title: Knowledge of risk factors and the periodontal disease-systemic link in dental students' clinical decisions.
abstract: This study evaluated second-, third-, and fourth-year dental students' ability to identify systemic conditions associated with periodontal disease, risk factors most important for referral, and medications with an effect on the periodontium and their ability to apply this knowledge to make clinical decisions regarding treatment and referral of periodontal patients. A twenty-one question survey was administered at one U.S. dental school in the spring semester of 2012 to elicit the students' knowledge and confidence regarding clinical reasoning. The response rate was 86 percent. Periodontal risk factors were accurately selected by at least 50 percent of students in all three classes; these were poorly controlled diabetes, ≥6 mm pockets posteriorly, and lack of response to previous non-surgical therapy. Confidence in knowledge, knowledge of risk factors, and knowledge of medications with an effect on the periodontium improved with training and were predictive of better referral decision making. The greatest impact of training was seen on the students' ability to make correct decisions about referral and treatment for seven clinical scenarios. Although the study found a large increase in the students' abilities from the second through fourth years, the mean of 4.6 (out of 7) for the fourth-year students shows that, on average, those students missed correct treatment or referral on more than two of seven clinical cases. These results suggest that dental curricula should emphasize more critical decision making with respect to referral and treatment criteria in managing the periodontal patient.
authors.affiliation: Dr. Friesen is Assistant Clinical Professor and Director of Corporate Clinical Research, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; Dr. Walker is Associate Dean for Research and Graduate Programs and Director of Oral and Craniofacial Sciences Graduate Program, Departments of Oral and Craniofacial Sciences and Restorative Dentistry, University of Missouri-Kansas City School of Dentistry; Ms. Kisling is a third-year dental student, University of Missouri-Kansas City School of Dentistry; Dr. Liu is Assistant Clinical Professor and Biostatistician, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; and Dr. Williams is Professor and Chair, Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine. friesenl@umkc.edu.
authors.forename: Lynn Roosa
authors.initials: LR
authors.lastname: Friesen
authors.affiliation: Dr. Friesen is Assistant Clinical Professor and Director of Corporate Clinical Research, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; Dr. Walker is Associate Dean for Research and Graduate Programs and Director of Oral and Craniofacial Sciences Graduate Program, Departments of Oral and Craniofacial Sciences and Restorative Dentistry, University of Missouri-Kansas City School of Dentistry; Ms. Kisling is a third-year dental student, University of Missouri-Kansas City School of Dentistry; Dr. Liu is Assistant Clinical Professor and Biostatistician, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; and Dr. Williams is Professor and Chair, Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine.
authors.forename: Mary P
authors.initials: MP
authors.lastname: Walker
authors.affiliation: Dr. Friesen is Assistant Clinical Professor and Director of Corporate Clinical Research, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; Dr. Walker is Associate Dean for Research and Graduate Programs and Director of Oral and Craniofacial Sciences Graduate Program, Departments of Oral and Craniofacial Sciences and Restorative Dentistry, University of Missouri-Kansas City School of Dentistry; Ms. Kisling is a third-year dental student, University of Missouri-Kansas City School of Dentistry; Dr. Liu is Assistant Clinical Professor and Biostatistician, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; and Dr. Williams is Professor and Chair, Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine.
authors.forename: Rebecca E
authors.initials: RE
authors.lastname: Kisling
authors.affiliation: Dr. Friesen is Assistant Clinical Professor and Director of Corporate Clinical Research, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; Dr. Walker is Associate Dean for Research and Graduate Programs and Director of Oral and Craniofacial Sciences Graduate Program, Departments of Oral and Craniofacial Sciences and Restorative Dentistry, University of Missouri-Kansas City School of Dentistry; Ms. Kisling is a third-year dental student, University of Missouri-Kansas City School of Dentistry; Dr. Liu is Assistant Clinical Professor and Biostatistician, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; and Dr. Williams is Professor and Chair, Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine.
authors.forename: Ying
authors.initials: Y
authors.lastname: Liu
authors.affiliation: Dr. Friesen is Assistant Clinical Professor and Director of Corporate Clinical Research, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; Dr. Walker is Associate Dean for Research and Graduate Programs and Director of Oral and Craniofacial Sciences Graduate Program, Departments of Oral and Craniofacial Sciences and Restorative Dentistry, University of Missouri-Kansas City School of Dentistry; Ms. Kisling is a third-year dental student, University of Missouri-Kansas City School of Dentistry; Dr. Liu is Assistant Clinical Professor and Biostatistician, Office of Research and Graduate Programs, University of Missouri-Kansas City School of Dentistry; and Dr. Williams is Professor and Chair, Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine.
authors.forename: Karen B
authors.initials: KB
authors.lastname: Williams
mesh_terms: D000367:Age Factors; D001291:Attitude of Health Personnel; D003657:Decision Making; D003729:Dental Care / Q000706:statistics & numerical data; D003774:Dental Plaque Index; D048909:Diabetes Complications; D004194:Disease; D064420:Drug-Related Side Effects and Adverse Reactions / Q000145:classification; D004497:Education, Dental; D005260:Female; D017823:Furcation Defects / Q000145:classification; D006801:Humans; D008297:Male; D010510:Periodontal Diseases / Q000150:complications*; D010514:Periodontal Pocket / Q000145:classification; D010517:Periodontics / Q000193:education*; D010519:Periodontium / Q000187:drug effects; D012017:Referral and Consultation; D012307:Risk Factors; D012649:Self Concept; D013335:Students, Dental
keywords: clinical decisions; dental education; diagnosis; periodontal disease; periodontics; referral; risk factors; systemic disease