DentalCore: Design and Implementation of a Rule-Based Clinical Decision Support System (CDSS) for Primary-Care Dentistry in Latin America

Background. Primary-care dental practices in Latin America operate under resource constraints, high patient turnover and, frequently, without clinical information systems that support decision-making. Clinical Decision Support Systems (CDSS) have been shown to improve clinical practice, yet their adoption in primary-care dentistry and resource-limited settings remains scarce. Objective. To describe the design and implementation of the DentalCore CDSS, a rule-based, deterministic, auditable dental decision-support system integrated into a practice-management platform and aimed at primary-care dentistry in Latin America. Methods. The system is implemented as a production-rule system with knowledge–inference separation: clinical knowledge is encoded in declarative knowledge bases, and three specialized inference engines apply it via forward chaining over the patient's structured clinical data: (1) phased treatment-plan inference from the odontogram and periodontogram; (2) medical-risk assessment and medical-consultation indication prior to procedures ("interconsultation as a clinical preflight"); (3) drug interaction and contraindication checking. We assessed conformance to the four CDSS effectiveness criteria of Kawamoto et al. (2005) and performed scenario-based verification (positive and negative cases). Results. The system meets all four Kawamoto criteria. Scenario-based verification showed that the rules generate the expected recommendations and, notably, do not over-alert in low-risk procedures (specificity). Knowledge–inference separation favors auditability and maintainability. The system adopts privacy and security by design, aligning its technical controls with principles common to the personal-data-protection and medical-record frameworks of Latin America and the European Union. Conclusion. A rule-based, deterministic, workflow-integrated CDSS is feasible and publishable as a design contribution for primary-care dentistry in Latin America, requiring neither clinical trials nor patient data.