'SHEEP scoring': A practical tool for evaluating the prognosis and restorability of compromised teeth.

Abstract

This article describes a practical approach to assessing compromised teeth using a process called 'SHEEP scoring' which is an acronym based on the categories of Structure, History, Endodontic, Expertise, and Periodontal. Any compromised tooth is awarded marks out of ten under each of those five categories. Totalling those five scores (out of a maximum 50) and multiplying that number by two results in a patient-understandable 'percentage chance odds' for that compromised tooth. This pragmatic way of identifying the pre-existing problems first, before quantifying those in an intelligible way, helps to develop trust by making potential patients more aware of any existing problems with their tooth/teeth. That analysis ought to be undertaken separately and well before offering any theoretically possible solutions.Only when both sides understand the significant problems that already exist, should a 'Benefits Risks and Nothing (BRAN) analysis' be undertaken with the patient. This involves discussing the benefits and risks that might be involved in different approaches, compared with the option of doing nothing. The main objective is to help patients to evaluate their likely odds of some 'theoretically possible' treatment being successful in their particular case. Those explanations lead to outlining the time and costs that could be involved, as opposed to monitoring the situation while helping that patient to prevent further deterioration. Analysing and discussing existing problems first (separately to discussing potential treatments, and thereby avoiding availability bias and confirmation bias), means that patients can exercise their autonomy over how they would like to proceed with some treatment - or with none - which should help to ensure that their consent is likely to be valid for whatever decision they make.