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.

What Factors Influence Patient Satisfaction in Restorative Dentistry

According to “The Dental Practice-Based Research Network” (GPBRN), five general factors that influence dental patient satisfaction include:

1.  Technical quality of care

2.  Interpersonal factors

3.  Convenience

4.  Financial issues

5.  Office environment

Patient Satisfaction can influence a “patient’s likelihood of choosing a dentist, making and keeping appointments, and complying with dentists’ recommendations” ^[1]. Satisfaction can be considered a combination of the dissonance between the patients’ expectations and their experiences. Therefore, patient satisfaction is an important part of dental care that has the potential to impact restorative dentistry treatment outcomes ^[1].

Higher ratings of patient satisfaction in restorative dentistry occurs in cases with more experienced dentists because of greater proficiency, when the defective restoration is repaired rather than replaced, when restorative materials are a natural tooth color material rather than amalgam, and when the tooth is a premolar or an anterior tooth.

Effectively communicating the patient’s treatment plan and paying attention to concerns they may have are the most prominent components when patients are judging a dentist’s skill and quality of care. Whether the dentist recognizes their patient’s pain, talks over their fears, and aids in conquering their fears are very significant in terms of patient satisfaction. Patients deduce dental expertise from the dentist’s capacity to manage discomfort and provide a dental visit free from negative experiences.

It is vital to include patients in treatment decisions on medications, restorative material options and dental prosthetic procedures. Dentist’s who educate and involve their patients in treatment decisions, provide adequate time to comprehend facts and have their questions satisfactorily answered are more likely to have higher rates of satisfaction among their patients. Patients who are given more preparatory information have much better control of postoperative discomfort because their dentist effectively communicated what they should expect in terms of pain and how to control the discomfort.

Indeed, patients tend to use non-technical aspects of dental visits to appraise dentists’ technical capabilities. A dentist’s skills and quality of care are partially based on personal interactions with the dentist, the patient’s level of comfort, and post-treatment sensitivity. Steps can be taken to improve patient satisfaction by changing office policies or procedures, patient education and involvement, and/or the dentist’s interpersonal methods.

Dental practitioners should remember that human and psychological aspects of care are essential factors in determining the quality of care provided.

About the Company:

Since 1991, Iverson Dental laboratory has provided dentists with high quality dental lab products and excellent dental lab services to ensure their dental patients are completely satisfied with the restoration outcome. Iverson dental labs strive to be a great dental resource for dentists by offering training on digital dentistry and new dental implant techniques at their high-tech on-site operatory and training facility. Iverson dental labs strongly believes in using high quality certified materials and authentic manufacturing components to fabricate their dental prosthetics. Iverson Labs also strongly believes in having a knowledgeable team of certified dental technicians because clinical evidence has shown the skills of the clinician and technician are important for the long-term success of a restoration.

Reference:

1. Riley, J., Gordan, V., Rindal, D., Fellows, J., Qvist, V., Patel, S., . . . Gilbert, G. (n.d.). Components of patient satisfaction with a dental restorative visit. The Journal of the American Dental Association, 1002-1010.