Dentistry diagnosis subset feedback from UK

Ian Green

Owner

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Dentistry diagnosis subset feedback from UK, specifically based on semantic types

Hi all,

We have received feedback centrally from the UK regarding the Diagnosis subset, the feedback is as follows:

721144007 General Dentistry diagnostic refset contains the code

109787002 Inflammatory fibrous hyperplasia of mouth (disorder)

 ..as a still active member, but this code was inactivated as ambiguous in July 2021.

Neither of its designated MAY_BE_A replacements is already a member.

The more contentious bit is initially exposed by the observation that the same refset also confusingly contains both of:

129263008 Impacted tooth (morphologic abnormality)

235104008 Impacted tooth (disorder)

Morph, Abnormality variant of this pair should never have been listed in this refset from the outset.

More generally, that Morph. abnormality codes should never be being recorded by clinicians directly as entries for anyEPR diagnosis, ever.

Their only legitimate use is in the context of a clinician (or author) when postcoordinating a novel expression from its concept model endorsed pieces.

This is a SNOMED Ninja mode of data entry that, currently, virtually no clinician on the planet ever does.

Therefore, for now, the entire set of Morph Abnormality codes should IMHO be routinely 100% invisible and inaccessible to all clinicians in all current code picking interfaces. Period.

No exceptions: if there isn’t a nicely worded existing precoordinated finding or disorder already out there, but there isan enticingly-monikered Morph Abnormality code, ask for a new finding code and be patient until it arrives.

Do NOT co-opt enticing members of the Morph Abnormality codeset just cos the words match your needs.

At all. Ever.

Similarly, steer clinicians clear of enticing “words” found amongst the detritus of the Qualifier, Observables, Record Artefact or Staging and Scales hierarchies.

Its not all just words…

There are therefore also five other Morph Abnormality codes that have been IMHO inappropriately included and so badly need booting out of this refset in favour of existing alternate (disorder) codes:

708578007 Active caries (morphologic abnormality) -> 733968004 Active dental caries (disorder)

708573003 Cavitated caries (morphologic abnormality) -> 80353004 Enamel caries (disorder), 702646000 Extensive cavitated lesion with exposed dentine (disorder) etc.

71379006 Erythroplakia (morphologic abnormality) -> 69299000 Erythroplakia of mouth (disorder)

708577002 Non-active caries (morphologic abnormality) -> 80753001 Non-active dental caries (disorder)

708574009 Non-cavitated caries (morphologic abnormality) -> 769020009 Non-cavitated caries of tooth root (disorder), 767060004 Non cavitated coronal lesion (disorder)

? errant inclusions of codes that are not diagnoses in that refset:

63161005             Principal (qualifier value)

255227004           Recurrent (qualifier value)

708584005           Inner half of enamel (body structure)

708579004           Inner third of dentin (body structure)

708580001           Middle third of dentin (body structure)

708585006           Outer half of enamel (body structure)

708581002           Outer third of dentin (body structure)

26671000             Structure of pulp of tooth (body structure)

168496002           Radiographic imaging procedure carried out (situation)

248140009           Oral habits (observable entity)

38592005             Dental behavior management (regime/therapy)

37743000             History and physical examination, monitoring (regime/therapy)

…and also challenge the medicolegal wisdom or clinical utility of these as “diagnoses”

373572006           Clinical finding absent (situation)

373573001           Clinical finding present (situation)
443859009           Possible clinical finding (situation)

…also whether normal findings have any place in a refset that claims to be restricted to diagnoses ie only to abnormal pathology

162005007           No tooth problem (situation)

718070001           Normal oral mucous membrane and osseointegrated bone tissue surrounding dental implant (finding)

711635006           Normal periapical tissue (finding)

714482007           Normal periodontal tissue (finding)

715842003           Normal periodontal tissue with attachment loss (finding)

711636007           Normal pulp of tooth (finding)

Happy to talk to this at a future meeting, and also get the UK along to support these positions,

Ian