Confronting dental uncertainty in old age

Abstract

Objective: To provide an overview of the literature about uncertainty in health care and how it relates to the oral health care of older people. Background: The medical literature describes uncertainty in health care from the initial informedconsent to its impact on a patient's ability to cope with undesirable outcomes. Methods: A narrative review of the medical, dental and psychological literature was conducted to identify pertinent information on the theory and implications of uncertainty in healthcare. The findings are infused into a case-report illustrating the recurrence of uncertainty experienced by an older woman who had multiple treatments over several years to restore her dentition damaged severely by dental caries. Results: Uncertainty originates from inadequate understanding, incomplete information and undifferentiated alternatives leading to unnecessary diagnostic tests and healthcare costs. A conceptual taxonomy clarifies the characteristics of uncertainty in the context of scientific, practical or personal sources and offers management possibilities through effective communications to identify choices and probabilities that help patients to adapt and cope with adverse events. Conclusions: Uncertainty pervades healthcare. It can lead patients to self-blame, anger and withdrawal from care unless it is communicated effectively so that they can adapt and cope with the disappointment of adversity and continue with alternative approaches to care.

The Culture of Certainty in Dentistry and Its Impact on Dental Education and Practice

“…A major question becomes “How can dental professionals practice with uncertainty when their patients expect them to deliver successful outcomes?” The answer lies in informed consent since we should communicate clearly all possible outcomes to patients, so that the risk is explicit and shared between the clinician and the patient 2 . This intentional and explicit dialoging action between patient and clinician needs to begin in dental education.…”

“…Researchers have shown the feedback loop in educational settings is critical to alter students' level of tolerance toward ambiguity or uncertainty 14, 15 . We hope to change educational practice to de‐emphasize certainty, encourage reflective and critical reasoning, and accept that not every clinical dilemma can have what Elangovan et al called a “high‐quality evidence‐based solution.” 16 Doing so will facilitate an increased reliance on team discovery 5 and solution seeking and improve communication by stimulating and promoting a more vigorous culture of informed consent 2 . These changes in clinical and educational practice are beginning to address the issues that result from the long‐standing culture of certainty in dentistry.…”

“…In this examination, the goal is to identify the role of certainty in clinical decision making and the impact of underappreciating the value of uncertainty. Understanding the potential for uncertainty in patient care situations is especially critical and requires the development of critical thinking skills to manage the situation 2 . When we examine the variations among dental professionals, dental teachers, or dental learners, we know that there are multiple characteristics that define who we are as professionals, a diversity that should make us aware not to be driven by a goal of “certainty.” 3 …”

An electronic oral health record to document, plan and educate

“…This is a general problem in dentistry that transcends the development of software programs. Consequently, the UBC‐EOHR will require constant adjustment to modify these criteria and their clinical implications as knowledge of oral health and disease expands .…”

Beliefs about managing dental problems among older people and dental professionals in Southern Brazil

“…Health problems are defined not only by physical malfunction but also by the psychosocial environments in which patients and clinicians experience and interpret problems, 14 and by the uncertainty that pervades clinical practice and experiences. 15,16 In turn, disease and illness are often used to describe the differences between the signs of disease assessed by healthcare professionals and the subjective symptoms of illness interpreted by patients. The social construction of illness purports that the culture of society influences how people respond to and interpret disease, and how medical knowledge is influenced by the interests and bias of clinical expertise.…”