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Advisory Committee Chair

Nada Souccar

Advisory Committee Members

Ramzi Abou Arraj

Chung How Kau

Maninder Kaur

Christos Vlachos

Document Type

Thesis

Date of Award

2020

Degree Name by School

Master of Science (MS) School of Dentistry

Abstract

ABSTRACT: The purpose of this project is to assess the level of calibration among dental students of two different education levels and postgraduate students of two different dental specialties during diagnosis and treatment planning of clinical cases with various levels of periodontal involvement, using the 2018 Classification of Periodontal and Peri-implant Diseases and Conditions. Fifty-seven second year dental students (D2), 45 fourth year dental students (D4), 17 orthodontic postgraduate students (OS) and 12 postgraduate periodontology (PS) students were presented with an anonymous survey of 10 different cases, each with 5 choices of diagnosis and 7 therapeutic approaches. Consensus diagnosis was established through a discussion between 2 experienced periodontists, and used as the gold standard. Diagnosis and treatment choices for each case were compared across educational groups using Fisher’s exact test. The level of agreement for diagnoses and treatments among educational groups was assessed using a multirater kappa coefficient. The levels of agreement for all participants for diagnosis was fair (0.24). The PS showed moderate agreement for diagnosis (0.55) whereas the D2, D4 and OS had lower levels of agreement (0.24, 0.26 and 0.30 respectively). Fair levels of agreement were registered for diagnosis when comparing all predoctoral students (0.23) and all postdoctoral (0.34) for diagnosis. There were tendencies to over-diagnose the severity of periodontitis as well as gingivitis as incipient periodontitis by the D2, D4 and OS groups, and to under-diagnose incipient periodontitis as gingivitis by all groups. All participants showed substantial agreement for scaling and root planing as a choice of treatment (0.63), and moderate agreement for periodontal maintenance therapy (0.44). The postgraduate group showed substantial level of agreement for scaling and root planing therapy (0.63) and extraction (0.63). The distribution of responses per case and per level of education indicates that PS have a higher frequency of responses agreeing with the gold standard than any other group. Treatment planning agreement was higher than diagnostic agreement. Clinical exposure and continuous reinforcement refine learning pathways. Distinguishing between health, gingivitis and periodontitis is a crucial step for all levels of education. For D2 and D4, an increase of case-based learning and more integration of diagnosis and treatment planning in the clinic could be beneficial. Continuous reinforcements of concepts for all students through calibration exercises is recommended for improved communication and planning of interdisciplinary treatments.

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