Downer M C, O'Brien G J
Department of Dental Health Policy, Eastman Dental Hospital, London, England.
Community Dent Oral Epidemiol. 1994 Aug;22(4):209-13. doi: 10.1111/j.1600-0528.1994.tb01805.x.
A simulation of the caries process over time in posterior approximal tooth surfaces was modelled and tentative evaluations made of health gain from restorative treatment under two sets of assumed conditions. Using published data, the decision model allowed the influence of three variables to be reflected in sensitivity analysis, 1. caries progression, 2. diagnostic accuracy, 3. survival time of fillings. Progress of 50 hypothetical initially sound surfaces, 40 with enamel, and 10 with dentine lesions, was followed over two notional, successive 5-yr time periods. A surface could terminate as sound, enamel lesion, dentine caries, filled, refilled, refilled twice or extracted. Utility values were applied to the end state frequencies to evaluate health gain (from 0 to 100). Under a set of conditions A, diagnostic accuracy reflected that of current general practice and 50% of fillings survived up to 5 yr. Under a set B, diagnostic accuracy was that of a trained epidemiologist and 50% of fillings survived up to 10 yr. Assumption A scored 75.3 while B scored 81.9, suggesting scope for added health gain through improvement of practice standards.
对后牙邻面龋病进程随时间的变化进行了模拟，并在两组假设条件下对修复治疗带来的健康收益进行了初步评估。利用已发表的数据，该决策模型在敏感性分析中反映了三个变量的影响：1. 龋病进展；2. 诊断准确性；3. 充填物的存留时间。对50个假设的初始健康牙面（40个为釉质病变，10个为牙本质病变）在两个连续的5年假想时间段内的进展情况进行了跟踪。一个牙面可能的最终状态为健康、釉质病变、牙本质龋、已充填、再次充填、再次充填两次或拔除。将效用值应用于最终状态频率，以评估健康收益（范围为0至100）。在条件A下，诊断准确性反映了当前一般临床实践的水平，50%的充填物在5年内存留。在条件B下，诊断准确性为经过培训的流行病学家的水平，50%的充填物在10年内存留。假设A得分为75.3，而假设B得分为81.9，这表明通过提高临床实践标准有增加健康收益的空间。
