title: Assessing periodontal disease risk: a comparison of clinicians' assessment versus a computerized tool.
abstract: BACKGROUND
  The authors conducted a study to compare risk scores assigned by subjective expert clinician opinion with quantitative scores generated for the same subjects using the Periodontal Risk Calculator, or PRC.
  
  
  METHODS
  The authors assembled a group of 107 subjects and performed standard periodontal examinations. The authors entered the resulting information into the PRC and calculated risk scores for two and four years, assuming no treatment would be performed. Using the same subject records, three groups of expert clinicians assigned risk scores for years 2 and 4. The authors analyzed the data to reveal the extent of interevaluator variation and the level of agreement between expert clinician scores and PRC scores.
  
  
  RESULTS
  The extent of variation among scores assigned by individual expert clinicians was greater than the authors had expected. Expert clinicians consistently assigned more subjects to PRC risk group 2 and fewer to risk group 5 than did the PRC. The authors observed very high heterogeneity in the risk scores expert clinicians assigned to patients in each of the PRC-assigned groups. Thus, expert clinicians varied greatly in evaluating risk and, relative to the PRC, they appeared to underestimate periodontitis risk, especially for high-risk patients.
  
  
  CONCLUSIONS
  The authors' observations suggest that use of risk scores generated for individual patients by subjective expert clinician opinion about risk in periodontal clinical decision making could result in the misapplication of treatment for some patients and support the use of an objective tool such as the PRC. Use of the PRC over time may be expected to result in more uniform and accurate periodontal clinical decision making, improved oral health, reduction in the need for complex therapy and reduction in health care costs.
authors.affiliation: Regional Clinical Dental Research Center, School of Dentistry, University of Washington, Seattle 98195, USA.
authors.forename: G Rutger
authors.initials: GR
authors.lastname: Persson
authors.forename: Lloyd A
authors.initials: LA
authors.lastname: Mancl
authors.forename: John
authors.initials: J
authors.lastname: Martin
authors.forename: Roy C
authors.initials: RC
authors.lastname: Page
mesh_terms: D000328:Adult; D000465:Algorithms; D032921:Consensus; D003661:Decision Support Techniques; D018450:Disease Progression; D004198:Disease Susceptibility; D005260:Female; D005792:General Practice, Dental; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D010510:Periodontal Diseases / Q000175:diagnosis / Q000453:epidemiology; D010517:Periodontics; D011237:Predictive Value of Tests; D011379:Prognosis; D018570:Risk Assessment / Q000379:methods*; D012984:Software; D018709:Statistics, Nonparametric