Working Poor Canadians Dental Treatment Preferences: Extraction versus Restorative Treatment

Background: Anecdotal reports suggest that income-deprived individuals opt for tooth extractions rather than restorative dental treatment options because of the cost differentials. Objective: The objective of this study was to explore the treatment preferences of working poor Canadians by identifying factors predicting extraction versus restorative treatment preferences. Method: A cross-sectional stratified sampling approach and telephone interviews collected data from a nationally representative sample of 1049 working poor individuals aged 18 to 64 years. Working poor persons worked for pay at least 20 hours a week, were not full-time students and had annual family incomes below $34,300. Trained interviewers used a pre-tested questionnaire including sociodemographic items, self-reported oral health indicators, dental visiting behaviour items and payment method items. Two items presenting hypothetical scenarios assessed respondents' preferences for having a “filling” or a “crown” rather than an extraction. Results: Most respondents preferred restorative treatment options, opting to “fill” (85.6%) or crown (80%) a tooth rather than have it extracted. Multivariate logistic regression identified three significant predictors of opting for tooth extraction after adjusting for other variables in the model: denture wearing [OR= 3.04 (95% CI: 1.49, 6.24); p=0.002]; last visit to the dentist > three years ago [OR= 2.38 (95% CI: 1.10, 5.15); p=0.03] and visiting the dentist only when in pain [OR= 3.56 (95% CI: 1.83, 6.93); p<0.001]. Conclusion: Working poor persons' preferences for tooth extractions were related to their denture wearer status (indicating a history of tooth extraction) and contact with dental health professionals. Grants: Ontario Ministry of Health and Long Term Care; CIHR Strategic Training Fellow, STP-53877