualization techniques in dentistry and general healthcare (Gross et al.,
2019). Data visualization techniques are extensively being used in dentistry as is also obvious
from the cited literature above, but still many visualization techniques are inadequate for cutting-
edge dental data sets. To address this challenge novel and tailored visualization strategies need to
be adopted that can fit in specific scenarios (O'Donoghue et al., 2018). In this context, machine
learning (ML), deep learning (DL), artificial neural networks (ANN) etc. (Schwendicke and
Krois, 2022)have been developed but these novel technologies present a challenge to the dental
practitioners and students’ as such digital literacy is limited within the dental community. The
future of data visualization in dentistry has great potential but many research gaps remain yet to
be addressed.
References
BILLINGS, M., PARASCANDOLA, M., IAFOLLA, T. & DYE, B. A. 2021. Data visualization
of the relationship between smoking and periodontal site‐specific effects across the
lifespan in the US adult population. Journal of Periodontology, 92, 1126-1135.
BORKIN, M. A., VO, A. A., BYLINSKII, Z., ISOLA, P., SUNKAVALLI, S., OLIVA, A. &
PFISTER, H. 2013. What makes a visualization memorable? IEEE transactions on
visualization and computer graphics, 19, 2306-2315.
CORISH, B. 2018. Medical knowledge doubles every few months; how can clinicians keep up.
Elsevier Connect.
DENSEN, P. 2011. Challenges and opportunities facing medical education. Transactions of the
American Clinical and Climatological Association, 122, 48.
DONOVAN, T. E., MARZOLA, R., MURPHY, K. R., CAGNA, D. R., EICHMILLER, F.,
MCKEE, J. R., METZ, J. E., ALBOUY, J.-P. & TROELTZSCH, M. 2018. Annual
review of selected scientific literature: A report of the Committee on Scientific
Investigation of the American Academy of Restorative Dentistry. The Journal of
Prosthetic Dentistry, 120, 816-878.
ECONOMIST. 2017. The world’s most valuable resource is no longer oil, but data [Online].
The Economist. Available: https://www.economist.com/leaders/2017/05/06/the-worlds-
most-valuable-resource-is-no-longer-oil-but-data [Accessed 11 February 2022].
GROSS, D., GROSS, K. & WILHELMY, S. 2019. Digitalization in dentistry: ethical challenges
and implications. Quintessence International, 50.
HARRISON, E., DRAKE, T. & OTS, R. 2020. Package “finalfit.”.
HEHMAN, E. & XIE, S. Y. 2021. Doing Better Data Visualization. Advances in Methods and
Practices in Psychological Science, 4, 25152459211045334.
JODA, T., WALTIMO, T., PROBST-HENSCH, N., PAULI-MAGNUS, C. & ZITZMANN, N.
U. 2019. Health data in dentistry: an attempt to master the digital challenge. Public
Health Genomics, 22, 1-7.
KOLAHI, J., DUNNING, D. G. & ROSSOMANDO, E. F. 2019. Scientific landscape of dental
literature in 2018. Dental Hypotheses, 10, 55.
KWON, H.-B., PARK, Y.-S. & HAN, J.-S. 2018. Augmented reality in dentistry: a current
perspective. Acta Odontologica Scandinavica, 76, 497-503.
LARGE, J., KEIGHTLEY, A. & BUSUTTIL-NAUDI, A. 2021. Participation of paediatric
patients in primary dental care before and after a dental general anaesthetic. European
Archives of Paediatric Dentistry, 22, 887-897.
LESAFFRE, E., GARCIA ZATTERA, M. J., REDMOND, C., HUBER, H., NEEDLEMAN, I.
& DENTISTRY, I. S. O. 2007. Reported methodological quality of split‐mouth studies.
Journal of clinical periodontology, 34, 756-761.
LLENA, C., FOLGUERA, S., FORNER, L. & RODRÍGUEZ‐LOZANO, F. 2018.
Implementation of augmented reality in operative dentistry learning. European Journal
of Dental Education, 22, e122-e130.
MELONCON, L. & WARNER, E. Data visualizations: A literature review and opportunities for
technical and professional communication. 2017 IEEE International Professional
Communication Conference (ProComm), 2017. IEEE, 1-9.
MIDWAY, S. R. 2020. Principles of effective data visualization. Patterns, 1, 100141.
NEEDLEMAN, S. Y. H. & NIEDERMAN, D. R. 2001. A bibliometric analysis of the pediatric
dental literature in MEDLINE. Pediatric dentistry, 23.
NIEMINEN, P. & VÄHÄNIKKILÄ, H. 2020. Use of data analysis methods in dental
publications: is there evidence of a methodological change? Publications, 8, 9.
O'DONOGHUE, S. I., BALDI, B. F., CLARK, S. J., DARLING, A. E., HOGAN, J. M., KAUR,
S., MAIER-HEIN, L., MCCARTHY, D. J., MOORE, W. J. & STENAU, E. 2018.
Visualization of biomedical data. Annual Review of Biomedical Data Science, 1, 275-
304.
PRITCHETT, R., COLEMAN, S., CAMPBELL, J. & PABARY, S. 2018. Understanding our
patient base: an introduction to data analytics in dental practice. Dental Update, 45, 236-
246.
QIN, X., LUO, Y., TANG, N. & LI, G. 2020. Making data visualization more efficient and
effective: a survey. The VLDB Journal, 29, 93-117.
R CORE TEAM. 2019. R: A Language and Environment for Statistical Computing [Online].
Vienna, Austria: R Foundation for Statistical Computing. Available: https://www.r-
project.org/ [Accessed 11 February 2022].
RIZZATTI, L. 2016. Digital data storage is undergoing mind-boggling growth. EE Times.
SCHWENDICKE, F. & KROIS, J. 2022. Data dentistry: how data are changing clinical care and
research. Journal of Dental Research, 101, 21-29.
SCHWENDICKE, F. A., SAMEK, W. & KROIS, J. 2020. Artificial intelligence in dentistry:
chances and challenges. Journal of dental research, 99, 769-774.
STANDARDS, N. I. O. & TECHNOLOGY 2019. US Leadership in AI: A Plan for Federal
Engagement in Developing Technical Standards and Related Tools. US Department of
Commerce Washington, DC.
STATISTICA. 2018. Total amount of global healthcare data generated in 2013 and a projection
for 2020*(in exabytes) [Online]. Statistica. Available:
https://www.statista.com/statistics/1037970/global-healthcare-data-volume/ [Accessed 11
February 2022].
TUFTE, E. 2001. The visual display of quantitative information. Cheshire: Graphic Press.–
2001.–213 p.
WEBER, K., DASILVA, A. F., DAULT, J. T., EBER, R., HUNER, K., JONES, D.,
KORNMAN, K., RAMASWAMY, V., SNYDER, M. & WARD, B. B. 2021. Using
business intelligence and data visualization to understand the characteristics of failed
appointments in dental school clinics. Journal of Dental Education, 85, 521-530.
WICKHAM, H., AVERICK, M., BRYAN, J., CHANG, W., MCGOWAN, L. D. A.,
FRANÇOIS, R., GROLEMUND, G., HAYES, A., HENRY, L. & HESTER, J. 2019.
Welcome to the Tidyverse. Journal of open source software, 4, 1686.
