Background: Growing evidence from the wider healthcare and psychology literature support the notion that stress may affect an individual’s decision making, technical and non-technical skills. Stress amongst dentists is prevalent and different stressors have been described in the dental literature. In dentistry, although extensive research has been conducted on dentists’ well-being and mental health, little is known about how different stressors may affect dentists’ performance. Aim: The current work aimed to examine the effect of stress, if any, on dentists’ decision making and performance. Methods: This ResM project was divided into three parts: a systematic review examining the impact of stress on dentists’ performance (Chapter 2), a systematic mapping review to identify dental decision making models and factors that may influence dental decision making (Chapter 3), and lastly an experimental study on the impact of time pressure, as a stressor, on dentists’ diagnostic performance when examining dental bitewing radiographs (Chapter 4). Results: The systematic search yielded 3535 citations, of which twelve were eligible for inclusion but they did not answer the research question; thereby demonstrating a gap in the research base. The mapping review identified the different study designs and methods used in evaluating dental decision making. It also offered a taxonomy of factors which may potentially influence dentists’ decisions based on previously described decision-making models. The identified factors were taxonomised as dentist, patient and environmental factors. Following an iterative process, factors that are perceived as influential by dentists but not evaluated in experimental studies (e.g. time pressure) were identified and informed the development of the subsequent experimental study of the ResM project. The experimental study demonstrated a statistically and clinically significant deterioration in dentists’ median diagnostic sensitivity of 30% when examining bitewing radiographs under time pressure. By contrast, median diagnostic specificity was 100% under both conditions. Conclusions: This work, following a comprehensive evidence based approach, identified a gap in the literature which warranted further exploration. It showed that time pressure, a frequently reported stressor in dental practice, has a negative impact on dentists’ diagnostic performance which could potentially have an adverse effect on the quality of patient care delivery and patient safety. Future studies are warranted to explore a) the mechanism(s) underlying the observed deterioration in performance, b) the impact of time pressure on different aspects of dentists’ performance c) the role of other stressors on dentists’ performance and d) approaches to minimising or mitigating the risk of diagnostic errors from occurring.

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