Self-assessment of oral malodor 1 year following initial consultation.

OBJECTIVE: In an initial study, subjects complaining of bad breath were generally unable to score the level of their own oral malodor in an objective fashion. Subjects were taught several techniques for self-measurement of bad breath. One year following the initial consultation, subjects were recalled to determine whether their ability to assess their own oral malodor had improved. METHOD AND MATERIALS: In the study, subjects were blinded to their own scores 1 year earlier, to the odor-judge scores, and to the results of the clinical laboratory tests. Thirty-two of 43 subjects in the original study who presented with a complaint of oral malodor agreed to participate in the follow-up study. Odor-judge scores and self-assessments of oral malodor (whole-mouth odor, tongue odor, and saliva odor) were compared with one another as well as with clinical parameters. RESULTS: Objective improvements were noted in both oral health parameters and malodor levels of subjects. Despite this, self-assessments generally remained unrelated to objective parameters (odor-judge scores, clinical indices, and laboratory tests). Self-assessments were all significantly correlated with one another, and also were significantly associated with corresponding self-estimates made 1 year earlier. CONCLUSION: Subjects with a complaint of oral malodor remain largely unable to score their own bad breath in an objective fashion. In addition, they are not capable of sensing reductions in oral malodor 1 year following the original assessment, even though, from a clinical standpoint, improvements have taken place.

Decision analysis of high-risk patient referral.

Decisions to refer obstetric patients are often complicated by social and financial considerations as well as medical risks. To study such decisions, 600 Fellows of the American College of Obstetricians and Gynecologists were studied using a new decision analysis technique. It was found that obstetricians base their referrals predominantly on medical factors, but that other considerations can affect a close decision. Physicians differed on their indications to refer, as well as on the weight placed on some factors. Such differences could not be explained by age, training, or practice characteristics. Studying the referral process is important because successful regionalization depends on appropriate referral.