Reproducibility of caries detection and clinical decision making among dentists from public health system: The importance of continuing education of health workers

With changes in the epidemiological pattern of dental caries, caries detection and treatment decisions have become a more complex task. Although the number of dentists working on this has increased significantly over the last decade, little it is known about the interexaminer reproducibility related to clinical decision making. The aim of this study was to evaluate the interexaminer reproducibility for caries detection and clinical decision making among dentists in the Public Health System and to evaluate the possible treatment costs to the system. A sample of 39 dentists was asked to evaluate 40 occlusal surfaces of permanent teeth, mounted on two dental mannequins, by means of visual-radiographic examination and recommend  possible treatment plans for each surface. It was verified that the interexaminer agreement was moderate for caries detection (k=0.42) and fair (k=0.29) for the clinical decision making. The average treatment cost calculated for mannequin No.1 was U$ 25.36 with a standard deviation of U$ 8.41 and the average cost calculated for mannequin No.2 was U$ 31.45 with a standard deviation of U$ 8.16. Great disparities were observed as regards treatments costs related to decision-making. Because of the high frequency of false-negative/positive decisions, the results showed the need for constant training/calibrations of professionals and the adoption of clinical
protocols of attendance, with the aim of reducing misleading information and to improve the use of public resources in these services. Assuming an in vivo situation, the dentists may be performing over-treatments and consequently interfering in the quality of patients’ oral health.