Endodontic treatment decisions: A study of the clinical decision‐making process

Abstract

From general decision‐making theory and endodontic teaching paradigms a hypothesis was evolved explaining variations in treatment decisions with variations in subjective probabilities of disease and complications. This hypothesis was tested on 20 general practitioners and 7 endodontists, who were introduced to 10 cases with endodontically‐treated teeth showing periapical radiolucencies of various proportions. For each case the examiners were instructed to assess probability of disease, probability of future complications and to determine mode of treatment. The results indicate that interindividual variations in endodontic treatment decisions are influenced to a rather low degree by subjective probabilities of different diagnoses and of expected complications. Instead, the decision makers seemed to rely on a limited number of heuristic principles which reduced the complex task of assessing probabilities and predicting outcomes to simpler judgemental operations.

Mandibular third molars as mediated by three cues: Dentist' treatment decisions on asymptomatic molars compared with molars associated with pathologic conditions

“…The overall agreement was fairly high between the dentists' treatment decisions and the removal rate among the molars subjected to removal. Thus, molars partially covered by soft tissue in patients aged 19 to 40 years had a high removal rate, and molars totally covered by bone tissue had the lowest removal rate in accordance with the dentists' treatment decisions. There were some exceptions.…”

Influence of Specialty Training and Experience on Endodontic Decision Making

“…The decision-making process regarding the retreatment necessity and the selection of the appropriate therapeutic alternative not only requires a sound evidence-based knowledge but might also be influenced by subjective factors emanating from both the clinician and the patient (6,16,17). The educational background and the differences in the clinical experience level constitute significant retreatment factors (14,15,(18)(19)(20)(21)(22)(23).…”

“…Immediate therapeutic interference entails therapy (nonsurgical, surgical, extraction) or no therapy, whereas in cases with healing potential, reexamination is the proper attitude (6). As in previous surveys (13,14,18,24,25), the protocol of the 5 treatment solutions was adopted.…”

“…Second, definite outcomes and insertion of its values (utilities) and probabilities to occur are determined. Finally, the most preferable treatment is estimated by computed calculations (14,15).…”

Endodontic retreatment decisions: no consensus

“…In addition to the diagnostic and technical problems, other characteristics of practitioners (e.g. their age, clinical experience, confidence, specialty training) may influence their decision making ( Reit et al . 1985 , Reit & Gröndahl 1987).…”