European Journal of Dental Education ISSN 1396-5883

An electronic oral health record to document, plan and educate I-V. Wagner1, M. A. J. Lex MacNeil2, A. Esteves1 and M. I. MacEntee1 1 2

Faculty of Dentistry, University of British Columbia, Vancouver, BC, Canada, College of Dental Medicine - Illinois (CDMI), Midwestern University, Oak Park, IL, USA

keywords electronic clinical record; human–computer interaction; dentistry; quality assurance. Correspondence Ina-Veronika Wagner Berliner Strasse 75c D – 14467 Potsdam Germany Tel: +49 331 2010501 e-mail: [email protected] Accepted: 23 September 2014 doi: 10.1111/eje.12123

Abstract The University of British Columbia (UBC) in collaboration with a software developer (Planmeca Oy, Finland) created an electronic oral health record based on the principles of cognitive ergonomics rooted in the European research and development project ‘ORQUEST’ to guide students through medical, dental, social histories, examinations, treatment planning and progress notes. Clinicians in each dental specialty of the Faculty of Dentistry and software engineers cooperated to define the clinical content and workflow of clinical procedures in three phases: (i) development of a radiographic module, (ii) development of medical, dental, social and family histories, intra- and extra-oral examinations, progress notes and treatment planning and (iii) development of the orthodontic section accompanied by an optimisation phase to correct technical problems and clinical content issues. From a practical perspective, this EOHR enhances the clinical performance of students and the quality assurance capacity of the institution. It facilitates audits of clinical productivity and research, and it can be modified with relative ease to suit similar educational and clinical environments in either public or private healthcare settings.

Introduction Appropriate clinical records are prerequisites for quality assessment and assurance and for auditing clinical activities and research. Paper-based clinical records typically do not optimise the efficient comprehension and management of multiple clinical findings, diagnoses and treatment plans; nor do they support clinical audits and research (1, 2). Until recently, the computerisation of dental practice has focused primarily on scheduling, billing and invoicing patients and, in a limited way, the recording of the physical status and treatment needs of patients along with the productivity of clinicians. However, clinical documentation, such as treatment planning and care, has been overlooked to a large extent (3, 4). Consequently, conventional digital records in dentistry benefit little from current information and communication technology (ICT) for support and improvement of clinical care (5–8). Electronic medical records based on narrative text rather than categorised data have similar limitations (6).

The European research and development project ORQUEST The European R&D project ORQUEST, supported by the European Commission, developed a prototype test version of

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a modular clinical workstation for chairside support in dentistry (9). The core of ORQUEST was the prototype of an electronic oral health record (EOHR) based on the cognitive processes used by dental clinicians to diagnosis problems and manage treatment plans as developed by Wagner and Schneider at Uppsala University (1, 3, 9–12). It emerged from the idea that human cognition occurs at both an upper conscious and a lower subconscious level and that calculating, inferencing and decision-making occur at the conscious level where the capacity for processing information and memorising is limited. The subconscious level, in contrast, has an almost unlimited capacity to process immense amounts of information simultaneously, but is not immune from interruptions by the conscious domain (13, 14). An experienced dentist, for example, operates a high-speed handpiece mostly at the subconscious level when a patient’s head movements are slight; whereas the operation becomes conscious and interrupted if the patient’s movements increase or become erratic. The limits of short-term memory and the cognitive burden of recalling multiple facts could be minimised by dentists who adjusted their clinical workflow to benefit from intuition or subconscious cognition (13, 14). It helps also if the clinician can focus on clinical reasoning and treatment planning without the distraction of organising clinical


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observations and related facts (8, 10). For example, the graphic display of the dentition (odontogram) should present clinical information that can be interpreted quickly and intuitively, and thus managed readily by the subconscious, usually by symbols that are easy to interpret and widely used (Figs 1 and 2). Similarly, treatment planning can be enhanced by a simultaneous presentation of the odontogram, the radiographs and a compilation of oral disease-related risk factors. In general, clinical information should be provided clearly and accurately with the ability to navigate easily and intuitively through its various disciplinary components. This means that the dentist and other professionals can move easily throughout the program and clinically approach patients and their problems as they have been trained and educated. The clinicians then progress towards the management and resolution of those problems. The ORQUEST prototype offered direct access to digital imaging (radiography and photography), as well as image- and rule-based decision-support for the interpretation and management of mucosal lesions (15, 16). It also provided information to educate patients and other software modules relating to specific clinical situations (17–20). The ORQUEST prototype and all its components were tested successfully in 12 clinical environments within eight European countries. (21). Subsequently, Planmeca Oy (Helsinki, Finland) joined UBC in the project as an industry partner with the task of transforming the ORQUEST prototype into a functional product that is now called RomexisTM.

