OralAgent: Integrating Reasoning, Tools, and Knowledge for Interactive Dental Image Analysis

Oral diseases affect billions of people worldwide, underscoring a pressing need for accurate and reliable dental assessment that integrates heterogeneous evidence from domain knowledge, radiographs, intraoral photographs, and 3D dental data. Most existing dental AI systems remain modality- or task-specific. Although recent vision-language models support flexible dental question answering, directly generated response leaves evidence implicit and untraceable. To address these limitations, we introduce DentAgent, an evidence-centric multi-agent framework, in which the Orchestrator coordinate five specialized agents spanning various modalities. Each specialist utilizes domain tools to convert observations into structured evidence records. The Evidence Blackboard manages these records as a shared evidence state, tracking coverage, gaps, and conflicts before response generation. This standardized evidence representation integrates isolated dental capabilities into a unified agentic workflow. Across four benchmarks, DentAgent demonstrates leading performance, even surpassing the senior specialists by 17.3 percentage points on multi-label diagnosis, which supports its value for broadly applicable and traceable multimodal dental reasoning, and highlights its potential as a technical foundation for population oral health assessment and management.

Background: Oral diseases affect nearly 3.5 billion people worldwide, yet the comparative clinical potential of large-scale AI models in dentistry remains poorly understood. Three distinct model categories have emerged: language-generative models, discriminative vision foundation models, and dental-specific foundation models, with no unified review examining their relationships and collective limitations. Methods: Following PRISMA-ScR guidelines, we systematically searched four databases (PubMed, Google Scholar, Scopus, arXiv), screened independently by two reviewers. After applying inclusion/exclusion criteria, 97 studies (2020-2026) were included. We propose a two-dimensional classification framework organizing models by architectural paradigm and dental specialization degree. Results: Language-generative models excel at text-based tasks (clinical reasoning, licensing exams, patient communication) but show inconsistent performance on image-dependent diagnostics. Adapted SAM and CLIP variants achieve strong tooth segmentation and lesion detection results. Dental-specific models (DentVFM, DentVLM, OralGPT) demonstrate strongest performance on complex multimodal tasks. Integrated pipelines consistently outperform single-model approaches. A data asymmetry is observed: dental-specific pretraining concentrates almost entirely in the vision domain, reflecting scarce large-scale dental text corpora. Conclusions: General-purpose and dental-specific models play complementary roles; the most effective systems combine both within structured pipelines. Safe autonomous deployment requires resolving three persistent barriers: hallucination in generative models, limited annotated dental datasets, and absent standardized clinical evaluation benchmarks.

Multimodal large language models (MLLMs) have emerged as a promising paradigm for dental image analysis. However, their ability to capture the multi-level cognitive processes required for radiographic analysis remains unclear. Here, we present a comprehensive benchmark to evaluate the cognitive capabilities of MLLMs in dental radiographic analysis. It spans three critical imaging modalities, i.e., periapical, panoramic, and lateral cephalometric radiographs, and defines four cognitive categories: perception, comprehension, prediction, and decision-making. The benchmark comprises 27 clinically grounded tasks derived from public datasets, with manually curated annotations and 3,820 clinician assessments for evaluation. Six frontier MLLMs, including GPT-5.2 and GLM-4.6, are evaluated. We demonstrate the performance gap between MLLMs and clinicians in dental practice, delineate model strengths and limitations, characterize failure patterns, and provide recommendations for improvement. This data resource will facilitate the development of next-generation artificial intelligence systems aligned with clinical cognition, safety requirements, and workflow complexity in dental practice.