The urgent ethical challenges of AI-driven caries detection

Fraser Macdonald, Dental Tribune International

Fri. 19 September 2025

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KARACHI, Pakistan: Artificial intelligence (AI) is transforming dentistry, offering powerful tools to detect caries with speed and precision once unimaginable. Yet, while the promise of AI in diagnostics continues to grow, so too do concerns about its ethical implications. A recent scoping review by researchers in Pakistan highlights the pressing need to balance technological progress with responsible frameworks that protect patients, uphold fairness and maintain trust within dental practice.

AI-based systems are rapidly being integrated into dental diagnostics, particularly in the detection of carious lesions through radiographs and intra-oral imaging. These technologies have demonstrated accuracy levels comparable to, and in some cases exceeding, those of human experts. However, the review underscores that the benefits of AI come with a complex set of pressing ethical challenges that must not be overlooked.

A key concern lies in diversity and representation, a crucial issue for the healthcare industry as a whole. Many AI models in dentistry have been trained on datasets from high-income, single-centre studies, raising the risk of bias when applied to more diverse populations. Without careful consideration of demographic and cultural variation, diagnostic tools may misinterpret or overlook certain caries presentations, ultimately leading to unequal standards of care.

Privacy also emerged as a recurrent issue. The use of patient images and radiographs is central to AI training, yet most studies offered limited clarity on how data identifiers were removed or protected. Because AI models require access to vast amounts of sensitive data, robust safeguards must be in place to prevent misuse and ensure compliance with data protection regulations.

Transparency and accountability are equally problematic. The complexity of deep learning models means that clinicians often cannot see how an AI system arrives at a diagnosis. This lack of clarity complicates questions of responsibility: if an AI-assisted diagnosis proves faulty, it is unclear whether accountability lies with the clinician, the software developer or the institution deploying the technology.

Equity is another dimension that requires scrutiny. While AI has the potential to enhance efficiency and support early intervention, it could also exacerbate disparities if access remains confined to well-resourced practices. Without inclusive frameworks, disadvantaged communities risk being excluded from the benefits of these innovations.

The review calls for the development of a specialised ethical framework for AI in dentistry, tailored to the unique clinical and patient-facing aspects of the field. This would include guidelines on dataset inclusivity, transparent reporting standards, clear governance structures and patient-centred safeguards around privacy and informed decision-making.

AI holds immense potential to advance dental care, but its integration must be guided by strong ethical standards. Addressing bias, privacy and accountability now will be essential to building patient trust and ensuring that the technology serves the profession equitably and responsibly.

The study, titled “Ethical insights into AI-driven caries detection: A scoping review”, was published online on 9 September 2025 in BDJ Open.