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The UBC-EOHR Modification of the prototype followed extensive consultation with discipline-specific experts in the UBC academic dental clinic, which led to many changes in the content and presentation of the clinical data. The medical, dental, social and family histories, along with chief concerns and past dental experiences (e.g. dental phobias) comprise specific disease- and condition-related questions that guide the novice student through the steps to be recorded. Disease-related risk assessment strategies, colour-coded ‘medical alerts’ and a customised periodic recall schedule (22) were also developed (Fig. 3). The radiographic section of the UBC-EOHR followed the principles for presentation established by ORQUEST (Figs 1 and 2). Radiographs and photographs can be displayed concurrently and adjusted visually in size and contrast as an imagearchive offering an overview of all available information (3, 23) (Fig. 2). Intra- and extra-oral radiographs are presented when performing examinations (Figs 1 and 2) and entering progress notes (Fig. 4), as well as when identifying problems at the beginning of treatment planning. Results of the examination are shown on graphical odontograms supplemented by space for textual descriptions of less frequently encountered observations. Symbols in the odontogram display the coronal, apical and periodontal findings concurrently to promote perceptually integrated reasoning and thereby facilitate treatment planning (Fig. 2). For recording

Fig. 1. UBC-EOHR - magnified periapical radiograph and data entry menu for radiographic interpretation. The image in true colour is available by following the links at


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Fig. 2. UBC-EOHR – clinical interface. Upper part from left to right: non-graphical text-field with ‘alert’ warning; oral status graphic; data entry field; Lower part from left to right: progress notes; imaging area for representing radiographic and photographic images (shown here with the image archive overview). The image in true colour is available by following the links at

various aspects of the oral status, the clinician has only to click on the teeth and/or surfaces represented in the odontogram and the corresponding finding in the data entry field (Fig. 2). Buttons are used to access frequent findings, and standardised drop-down menus are available for less frequent findings; however, the user can still resort to free text for rarely occurring conditions. It should be noted that drop-down menus are utilised wherever possible in order to minimise the use of free text, as free text is difficult to search for reporting and research purposes. Progress notes document treatment procedures which are identified from standardised drop-down menus and based on detailed workflow sequences of clinical procedures including the materials and medications used. As treatment proceeds, changes to the oral status are updated (Fig. 4). For example, a cavitated tooth-surface carious lesion at baseline is replaced by the symbol of the restoration, after treatment. Moreover, a patient’s status at any point in the past can be recalled to compare with the present and thereby help monitor clinical progress or regression. Concurrently, a link is technically foreseen to update the financial database in response to charges and payments associated with treatments (3, 23). A section of the UBC-EOHR guides the clinician on planning treatment to (i) identify, list and group problems from the examinations (Fig. 5), (ii) link problems to treatment options, (iii) connect treatment options and prognoses to each group of problems, (iv) estimate a fee for each option,

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(v) specify the option acceptable to the patient, (vi) list clinical procedures associated with the acceptable option, (vii) arrange the selected options into a coherent and sequenced treatment plan, (viii) establish the required appointments for the treatments and finally (ix) estimate the financial costs. University of British Columbia based the design of the EOHR treatment planning module on the paper-based version which had previously been developed to support their clinical teaching philosophy. The UBC experts strongly believe that the treatment planning process is the central pillar of appropriate patient care and that it is a higher cognitive process requiring the clinician to integrate vast amounts of information related to an infinite number of clinical data. Additionally, the patient should be involved in this planning process as a cotherapist and must be keenly aware of the nature of the therapies that are being considered, including related factors such as prognoses, cost and the time required to provide the treatment. All of these elements are essential for the patient to provide a valid informed consent. The expert clinician moves relatively quickly through this process. On the other hand, the novice clinician (i.e. the student, and even new graduates) can easily become confused and often overlooks important pieces of the puzzle that need to be unravelled and/or assembled. Therefore, the UBC protocol represents a segmentation and sequencing of the required cognitive processes in a well-defined guide for the novice learner. This guide essentially takes the student from the


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Fig. 3. UBC-EOHR – medical/dental/social history with guiding question. The image in true colour is available by following the links at http://www.

