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This study uses decision analysis in order to explore the maximum expected utility of positive and negative restorative decisions, made on the basis of bitewing radiography. The a posteriori probabilities of disease, given a positive/negative treatment decision were derived from a study in which 20 dentists made 7200 decisions about 15 pairs of simulated bitewing radiographs. Lesion depths in the teeth examined were ascertained by light microscopy. A review of the available data on lesion progression/regression was undertaken to provide probability values for the decision model, and population utilities for the outcomes of the decision were derived from a survey of 110 members of the public. The decision analysis showed that negative treatment decisions always attracted the highest maximum expected utility, except in highly disease-prone individuals. This analysis demonstrates that lesion depth, likelihood of pain, and the rate of lesion progression have minimal effect on the utility of a positive treatment decision. It is concluded that an over- concentration on the biomedical model of dental health may cause dentists to make decisions which are inappropriate to their patients' values and preferences. [ABSTRACT FROM AUTHOR]

The implicit valuations which dentists place on the outcomes of their treatment decisions may be a major contributory factor in dentists' decisions about when to restore teeth. This study sought to examine the relationship between dentists treatment attitudes and restorative dental treatment decision making. A group of 20 dentists were asked to indicate teeth in need of filling from 15 simulated bitewing radiographs. The dentists graded their level of certainty about their treatment decision as "definite", "probable" or "possible". Afterwards, the teeth were sectioned and examined using a microscope in order to determine how far through the tooth the caries had penetrated. The gold standard treatment criterion was that caries extending into the dentine of the tooth would require restoration. Receiver Operator Characteristic (ROC) analysis was used to examine the apparent weighting the dentists were giving to decision errors when planning treatment on the basis of bitewing radiographs. The dentists also completed a treatment attitudes questionnaire to determine their views about the relative importance of false negative and false positive treatment decisions. The results suggest that the most appropriate operating point for most of these dentists to achieve an outcome which matched their views about the relative importance of the two types of treatment error would be the point at which a filling would "definitely" be required. [ABSTRACT FROM AUTHOR]

It has been recognised for many years that treatment decision-making among dentists often shows wide variation. This study sought to examine the effect of dentists stated treatment thresholds as a source of variation between them. Twenty dentists made 360 treatment decisions about the approximal surfaces of extracted teeth seen in simulated bitewing radiographs. They also stated their personal treatment thresholds, i.e. the depth of lesion which they intended to restore. One hundred and ninety pairwise comparisons of treatment decisions showed that only 16% of the dentist pairs showed substantial agreement. Dentist pairs who reported that they held the same interventive threshold achieved exactly the same mean level of agreement in treatment decision-making as dentist pairs who disagreed about the appropriate threshold for restorative intervention. The study suggests that restorative thresholds which are reported to be used by dentists may he poorly correlated with the number of positive treatment decisions actually made. [ABSTRACT FROM AUTHOR]

It has been evident for many years that dentists, when planning treatment for patients, do not act in a standard manner, and previous research has shown there to be wide variations in treatment planning amongst groups of dentists. Signal detection theory and Receiver Operating Characteristic (ROC) analysis allows measurement of an observer's ability to detect a lesion, while at the same time allowing examination of how a lesion, once perceived, is judged to he in need of treatment. An ROC curve is constructed by plotting the sensitivity (or true positive rate) of decisions made, against the false positive rate (equivalent to 1-specificity) when various decision attitudes, from interventionist to non-interventionist, are held. Fifteen pairs of simulated bitewing radiographs were shown to 20 dentists, who were asked to specify, for each approximal lesion, whether or not they would place a conventional restoration. The 7200 decisions made by the dentists were validated by sectioning and microscopically examining the teeth. The mean sensitivity of the dentists' decisions, when the strictest operating thresholds were held and caries into dentine was the validating criterion, was 0.26 and the mean specificity was 0.96. ROC analysis shows that when operating at the strictest threshold, the dentists were implying that specificity was weighted as being 2.7 times more important than sensitivity. ROC analysis leads to insight into how dentists differentially weight the true and false, positive and negative, outcomes of their decisions and thus allows explanation of why two dentists would rarely make exactly the same treatment plan for one patient, and also why different treatments might be offered to two patients exhibiting the same levels of disease. [ABSTRACT FROM AUTHOR]

This study investigates the validity of the treatment decisions made by 10 hospital dentists, who examined the fissures of extracted teeth using a visual-only technique. The study shows that 8 of the 10 dentists were more likely to leave carious teeth unrestored than unnecessarily treat sound teeth. The authors suggest that this system of diagnosing occlusal caries is a satisfactory one in terms of its sensitivity and specificity. [ABSTRACT FROM AUTHOR]

This study aimed to investigate the variations in dentists' perception of need for orthodontic treatment. Sixteen dentists viewed forty clinical vignettes and recorded their decisions according to the certainty with which they would offer treatment for each case. Receiver Operating Characteristic (ROC) analysis was per- formed on this data, using the Index of Orthodontic Treatment Need (IOTN) as the `gold standard'. The data suggest that dentists treatment decisions do not concur with current guidelines in use in the UK. [ABSTRACT FROM AUTHOR]

Objective To review publications in dentistry of decision analyses during the last 30 years. Data sources Medline 1969-1998 and hand-searching of reference lists of retrieved publications. Study selection Articles presenting a decision analysis with utilities and sensitivity analyses were included. Data extraction and synthesis A quality assessment of the included studies but no formal synthesis due to the range of clinical applications considered. Results Sixty-seven articles were identified with 22 fulfilling the criteria for inclusion. Conclusions Decision analyses publications in dentistry have declined in recent years. The quality of decision analyses in dentistry is variable. Improvement in this promising technique will depend on improvement in the quality of basic research data. [ABSTRACT FROM AUTHOR]