Restoration of approximal carious lesions - application of decision analysis

This study uses decision analysis in order to explore the maximum expected utility of positive and negative restorative decisions, made on the basis of bitewing radiography. The a posteriori probabilities of disease, given a positive/negative treatment decision were derived from a study in which 20 dentists made 7200 decisions about 15 pairs of simulated bitewing radiographs. Lesion depths in the teeth examined were ascertained by light microscopy. A review of the available data on lesion progression/regression was undertaken to provide probability values for the decision model, and population utilities for the outcomes of the decision were derived from a survey of 110 members of the public. The decision analysis showed that negative treatment decisions always attracted the highest maximum expected utility, except in highly disease‐prone individuals. This analysis demonstrates that lesion depth, likelihood of pain, and the rate of lesion progression have minimal effect on the utility of a positive treatment decision. It is concluded that an over‐concentration on the biomedical model of dental health may cause dentists to make decisions which are inappropriate to their patients' values and preferences.