Advanced Search

Journal Navigation

Journal Home

Subscriptions

Archive

Contact Us

Table of Contents

CiteULike is a free service for managing and discovering scholarly references - click here to get started.

Sign In to gain access to subscriptions and/or personal tools.
Journal of Dental Research
This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Knutsson, K.
Right arrow Articles by Rohlin, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Knutsson, K.
Right arrow Articles by Rohlin, M.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?

Dentists' Judgment Strategies on Prophylactic Removal of Mandibular Third Molars

K. Knutsson

'Department of Oral Radiology, Faculty of Odontology, Centre for Oral Health Sciences, Malmö University, Carl Gustavsv. 34, S 214 21 Malmö, Sweden

L. Lysell

Department of Oral Surgery, Central Hospital, Kristianstad, Sweden

M. Rohlin

'Department of Oral Radiology, Faculty of Odontology, Centre for Oral Health Sciences, Malmö University, Carl Gustavsv. 34, S 214 21 Malmö, Sweden

The number of molars selected for prophylactic removal varies widely among general dental practitioners and oral surgeons. To understand the basis for such variations, we investigated two hypotheses: (1) Individual judgment strategies will differ concerning the use of cues (items of information), and (2) few dentists will integrate the cues according to evidence in the literature. To analyze 30 general dental practitioners' (GDPs) and 10 oral surgeons' use of cues in the judgment preceding the treatment decision, we used the Brunwik's lens as a conceptual model. The cues were the patient's age, and the angular position and the degree of impaction of the molar. The clinical situation was simulated by written case descriptions. The proportion of variation explained by the cues and their combinations (total model) varied between 61% and 100% and between 4% and 76% as main effects. Two GDPs and one oral surgeon integrated the cues additively, i.e., any of the cues is independent of the other cues in the judgment. In general, the dentists integrated the cues interactively, i.e., the impact of one cue depends on the levels of some other cues. Even though most variations in judgments were accounted for by the cues, the dentists did not integrate the cues according to evidence in the literature and lacked insight into their decision-making thought processes.

Key Words: third molar • dental • decision-making • judgment analysis • treatment variation.

