Grey areas in restorative dentistry: introduction

This is the first of a series of articles considering the ‘grey’ areas in restorative dentistry. Their origins lie in the book: Grey Areas in Restorative Dentistry – Don't Believe Everything you Think! by the present author.¹ This series will look at the often-difficult decisions that have to be made every day in general dental practice to answer the ‘who, how, why, when and where’ questions about intervention that arise when looking inside a patient's mouth. There isn't a probe that we can put on a particular tooth that will tell us what to do. Fill this one. Watch this one. Repair this filling. Put a post in that tooth. These are all decisions that are ultimately subjective and are, therefore, the reason for the variations that we see in care plans between different dentists and even between the same dentist on different days and at different times. As human beings, we are not as consistent and reliable as we would like to think. As Kahnemann states:² ‘The extent of the inconsistency is often a matter of real concern. Experienced radiologists who evaluate chest X-rays as ‘normal’ or ‘abnormal’ contradict themselves 20% of the time when they see the same picture on separate occasions. A study of 101 independent auditors who were asked to evaluate the reliability of internal corporate audits revealed a similar degree of inconsistency. A review of 41 separate studies of the reliability of judgments made by auditors, pathologists, psychologists, organisational managers and other professionals suggests that this level of inconsistency is typical, even when a case is re-evaluated within a few minutes. Unreliable judgments cannot be valid predictors of anything’. Like it or not, our decisions are going to vary.