Preradiation dental extraction decisions in patients with head and neck cancer.
OBJECTIVE
The first objectives of this international survey were to study how dental-related and radiotherapy-related risk factors influence clinicians' preradiation dental decision making in patients with head and neck cancer and to evaluate clinicians' degree of certainty in making such decisions. A further objective was to examine the correlation of clinicians' policies with a policy based on a model for dental decision support that was presented in an earlier article.


METHODS
A consensus questionnaire was mailed to 54 oral-maxillofacial surgeons and hospital-based dentists at a number of international locations. The responses were aggregated and anonymously analyzed through use of a multiple regression procedure.


RESULTS
Forty-four clinicians returned the questionnaire (response rate, 81%). Nine clinicians (20%) were using printed clinical guidelines for preradiation dental screening. Eighty-eight percent of clinicians' preradiation decisions and 49% of their certainty could be explained by the studied risk factors. Not all risk factors were significant at P <.001. Clinicians' policies showed high correlation (.85) with the policy based on the model for dental decision support.


CONCLUSIONS
The findings support our previous assumption that policies in this field seem to be based primarily on clinical experience and opinions rather than on evidence-based clinical guidelines. We conclude that the clinical usefulness and validity of the model for dental decision support should now be tested and that it could also serve as a training tool.
Bruins
H H
HH
Department of Oral & Maxillofacial Surgery, University Medical Center Utrecht, University of Utrecht, The Netherlands.
Jolly
D E
DE
Koole
R
R
D001315:Australia; D003131:Combined Modality Therapy; D003661:Decision Support Techniques; D005060:Europe; D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D009656:North America; D017410:Practice Guidelines as Topic; D012044:Regression Analysis; D012307:Risk Factors; D011795:Surveys and Questionnaires; D014081:Tooth Extraction / Q000706:statistics & numerical data