Title: Feasibility Study of Suspicious Lesion Decisions Among Scottish/US PBRN Dentists
Sonia Makhija (Presenter)
University of Alabama at Birmingham
James Bader, University of North Carolina Chapel Hill
Daniel Shugars, University of North Carolina Chapel Hill
Jan Clarkson, University of Dundee
Lorna Barnsley, University of Dundee
Linda Young, University of Dundee
Gregg Gilbert, University of Alabama at Birmingham
Michael Robinson, University of Florida
Objectives: To test the feasibility of international collaboration for a study involving online case-study presentations (or vignettes).
Methods: An international collaboration was established between the U.S. National Dental Practice-Based Research Network (PBRN) and the Scottish Dental PBRN, to test the feasibility of using identical questionnaires to measure practitioners’ treatment decisions. An online questionnaire from the National Dental PBRN study “Decision Aids for the Management of Suspicious Occlusal Caries Lesions (SOCLs)” was used. The main questionnaire objective was to assess dentists’ decision policies for SOCLs. An online patient vignette system was used to capture individual decision policies (idiographic analysis). Practitioners were presented a series of 16 vignettes that represented all combinations of 4 cues: color, luster, lesion roughness, and patient-level caries risk. Each vignette included a description of the patient and a picture of a tooth that, taken together, present the 4 cues. Dentists were asked to decide the likelihood that the lesion was in dentin for each vignette.
Results: A total of 107 US dentists and 19 Scottish dentists participated. 86% of US PBRN dentists had a statistically reliable decision policy compared to 89% for the Scottish PBRN dentists. The percentages of dentists who made reliable use of a cue were as follows: luster (49%-US; 63% Scottish), color (58%-US; 53% Scottish), roughness (36% US; 47% Scottish), and risk (35% US; 42% Scottish).
Conclusions: The online system demonstrated that decision strategies are highly individualized. US and Scottish PBRN dentists were similar in their decisions. Dentists’ adoption of more evidence-based treatment approaches could be facilitated by knowing that most dentists are consistent in their cue use. There is little evidence about how dentists use these cues when judging the extent of caries progression. International collaborations on these topics appear feasible. Support: U19-DE-22516, UAB funds.