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Stomatologija 2013; 15 (3): 84-91 296 KB

A preliminary study applying decision analysis to the treatment of caries in primary teeth

Vytautas Tamošiūnas, Elizabeth Kay, Rebecca Craven

Summary

Objective. To determine an optimal treatment strategy for carious deciduous teeth.

Setting. Manchester Dental Hospital.

Design. Decision analysis

Method. The likelihoods of each of the sequelae of caries in deciduous teeth were determined from the literature. The utility of the outcomes from non-treatment and treatment was then measured in 100 parents of children with caries, using a visual analogue scale. Decision analysis was performed which weighted the value of each potential outcome by the probability of its occurrence. A decision tree "fold-back" and sensitivity analysis then determined which treatment strategies, under which circumstances, offered the maximum expected utilities.

Results. The decision to leave a carious deciduous tooth unrestored attracted a maximum utility of 76.65 and the overall expected utility for the decision "restore" was 73.27 The decision to restore or not restore carious deciduous teeth are therefore of almost equal value. The decision is however highly sensitive to the utility value assigned to the advent of pain by the patient.

Conclusions. There is no clear advantage to be gained by restoring deciduous teeth if patients’ evaluations of outcomes are taken into account. Avoidance of pain and avoidance of procedures which are viewed as unpleasant by parents should be key determinants of clinical decision making about carious deciduous teeth.

Key words: decision analysis, primary teeth, caries, treatment.

Received: 28 10 2012

Accepted for publishing: 23 09 2013

¹Private practice, Vilnius, Lithuania

²Peninsula College of Medicine and Dentistry, Plymouth, England

³School of Dentistry, The University of Manchester, England

Vytautas Tamošiūnas¹ – D.D.S., Mphil

Elizabeth Kay² – BDS, MPH, FDSRCPS, FDSRCS, FFGDP, PhD

Rebecca Craven³ – BDS, MPH, FDS RCPS, FDS (DPH) RCPS, DDPHRCS, FFPH, PhD, lect.

Address correspondence to Dr. Vytautas Tamošiūnas, Dental practice, Amicus Dentis, Ševčenkos 12-31, Vilnius, Lithuania.

E-mail address: vytautast@hotmail.com



	Baltic Dental and Maxillofacial Journal

September, 2013, Vol. 15, No. 3 CONTENTS LETTER TO EDITOR 5-aminolevulinic acid based photodynamic therapy for basal cell carcinoma: A 10-years follow-up study Eidi Christensen ii REVIEW Relationship between breastfeeding, bottle-feeding and development of malocclusion Indrė Narbutytė, Agnė Narbutytė, Laura Linkevičienė 67-72 SCIENTIFIC ARTICLES Periapical status and quality of root fillings in a selected adult Riga population Ilana Jersa, Rita Kundzina 73-77 Oral cancer calibration and diagnosis among professionals from the public health in São Paulo, Brazil José Carlos Alves, Renato Pereira da Silva, Karine Laura Cortellazzi, Fabiana de Lima Vazquez, Regina Auxiliadora de Amorim Marques, Antonio Carlos Pereira, Marcelo de Castro Meneghim, Fábio Luiz Mialhe 78-83 A preliminary study applying decision analysis to the treatment of caries in primary teeth Vytautas Tamošiūnas, Elizabeth Kay, Rebecca Craven 84-92 CASE REPORTS Differential diagnosis of antral pseudocyst. A case report Augusto César Sette-Dias, Marcelo Drummond Naves, Ricardo Alves Mesquita, Evandro Neves Abdo 93-95 © 2013 Stomatologija		Stomatologija 2013; 15 (3): 84-91 296 KB A preliminary study applying decision analysis to the treatment of caries in primary teeth Vytautas Tamošiūnas, Elizabeth Kay, Rebecca Craven Summary Objective. To determine an optimal treatment strategy for carious deciduous teeth. Setting. Manchester Dental Hospital. Design. Decision analysis Method. The likelihoods of each of the sequelae of caries in deciduous teeth were determined from the literature. The utility of the outcomes from non-treatment and treatment was then measured in 100 parents of children with caries, using a visual analogue scale. Decision analysis was performed which weighted the value of each potential outcome by the probability of its occurrence. A decision tree "fold-back" and sensitivity analysis then determined which treatment strategies, under which circumstances, offered the maximum expected utilities. Results. The decision to leave a carious deciduous tooth unrestored attracted a maximum utility of 76.65 and the overall expected utility for the decision "restore" was 73.27 The decision to restore or not restore carious deciduous teeth are therefore of almost equal value. The decision is however highly sensitive to the utility value assigned to the advent of pain by the patient. Conclusions. There is no clear advantage to be gained by restoring deciduous teeth if patients’ evaluations of outcomes are taken into account. Avoidance of pain and avoidance of procedures which are viewed as unpleasant by parents should be key determinants of clinical decision making about carious deciduous teeth. Key words: decision analysis, primary teeth, caries, treatment. Received: 28 10 2012 Accepted for publishing: 23 09 2013 ¹Private practice, Vilnius, Lithuania ²Peninsula College of Medicine and Dentistry, Plymouth, England ³School of Dentistry, The University of Manchester, England Vytautas Tamošiūnas¹ – D.D.S., Mphil Elizabeth Kay² – BDS, MPH, FDSRCPS, FDSRCS, FFGDP, PhD Rebecca Craven³ – BDS, MPH, FDS RCPS, FDS (DPH) RCPS, DDPHRCS, FFPH, PhD, lect. Address correspondence to Dr. Vytautas Tamošiūnas, Dental practice, Amicus Dentis, Ševčenkos 12-31, Vilnius, Lithuania. E-mail address: vytautast@hotmail.com