Fig. 4. UBC-EOHR – documentation of the progress notes (restoration #14) with automatic update of the oral status graphic. The image in true colour is available by following the links at


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Fig. 5. UBC-EOHR – treatment planning step 1 – exam findings (left) and treatment concerns with problem list (right) selected from the examination findings. The image in true colour is available by following the links at

accumulated data recorded during patient assessment to the point of a complete treatment plan for that patient. Quality assurance is enhanced by built-in checks to ensure that treatment by students is approved and assessed at the appropriate stages. Treatment planning at UBC involves all clinical disciplines. From the list of clinical findings, problems are identified and transferred into the treatment planning section. The system alerts the user if any finding that was previously identified as a problem has not been considered for treatment. Furthermore, a student cannot proceed past a patient’s history without the electronic approval of an instructor, radiographs cannot be made without electronic approval, and treatment cannot begin until the quality and interpretation of the radiographs has been verified electronically. Also, progress notes must be approved after recording the treatment performed in a realistically detailed sequence of clinical workflow using standardised drop-down menus that identify all procedures, materials and medications used.

Implementing the UBC-EOHR Until 1996, clinical patient records at the Faculty of Dentistry at the University of British Columbia (UBC) were entirely paper-based and complimented by a DOS-based patient management and billing system. The latter was replaced in 1997 by a state-of-the-art electronic billing program with a rudimentary clinical record that had been previously used in

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private practice and subsequently reconfigured for multiple users as encountered in the educational environment. Meanwhile, the clinic administration team developed a high motivation to create a completely electronic clinical patient record; in other words, a truly paperless and intuitive Electronic Oral Health Record. Consequently, in 2005, the Faculty of Dentistry at UBC collaborated with Planmeca Oy (Helsinki, Finland) to adapt the original ORQUEST prototype to the requirements of North American dental education in a multidisciplinary clinic with more than 120 dental units. The collaboration added substantially more clinical content and functionality to the patient’s history, intra- and extra-oral status findings and progress notes. It also added new components for diagnosis, mapping of soft tissue lesions, radiographic presentation and interpretation, treatment planning and a complete orthodontic module. A feature called the ‘Clinical Content Editor’ was developed which allows customised configuration and maintenance of the clinical content linked to the application server of the university clinic. The university assumed responsibility for the clinical content and workflow sequencing of clinical procedures whilst Planmeca Oy assumed responsibility for programming. The hardware and software emerged in phases according to the timeline and business needs of the faculty, staff and students. The program is written in Java using an Oracle database, and the Clinical Content Editor developed by Planmeca uses Java and XML Technology (Extensive Markup Language).


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Initiation (2005–2007)

Phase 1 (2007–2008)

Sixteen experts representing the 11 clinical teaching disciplines of the UBC Faculty of Dentistry1 were consulted regarding the clinical content and workflow sequencing of the paper-based UBC-OHR and their expectations for the UBC-EOHR. They recommended a format for recording the patient history, images (radiographs, photographs) and specific clinical formats such as data on growth and development, jaw movements, pulpal status, etc., along with appropriate documentation of progress notes. Overall, they accepted the basic structure and functionality of the ORQUEST prototype. However, there were several continuing discipline-based differences related to patient examination and progress note data that required negotiations. Consensus was achieved on suitable specifications for the workflowbased menus to support appropriate patient care and the educational program of the Faculty. Essentially, the content of each menu was reviewed by the experts and changes were incrementally implemented as this consensus emerged and grew.

