Decision-making regarding dental treatments – What factors matter from patients’ perspective and does Covid-19 influence patients’ behavior? A systematic review

Abstract

Background Achieving dental health for the population should be a concern of a public health care system, as it may affect its expenditures in the long term. Patients often face individual challenges in dental health care. Why patients decide for or against dental treatments can be determined by many factors, e.g., own financial resources, preferences, and external circumstances. The study’s aim is to identify these factors with an international perspective. Methods We systematically searched for literature in three biomedical databases. Factors of choice were extracted from relevant publications. We used a qualitative approach for analysis, and the MMAT (Mixed Methods Appraisal Tool) for quality assessment. Results After multistage screening of n = 4,226 publications by two reviewers, n = 233 relevant articles of different study types [qualitative (n = 42), quantitative (n = 177), and mixed methods (n = 14)] were included in the analysis. Data collection was realized across different settings [e.g., practice (n = 18)] and approaches (e.g., interviews) in n = 49 countries. Included articles focused on specific treatments (e.g., caries treatment) or treatments in general (e.g., dental tourism). Across countries, various factors of choice (n = 101) were identified, divided into three categories: (I) "dentist & dental institution" (e.g., communication), (II) "patient" (e.g., dental fear), and (III) "treatment" (e.g., durability). The factors out-of-pocket payment and dental fear were mentioned most frequently (n = 148, n = 73). In countries with most articles [UK (n = 28), Saudi Arabia (n = 23), USA (n = 22), India (n = 19), and Brazil (n = 14)], out-of-pocket payment was identified most often [e.g., India: in 68%, and the UK: in 56% of articles]. Frequency of the factor dental fear varied by country. One publication addressed the Covid-19 pandemic reporting that treatment appointments were cancelled by patients due to their fear of infection with SARS-CoV-2. Study quality is highly variable. Conclusions A variety of factors influence patients' choice regarding dental treatments. There is little research on impact of the Covid-19 pandemic. Knowing patients’ reasons for seeking dental care can help to inform decisions about interventions to improve dental health. Regulatory measures and information efforts should be adapted to reduce patients’ access barriers to dental care, and to reduce expenditures of health care systems in the long term.