25th Annual NJAE Winter Symposium

“Becoming a better diagnostician by understanding decision and probability theory”
Dr. Kehn E. Yapp

Synopsis:
A sophisticated understanding of the testing process is imperative for any clinician involved in diagnostic decision making. Whilst these concepts are established and widely prevalent in the medical community, they are yet to achieve widespread acceptance in dentistry. Grasping and implementing concepts of probability and decision theory – such as Bayes’ theorem and receiver operating characteristic analysis – will only lead to improved decision making, a greater understanding of the type of information to be collected and the kinds of errors that can be made. At another level, this leads to an understanding of the types of questions and their usefulness that should be asked in the diagnostic domain.

Learning objectives:
–  Understand the principles of diagnostic testing from a probabilistic perspective.
–  Describe the performance characteristics and identify the limitations of a diagnostic test.
–  Use concepts of probability to be aware of the types of errors in decision making.

“Cognitive biases in test interpretation – how to recognize them and avoid being fooled”
By: Dr. Kehn E. Yapp

Synopsis:
The human element of test interpretation can be subject to occult biases which may have significant effects on diagnostic decisions. These can range from simple language descriptors to test findings being associated with unknown disease progression or morbidity. Whilst the spectrum of available test modalities in endodontics may be limited, the components of many aspects of the interpretive process have not yet been thoroughly studied. Immediate recognition of the sources of error can be difficult when there is a lack of awareness and understanding of the biases in perception and interpretation. When a careful and methodical approach to test interpretation is used, along with an awareness of the likely biases that may affect decision making, clinicians can be more likely to overcome common errors in the diagnostic interpretive process.

Learning objectives:
–  Be aware of cognitive biases in test interpretation.
–  Understand how perception can influence diagnostic decision making.
–  Limit diagnostic error by accounting for the effect of cognitive biases in the interpretive process.

“Treatment of Compromised teeth: What is possible?”
Dr. Robert E. Grover

Synopsis:
In their book, “Evidenced-Based Decision Making in Dentistry”, Dr’s Rosen, Nemcovsky, and Tsesis state that “the ultimate goal of conservative dental treatment is to preserve the natural dentition”. They recognize however, that in compromised cases, where a more complex multidisciplinary approach may be necessary, the attempt to retain a tooth for the long-term may be less predictable creating a potentially difficult decision for the clinician and therefore the patient. Should a compromised tooth be retained or extracted in favor of replacement with an implant? In their position paper on implants, the AAE stated that implants have “enhanced oral function for many patients by profoundly affecting treatment planning for teeth with an unfavorable prognosis, and for the rehabilitation of edentulous spaces”. Though implants were initially designated as replacements for missing teeth, many clinicians have migrated to using implants as substitutes for existing teeth.

The AAE’s position is that the “early removal of a compromised tooth and replacement with an implant” paradigm should be reconsidered. In 2014, the AAE released a treatment guide for compromised teeth including root amputations, resorptions, procedural complications, and endodontic retreatment. This guide provided treatment considerations and prognosis for each of the categories of compromised teeth. However, little consideration was given to the long-term outcomes of the treatment described in the guide.

Over the past seven years, Dr. Grover has followed over 4,000 of cases that he has treated since opening a private endodontic practice in 1995. Using the AAE’s decision making guide as a template, Dr. Grover will attempt to illustrate what is possible with regards to treatment of compromised teeth.

Learning objectives:
– Describe and understand what is meant by the term compromised teeth.
– Be able to discuss the benefits of retaining compromised teeth.
– Understand the conditions that may enhance the retention of compromised teeth.