Clinical decision‐making in complex endodontic cases between postgraduate students across dental specialties at a UK dental school: A pilot study

Abstract

Introduction Treatment decisions for a heavily restored endodontically treated tooth vary amongst clinicians owing to multitude of factors. This phenomenon not only often poses dilemmas to clinicians of different clinical backgrounds, but also exerts a degree of treatment difficulty to the treating clinician. Previous studies indicated that specialty training and clinical experience significantly impacted clinical decision‐making process. Materials and methods Master of Science postgraduate students in endodontics, prosthodontics, periodontics, oral surgery and implantology participated in a questionnaire‐based cross‐sectional study. The dental specialties were further categorised into restorative and surgical dentistry. A multiple‐choice questionnaire with three clinical cases was distributed to the students. Data were analysed for trends using descriptive statistics. Results There was a 44% response rate; the majority of respondents were from restorative dentistry specialties. Cases 1 and 2 were rated as moderate to high difficulty, and Case 3 was predominantly rated as high difficulty with procedure predictability being the main factor affecting their clinical decision‐making in three cases. Endodontic retreatment was selected as the preferred treatment in Cases 1 and 2 and periradicular surgery in Case 3. The students were fairly confident in managing Cases 1 and 2, but not in Case 3. Referral patterns were consistent in Cases 1 and 2 with endodontists being the first choice of referral except for Case 3 where 48% preferred to refer to oral surgeons and 35% choosing endodontists. Some indication of differences between specialties were noted throughout. Years in practice appeared to be related to the importance of predictability in Case 3 only. Conclusion Considerable inter‐clinician variability was noted whereby specialty postgraduate training impacted on clinical decision‐making. Overall, procedural predictability, technical difficulty, risk of damage to the tooth and patient preference were the most highly ranked factors affecting clinical decision‐making. Evidence‐based treatment guidelines and dental curricula should be reviewed to enhance inter‐clinician agreement in clinical decision‐making, ultimately improving patient care.

Determinants of Clinical Decision Making under Uncertainty in Dentistry: A Scoping Review

“…Four studies found that the type of treatment had effects on confidence in clinical decision making [ 23 , 24 , 36 , 41 ]. Procedural predictability, technical difficulty and risk of iatrogenic damage influenced the clinician’s confidence in decision making [ 36 ].…”

“…Four studies found that the type of treatment had effects on confidence in clinical decision making [ 23 , 24 , 36 , 41 ]. Procedural predictability, technical difficulty and risk of iatrogenic damage influenced the clinician’s confidence in decision making [ 36 ]. McGeown et al adds that equipment limits and time and facilities also played a role, while Fu et al considered timing of clinical findings as important for confidence in treatment planning, where late detection of tooth eruption disturbances can lead to greater complexity [ 23 ].…”

“…Similar conclusions were drawn regarding extraction in periodontally affected teeth [ 49 , 50 ] and prosthodontic cases [ 51 ], linking greater experience with well-founded and conservative treatment decisions. However, more experience also led to greater variability in treatment recommendations [ 52 ] and did not alter the perceived difficulty [ 36 ]. Greater clinical experience was also shown to increase the practitioners’ confidence in producing an accurate diagnosis in dental hygienists [ 53 , 54 ].…”

Outreach dental care programme for older adults using long‐term care services in Hong Kong: A qualitative study

“…22 This study also revealed that different outreach dental teams uate training in various specialities, on the treatment decisions for complex endodontic cases reported that procedural predictability, technical difficulty, risk of damage to the tooth and patient preference were the most important factors affecting clinical decisionmaking. 23 The authors suggested that evidence-based treatment guidelines and dental curricula should be reviewed to enhance interclinician agreement in clinical decision-making. These guidelines should also be available for the patients and their caregivers and they should be included in the clinical decision-making process to enhance patient care and cooperation.…”

A bibliometric comparison of undergraduate and postgraduate endodontic education publications: The topics, trends, and challenges

“…By contrast, postgraduate endodontic education is an advanced level of endodontic knowledge and skills. It allows students to apply their knowledge and skills in a real patient setting under the guidance of experienced clinicians, aiming to cultivate high‐quality professionals with a solid theoretical foundation, 3 outstanding technical skills, 4 and the ability to think critically and conquer complex problems in a clinical context 5 . Such education requires a commitment to professional growth, as well as a continuous drive to innovate and advance through practical research.…”