Factors influencing the likelihood of successful decisions to treat dentin caries from bitewing radiographs

Abstract

The purpose of this study was to describe the role played by the ability to estimate caries depth in successfully deciding to treat dentin caries when making use of bitewing radiographs as a diagnostic test. A 10% random sample (n = 444) of Dutch dental practitioners was sent a two-wave questionnaire concerning radiographic caries diagnosis and restorative treatment decision making. The second wave consisted of simulated bitewing radiographs of 105 tooth surfaces with and without dentin caries according to two measuring standards: (a) a micro-radiographic "gold" standard and (b) a norm of expert observers. The dentists were asked to diagnose caries at 4 depths of penetration using a 5-point certainty scoring system to measure diagnostic ability; and to make a treatment decision for each surface. The overall response was 61% (273). A regression analysis was carried out using the chance per dentist of correctly deciding to treat dentin caries as the dependent variable. The degree of agreement with the experts' diagnosis of radiographic caries depth was used to create variables measuring diagnostic ability. Five significant (P less than 0.05) variables explained 60% (R2 = 0.60) of the variation in decision making. The best diagnostic ability variable explained 47% of the variation while the treatment criterion reportedly used explained 3%. We conclude that the ability of practitioners to interpret radiographs plays a major role in treatment decision making and that their reported treatment decision making criteria should not be taken at face value.

Pre-operative diagnostic radiograph interpretation by general dental practitioners for root canal treatment

“…43, 44 Dawson et al 45 hypothesized that diagnosis of periapical lesion is not influenced by diagnostic confidence; dentists who feel confident about diagnosing pathology from radiographs are not necessarily able to correctly diagnose the lesion. 46 This was proven in a study by Stheeman et al 47 where a dentist's ability to diagnose a radio-opaque lesion was independent of their diagnostic confidence and their diagnostic ability increased when they were more confident regarding the lesion when confronted with a radiograph. In agreement with these studies, our results show that there was significant variation in what the practitioner said they will be detecting from the radiograph and what they were able to detect from the radiographs provided.…”

Recruitment and standardization of a group of Australian dentists for a multipractice study on dental caries prevention

“…[15][16][17][18] Attempts have been made to maintain inter-examiner and intra-examiner consistency by means of intensive training. [19][20][21] Previous studies have concluded that it is possible to train dentists in order to achieve high levels of inter-examiner consistency and to maintain these levels after 12 months, although the results are somewhat inconsistent.…”

The Effect of a Knowledge-based, Image Analysis and Clinical Decision Support System on Observer Performance in the Diagnosis of Approximal Caries from Radiographic Images

“…Thus, it is not surprising that investigators report substantial disagreement among dentists who have examined the same radiographs, about which teeth require approximal restorations [Bader and Shugars, 1992;Elderton and Nuttall, 1983;Kay et al, 1992;Mileman et al, 1992]. This divergence in treatment planning is not the result of different philosophies of restorative intervention, but primarily of different abilities to perceive the presence and extent of radiographic caries in an objective, consistent manner [Kay et al, 1992;Mileman et al, 1992].…”

“…This divergence in treatment planning is not the result of different philosophies of restorative intervention, but primarily of different abilities to perceive the presence and extent of radiographic caries in an objective, consistent manner [Kay et al, 1992;Mileman et al, 1992]. Further, it is evident that these differences in diagnostic ability and the resulting therapy inevitably result in some incorrect and inappropriate treatment [Rytömaa et al, 1979].…”

“…An essential source of information for this task is intraoral radiography, especially the bitewing projection [Barr and Gresham, 1950;Hansen 1980;Kidd and Pitts, 1990]. However, investigations have shown that dentists achieve only a modest level of accuracy and agreement in the diagnosis of caries on approximal surfaces from radiographs [Douglas et al, 1986;Gröndahl, 1989;Kantor et al, 1985;Mileman et al, 1992;White et al, 1988White et al, , 1984.…”