Factors Affecting Dental Restorative Treatment Decisions

Kay, Elizabeth Jane (1991) Factors Affecting Dental Restorative Treatment Decisions. PhD thesis, University of Glasgow.

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Abstract

Dental caries is a dynamic process rather than a diagnosis. It is therefore inappropriate to cite an exact 'threshold' at which interventive operative dental care becomes the 'correct' treatment option. This thesis explored this problem by applying decision theory to one diagnostic test for caries - namely the bitewing radiograph. Fifteen 'mock' dentitions were assembled, using materials of similar radiodensity to oral structures. A number of cariously involved teeth were included in these dentitions. Radiographs were taken using a standardised technique to ensure that the quality and density of the simulated radiographs were as similar as possible to those taken 'in vivo'. Twenty dental practitioners each made 360 treatment decisions based on these bitewing radiographs. Subsequently the teeth were serially sectioned, examined histologically, and the extent of any caries in each tooth was recorded and correlated with the visual appearance of the tooth surfaces. The dentists' decisions were then subjected to Receiver Operator Characteristic (ROC) and Kappa analysis. The work described also explored the value placed on various tooth-states by the population. By using the available literature and the results of the two studies described above, a decision tree was constructed which permitted examination of the expected values of treatment decisions. This decision analysis allowed recommendations to be made concerning the setting of treatment thresholds. The first part of the study showed that the microscopic, radiographic and visual appearances of a tooth were not always directly related to one another. The analysis of the dentists' decisions indicated that individual practitioners have differing views about the importance of sensitivity and specificity, and therefore have different thresholds at which they institute treatment. These values and attitudes influenced the treatment decisions made to a greater extent than the dentists' views about the depth of lesion needing restoration. The decision analysis indicated that, for the sample populations of dentists and patients investigated, the detectability of caries on bitewing radiographs was not great enough to warrant their routine use as diagnostic tools. The treatment thresholds held by the group of dentists in the study were inappropriate in relation to the utilities for dental health held by the population examined. This study has highlighted the importance of three methods of evaluating diagnostic tests. It has shown that the values dentists place on the outcomes of their decisions affect their treatment thresholds more profoundly than lesion depth. Therefore restorative treatment thresholds should be reviewed and appropriate training given so that dental diagnostic skills are improved and clinical decisions made according to the values that patients hold.

Item Type: Thesis (PhD)
Qualification Level: Doctoral
Keywords: Dentistry
Date of Award: 1991
Depositing User: Enlighten Team
Unique ID: glathesis:1991-78331
Copyright: Copyright of this thesis is held by the author.
Date Deposited: 30 Jan 2020 15:32
Last Modified: 30 Jan 2020 15:32
URI: http://theses.gla.ac.uk/id/eprint/78331

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