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Medical Decision Making
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Decision Analysis for lower-third-molar Surgery

Mark Brickley, BDS, MScD

Elizabeth Kay, BDS, MPH, PhD

Jonathan P. Shepherd, BDS, MSc, PhD

Rosemary A. Armstrong

The objective of the study was to identify those factors that should affect treatment planning for patients who have lower third molars, using decision-analytic techniques. Utility values based on data from 104 patients indicated that the respondents considered that postoperative complications (except mild pain and temporary paresthesia) reduced health to a greater degree than did complications following non-intervention. A decision analysis indicated that the maximum expected utility of prophylactic third-molar surgery (60.25) was lower than that for non-intervention (76.96). The decision was sensitive to changes in the probabilities of occurrence of recurrent pericoronitis (threshold = 0.52), resorption of an adjacent tooth (threshold = 0.29), loss of an adjacent tooth (threshold = 0.32), and cystic change (threshold = 0.34). These thresholds are much higher than the incidence of problems affecting the lower third molar shown by a concurrent clinical audit and literature review. This study therefore suggests that lower third molars should not be removed prophylactically. Key words: decision analysis; utility values; third molar surgery. (Med Decis Making 1995;15:143-151)

Medical Decision Making, Vol. 15, No. 2, 143-151 (1995)
DOI: 10.1177/0272989X9501500207
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