Monday, October 5, 2015

How Patients’ Decisions Influence Treatment Planning in Restorative Dentistry

As part of treatment planning, you as the dentist introduce options to your patients. After a relaxed conversation, a treatment plan is agreed upon between you and your dental patient. You use the best available research-based literature, clinical experience and patient opinions to guide your treatment decisions. As a dentist, you exercise substantial influence on which treatment method is chosen. Patients’ decisions can lead to less than ideal, though clinically adequate, treatment plans that give patient satisfaction over the long-term1. Patients’ decisions are most affected by their relationship with you as their dentist over factors such as time, access, and cost1. Health service providers may affect the decision-making process between you and your patient if specific treatments are favored or excluded on financial grounds. Kalsi and Hemmings recommends letters should be sent to patients explaining the “nature of all proposed options, including advantages and disadvantages, complications, success rates, biological and financial costs” and the consequences if no treatment is carried out1.

Many psychological and social determinants influence patients’ values and decision-making when choosing a treatment plan in restorative dentistry. Frequently, a component of compromise between both parties in deemed acceptable even when clinical evidence indicates an alternative treatment to be more appropriate.

The best possible treatments should be based on the best available literature; however, the majority of treatment plans are greatly impacted by patients’ desires and expectations, which may not be based on sound knowledge1. Patients’ wishes should be determined at the first treatment planning consultation to sort out whether they are realistic and possible within your own skill set, experience and knowledge1. It is widely known that no dentist should perform any treatment that could harm a patient.

Time, number of appointments, use of anesthesia or sedative agents, pain and suffering are significant aspects to your patients’ decisions when selecting a treatment plan. You need to clarify biological and financial cost-benefit analyses to the patient1. Also identify clinical factors, such as age, medical history and economics.

Patients seek dental treatment for three main reasons: comfort, aesthetics, and function. Patients are the real judge of whether their treatment is successful or not, so it is vital that they are pleased with their dental product1. Their subjective assessments of a proposed treatment do not always correspond with their acceptance of evidence-based suggestions from clinical research literature. This assessment is contingent on the value patients accredit to a treatment. Aesthetic awareness can push patients to ask for destructive, biologically invasive work in situations where appearances could easily and equally be improved with lower risks of morbidity. For example, bleaching and bonding with veneers may “improve aesthetics with the same effect as full coverage crowns, with less tooth destruction and risk of dental pulp death and pain”1.

Factors that affect patients’ decisions when deliberating treatment options:
  Availability and access to care
  Real cost per treatment option
  Perceived value for money
  Past dental history: positive or negative attitudes
  Dentist’s confidence and competence
  Patient’s confidence in dentist’s competence
  Patient’s confidence in the treatment plan
  Time and number of appointments
  Perceived impact to quality of life
  Pain and inconvenience associated with treatment1

Interestingly, patients place more emphasis on your recommendations rather than on objective, evidence-based literature1. If a dentist advocates a treatment, the patient is 2−21 times more likely to have it done1. Comparatively, Kalsi and Hemmings found the endorsements made by evidence-based literature made no difference to a patient when choosing to proceed with a treatment. Confidence in your advice establishes the foundation of a professional relationship with the patient.

The significance of the dentist-patient relationship cannot be minimized, and a positive relationship is most likely to prompt a patient consenting for treatment. Patients put a lot of value on your recommendations. At the same time, patients want to play a collaborative role with you in the decision-making process. A treatment plan that is not evidence-based or approved with the patient runs the risk of losing a patient or, at worst, medico-legal action1. However, treatment plans with an “element of compromise can be acceptable if, following full discussion with the patient, and taking into account all relevant factors, the benefits outweigh the disadvantages. This is the basis of informed consent”1.

About the Company

Since 1991, Iverson Dental laboratories have provided dentists with high quality dental lab products and excellent dental lab services to ensure dental patients are completely satisfied with their restoration outcome. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental prosthetics given that material quality influences longevity of the restoration. Iverson values their skilled team of certified dental technicians because clinical evidence has shown adequate skills of the technician are important for the long-term success of a restoration. Iverson labs strive to be a great dental resource for dental professionals, offering training on CAD/CAM technologies in digital dentistry and advanced dental implant techniques at their cutting edge on-site operatory and training facility.

To find more helpful resources about restorative dentistry or to inquire about our dental lab services, please visit http://www.iversondental-labs.com or call us at (800) 334-2057.



References:

1. The influence of patients' decisions on treatment planning in restorative dentistry. (2013). Dental Update, 40, 698-710.

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