Special Concern: Clinical decision making in evaluating patients: a process study

Abstract

A volunteer patient was examined by five dentists experienced in caring for geriatric patients. The patient and dentist interaction was videotaped and reviewed to evaluate a previously generated hypothesis regarding the diagnosis process. This descriptive study suggests that dentists experienced in geriatric care did assess and evaluate a wide range of patient characteristics. However, they did not follow the previously hypothesized process in arriving at an appropriate treatment plan. Instead, they relied heavily on past experiences with similar situations. The possible implications of this process for treatment planning and teaching of geriatric dentistry are discussed.

Taste‐related sensations in old age

“…The most prevalent possible mechanism for the drug‐induced taste disorder is ascribable to the chelating reaction of a drug with zinc ion and the following zinc deficiency . Older people frequently have more chronic diseases and thus are more likely to require medication, than younger adults , affecting taste acuity solely or in combination.…”

“…Older people are more likely to suffer from multiple chronic diseases, with higher intakes of medication . The diseases and the living situation of institutionalised older adults are more likely to cause of the decreased taste sensitivity .…”

Karnofsky performance status scale

“…The treatment plan is based on the dentist' s clinical experience rather than any specific guidelines. 15 This modification of the KPSS may help dentists in their decision making by helping them understand how that patient functions in his or her environment. We are interested in feedback from the readers of this journal on their perception of the usefulness of this scale in their practices.…”

“…Clinical decision making in dentistry for geriatric and special needs patients has been based on qualitative, subjective estimates that the patient will be able to tolerate the treatment regimen. The treatment plan is based on the dentist's clinical experience rather than any specific guidelines 15 . This modification of the KPSS may help dentists in their decision making by helping them understand how that patient functions in his or her environment.…”

Are dental students ready for supercomplex dental practice?

“…Under conditions of supercomplexity, dentists are expected to prevent and treat disease in a society where oral diseases are recognised as being significantly influenced by the web of social, cultural and political conditions experienced over a person's life course . Patients who have a variety of combinations of acute and chronic oral, systemic and social problems require clinicians to have a sophisticated understanding of the experience of disease, cultural influences and related circumstances as well as a strong understanding of human pathophysiology and the fundamentals of clinical medicine. When faced with supercomplex situations, it may be difficult to define a problem and then a procedure may be an inadequate approach to a problem.…”