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Louis Lee

Author: Louis Lee (2013)

Primary Advisor: Muhammad F. Walji, PhD

Masters thesis, The University of Texas School of Biomedical Informatics at Houston.

Abstract:

Background: Computerized clinical decision support (CDS) is an emerging technology that can guide clinicians toward better decisions and prevent costly errors.  These tools are an area of great interest in medicine, but are relatively new in dentistry.  In this study we sought to determine the types of CDS systems used in dentistry and assess their ability to produce positive outcomes.

Types of Studies Reviewed: We conducted a systematic review of the literature for computerized decision support systems developed for chairside use in dentistry.  Due to the novel nature of dental CDS systems, all relevant studies including preliminary case reports and case series were included.

Results:  19 of the 23 included studies showed high levels of accuracy or agreement with expert evaluations.  Computerized CDS systems aided dentists with diagnosis, risk assessment, image interpretation, and other forms of treatment planning.  Image interpretation systems showed accuracies as high as 98% and diagnostic systems improved diagnostic accuracies by up to 39.4%.   Treatment planning systems for extraction decisions in orthodontics demonstrated an average accuracy of 85% and another system for treating mobile teeth was found to suggest treatments at an expert level.  Risk assessment and caries detection systems were not as favorable, and systems demonstrated mixed results when aiding users with creating risk profiles for caries and diagnosing caries.

Clinical Implications: Computerized CDS systems can address uncertainty and inconsistency during diagnosis and treatment planning in most specialties of dentistry.  The strong performance of most systems demonstrates accurate and consistent decision support, but most CDS systems are still in the preliminary stages of testing.  In addition, most systems are developed as standalone applications that are not integrated with an electronic health record (EHR) system. As a result, commercial availability and adoption of these systems remains limited.  Initial testing of computerized CDS systems shows great potential for saving dentists time and helping them make more informed decisions.