A Controlled Terminology for Diagnoses and Findings in General Dentistry

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DESCRIPTION (provided by applicant): The absence of a validated, broadly accepted terminology for Dental findings and diagnoses is a significant barrier to systematically measuring and improving oral health. In 1999, the American Dental Association released the Systematic Nomenclature of Dentistry (SNODENT); however, this terminology has not been evaluated, nor is it in use, in clinical Dentistry. Dental concepts have increasingly appeared in both standalone/localized and mainstream healthcare terminologies, but little is known about the domain coverage of these terminologies. The objective of this application is to measure the coverage of diagnoses and findings commonly used in general Dental practice by several healthcare terminologies (including SNODENT), and to use the results to develop SNODENT into a validated clinical reference terminology for this domain. Our first Aim is to collect clinical concepts from diagnostic work-ups and treatment planning of 20 patient cases by 10 general Dentists, and by observing 120 initial patient examinations performed by 40 general Dentists. Using the NLM MetaMap Transfer tool, a training set (80% of the collected concepts) will be matched against SNODENT, SNOMED, MeSH and ICD-10 using a five-item scale: "exact match (4),", "lexically equivalent match (3)," "semantically equivalent match (2)," "partial match (1)," and "no match (0). "We posit that no more than 60% of the concepts will have a "good match," i.e. a score better than 1, in any of the target terminologies. Our second Aim is to convert SNODENT to the structure of SNOMED-CT, and to update and modify its content to improve domain coverage. An expert group composed of 12 terminology specialists, Dental informaticians, Dentists and Dental hygienists will recommend changes to SNODENT, which will be implemented by project staff. We will use the Terminology of Apelon Development Environment to specify concepts and their properties, qualifiers, roles and associations. We will then repeat the evaluation performed in Specific Aim 1 using a test set (20% of the concepts). Our working hypothesis is that the "new SNODENT" will have more than 80% "good matches" in this pilot evaluation. In both Specific Aims, we will use existing Dental findings and diagnosis vocabularies to provide external validation of our results. The reference terminology we propose to develop will have multiple benefits. First, it can serve as a source of developing derived, specialized terminologies, such as a reason-for-treatment classification. Second, over the long term, we expect it to facilitate significant advances in measuring and improving oral health status at the individual, group and population level; enabling evidence-based Dentistry; speeding the translation of research into practice; and easing the exchange of oral health information in the context of the NHII.