Decision analysis for lower-third-molar surgery.
The objective of the study was to identify those factors that should affect treatment planning for patients who have lower third molars, using decision-analytic techniques. Utility values based on data from 104 patients indicated that the respondents considered that postoperative complications (except mild pain and temporary paresthesia) reduced health to a greater degree than did complications following non-intervention. A decision analysis indicated that the maximum expected utility of prophylactic third-molar surgery (60.25) was lower than that for non-intervention (76.96). The decision was sensitive to changes in the probabilities of occurrence of recurrent pericoronitis (threshold = 0.52), resorption of an adjacent tooth (threshold = 0.29), loss of an adjacent tooth (threshold = 0.32), and cystic change (threshold = 0.34). These thresholds are much higher than the incidence of problems affecting the lower third molar shown by a concurrent clinical audit and literature review. This study therefore suggests that lower third molars should not be removed prophylactically.
Brickley
M
M
Department of Oral Surgery, Medicine and Pathology, University of Wales College of Medicine, Heath Park, Cardiff, United Kingdom.
Kay
E
E
Shepherd
J P
JP
Armstrong
R A
RA
D003663:Decision Trees; D006304:Health Status; D006801:Humans; D008485:Medical Audit; D008964:Molar, Third / Q000601:surgery*; D010347:Patient Care Planning; D011183:Postoperative Complications / Q000209:etiology; D011322:Primary Prevention; D016896:Treatment Outcome; D014600:Utilization Review