How people make decisions about whether or not to seek orthodontic care: Upstream in the treatment chain.

Abstract

"Upstream" decisions by patients are important in determining whether they seek orthodontic care for their children and for themselves and whether they seek care from general dentists or from orthodontists. Classic marketing theory suggests that purchase decisions naturally progress through a sequence beginning with awareness and proceeding to information, emotional preferences, and final purchase commitment. A survey was used to assess patient demographics and care history, motives for seeking care for themselves and their children, perceived barriers to care, trust in various sources of information, and preference for treatment by a general dentist or by an orthodontist. Three hundred fifty-two responses were received from patients in all states in the United Sates attending their general dentists. Care for children was most often initiated in response to a suggestion from the family dentist, and traditional treatment with braces was expected. Adults were slightly more likely to make a decision for care themselves and for appearance reasons, often with "invisible" braces. Cost was the principal barrier to seeking care for either functional or appearance reasons. More personal and individualized sources of information, such as the family dentist or referral to a specialist were strongly more influential, with indirect sources, such as dentist Web pages or advertisements, being least influential. There was a preference for care by orthodontists compared with general dentists for functional reasons and when complications were anticipated. Orthodontists were seen as being better at identifying complications, managing complications, and delivering reliable results. Orthodontic care provided by general dentists was favored for convenience and based on established relationships. Patients with more education, higher incomes, and more preventive oral habits preferred treatment by orthodontists. Although it was expected that orthodontists would charge more, income and cost were not factors among those considering treatment. This study suggests that orthodontists should focus on educating potential patients about the functional health features of treatment for malocclusions, especially for children. Furthermore, orthodontists would benefit from working with general dentists, given their role as gatekeepers in the sequential process of reaching an upstream decision about seeking orthodontic care.