What influences the clinical decision-making of dentists? A cross-sectional study

Abstract

Clinical decision-making is a complex process influenced by clinical and non-clinical factors. The aim of this study was to investigate the association between provider, patient, and practice factors with clinical decision-making among dentists in Ontario, Canada's most populated province and its largest dental care market. This was a cross-sectional, selfadministered survey of a random sample of general dentists in Ontario (n = 3,201). The 46item survey collected demographic, professional, and practice information. The outcome (treatment intensity) was measured using a set of clinical scenarios, which categorized dentists as either relatively aggressive or conservative in their treatment decisions. Associations were assessed using bivariate analysis and logistic regressions. One thousand and seventy-five dentists responded (33.6% response rate). Age (p = 0.001), place of initial training (p<0.001), number of dependents (p = 0.001), number of hygienists employed (p = 0.001), and perceptions of practice loans (p = 0.020) were associated with treatment intensity. Dentists who were <40-years old (OR = 2.06, 95% CI:1.39-3.06, p<0.001), American-trained (OR = 2.48, 95% CI:1.51-4.06, p<0.001), and perceived their practice loans as large (OR = 1.57, 95% CI:1.02-2.42, p = 0.039), were relatively more aggressive in their treatment decisions. Various non-clinical factors appear to influence the clinical decision-making of dentists in Ontario.

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

“…Such lack of consensus has already been reported for teeth with AP and previous RCT and endorses the described claims of subjective and inconsistent treatment recommendations [ 48 , 49 ]. Previously reported factors disturbing the adoption of modern and evidence-based dental technology and science in decision making, such as psychosocial and behavioral factors, as well as a complex interplay of perceived benefits might provide an explanation of this observation [ 50 , 51 ]. The outcomes of this survey reflect the current clinical situation of the dental society in Germany and worldwide, where, even though dentists are capable of saving a tooth with AP through endodontic treatment, some clinicians are more likely to extract the tooth for implantation or recommend other non-evidence-based treatment options.…”

Relative share, frequency and correlation of restorations in both dental dentitions in childhood

“…The information for the diagnostics of caries in primary teeth is scarce [39] and in this dentition there are different criteria depending on the thin layers of enamel and dentin and the wider interdental contacts [40]. The indications for restorative/obstructive/therapy are scarcely studied and the decisions depend on the assessment of the clinician [41]. In modern dental clinics there is still a need for making a decision when to restore a caries lesion, the clinical criteria for visual discovery of enamel cavitation, observation of the enamel and x-ray of the lesions [42]- [44].…”

How effective and cost-effective is water fluoridation for adults? Protocol for a 10-year retrospective cohort study

“…Factors which are known to be related to the intervention threshold of dentists include age, dental school, access to continued professional development, size of practice, gender and remuneration system. 64 , 65 Some of these factors could feasibly show geographic clustering, for example, in cities or closer to dental schools. Because there are relatively few fluoridated areas in England, it could occur by chance that clusters of such dentist and dental practice factors are unequally distributed across intervention groups.…”