Clinical Decision Making and Periodontal Treatment - General Dentists' Perspectives

Objectives: to explore which factors affect (a) how general dentists make decisions concerning treating patients with periodontal disease (Aim 1), and (b) their expectations of treatment outcomes (Aim 2). Specifically, it will be explored which (a) diagnostic considerations, (b) provider, and (c) patient factors affect this process.

Methods: Data were collected from 117 members of the Michigan Dental Association. The dentists were predominantly male (81.9%), white (91.1%), and averaged 46.85 years (SD=11.849).

Results: When general dentists were asked which probing pocket depth and which percentage of radiographic bone loss they use to make a decision to extract a tooth or recommend periodontal surgery, their responses showed that these responses varied considerably (Need for extraction: 4 to 15 mm; 0 to 100%; Need for surgery: 2 to 12 mm; 0 to 80%). However, the different indicators were significantly correlated (mm for extraction / mm for surgery: r=.42; p<.001). Factors that correlated with the percentage of bone loss considered when recommending extraction were provider characteristics such as age (r=-.245; p<.03), years practiced (r=-.235; p=.039), and the number of hours worked per week (r=.217; p=.056), as well as patient factors such as the patient's ability to pay (r=.235; p=.039), and the quality of the rapport with the provider (r=.215; p=.060). In addition, the dentists' expectations for positive treatment outcomes were also affected by provider and patient factors.

Conclusion: Given the findings of a recent study that showed that some general dentists refer patients with periodontal disease not at all or too late to periodontists, it seems important to gain a better understanding of their decision making process and the considerations they take into account when they recommend a treatment for patients with periodontal disease. These data showed that provider characteristics as well as patient-related factors are considered in the decision making process.