Precision or personalised medicine – the concept of tailoring treatment to a patient's unique needs based on their genomic profile, environment, and lifestyle factors – has made significant headway in recent years in medical and surgical specialties.1 The evolution of electronic health records, Omics technologies, the availability of large volumes of multimodal data from diverse sources, and the use of artificial intelligence-based tools have further accelerated this.2,3 There has been much interest in applying the precision/personalised medicine paradigm in dentistry. However, there are several high-stakes ethical, legal, and implementation ramifications of using genomic records in dental practice and academic settings (Table 1).

Table 1 Challenges of using genomic records in dental practice
Full size table

First, operationalising the collection of genomic records in a dental practice presents unique challenges: which biospecimens will be collected from each patient (e.g., saliva, blood, tissue), and how will they be stored? Not every practice has the resource bandwidth to collect, appropriately store, and send the specimens to the lab for sequencing. Even though the cost of genomic sequencing has decreased substantially in recent years, sequencing every patient is likely to be an expensive endeavour.4 Whether the costs would be assumed by the patient, the dentist, insurance companies, or governmental payers, the associated increase in healthcare costs should be objectively weighed with the high anticipated long-term benefits of these efforts.

Second, we must be cognisant of the legal implications of genomic sequencing and ensure patients can provide true informed consent regarding how their data may be used in the future. Variability in dentists' ability to interpret the gathered genomic data, ethical and legal concerns of incidental or missed diagnoses, insurance companies' access with potential impact on premiums and access to care are some examples.

Third, a patient's genomic records are unique and cannot be anonymised. Any data breaches could have catastrophic consequences for patients, healthcare providers, and healthcare organisations. Last year, a healthcare data hack in the United States affected the personal information of over 190 million people.5

Finally, integrating concepts of genomics, personalised medicine, and artificial intelligence into an already crowded dental education curriculum is still in its nascent stages and will not be an easy endeavour for dental schools. There is a substantial asymmetry in what is needed and what is available in terms of faculty expertise in precision/personalised dentistry.

It has been demonstrated across several specialties that precision/personalised medicine offers substantial benefits,1,6 but a wide array of challenges exists in dentistry to fully implement these concepts into dental education and everyday clinical care.