A COMPARISON OF SENIOR DENTAL STUDENTS AND NORMATIVE STANDARDS WITH REGARD TO CARIES ASSESSMENT AND TREATMENT DECISIONS TO RESTORE OCCLUSALSURFACES OF PERMANENT TEETH

Statement of problem. Even though assessments of borderline restorativ e items in terms of accuracy and interexaminer variation have been rep orted, no attempt has been made to simultaneously evaluate diagnostic and treatment planning decisions using objective normative standards. Purpose. This study established the accuracy of caries presence assess ment as compared with gold standards, interexaminer agreement in asses sment of caries presence and restorative needs, and influences of perc eived caries status and restoration quality on treatment planning in b orderline restorative situations. Materials and methods. Fifteen senio r dental students in Mexico City (66% women; mean age 23.2 years) eval uated predetermined areas in 109 restored and unrestored posterior tee th in an in vitro model. Teeth were subsequently assessed for restorat ion quality and the presence of enamel and dentinal caries by use of h istologic and specific dye techniques. Student's t test, Cohen's kappa , and Pearson's correlation analyses were used to analyze the data. Re sults. There were significant caries misdiagnoses and substantial over treatment proposed. In a few instances, teeth were left. untreated, bu t usually they were programmed for restoration. Interexaminer agreemen t varied markedly and was not high. However, performance while correct ly detecting lesions was better than in treatment planning. Conclusion . There was a high correlation between a diagnosis of caries and resto rative treatment in unrestored teeth; the correlation was lower for re stored teeth, although they were allocated to restorative treatment mo re often. This difference hinged on perceived quality of the restorati on, an important factor in the frequency of proposed re-restoration.