Patients’ factors of choice in dental care and impact of the Covid-19 pandemic – a systematic review

Abstract

Abstract Background Patients often face individual challenges at their dentist, e.g., high co-payments. Why patients decide for or against dental treatment can be determined by many factors: own financial resources, preferences, and external circumstances. The study's aim is to identify these factors with an international perspective. Methods We systematically searched for literature in three biomedical databases. Factors of choice etc. were extracted from relevant publications. We used a qualitative approach for analysis, and the MMAT (Mixed Methods Appraisal Tool) for quality assessment. Results After multistage screening of n = 4,226 publications by two reviewers, n = 233 relevant articles of different study types [qualitative (n = 42), quantitative (n = 177), and mixed-methods (n = 14)] were included in the analysis. Data collection was realized across different settings [e.g., practice (n = 18)] and approaches (e.g., interviews) in n = 49 countries. Included studies focused on specific treatments (e.g., caries treatment) or treatments in general (e.g., dental tourism). Across countries, various factors of choice (n = 101) were identified, divided into three categories: (I) ‘dentist & dental institution’ (e.g., communication), (II) ‘patient’ (e.g., fear), and (III) ‘treatment’ (e.g., durability). Cost and dental fear were mentioned most frequently (n = 148, n = 73). In countries with most articles [UK (n = 28), Saudi Arabia (n = 23), USA (n = 22), India (n = 19), and Brazil (n = 14)], the cost factor was identified most often [e.g., USA (n = 16, 73%)]. One publication addressed the Covid-19 pandemic reporting that treatment appointments were cancelled by patients due to their fear of infection with SARS-CoV2. Study quality is highly variable. Conclusions A variety of factors influence patients’ choice regarding dental treatment. There is little research on impact of the Covid-19 pandemic. Regulatory measures and information efforts should be adapted to reduce patients’ access barriers to dental care. Key messages • A variety of factors influence patients’ choice regarding dental treatment. • Fear of SARS-CoV2 infection is a new factor of choice in dental care from patients’ perspective.