Increasing awareness of risk literacy

Sir, risk literacy refers to ‘the ability to accurately interpret and act on information about risk'.¹ A systematic review² of clinicians' expectations of benefits and harms of treatments, screening, and tests found ‘clinicians more often underestimated rather than overestimated harms and overestimated rather than underestimated benefits'. The importance of risk literacy in medical decision-making³ has been recognised.

Risk literacy may also be of concern for dentists as seen in the following instance. An expert consensus panel⁴ recommended proximal carious lesions confined to enamel did not require restorative intervention. Some dentists⁵ determine need for restorations for proximal carious lesions confined to enamel of permanent teeth even in individuals with low caries activity. Risk literacy is one attribute likely different between dentists who provide restorative intervention for proximal carious lesions confined to enamel and those who provide non-invasive management and includes:

• a. Risk numeracy - recognising number of cavitated proximal carious lesions in enamel (10%)⁶

• b. Recognising future need for replacement restorations⁷

• c. Recognising potential adverse events related to restorative process (eg bur injury to adjacent tooth).

It is important to ‘recognise the enormous difference between a disease that presents clinically and “the same” disease that is found only because we have decided to search for it'.⁸

Dentists may benefit from assessment of risk literacy and may examine the Berlin Numeracy Test¹ (http://www.riskliteracy.org) used to assess risk literacy of physicians.⁹ Select risk literacy resources include:

• Harding Center for Risk Literacy (https://www.hardingcenter.de/en)

• University of Cambridge's Winton Centre for Risk and Evidence Communication (https://wintoncentre.maths.cam.ac.uk/).