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J Dent Educ. 69(3): 325-337 2005
© 2005 American Dental Education Association
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Faculty Development

Variation in Periodontal Diagnosis and Treatment Planning Among Clinical Instructors

Sharon K. Lanning, D.D.S.; Scott D. Pelok, D.D.S.; Brent C. Williams, M.D., M.P.H.; Philip S. Richards, D.D.S., M.S.; David P. Sarment, D.D.S., M.S.; Tae-Ju Oh, D.D.S., M.S.; Laurie K. McCauley, D.D.S., Ph.D.

Dr. Lanning is currently Assistant Professor, Department of Periodontics, Virginia Commonwealth University School of Dentistry, and formerly Clinical Assistant Professor, Department of Periodontics, Prevention, and Geriatrics, University of Michigan School of Dentistry; Dr. Pelok is Clinical Assistant Professor, Department of Cariology, Restorative Science, and Endodontics, University of Michigan School of Dentistry; Dr. Williams is Associate Professor, Department of Internal Medicine, University of Michigan School of Medicine; Dr. Richards is Clinical Associate Professor, Department of Periodontics, Prevention, and Geriatrics, University of Michigan School of Dentistry; Dr. Sarment is Clinical Assistant Professor, Department of Periodontics, Prevention, and Geriatrics, University of Michigan School of Dentistry; Dr. Oh is a Clinical Assistant Professor, Department of Periodontics, Prevention, and Geriatrics, University of Michigan School of Dentistry; and Dr. McCauley is Professor and Chair, Department of Periodontics, Prevention, and Geriatrics, University of Michigan School of Dentistry. Direct correspondence and requests for reprints to Dr. Sharon Lanning, 520 North 12th Street, P.O. Box 980566, Richmond, VA 23298-0566; 804-828-7951 phone; 804-828-0657 fax; sklanning{at}vcu.edu.

Key words: faculty development, dental faculty, dental hygiene faculty, periodontology, diagnosis, treatment planning, educational research, student assessment, educational technology, case study

Submitted for publication 09/27/04; accepted 01/07/05

Consistency in clinical decision making may be necessary for reliable assessment of student performance and teaching effectiveness, yet little has been done to examine variation in periodontal diagnosis and treatment planning among dental school faculty. The purpose of this investigation was to examine variation among faculty in diagnosis and management of common periodontal diseases. Twenty-seven clinical instructors (periodontists, general dentists, dental hygienists, and first- and second-year periodontal graduate students) reviewed three web-based cases and answered a brief questionnaire focusing on radiographic interpretation, periodontal diagnosis, and treatment planning. Response rates for the three cases ranged from 62 percent to 70 percent. Clinical instructors’ rating of percent bone loss in the majority of cases varied between three descriptive categories for the same tooth. Greater consistency in periodontal diagnosis was noted within the graduate student group as compared to periodontal and dental hygiene faculty groups. Diagnoses offered for one of the three patients varied between gingivitis and chronic and aggressive periodontitis. Six to nineteen different treatment plans (many with subtle differences) were submitted for each of the three cases. Inter-rater variation was qualitatively more prevalent than intra-rater variation. To our knowledge, this is the first study to document substantial variation among instructors in radiographic interpretation, diagnosis, and treatment planning for common periodontal diseases. Qualitative judgments speculating on the impact of variability among dental school faculty on student performance and patient care can be made but as yet remain unknown. Consistent use of accepted practice guidelines and greater consensus-building opportunities may decrease variation among faculty and enhance dental education.




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