Clinical decision support system for tooth retention or extraction
Creators: name: Sayed, Mohammed
Publisher: name: No Publisher Supplied
Year: 2017

description: Treatment planning with regard to retention or extraction decision-making is often challenging, especially to dental students and inexperienced dentists.  Such a decision requires consideration of many factors and clinical parameters to achieve an accurate definitive plan and therefore proper dental care. Contemporary dentistry has adopted the concept of evidence-based practice guidelines. Our project has followed this concept, thus literature evidence, clinician’s expertise, patient’s desires and preferences were factored-in to develop a contemporary approach for determining the overall tooth prognosis accurately. Although, several studies have been published to report the affect of specific clinical parameters on individual tooth prognosis, these studies were isolated and focused on particular aspects for developing tooth prognosis scale rather than evaluation of teeth in comprehensive manner covering all factors relevant to retention or extraction decision-making. Retention of non-salvageable teeth as well as extraction of salvageable teeth can be drastically devastating to patients since they are time consuming, cost more time and money and may lead to loss of trust and confidence in care givers. Thus, a multi-factorial approach for development of accurate prognosis is required. This approach requires sound knowledge of principles that span across multiple dental specialties of restorative/prosthodontics, periodontics and endodontics. It is extremely difficult for clinicians to recall an extensive list of factors that determine the overall tooth prognosis, especially for dental students and less experienced clinicians. On the other hand, expert clinicians with their knowledge and years of experience are accustomed to critical thinking utilizing comprehensive list of factors on day-to-day clinical practice. However, experts may not always be accessible for consultation at the point of care. To fulfill this ever-outstanding need, we propose the development of a clinical decision support system that satisfies the concept of evidence-based dentistry considering all factors relative to research evidence, clinician’s expertise, patient’s desires and preferences. Utilizing Exsys Corvid expert system development platform, we have developed an efficient, interactive and user-friendly tool that can easily be hosted on the web, implemented in clinical settings, and integrated with treatment planning procedures into the daily clinical practice. In addition to assistance in clinical setting, our system can also be considered as an educational tool that helps dental students and inexperienced dentists to process challenging clinical scenarios like expert clinicians since it includes comprehensive list of factors that acquires evaluation and response prior to reaching final recommendations. Based on information entered by the user, our system provides clinical recommendations, options and alerts labeled with patients and providers identification numbers, time and date for documentation purposes. Since our system was designed to review user’s entry at the results screen, this feature helps clinicians to educate their patients, justify their clinical recommendations and therefore obtain patient’s trust and acceptance of treatment. It also allows sharing the results, electronically via emails, with patients and other providers for ease and quick communications. Due to the fact that our system was developed based on evidence-based guidelines, we anticipate improvement in prognostication and treatment planning of questionable teeth and therefore better clinical decision-making as a step to ensure patient’s satisfaction and enhanced dental care.