REFERENCES

  • Ahlqwist M., Grondahl H-G (1991). Prevalence of impacted teeth and associated pathology in middle-aged and older Swedish women. Community Dent Oral Epidemiol 19:116-119.[CrossRef][Medline] [Order article via Infotrieve]
  • Altman DG (1995). Practical statistics for medical research. London: Chapman and Hall, pp. 268-269.
  • Armstrong RA, Brickley MR, Evans DJ, Cowpe JG, Shepherd JP (1996). Patient perceptions regarding the risks of morbidity and complications of lower third molar removal. Community Dent Health 13:17-21.[Medline] [Order article via Infotrieve]
  • Bader JD, Shugars DA (1995). Variation, treatment outcomes, and practice guidelines in dental practice. JDent Educ 59:61-95.
  • Bader J., Ismail A., Clarkson J. (1999). Evidence-based dentistry and the dental research community. J Dent Res 78:1480-1483.
  • Baron J. (1994). The lens model. In: Thinking and deciding. 2nd ed. Baron J, editor. Cambridge: Cambridge University Press, pp. 404-411.
  • Bowden J., Marton F. (1998). Learning and research. In: The university of learning. Beyond quality and competence in higher education. Bowden J, Marton F, editors. London: Kogan Page, pp. 74-87.
  • Brehmer B. (1979). Effects of practice on utilization of nonlinear rules in inference tasks. Scand J Psychol 20:141-149.
  • Brehmer B. (1980). In one word: not from experience. Acta Psychol 45:223-241.[CrossRef]
  • Brehmer B. (1988). The development of social judgment theory. In: Human judgment. The SJT view. Brehmer B, Joyce CRB, editors. Amsterdam: Elsevier Science Publishers BV, pp. 13-40.
  • Brehmer A., Brehmer B. (1988). What have we learned about human judgment from thirty years of policy capturing? In: Human judgment. The SJT view. Brehmer B, Joyce CRB, editors. Amsterdam: Elsevier Science Publishers BV, pp. 75-114.
  • Brickley M., Kay E., Shepherd JP, Armstrong RA (1995). Decision analysis for lower-third-molar surgery. Med Decis Making 15:143-151.[Abstract/Free Full Text]
  • Brooks LR, Norman GR, Allen SW (1991). Role of specific similarity in a medical diagnostic task. J Exp Psychol 120:278-287. (AQ6)
  • Bruce RA, Fredrickson GC, Small GS (1980). Age of patients and morbidity associated with mandibular third molar surgery. J Am DentAssoc 101:240-245.
  • Chaput de Saintonge DM, Hathaway HR (1981). Antibiotic use in otitis media: patient simulations as an aid to audit. Br Med J 283:883-884.[Abstract/Free Full Text]
  • Department of Health (1993). Hospital episode statistics 1990. London: DoH.
  • Halverson BA, Anderson WH 3rd (1992). The mandibular third molar position as a predictive criteria for risk for pericoronitis: a retrospective study. Mil Med 157:142-145.[Medline] [Order article via Infotrieve]
  • Hammond KR (1996). How convergence of research paradigms can improve research on diagnostic judgment. Med Decis Making 16:281-287.[Abstract/Free Full Text]
  • Hammond KR, Hursch CJ, Todd FJ ( 1964). Analyzing the components of clinical inference. Psychol Rev 71:438-456.[CrossRef][Medline] [Order article via Infotrieve]
  • Kay LW (1966). Investigations into the nature of pericoronitis. Br J Oral Maxillofac Surg 3:188-205.
  • Kirwan JR, Chaput de Saintonge DM, Joyce Crb, Currey Hlf (1983a). Clinical judgment in rheumatoid arthritis. I. Rheumatologists' opinions and the development of 'paper patients'. Ann Rheum Dis 42:644-647.[Abstract/Free Full Text]
  • Kirwan JR, Bellamy N., Condon H., Buchanan WW, Barnes CG (1983b). Judging "current disease activity" in rheumatoid arthritis-an international comparison. J Rheumatol 10:901-905.[Medline] [Order article via Infotrieve]
  • Knutsson K., Brehmer B., Lysell L., Rohlin M. (1992a). General dental practitioners' evaluation of the need for extraction of asymptomatic mandibular third molars. Community Dent Oral Epidemiol 20:347-350.[Medline] [Order article via Infotrieve]
  • Knutsson K., Brehmer B., Lysell L., Rohlin M. (1992b). Asymptomatic mandibular third molars: oral surgeons' judgment of the need for extraction. J Oral Maxillofac Surg 50:329-333.[Medline] [Order article via Infotrieve]
  • Knutsson K., Brehmer B., Lysell L., Rohlin M. (1996). Pathoses associated with mandibular third molars subjected to removal. Oral Surg Oral Med Oral Pathol Oral Radiol Endo 82:10-17.
  • Knutsson K., Brehmer B., Lysell L., Rohlin M. (1997). Mandibular third molars as mediated by three cues. Dentists' treatment decisions on asymptomatic molars compared to molars associated with pathology. Acta Odontol Scand 55:372-377.[Medline] [Order article via Infotrieve]
  • Kostopoulou 0, Brickley MR, Shepherd JP, Knutsson K., Rohlin M. (1997). Agreement between practitioners concerning removal of asymptomatic third molars. Community Dent Health 14:129-132.[Medline] [Order article via Infotrieve]
  • Kugelberg CF, Ahlstrom U., Ericson S., Huguson A. (1985). Periodontal healing after impacted third molar surgery. Int J Oral Surg 14:29-40.[Medline] [Order article via Infotrieve]
  • Leone SA, Edenfield MJ (1987). Third molars and acute pericoronitis: a military problem. Mil Med 152:146-149.[Medline] [Order article via Infotrieve]
  • Leone SA, Edenfield MJ, Cohen ME (1986). Correlation of acute pericoronitis and the position of the mandibular third molar. Oral Surg Oral Med Oral Pathol 62:245-250.[Medline] [Order article via Infotrieve]
  • Lysell L., Rohlin M. (1988). A study of indications used for removal of the mandibular third molar. Int J Oral Maxillofac Surg 17:161-164.[CrossRef][Medline] [Order article via Infotrieve]
  • Marton F., Saljo R. (1976). Qualitative differences in learning I: outcome and process. Br J Educ Psychol 46:115-127.
  • Nitzan DW, Tal 0, Sela MN, Shteyer A. (1985). Pericoronitis: a reappraisal of its clinical and microbiologic aspects. J Oral Maxillofac Surg 43:510-516.[Medline] [Order article via Infotrieve]
  • Nordenram A. (1966). Den retinerade tredje molarens lagesrelation. Svensk Tandläkare-Tidskrift 59:591-600 (in Swedish).
  • Norman GR, Feightner JW (1981). A comparison of behaviour on simulated patients and patient management problems. Med Educ 15:26-32.[Medline] [Order article via Infotrieve]
  • Norman GR, Brooks LR, Cunnington Jpw, Shali V., Marriott M., Regehr G. (1996). Expert-novice differences in the use of history and visual information from patients. Acad Med 71:62-64.
  • Page GG, Fielding DW (1980). Performance on PMPs and performance in practice: are they related? Med Educ 55:529-537.
  • Rantanen AV (1967). The age of eruption of the third molar teeth. A clinical study based on Finnish university students (thesis). Acta Odontol Scand 25(Suppl 48).
  • Shepherd JP (1993). The third molar epidemic (editorial). Br Dent J 174:85.[Medline] [Order article via Infotrieve]
  • Skaner Y., Strender LE, Bring J. (1998). How do GPs use clinical information in their judgments of heart failure? A clinical judgment analysis study. Scand J Prim Health Care 16:95-100.[Medline] [Order article via Infotrieve]
  • Smith DG, Wigton RS (1987). Modeling decisions to use tube feeding in seriously ill patients. Arch Intern Med 147:1242-1245.[Abstract/Free Full Text]
  • Speroff T., Connors AF, Dawson NV (1989). Lens model analysis of hemodynamic status in critically ill. Med Decis Making 9:243-252.[Abstract/Free Full Text]
  • Stanley HR, Alattar M., Collett WK, Stringfellow HR Jr, Spiegel EH (1988). Pathological sequelae of "neglected" impacted third molar. J Oral Pathol 17:113-117.[CrossRef][Medline] [Order article via Infotrieve]
  • Stewart TR (1988). Judgment analysis: procedures. In: Human judgment. The SJT view. Brehmer B, Joyce CRB, editors. Amsterdam: Elsevier Science Publishers BV, pp. 41-74.
  • Tape TG, Heckerling PS, Ornato JP, Wigton RS (1991). Use of clinical judgment to explain regional variations in physicians' accuracies in diagnosing pneumonia. Med Decis Making 11:189-197.[Abstract/Free Full Text]
  • Tulloch Jfc, Antczak-Bouckoms AA (1987). Decision analysis in the evaluation of clinical strategies for the management of mandibular third molars. J Dent Educ 51:652-658.[Abstract]
  • Venta I., Turtola L., Murtomaa H., Ylipaavalniemi P. (1993). Third molars as an acute problem in Finnish university students. Oral Surg Oral Med Oral Pathol 76:135-140.[Medline] [Order article via Infotrieve]
  • Wigton RS (1988a). Applications of judgment analysis and cognitive feedback to medicine. In: Human judgment. The SJT view. Brehmer B, Joyce CRB, editors. Amsterdam: Elsevier Science Publishers BV, pp. 227-245.
  • Wigton RS (1988b). Use of linear models to analyze physicians' decisions. Med Decis Making 8:241-252.[Abstract/Free Full Text]
  • Wigton RS, Hoellerich VL, Patil KD (1986). How physicians use clinical information in diagnosing pulmonary embolism. An application of conjoint analysis. Med Decis Making 6:2-11.[Abstract/Free Full Text]
  • Winter GB (1926). Principles of exodontia as applied to the impacted third molar. St. Louis: American Medical Books.

