Since the 1970s, diagnostic tests have been evaluated using a hierarchical six-level framework. Within this framework, clinical relevance and potential utility represent level 4 and 5 evidence and is typically assessed by means of randomized controlled trials where diagnostic tests are randomized and the decisions made by clinicians (level 4 evidence) or the tangible outcomes observed in patients (level 5 evidence) are tabulated. Using such an evidence-based framework within dentistry would be particularly useful for assessing diagnostic tests aimed at detecting subtle changes or involving ionizing radiation. Diagnosing subtle anatomical, crevicular fluid, or microbiological changes in the oral cavity of symptom-free patients has the potential to drastically increase dental disease prevalence and dental treatment utilization. Experiences with diagnostic tests in other disease areas such as prostate cancer indicates that such redefining of disease leads to uncertainties in assessing harm-benefit ratios because it often is unclear whether those subtle changes that can be detected and treated need to be treated, and whether those subtle changes that need to be treated, can be detected and treated. Diagnostic tests involving ionizing radiation can have potentially adverse health consequences, and additional pressures exist to provide evidence that their benefits outweigh harms. Considering the high prevalence of radiation usage and the lack of individual-patient dosemonitoring, there is a need to determine which radiographs improve patient outcomes. The high potential impact of dental diagnostic testing on dental utililzation combined with the high prevalence of dental visits make it that an evidence-based framework of the assessment of diagnostic tests would offer a welcome addition to the dental knowledge database.
Keywords: diagnostic testing, patient benefits, ionizing radiation, harms