Introducing high-cost health care to patients: dentists' accounts of offering dental implant treatment

Awareness, attitudes and cost among patients for dental implants in teeth replacement

Dental implants are increasingly viewed as a preferred treatment option for tooth replacement, yet gaps remain in patient knowledge, attitudes, and cost perceptions. This cross-sectional, in vitro study surveyed 150 adults aged 20-60 to assess their awareness, attitudes, and perceived costs of dental implants. Results show that while 70% of patients are aware of implants, only 30% understand the procedure. Though 60% expressed interest in implants, 45% perceived them as too expensive. Positive attitudes correlated with greater awareness, highlighting the need for enhanced education on the benefits and financial options associated with implants.

Determinants of Clinical Decision Making under Uncertainty in Dentistry: A Scoping Review

Clinical decision-making for diagnosing and treating oral and dental diseases consolidates multiple sources of complex information, yet individual clinical judgements are often made intuitively on limited heuristics to simplify decision making, which may lead to errors harmful to patients. This study aimed at systematically evaluating dental practitioners' clinical decision-making processes during diagnosis and treatment planning under uncertainty. A scoping review was chosen as the optimal study design due to the heterogeneity and complexity of the topic. Key terms and a search strategy were defined, and the articles published in the repository of the National Library of Medicine (MEDLINE/PubMed) were searched, selected, and analysed in accordance with PRISMA-ScR guidelines. Of the 478 studies returned, 64 relevant articles were included in the qualitative synthesis. Studies that were included were based in 27 countries, with the majority from the UK and USA. Articles were dated from 1991 to 2022, with all being observational studies except four, which were experimental studies. Six major recurring themes were identified: clinical factors, clinical experience, patient preferences and perceptions, heuristics and biases, artificial intelligence and informatics, and existing guidelines. These results suggest that inconsistency in treatment recommendations is a real possibility and despite great advancements in dental science, evidence-based practice is but one of a multitude of complex determinants driving clinical decision making in dentistry. In conclusion, clinical decisions, particularly those made individually by a dental practitioner, are potentially prone to sub-optimal treatment and poorer patient outcomes.

Personality Traits and Annual Income Determine the Willingness to Pay for a Single Tooth Implant

The objective of this study was to evaluate the factors influencing the willingness to pay for a single tooth implant in Malaysia and to assess if an additional evidence-based patient education video increases the willingness to pay. A total of 100 subjects seeking single tooth replacement at the Oral Health Centre, International Medical University (IMU), Kuala Lumpur, Malaysia, were asked to complete questionnaires about personal demographics and personality traits. Subsequently, they were randomly allocated into two groups. Group C received a conventional patient-dentist interaction on treatment options for missing teeth, while Group EV received the same content with an additional evidence-based video on the survival rate and complications for each option from recent meta-analyses. Willingness to pay the median price and the highest price that the subjects were willing to pay were assessed by a structured bidding process. A higher annual income was significantly associated with willingness to pay the median price for a single tooth implant (χ² = 6.91, p = 0.03). Dominant personality traits of openness (r = -0.25), conscientiousness (r = -0.30) and agreeableness (r = -0.20) were negatively correlated with the highest price that the patients were willing to pay for a single tooth implant (Pearson's correlation test, p < 0.05). No significant difference in willingness to pay was found between Group C and Group EV (χ² = 0.05, p > 0.05). In conclusion, patient education strategies for single tooth replacements with dental implants should be customized based on a patient's personality and income to maximize effectiveness.

A critical review of qualitative research publications in dental implants from 2006 to 2020

OBJECTIVES

This critical review is aimed to investigate the current status of qualitative research in dental implant research and to explore the quality of available information.

MATERIAL AND METHODS

A systematic search was done on the journal databases to identify dental implant research articles that used qualitative methodology during 2006 and 2020. The resulting articles were appraised against the checklist offered by the Critical Appraisal Skills programme (CASP) tool. Also, the theories evolved from the research were reviewed to understand the value of this methodology in dental implant research.

RESULTS

Twenty-five (25) articles out of the 8,421 original results were identified as using qualitative methodology. The researchers have sought to identify the views of patients about tooth loss, dental implants, and the information they receive from dental professionals, and views of the dentists about dental implant practice. The review found that there were few inconsistencies in the quality of such research especially the qualitative data analysis.

CONCLUSIONS

The quantity of qualitative research in dental implants remains low; however, the quality has improved in the past two decades. Despite these improvements, there is still a lack of research in understanding both patients' and dentists' views on dental implant procedures and management.

