Variations in caries diagnoses and treatment recommendations and their impacts on the costs of oral health care

To evaluate the reproducibility of caries detection and treatment planning among public health dentists and estimate the possible impact of their decisions on financial costs. RESEARCH DESIGN AND SETTINGS: Thirty nine dentists working in the public health service of Piracicaba, São Paulo, Brazil mad...

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Bibliographic Details
Published in:	Community dental health Vol. 29; no. 1; p. 25
Main Authors:	da Silva, R P, Meneghim, M C, Correr, A B, Pereira, A C, Ambrosano, G M B, Mialhe, E L
Format:	Journal Article
Language:	English
Published:	England 01-03-2012
Subjects:	Bicuspid - pathology Brazil Composite Resins - economics Decision Making Dental Amalgam - economics Dental Atraumatic Restorative Treatment - economics Dental Care - economics Dental Caries - diagnosis Dental Caries - pathology Dental Caries - therapy Dental Enamel - pathology Dental Materials - economics Dental Restoration, Permanent - economics Dentin - pathology Fluorides, Topical - economics Fluorides, Topical - therapeutic use Glass Ionomer Cements - economics Health Care Costs Humans Molar - pathology Observer Variation Patient Care Planning - economics Pit and Fissure Sealants - economics Pit and Fissure Sealants - therapeutic use Public Health Dentistry - economics Reproducibility of Results Sensitivity and Specificity Watchful Waiting - economics Young Adult Brazil
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Summary:	To evaluate the reproducibility of caries detection and treatment planning among public health dentists and estimate the possible impact of their decisions on financial costs. RESEARCH DESIGN AND SETTINGS: Thirty nine dentists working in the public health service of Piracicaba, São Paulo, Brazil made a combined visual-radiographic caries examination of 40 occlusal surfaces of extracted permanent teeth mounted on two dental mannequins and proposed treatment plans for each tooth. Histological validation then evaluated the diagnoses validity and the suitability of the treatment plans. Inter-examiner agreement was calculated by Cohen's Kappa statistics. The sensitivity and specificity of caries detection and treatment decision were calculated. The costs of dental treatment plans for public health system were calculated from a Brazilian public health service fee scale. Inter-examiner agreement for caries detection was moderate (kappa = 0.42) while for treatment decisions it was fair (kappa = 0.29). The sensitivity and specificity were 0.69 and 0.65 for caries detection and 0.56 and 0.65 for treatment decision respectively. Dentists overestimated the presence and depth of carious lesions and there was a tendency to treat enamel lesions using invasive therapeutic procedures. Mean treatment cost across the two cases was 32US$ (range 9-65) while the histologically validated cost was 23US$. The variability in caries detection and treatment decision negatively affected the cost of the dental treatment.
ISSN:	0265-539X
DOI:	10.1922/CDH_2659Mialhe04