Development started with the radiographic module to convert from analogue to digital radiography. The developer of the radiographic software (Planmeca Oy, Helsinki, Finland) provided the radiographic hardware and a customised software to support the specifications of the institution for approving, acquiring, evaluating and interpreting radiographs based on the principles of ‘as low as reasonably achievable (ALARA)’ dose of radiation for each patient, and always subject to the approval of clinical instructors. Planmeca also provided links between the criteria for interpreting radiographs and the diagnosis, treatment planning, progress notes and updating of the patient’s oral status.

Training and testing (2007–2009) The experts, along with the clinical faculty and staff in each discipline, participated in the pre-clinical testing of the UBC-EOHR, which led to further reconfiguration of the system and removal of software faults (‘bugs’), before operating fully in the clinics. Technical and clinical errors and problems were corrected. A separate server and database provided tutorials and personal instruction for faculty, staff and students without interfering with real clinical records during the development process. The scenarios and exercises used in the tutorials were based on simulated clinical situations relevant to each discipline. Later in the implementation process, training scenarios were incorporated within the dental curricula of years 1 and 2 of the DMD program to coincide with the students’ introduction to new clinical situations.

Phased introduction A phased implementation from 2007 to 2009 allowed for an incremental delivery of information and continuous introduction to different parts of the program. This process was not immune to the usual hardware, software and network interruptions that occur during the implementation of any new software program, particularly an implementation of this scale. These situations challenged the morale of those new users and, in this case, required general meetings and individual consultations with the faculty, staff and students as the UBC-EOHR evolved.


Oral Medicine and Oral Pathology; Occlusion; Endodontics; Periodontics; Prosthodontics; Operative Dentistry; Paediatric Dentistry; Orthodontics; Oral and Maxillofacial Radiology; Oral and Maxillofacial Surgery; Dental Biomaterials.


Phase 2 (2007–2009) The medical, dental, social and family histories, intra- and extra-oral examinations, progress notes and treatment planning modules were developed in Phase 2. Achieving consensus on the treatment planning process was challenging due to the varying philosophies and perspectives of each discipline as to how treatments should be determined and implemented (24–28). It should be noted that the workflow analysis required for a software conversion often identifies areas that are by nature not definitive. Variations in opinion also occurred at this stage between the software engineers and the business analysts related to various proposed functionalities of the treatment planning module which delayed its implementation. Additionally, the software engineers had difficulty distinguishing between the educational and financial demands of the clinic. However, an added benefit is that the educators gained a greater appreciation of the higher level of cognition that treatment planning requires and how that must be accommodated for the novice learner. Phase 3 (2009–present) In 2009 and 2010, a special orthodontic section was developed and integrated into the UBC-EOHR. Optimisation of the UBC-EOHR began in 2009 by identifying technical and clinical bugs as it came into full operation in the clinic. The initial inflexibility of the approval process of the patient’s history and radiography caused distress until modified to distinguish between students with different levels of clinical judgment. Other less serious but annoying limitations interfered with the perceived fluidity of the clinical recordings, and at times threatened rejection of the digital record by the clinicians. Software engineers continued to misunderstand the content and workflow of clinical activities, and the construction of software code frequently required several attempts before achieving acceptability by the clinicians. Some of the clinicians lacked the interest and time to provide the engineers with a detailed workflow analysis of their activities. Indeed, the skills associated with analysing workflow were greatly under-appreciated and misunderstood by the clinicians in all phases of developing the UBC-EOHR. ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 19 (2015) 209–216

