Kostopoulou O, Brickley M R, Shepherd J P, Newcombe R G, Knutsson K, Rohlin M
Department of Oral Surgery, Medicine and Pathology, University of Wales College of Medicine, Heath Park, Cardiff.
Br Dent J. 1998 Jun 13;184(11):557-9. doi: 10.1038/sj.bdj.4809697.
To investigate reliability of practitioners' removal decisions and judgements of risk of pathology associated with asymptomatic third molars.
10 oral surgeons and 18 family dentists from South Wales with experience ranging from 5 to 28 years.
Participants were presented with periapical radiographs of 36 asymptomatic, mandibular third molars and were informed of the age and sex of the patients and the degree of eruption of the third molars. Participants were asked to assess, using visual analogue scales, the likelihood of future pathology if the third molars were left in situ and to indicate if they should be removed or not. To assess intra-observer reliability, the 36 cases were duplicated and presented to the participants on a different occasion, a month later. The same questions were asked as on the first occasion.
Significant correlations (Pearsons correlation coefficients) were found between initial and repeat assessments of all measures but there was little agreement about the need for removal (Kappa values: 0.54 for oral surgeons and 0.41 for the family dentists). For every item studied, changes in position on the visual analogue scale of two-thirds or more of the total length occurred from the first to the second assessment.
Treatment decisions about whether or not to remove asymptomatic third molars were not made on a rational basis. Since similar conclusions were recorded in a previous Swedish study, it is inferred that until further high quality evidence of disease prediction is published, decisions to remove third molars prophylactically cannot be made reliably.
调查从业者关于无症状第三磨牙的拔除决策以及对其病理风险判断的可靠性。
来自南威尔士的10名口腔外科医生和18名全科牙医，从业经验在5至28年之间。
向参与者展示36例无症状下颌第三磨牙的根尖片，并告知患者的年龄、性别以及第三磨牙的萌出程度。要求参与者使用视觉模拟量表评估如果第三磨牙保留在原位未来发生病理情况的可能性，并指出是否应该拔除。为评估观察者内信度，将这36个病例复制，并在一个月后的不同时间呈现给参与者。询问与第一次相同的问题。
所有测量指标的初次评估和重复评估之间均发现显著相关性（皮尔逊相关系数），但对于是否需要拔除的意见一致性较低（卡帕值：口腔外科医生为0.54，全科牙医为0.41）。对于所研究的每个项目，从第一次评估到第二次评估，视觉模拟量表上三分之二或更多总长度的位置发生了变化。
关于是否拔除无症状第三磨牙的治疗决策并非基于合理依据做出。由于之前一项瑞典研究也得出了类似结论，因此推断在进一步高质量的疾病预测证据发表之前，无法可靠地做出预防性拔除第三磨牙的决策。
