Investigating dentists’ decision making and patients’ preferences in the prevention of dental caries

Aim: The aim of this study was to examine the decision making of dentists and patients in the
prevention of dental caries in the UK and ROI. Contribution: This was the first study to investigate such a theme using a DCE approach. A framework analysis was applied with qualitative data to develop two DCE surveys. Policy suggestions for increasing prevention were also offered from dentist, patient and dentist patient relationship perspectives. Methods: A mix of qualitative methods were used in an iterative process to develop separate DCE surveys for dentists and patients. Finally, 143 dentists were recruited through snowball sampling and 353 members of the general public were recruited through an online panels company and Facebook. Mixed logit models were used to measure preferences from their survey responses. Latent class models were applied to explore preference heterogeneity. Results: The main model in the dentists’ study highlighted the following points. 1. Dentists placed great importance on preventive advice for patients with an adverse dental condition. 2. They disliked providing restorative treatment to a patient with a mild caries condition. 3. They felt obliged not only to treat the lesion by intervention but also to offer a toolkit of advice which would be helpful to the patient to prevent future caries. 4. They chose treatment plans containing the least possible intervention in cases of mild caries condition, preferring to deliver more preventive advice instead of preventive and restorative care. 5. They had stronger preferences for delivering preventive advice to younger patients. Latent class modelling showed that female, part-time dentists, those with more years since graduation, individuals working in small, public or mixed private-public practices, those more frequently delivering preventive care, and dentists seeing a higher share of patients exempted from payment had a higher tendency towards preventive care. The main model in the patients’ study underlined the following points. 1. Patients placed great importance on preventive treatment. 2. They preferred oral hygiene advice over dietary advice. 3. They preferred to see the dentist as opposed to a different dental professional and to avoid longer travel and waiting times. Latent class modelling demonstrated that older, unemployed, female patients, those with higher dental attendance, no private insurance, better education and with a less healthy oral profile were more likely to prefer preventive care. Discussion: The use of a mix of qualitative methods assisted in the development of the two DCE surveys. Dentists preferred to deliver restorative care as well as preventive treatment and advice for patients with an adverse dental condition. They tended to offer more preventive advice but less restorative and preventive care for patients with a mild caries condition. Patients preferred preventive treatment and oral hygiene advice while they were less inclined towards dietary advice. The welfare of patients was not worsened off to a great extent by whether a dentist or a different dental professional including a dental hygienist, therapist or nurse deliver preventive care. Checking for preference heterogeneity in both groups revealed that certain sociodemographic characteristics of dentists and patients were associated with a more prevention oriented behaviour. Recommendations: DCEs using patient vignettes were successfully used to measure preferences of dental professionals in the delivery of care. DCEs were also a feasible way to evaluate the preferences of patients towards the prevention of dental caries in a way which had not been previously reported. A framework analysis of data collected in the qualitative phase of a DCE study is proposed to deal with problems in a targeted manner and improve understanding of the DCE survey. Specific guidelines could be designed prioritising the need of preventive treatment for all groups of patients. Policies should target at remunerating dentists more properly for preventive treatment so that they could be motivated to offer more prevention. Implications of results: Preventive treatment could be assigned to a different dental professional including a dental hygienist, therapist or nurse without worsening off to a great extent the welfare of patients. Dentists could be trained to provide more information on the benefits of dietary advice as patients were less likely to prefer such advice. Focus of educational initiatives to enhance prevention should be placed on certain segments of the population instead of entire populations to permit a more efficient use of resources in preventive care.