Bigras

Differences in clinical decision making: a comparison between specialists and general dentists
Brigitte R. Bigras, DMD,a Bradford R. Johnson, DDS, MHPE,b Ellen A. BeGole, PhD,c and Christopher S. Wenckus, DDS, FICDd Chicago, Illinois
COLLEGE OF DENTISTRY, UNIVERSITY OF ILLINOIS

Objective. The aim of this study was to compare clinical decision making choices of general dentists,prosthodontists, endodontists, oral surgeons,and periodontists when presented with endodontics-related patient scenarios. Study design. A survey instrument with 5 patient scenarios was mailed to 1,250 randomly selected dentists, 250 in each group noted above. The participants were asked to choose from different treatment options and to assess the difficulty of making their choice. The answers were analyzed toidentify differences in clinical decision making between groups. Results. A total of 293 surveys were returned, for an overall response rate of 23.4%. Significant differences in treatment planning decisions between the 5 groups were found. Practitioners expressed more difficulty and more variation in making treatment recommendations in cases involving previously endodontically treated teeth thaninitial treatment scenarios. Conclusions. Dental specialty status has a significant influence on a clinician’s recommendation to perform root canal therapy or extract a tooth. (Oral Surg Oral Med Oral Pathol Oral Radiol Endod 2008;106:139-44)

Clinical decision making is a complex cognitive process that involves consideration of the best available evidence, case-specific clinical judgement, and patientpreferences to reach the optimum treatment choice for an individual patient. However, treatment decisions are almost always made under conditions of at least some uncertainty. Treatment decisions can vary widely among dentists and dental specialists and may be based more on personal values and experience than an objective analysis of treatment benefits, risks, costs, prognosis, andalternatives.1-3 In recent years, the evolution of implant technology has led to a rapid increase in the placement of implantsupported prostheses. Endodontic therapy and implant therapy are both predictable treatment options with well documented long-term success.4-11 The choice of treatment for an endodontically involved tooth is dictated by a number of factors. Because the expected success for implant therapyand initial endodontic therapy is simia

lar,8,9 the choice should not be based solely on expected treatment outcome.12 The absence of clear guidelines for when to preserve an endodontically involved tooth and when to extract and replace with an implant-supported prosthesis has created a treatment-planning dilemma for many clinicians.12-14 Location in the mouth, quality and quantity of bone,clinician skill, periodontal support, bulk of remaining tooth structure and restorability of a tooth, patient susceptibility to recurrent caries, esthetic considerations, patient preferences, and the possible influence of certain systemic conditions on treatment outcome are some of the variables that should be considered in the treatment-planning process. The aim of the present study was to compareclinical decision making choices of general dentists, prosthodontists, endodontists, oral surgeons, and periodontists when presented with patient scenarios with varying degrees of endodontic involvement and complexity. A secondary objective was to assess the self-reported level of difficulty in making a treatment choice in each of 5 different patient scenarios. MATERIAL AND METHODS This study wasapproved by the University of Illinois at Chicago Institutional Review Board. Digital radiographs of 5 endodontically involved teeth, representing 5 different clinical scenarios, were obtained from existing patient records. All identifying information was removed from the image files except tooth number. Fictional case descriptions were developed for each radiograph (Figs. 1-5). The patient...