Dentists’ restorative treatment decisions: A south african study

Abstract

Aim: To focus on clinical decision-making by dentists for defective restorations in the context of an overburdened healthcare system and a high caries rate. Materials and Methods: A cross-sectional study was conducted using mixed-methods. An online survey was administered to all members of the South African Dental Association followed by in-depth interviews of 15 purposefully selected dentists in the Western Cape. The online data included demographic data, education level, knowledge, attitudes, and practises related to dental amalgam use. The interviews consisted of two patient cases where dentist were asked to explain their treatment decisions. Quantitative data was analysed using statistical software SAS (SAS Institute Inc., Cary, NC, USA) and a Chi-square test and Spearman’s correlation was used with P < 0.05. The interviews were coded, transcribed, and analysed using the Atlas.ti ® software. Responses were analysed using the framework method. Results: A significant relationship was found between dentists with more than 21 years of experience and the repair of defective restorations (P = 0.0027*). Remaining tooth structure and the presence of pain were the most important clinical factors influencing treatment decisions. Non-clinical factors such as fear, ethical conscience, cost to patient and dental school had an influence on their decisions. Conclusion: Clinical factors and non-clinical factors influence dentists’ treatment decisions. There was a lack of translation of evidence-based information to everyday general practice dentistry in South Africa. These results have implications in changing current continuing professional education activities and motivating policy makers to incentivize preventive and minimally invasive dentistry.