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Future developments Since 2009, the UBC-EOHR has been used by six full cohorts of graduating dental students (~360 students), and five classes of students (~125 dentists) in dental specialty programs as their only clinical record. It is generally recognised within the clinical dental education community that the prevailing electronic dental health records currently in widespread usage in North America and parts of Europe have shortcomings in relation to the recording and management of oral status data. These programs largely evolved from patient management and financial transaction systems, with the oral status aspect added on later to accommodate the academic environment. The UBC-EOHR is strictly an oral health record and has its roots in academic dentistry and cognitive ergonomics. The program was developed with the goal of providing clinical information clearly and accurately and with the ability to customise the clinical content and to navigate easily and intuitively through its various modules and sections. It will be interesting for investigators within the University to actually compare both types of programs in this regard and thereby confirm the utility of the UBC-EOHR. As with all software programs, refinements and enhancements need to be accommodated. For example, the module for treatment planning requires adjustment to address some relatively small and mostly technical annoyances. However, the general uncertainty underlying much clinical criteria in use in dentistry, and on which many diagnostic and planning decisions rest, continues to challenge the credibility and acceptance of any system based on them. This is a general problem in dentistry that transcends the development of software programs. Consequently, the UBC-EOHR will require constant adjustment to modify these criteria and their clinical implications as knowledge of oral health and disease expands (24, 29). Additional development is required to link the current system with the existing financial and management module operating independently on another software platform. Attempts to link the two systems failed in the past due to conflicting proprietary interests and concerns. The development of this system by an amalgamation of seemingly incompatible academic and commercial interests posed serious challenges that may recur. However, the creative benefits of such a collaboration are more apparent now that the UBC-EOHR operates successfully. Despite these obstacles, which at times seemed insurmountable, the UBC-EOHR is useful for students, faculty, staff and patients and offers new possibilities for quality assurance in dental education and clinic research.

Summary An EOHR system based on cognitive and ergonomic analyses of dental workflow and practice was developed at Uppsala University and successfully tested as a prototype for dental practices in Europe. The UBC-EOHR was designed on the principles of the ORQUEST prototype, and new components were added and the clinical content substantially expanded specifically to meet the needs of a large multidisciplinary academic dental clinic. It emerged from a prolonged collaboration of clinical educators, students and software engineers to serve as a ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 19 (2015) 209–216

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conceptual foundation for applying information technology to dentistry in other large clinical settings where clinical practice and education are combined. The UBC-EOHR is based on the workflow of clinical procedures and supports students to perform quality assured clinical documentation. It was developed and introduced in phases and evolved over 3 years (2007–2009) of interdisciplinary cooperation and discourse and now successfully operates as the main record of patients attending the clinics of the Faculty of Dentistry at UBC.

Acknowledgements We are grateful for the support and contribution of the dental students, staff and faculty of the University of British Columbia, in particular Edwin Yen, who, as Dean, obtained the financial funds for the development of equipment and software. We acknowledge also the contributions of Ms Neala Welburn to the ongoing evaluation of the system, and of Wei Zhang and Colin Ng to the development of the software. Finally, we wish to thank the administration and information technology experts at Planmeca Oy (Helsinki, Finland) who stayed with us despite the distance between Helsinki and Vancouver.

References 1 Wagner I-V. The Use of Information Technology for Continuous Improvement of Patient Care. In: Abbey LM, Zimmerman JL, eds. Dental informatics. New York: Springer Verlag, 1992: 77–91. 2 Schleyer T, Spallek H, Hernandez P. A qualitative investigation of the content of dental paper-based and computer-based patient record formats. J Am Med Inform Assoc 2007: 14: 515–528. 3 Wagner I-V, Ireland RS, Eaton KA. Digital clinical records and practice administration in primary dental care. Brit Dent J 2008: 2049: 387–395. 4 Dental Practice Board. Dental computer survey. London: Department of Health NHS Management Executive, 1998. 5 Thyvalikakath TP, Monaco V, Thambuganipalle HB, Schleyer TJ. A usability evaluation of four commercial dental computer-based patient record systems. J Am Dent Assoc 2008: 139: 1632–1642. 6 Atkinson JC, Zeller GG, Shah C. Electronic patient records for dental school clinics: more than paperless systems. J Dent Educat 2002: 66: 634–642. 7 Acharya A, Mital DP, Schleyer T. Electronic dental record information model. Int J Med Eng Inform 2009: 1: 418–434. 8 Thyvalikakath TP Designing clinical data presentation using cognitive task analysis methods. PhD-Dissertation, University of Pittsburgh, 2012. 9 European Research and Development Project ORQUEST (1996 – 1998). European Commission DG XIII Telematic Applications Programme, Health Care – project number 1037 10 Nygren E. From paper to computer screen. Human information processing and user interface Design Acta Univ. Ups., Comprehensive Summaries of Uppsala Dissertations from the Faculty of Science and Technology 188.31 pp. Uppsala. ISBN 91554-3699-4, 1996. Accessed December 27, 2013. 11 Schneider W, Wagner I-V. The use of electronical clinical recording and pro-active learning in dentistry and dental education. In: Scott JJ, ed. Proceedings, 19th meeting of the association for dental education in Europe. Dublin: Atrium Productions Ltd., 1993: 29– 35. 12 Wagner I-V, Schneider W. New concepts of multimedia- and telematics-based medical worksations. In: Lemke HU, Vannier MW,