Shared Decision Making in Endodontics

Engaging patients in shared decision making (SDM) is a professional requirement since the Montgomery ruling in 2015. Endodontic treatments present a specific challenge to achieving SDM, both for the clinician and the patient. The treatments are often perceived as more challenging to complete by the clinician, and the assessment of risk and likely outcome requires a deep understanding of the (limited) evidence base. For the patient, decisions can be required at a time of acute symptoms and prolonged treatments. There are health literacy demands in comparison to some less complex dental treatments. Treatment decisions may be based more on inherent biases and prior experiences than objective probabilities. This article discusses options and supports effective shared decision making in endodontic treatment.

German Dentists' Preferences for the Treatment of Apical Periodontitis: A Cross-Sectional Survey

Currently, there is no standard treatment protocol for apical periodontitis (AP). Thus, restorable teeth might get extracted and replaced prosthetically. This study evaluated German dentists’ preferred AP treatment decisions and the influencing factors for selecting tooth retention by initial/repeated surgical/non-surgical root-canal treatment (RCT) or extraction with/without prosthetic replacement. Through an online-survey, participants (n = 260) rated different treatment options for four case scenarios with AP in anterior/posterior teeth without/with previous RCT. Statistical analysis included the Friedman test for intra-case comparisons and Chi-squared test for factor-associations (p ≤ 0.05). Tooth retention using initial/repeated RCT was ranked first in all scenarios and rated as (very) appropriate by most participants, while implant-supported crowns (ISC) and apicoectomy had the second ratings. ISC were preferred more on posterior teeth or previous root-canal-treated teeth. Rating levels of treatment options displayed significant differences for all case scenarios. Posterior tooth retention by RCT demonstrated a significant association with work experience. Tooth retention with previous RCT displayed a significant correlation with dentists’ privately insured patients. Most dentists preferred tooth preserving with initial/repeated RCT, while others selected non-evidence-based choices. This reflects a lack of consensus of AP treatment decisions in Germany. Fixed treatment guidelines and further evaluation of treatment–decision-correlated factors are recommended for correct treatment planning.

Exploring dentists' professional behaviours reported in United Kingdom newspaper media

Aim Stories of dentists and their professional behaviours can be communicated around the world through news media. This may influence people's perceptions of dentistry and their trust in professionals. The aim of this study was to explore reports of dentists and their professional behaviours in newspaper media.Method All articles which included the term 'dentist' alongside 'professional' or 'misconduct' or 'behaviour' between 1 January 2016 and 31 October 2019 were retrieved from the ten most commonly read newspaper print media in the United Kingdom. Thematic analysis was undertaken following the application of inclusion and exclusion criteria.Results A total of 122 articles were identified. Key themes included poor practice, dishonesty and fraud, the killing of Cecil the lion, sexual misconduct, racism and crime. Many articles focused on a small number of extreme cases, labelling the dentists involved and sensationalising the stories. Reports did not reflect the majority of fitness to practise cases seen by the General Dental Council.Conclusion The sensationalist approach to the reporting of dental professional behaviours in the news may cause patients to have less trust in their dentist, and it is recommended that dentists and journalists work constructively together in the best interests of the public.

Are UK graduates equipped with the skill set required to meet the demands of the UK's edentulous population?

As the UK witnesses a decline in the number of edentulous adults, there is a simultaneous reduction in the number of cases available to undergraduate dental students for the teaching of complete dentures. When edentulous adults are unable to function with conventional complete dentures, particularly pertaining to the mandibular denture, an implant-supported mandibular overdenture has been evidenced as the gold standard for edentulous patients. The evidence in favour of mandibular implant-supported overdentures is one of the most robust evidence bases for any clinical treatment and similarly it has been shown that undergraduate students are equally as capable in the provision of implant-supported overdentures as experienced prosthodontists. Yet there appears to be a disparity in the General Dental Council's undergraduate learning outcomes pertaining to care for edentulous adults. Furthermore, the UK seems to be falling behind in this respect in comparison to our European, American and Australian colleagues. This review looks at the evidence for the provision of implant-supported overdentures in the setting of the undergraduate dental curriculum, the potential barriers within this teaching forum and how well prepared UK undergraduates are for the clinical management of edentulous patients in the future.

