title: The role of insurance and training in dental decision making.
abstract: BACKGROUND
  The purpose of this investigation was to evaluate (1) the differences in treatment planning decisions between dental general practitioners and specialists and (2) the role of patients' insurance and/or type of treatment in decision making.
  
  
  METHODS
  One hundred eighty subject charts were selected from 1,740 dental charts. Two specialists examined radiographs and reviewed the charts and then independently generated treatment plans. If there was disagreement between the 2 specialists, they discussed all aspects of the case until a consensus was reached.
  
  
  RESULTS
  Four subjects were excluded. Thus, 176 patients were evaluated. A statistically significant difference (χ(2) = 202.303, P = .0001) was found between treatment plans designed by GPs and those designed by specialists. Patients' insurance status did not influence the degree of agreement between specialists and GPs. The odds ratio for Medicaid was 0.431 (95% confidence interval [CI], 0.103-1.801; P = .249), and for self-pay, it was 0.801 (95% CI, 0.328-1.955; P = .627). However, logistic regression analysis showed that the type of treatment plan designed by GPs (ie, endodontic treatment, endodontic retreatment, and extraction followed by implant placement) was significantly related to the degree of disagreement with the specialists (odds ratio = 4.522; 95% CI, 1.378-14.84; P = .013).
  
  
  CONCLUSIONS
  Insurance did not play a role in the decision-making portion of the treatment plan. However, the type of treatment was found to be significant. Implant cases had the highest disagreement between the specialists and the general dentists.
authors: Department of Endodontics, UMKC School of Dentistry, Case School of Dental Medicine, Cleveland, Ohio. Electronic address: Axa53@case.edu.
authors: Anita
authors: A
authors: Aminoshariae
authors: Department of Comprehensive Care, UMKC School of Dentistry, Case School of Dental Medicine, Cleveland, Ohio.
authors: Sorin
authors: S
authors: Teich
authors: Department of Pediatric Dentistry, UMKC School of Dentistry, Case School of Dental Medicine, Cleveland, Ohio.
authors: Masahiro
authors: M
authors: Heima
authors: Department of Endodontics, University of Missouri-Kansas City School of Dentistry, Kansas City, Missouri.
authors: James C
authors: JC
authors: Kulild
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D003657:Decision Making; D015921:Dental Implants; D003815:Dentists / Q000523:psychology; D004499:Education, Dental, Graduate; D004708:Endodontics / Q000193:education*; D005260:Female; D005382:Financing, Personal; D005792:General Practice, Dental / Q000193:education; D006801:Humans; D007348:Insurance, Health; D008297:Male; D008484:Medicaid; D008875:Middle Aged; D010347:Patient Care Planning; D019233:Retreatment; D012390:Root Canal Therapy / Q000379:methods; D013039:Specialties, Dental / Q000193:education; D014081:Tooth Extraction / Q000379:methods; D014481:United States; D055815:Young Adult
chemical_list: D015921:Dental Implants
keywords: Decision making; endodontics; implants; insurance; treatment planning