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13 14






Inamura K, Farman AG, eds., Procs. CAR’97 – computer assisted radiology. Amsterdam: Elsevier Science B.V., 1997: 317–322. Gigerenzer G. Gut feelings. The intelligence of the unconscious. New York: Viking, 2007. Miller GA. The magic number seven, plus or minus two: some limits on our capacity for processing information. Psychol Rev 1956: 63: 81–97. White S, Wagner I-V, van der Stelt P. Decision support for interpretation and clinical management of radiographic lesions Berlin Quintessenz Verlags-GmbH, CD-ROM 2003/2007. Straßburg M, Wagner I-V, Schneider W. Decision support for the interpretation of oral mucosa lesions. Mundschleimhauterkrankungen - Entscheidungsunterst€ utzung f€ ur die t€agliche Praxis, Berlin: Quintessenz Verlags-GmbH, CD-ROM 1997/2007. Koch S, Wagner I-V, Schneider W, Han F. New concept of an integrated IT&T-based dental workstation for quality assurance in oral health care. In: Cesnik B, McGray AT, Scherrer J-R, eds. Proc. 9th world congress on medical informatics, Seoul, Korea, August 18–22. Amsterdam: IOS, 1998: 107–111. Wagner I-V, Schneider W, Balconi D, Han F, Koch S. ALL in ONE - das europ€aische Projekt ORQUEST. Computer in Zahnarzpraxis und Dentallabor - EDV-Jahrbuch ‘98 H€ uthig Verlag 1998:80-83. Wagner I-V, Schneider W, Koch S, Balconi D, Han F. Der Einsatz multimedialer Informationstechnologie f€ ur Diagnostik und Therapie zur Qualit€atsentwicklung im klinischen Management - das europ€aische Projekt ORQUEST ZMK (Magazin f€ ur Zahnheilkunde, Management und Kultur). 1998;6:34-42.


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20 Koch S. Designing clinically useful systems: examples for medicine and dentistry. Adv Dent Res 2003: 17: 65–68. 21 Final Report – HC 1037, ORQUEST A Telematic System for Oral Health Quality Enhancement, European Commission DG XIII, Telematics Application Programme, 1999. 22 Clarkson JE, Amaechi BT, Ngo H. Recall, reassessment and monitoring. Monogr Oral Sci 2009: 21: 188–198. 23 Wagner I-V. Quality assurance and quality enhancement by use of digital clinical documentation. Int J Comp Dent 2006: 9: 195–204. 24 Han PKJ, Klein WMP, Arora NK. Varieties of uncertainty in health care. A conceptual taxonomy. Med Decis Making 2011: 31: 828– 838. 25 Tokede O, Walji M, Ramoni R, et al. Treatment planning in dentistry using an electronic health record: implications for undergraduate education. Eur J Dent Educ 2013: 17: e34–e43. 26 Bader JD, Shugars DA. What do we know about how dentists make caries-related treatment decisions? Community Dent Oral Epidemiol 1997: 25: 97–103. 27 Maupome G, Sheiham A. Clinical decision-making in restorative dentistry. Content-analysis of diagnostic thinking process and concurrent concepts used in an educational environment. Eur J Dent Educ 2000: 2000: 143–152. 28 Khatami S, MacEntee MI. Evolution of clinical reasoning in dental education. J Dent Educ 2011: 75: 321–328. 29 MacEntee MI, Mathu-Muju K. Confronting dental uncertainty in old age. Gerodontology 2014: 31 (Suppl. 1): 37–43.

ª 2014 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd Eur J Dent Educ 19 (2015) 209–216

An electronic oral health record to document, plan and educate.

The University of British Columbia (UBC) in collaboration with a software developer (Planmeca Oy, Finland) created an electronic oral health record ba...
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