Scoping Review of the Role of Shared Decision Making in Dental Implant Consultations

To what extent does dental research on implant consultations focus on the use of shared decision making? There has been an explosion in the use of implant therapies in dentistry, but very little is known about the decision-making processes involved in the provision of dental implants. The use of shared decision making (SDM) has been found to reduce undesirable outcomes and increase patient and clinician satisfaction in other health care fields. This scoping review reports on the current status of SDM in research on implant therapies. A scoping review methodology was used. Web of Knowledge, MEDLINE via OvidSP, MEDLINE via PubMed, Embase, Scopus, Cochrane, DARE, and CINAHL databases were reviewed between 1900 and December 1, 2017. The search strategy resulted in 2,289 eligible articles; 1,892 duplicated articles were deleted, resulting in a hand search of 397 titles and abstracts. These were subsequently evaluated while applying the inclusion and exclusion criteria, resulting in 48 articles for full-text evaluation. After full-text evaluation of these 48 studies, a further 27 were eliminated as not being relevant, leading to the inclusion of 21 studies for the review. No studies to date have examined how patients and dentists engage in decisions to place dental implants. Aspects that were discussed in the literature related to the decision-making process included a discussion about patients' values and discussing possible treatment options. How patients and dentists interacted during implant consultations was poorly explored. Shared decision making has been shown to improve health care quality and increase clinician and patient satisfaction. Further research concerning dental implant decisions is warranted with emphasis on evaluating patients' contributions to treatment, which is currently poorly understood. Exploring existed methods for examining the SDM process in implant consultations should facilitate improve care and consent. Knowledge Transfer Statement: The findings of this scoping review can be used by all dentists when deciding which decision-making model they wish to use when planning implant therapy. The article places special emphasis on the role of shared decision making in improving health care quality and increasing patients' and clinicians' satisfaction.

Provision of information on dental implant treatment: Patients' thoughts and experiences

OBJECTIVES

To explore patients' thoughts and perceptions of information provision regarding dental implant treatment.

METHODS

This generic qualitative study involved 38 semi-structured face-to-face and telephone interviews with 34 participants, who were at different stages of dental implant treatment. The interviews were transcribed verbatim. The data collection and coding process followed the principles of qualitative thematic analysis.

RESULTS

Clinical sources of information were generally trusted by patients; however, patients clearly lacked information relative to their own specific situation, concerns and preferences, and this may lead to patients' reliance on other general sources of information. Crucial information on the long-term prosthesis needs was requested by patients at all treatment stages. Issues concerning the longevity and functional capability of the implant restoration and the long-term maintenance including optimisation of hygiene practice were questioned by patients and required greater explanation.

CONCLUSION

With growing patient interest in implants for replacement of missing teeth, complete and accurate knowledge and understanding of implants should be established with patients. This should be undertaken with more reliance on reliable clinically based sources of implant information.

An Instrument to Assess Dental Students' Competence in Shared Decision Making: A Pilot Study

Evidence suggests that involving patients in health care decisions has a positive impact on health care outcomes and patients' perception of quality. However, the extent to which dental students are trained in communication and shared decision making (SDM) differs, and studies have identified a need for intensified learning and assessment of this competence. A need to more clearly define and operationalize what it means to be proficient in this area has been identified. The aim of this study was to operationalize communicative and relational skills in a comprehensive assessment instrument for SDM. Relevant skills in information exchange, negotiation, communication, and relationship-building were identified through an extensive review of previous research and instruments for assessing communication competence. Indicators for assessing these skills were formulated. The instrument was submitted to a pilot test in 2016 and evaluated on test content, internal structure, and response processes. The Assessment of Shared Decision Making (ASDM) instrument consists of 18 items addressing various aspects of the construct and three types of skills. Findings suggest that the ASDM represents a valid measure of SDM with three major components. The importance of developing the ASDM lies both in the summative assessment of students' communication with patients and for formative assessment purposes. Once identified, the components essential for SDM can be woven into the curriculum and shared with students. Thus, the ASDM provides a structure that can meet the need for intensified learning and assessment of dental students' competence in communication and SDM.

Frequency of bone graft in implant surgery

BACKGROUND

Implant surgery has become popular with the advance of surgical techniques such as sinus lifting, guided bone regeneration, and block bone graft. However, there were no data about the frequency of bone graft during implant surgery. The purpose of this study was to report the frequency and types of bone graft depending on dental implant patients' profile to complement the database regarding implant surgery.

METHODS

The implant operations had been performed from January 2006 to October 2014. The upper and lower jaws were divided into six sextants. A total of 792 sextants were included in this study. Patient information including sex, age, sites, bone graft, and types of bone were investigated.

RESULTS

A total of 1512 implants had been placed. Male and female sextants were 421 and 371, respectively (M:F = 1:0.88). Average age was 54.3 (ranging from 20 to 88 years old). Implants were placed in the posterior maxilla (322 sextants, 40.7 %), posterior mandible (286 sextants, 36.1 %), anterior maxilla (127 sextants, 16.1 %), and anterior mandible (57 sextants, 7.2 %). Bone graft was performed in 50.3 % of the sextants. Among the bone grafted sites, sinus lifting with lateral approach (22.1 %) and guided bone regeneration (22.7 %) were performed most frequently.

CONCLUSIONS

Bone graft in implant surgery was necessary to augment defects. More than half of the sextants needed bone graft for implant installation.