Long-term dental care for a patient with Parkinson's

0 of 12 answers from three frontier models passed. A practicing dentist wrote this question. Three frontier models each answered it four times. None of the twelve answers passed.

  1. 01

    A question only a dentist would ask

    Written by a practicing dentist in clinical language. The right answer depends on the patient, not the textbook.

    I have a patient. He is 75 years old. He has Parkinson's disease. He is living in a government run long term care home. He has limited income. He has generalized root and recurrent caries. What are the best options for managing his long term dental care.

    • General dentistry
    • Treatment plan
  2. 02

    The dentist's plan

    Before any model sees the case, the dentist writes the gold-standard answer. It works through the options for this patient in order and commits to one plan. Every attempt is measured against it.

    The dentist's reasoning

    1. Restoring all the carious teeth is not realistic for this patient.
    2. Extraction of all teeth with fixed implant-supported bridges would be ideal, but it is ruled out because of the patient's finances.
    3. A conventional lower complete denture is hard to retain, so any lower denture needs implant support.
    4. Weigh his likely remaining lifespan against how long each treatment takes and how long it lasts.
    5. Care home staff maintain the implants and dentures with ongoing daily oral hygiene.

    Preferred solutionImplant-supported removable dentures

  3. 03

    A rubric that rewards the right plan

    Most of the points are for getting the plan right. General advice earns some, but not enough to pass.

  4. 04

    Every answer, graded

    Three frontier models each answered four times. The two other models graded each answer against the rubric. Scores ranged from 4% to 44%. The pass line is 60%.

    Claude Opus 5.5Attempt 136%Attempt 229%Attempt 326%Attempt 444%
    GPT-6 AstraAttempt 118%Attempt 228%Attempt 315%Attempt 44%
    Gemini 4 ArgonAttempt 126%Attempt 233%Attempt 335%Attempt 436%
  5. 05

    What the models did instead

    Both agreed that restoring every tooth isn't realistic. They split on what to do instead. The dentist planned for this patient. The models gave the general answer.

    What the models did

    Prevention first. No implants.

    • Silver diamine fluoride and high-fluoride toothpaste in all 12.
    • Glass-ionomer restorations in 9.
    • Several ruled implants out on cost and disease progression.

    Checked against the dentist's reasoningAcross 12 attempts

    1. Restoring all the carious teeth is not realistic for this patient.Most said this
    2. Extraction of all teeth with fixed implant-supported bridges would be ideal, but it is ruled out because of the patient's finances.Almost never
    3. A conventional lower complete denture is hard to retain, so any lower denture needs implant support.No attempt
    4. Weigh his likely remaining lifespan against how long each treatment takes and how long it lasts.No attempt
    5. Care home staff maintain the implants and dentures with ongoing daily oral hygiene.No attempt

    Preferred solutionImplant-supported removable denturesNo attempt chose it

  6. 06

    Check our work line by line.

    This is the full rubric for the sample case. Each line is one thing a good answer must say. Model success rate is how often the 12 attempts earned that line.

    Earned by some attemptsModel success rate

    • Takes the patient's ability to pay for treatment into account96%
    • States that restoring all carious teeth is not realistic for this patient75%
    • States that Parkinson's disease reduces manual dexterity, so the patient cannot reliably clean his own teeth or dentures67%
    • States that a long-term care home resident relies on staff for daily oral hygiene, and that this care is often limited42%
    • States that with Parkinson's, involuntary movements may dislodge the denture25%
    • Rules out the fixed implant options because of the patient's finances12%

    Never earned by any attemptModel success rate

    • Recommends implant-supported removable dentures (implant-retained dentures or overdentures) as the preferred solution0%
    • States that a conventional lower complete denture is hard to retain, so a lower denture needs implant support0%
    • Weighs the patient's likely remaining lifespan against how long each treatment takes and how long it lasts0%
    • States that extraction of all teeth with fixed implant-supported bridges would be ideal, but is not suitable for this patient0%
    • Recommends that care staff maintain the implants and dentures with ongoing daily oral hygiene0%
    • Explains that fixed implant bridges avoid a removable denture and its acrylic0%

    PenaltiesTriggered

    • Recommends a lower complete denture without implantsNever
    • Lists more than 3 treatment options without committing to one8%
    • Fails to advise the patient about ongoing maintenanceNever

    This case was written as a sample and is not for sale. The cases we sell are never published.

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