The purpose of this study was to make and ascertain a decision making process on the base of subjective evaluation of patients in the treatment of patients of chronic adult periodontitis.
One hundred patients treated in the Christian hospital were chosen according to the selection criteria. Sixty three patients agreed to participate in this study. NS group (N=32) was treated with scaling and root planing without any surgical intervention, and the other S group (N=31) was done with flap operation. During the active treatment and healing time, all patients of both groups were educated about the importance of oral hygiene and controlled every visit to the hospital. When periodontal treatment needed according to the diagnostic results after active treatment, some patients were subjected to professional tooth cleaning and scaling once every 3 months according to an individually designed oral hygienic protocol. Probing depth was recorded on baseline and 18 months after treatments. After evaluation, maintenance treatment program individually designed for each patient were provided for maintaining the periodontal health. A questionnaire composed of 6 kinds (hygienic easiness, hypersensitivity, post-treatment comfort, complication, food impaction, compliance of re-treatment) of questions was delivered to each patient to obtain the subjective evaluation regarding the effectiveness of therapy.
The decision tree for the treatment of adult periodontal disease was made on the result of 2 kinds of periodontal treatment and patient’s subjective response. The optimal path was calculated by using the ratio of satisfaction level of the response as the probability and utility according to relative value and the economic value in the insurance system. The pooling results of subjective evaluation by using a questionnaire were more than 69% for satisfaction level and 31 % for dissatisfaction level in the patient group receiving non-surgical treatment and 62% and 38% in the other group receiving surgical treatment. For each subjective evaluation variable, there are not any statistically significant differences between two treatment modalities except food impaction variable. Surgical group expressed more dissatisfaction. The utilities for 5 satisfaction levels were set up as 100, 90, 80, 70, 60 according to the successful treatment result with self-performed prophylaxis. For non-surgical approach, the weight value for cost and complication, 5 was subtracted from each utility value of 5 satisfaction level and for surgical group, 7.5 done.
The optimal path of periodontal treatment was rolled back by timing the utility on terminal node and the distributed ratio of response level. And utility value was also varied according to the range of the weight value for cost and complication. Thus sensitivity analysis on the utility variable set up by the cost weight was also performed. Both results of the calculation were non surgical treatment. Therefore, it can be said that non-surgical treatment may be the optimal decision to treatment alternatives for the treatment of chronic adult periodontitis if the goal of the periodontal treatment is to achieve the treatment goal and if the utilitarian concept to maximize the expected utility in view point of patients is advocated.
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