Journal of Dental Research, Vol. 79, No. 12, 1989-1995 (2000)
DOI: 10.1177/00220345000790121101
Add to CiteULike CiteULike   Add to Complore Complore   Add to Connotea Connotea   Add to Del.icio.us Del.icio.us   Add to Digg Digg   Add to Reddit Reddit   Add to Technorati Technorati   Add to Twitter Twitter    What's this?


This article has been cited by other articles:


Home page
 J Dent EducHome page
Y. Zadik and L. Levin
Clinical Decision Making in Restorative Dentistry, Endodontics, and Antibiotic Prescription
J Dent Educ., January 1, 2008; 72(1): 81 - 86.
[Abstract] [Full Text] [PDF]

This Article
Right arrow Abstract Freely available
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Similar articles in PubMed
Right arrow Alert me to new issues of the journal
Right arrow Add to Saved Citations
Right arrow Download to citation manager
Right arrowRequest Permissions
Right arrow Request Reprints
Right arrow Add to My Marked Citations
Citing Articles
Right arrow Citing Articles via HighWire
Right arrow Citing Articles via Google Scholar
Right arrow Citing Articles via Scopus
Google Scholar
Right arrow Articles by Knutsson, K.
Right arrow Articles by Rohlin, M.
Right arrow Search for Related Content
PubMed
Right arrow PubMed Citation
Right arrow Articles by Knutsson, K.
Right arrow Articles by Rohlin, M.
Social Bookmarking
Add to CiteULike   Add to Complore   Add to Connotea   Add to Del.icio.us   Add to Digg   Add to Reddit   Add to Technorati   Add to Twitter  
What's this?