Need for change in standards of caries diagnosis–epidemiology and health services research perspective

Jd, Bader; Shugars, DA

doi:10.1002/j.0022-0337.1993.57.6.tb02767.x

Cited by 25 publications

(6 citation statements)

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“…Importantly, once a matching caries script has been identified, the treatment decision is often given by virtue of the script. Thereby, diagnostic considerations are altogether skipped and replaced by scripts in the form of 'this-type-of-lesionneeds-this-kind-of-treatment' decisions [10,13,14], and dentists often 'diagnose' lesions for treatment using the intended treatment to identify and describe the observation in charts and patient records [13,17].…”

Section: Caries Detection--caries Script Matchingmentioning

confidence: 99%

What is an appropriate caries diagnosis?

Bælum¹

2010

Acta Odontologica Scandinavica

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This aim of this paper is to spur a discussion of the direction of caries-lesion detection activities in clinical dental practice. It is argued that since the dental clinician's caries-related decision making is a script-matching enterprise in which clinical decisions are made on the basis of 'this-lesion-needs-this-kind-of-treatment' reasoning, the methods and strategies employed for caries lesion detection should accommodate this fact. This may be done by employing a clinical visual-tactile method for caries lesion detection that evaluates the two aspects that are crucial for appropriate caries management: lesion activity and surface integrity. The use of diagnostic methods that do not assess these features directly but involve assumptions about activity status and surface integrity should be avoided. This includes the use of bite-wing radiography for the detection of approximal caries lesions, as it may be shown that plain reliance on radiographs leads to considerable overtreatment. If clinical dentistry is to retain its status as a profession committed to doing good, changes in diagnostic practices along these lines are warranted.

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Section: Caries Detection--caries Script Matchingmentioning

confidence: 99%

What is an appropriate caries diagnosis?

Bælum¹

2010

Acta Odontologica Scandinavica

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“…In two studies, Bader and Shugars found that some of those disagreements could be attributed to thoroughness of diagnosis or to strong personal opinions or beliefs of the clinician 6 , 7 . Other studies have found inherent variability in diagnosis and treatment planning among clinicians 8 – 10 . The variability often seen in periodontal diagnosis and treatment planning may originate from the multifactorial nature of periodontal disease when formulating a diagnosis.…”

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confidence: 99%

Periodontal Diagnosis and Treatment Planning Among Indiana Dental Faculty, Periodontists, and General Practice Dentists: A Multi‐Group Comparison

Marlow

Hamada

Maupomé

et al. 2018

Journal of Dental Education

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Diagnosis and treatment planning for periodontal disease are fraught with challenges because of the complex and multifactorial nature of the disease as well as the inherent variability in interpretation of clinical findings. It is important for all practitioners to be accurate and consistent in formulating diagnoses based on the American Academy of Periodontology classification guidelines and to implement treatment plans to adequately address patients' needs. The aim of this study was to compare diagnoses and treatment plans among four groups of participants: full-time and part-time periodontology faculty at Indiana University School of Dentistry (IUSD), full-time and part-time IUSD general practice faculty, full-time periodontists in private practice, and full-time general practitioners in private practice. The study, conducted September 2016 to February 2017, also sought to determine if the calibrated participants had more correct diagnoses and treatment plans than those who had not received calibration training. Each of the four groups had 20 participants each. Participants evaluated ten de-identified case records and selected a diagnosis and treatment plan for each case. In the results, the 20 IUSD periodontal faculty members, most of whom had participated in calibration sessions, had overall better agreement and more correct responses for diagnoses and treatment plans than the IUSD general practice faculty members, private practice general practitioners, and private practice periodontists (only one of those 60 participants had participated in calibration sessions). The results supported the notion that periodic calibration is needed to standardize faculty criteria, facilitate better agreement and accuracy, and enhance consistency in the use of clinical criteria during training for dental students and in practice.

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“…The progression of oral diseases does not only depend on individual risk factors and indicators (15). Other relevant factors are the variation in diagnostic performance (16), the availability of manpower in dentistry (17), the differences between dentist's characteristics and orientations in delivering oral care (18, 19), and the willingness of patients to visit the dentist regularly.…”

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confidence: 99%

Predictors of recall assignment decisions by general dental practitioners performing routine oral examinations

Mettes

Sanden

Mulder

et al. 2006

European J Oral Sciences

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The aim of this study was to explore the decision-making behavior of general dental practitioners (GDPs) in performing routine oral examinations (ROEs). Change over time was studied by comparing data from a cohort sample of participants in two surveys in 2000 and 2005. A written questionnaire was sent to 809 dentists (509 responses were obtained) and 475 (61%) were used for analysis. Of the respondents, 347 also participated in the survey in 2000. The mean number of diagnostic ROE items per ROE was 6.9 (standard deviation = 1.7). Groups of GDPs were distinguished based on their answer to the question 'Do you apply for all patients a fixed recall interval between two successive ROEs?' and four personal profiles. Of the GDPs, 38.5% (n = 183) assigned fixed recall intervals (Fxs) for all patients. Individual recall intervals (Ivs) were applied by 61.5% (n = 292) of GDPs, depending on specific selected patient characteristics and risk factors. Logistic regression showed that GDPs applying Fxs also used fixed periods between successive bitewing radiographs. Furthermore, GDPs applying Ivs conducted more frequent periodontal screening and, in the event of periodontal problems, were more inclined to prescribe radiographs. Over a 5 yr period, a shift towards Ivs assignment (from 49% in 2000 to 61.5% in 2005) was found. Differences in assigned recall intervals (Fxs/Ivs) by GDPs are determined by three clinical ROE predictors and two GDP profiles. A shift towards a more individual assessment was found between 2000 and 2005 in the way that Dutch GDPs are dealing with the assignment of recall interval frequency.

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Need for change in standards of caries diagnosis–epidemiology and health services research perspective

Cited by 25 publications

References 0 publications

What is an appropriate caries diagnosis?

What is an appropriate caries diagnosis?

Periodontal Diagnosis and Treatment Planning Among Indiana Dental Faculty, Periodontists, and General Practice Dentists: A Multi‐Group Comparison

Predictors of recall assignment decisions by general dental practitioners performing routine oral examinations

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