Understanding dentists' restorative treatment decisions.

A critical review of the literature is presented that examines variation in dentists' restorative treatment decisions and the factors associated with this variation. Substantial variation has been documented in dentists' assessment of caries, in dentists' decisions to intervene, and in the selection of treatment recommended to the patient. However, the factors associated with this variation are not well documented. Following discussion of this review, a model is proposed to help guide further studies of dentists' restorative treatment decisions. This explanatory model incorporates the factors identified in the review, as well as others either observed informally or found in the medical literature. The implications of variation in dentists' treatment decisions highlight the importance of a full explication of the process dentists follow in making treatment decisions. Understanding this process, which heretofore has been examined only superficially because it has been regarded as a function of "clinical judgement," is fundamental to determinations of normative treatment needs, to interventions designed to reduce the frequency of inappropriate treatment, and to the development of valid practice parameters.