A Study to Scrutinize the Aspects Concerning Patient Decision-making and Dental Prosthesis Selection.

Introduction: Apt treatment scheming and decision-making are essential when fabricating dental prostheses that satisfy the patients' needs and have acceptable lifetime and function. As a result, not only do the dentist's technical skills and clinical judgment matter, but the patients' attitude toward treatment also matters when it comes to posttreatment contentment. Aim: The goal of this trial is to contemplate the elements that impact patients' decision-making and dental prosthesis choice. Materials and Procedures: A cross-sectional survey was done to examine patients' attitudes toward tooth auxiliary. This survey was organized using a prevalidated questionnaire that included each patient's demographic information, either they accept or deny the dentist's treatment plan, and a closed-ended multiple-choice question describing the reasons.
Results: The data were statistically analyzed using the Chi-square test with a significance threshold of P = 0.05. The top five reasons were excessive costs (35%), fear of dental treatment (20%), lack of need (15%), unwillingness to undergo preprosthetic therapy (11%), reliance (6%), and other factors (13%).
Conclusion: The majority of patients in the sample population analyzed denied the offered treatment plan and agreed to take the substitute. The most prevalent reason for this rejection is excessive spending. Copyright:

INTRODUCTION

Teeth play a crucial function in maintaining an encouraging self-perception.[12] Tooth loss is distressing and disconcerting, and it is considered a major life affair that necessitates extensive social and psychological readjusting.[34] It has been hypothesized that negative feedbacks to edentulousness, as well as sentiments regarding dentures, are crucial factors in determining whether new dentures are accepted.[5] Many prosthetic treatment decisions, such as removable, fixed, or implant-supported prostheses, may be propounded for an explicit clinical context. Prosthodontic treatment decisions and treatment considerations have traditionally been regarded as a component of the practitioner's professional obligation. Patients are progressively taking a dynamic part in establishing their authentic treatment requirements in modern clinical practice by stating their expectations and restrictions.[6] Ease, role, and esthetics are the three key factors that govern whether therapy is acceptable.[6] Luxury and purpose are determined by mechanical and biological variables. Patients' acceptance of the esthetic features of prosthodontic therapy, however, may be influenced by a range of societal and cultural impacts, insolences, and opinions.[7] In prosthetic treatment planning, more focus is being sited on patient-arbitrated issues. As a result, more information on rational treatment requirements and socio-dental treatment requirements of various populaces has been provided.[89101112131415] Patients' insolences toward treatment, as measured by a questionnaire before they receive treatment, could be a useful means for determining gratification with the treatment chosen.[9] Gender, age, schooling, economic status, curiosity and expectations about health, and the surrounding environment are all expected to play a role in deciding whether to get dental prosthesis therapy.[6] As a result, the intention of this trial was to assess patients' decisions regarding tooth auxiliary, which is sited in Kerala. To the author's knowledge, no study has been done in Kerala to assess patient decision-making and dental prosthesis selection.

METHODOLOGY

A cross-sectional scrutiny was done to examine patients' attitudes toward tooth auxiliary. The Institutional Ethical Committee provided ethical approval. This scrutiny was conducted in two sections using a prevalidated questionnaire.

Part A included demographic data such as the patients' name, age, gender, educational status, marital status, and monthly income, trailed by clinical scrutiny noted by a single calibrated investigator to eliminate concerned worker's bias. This section of the trial allowed for a better understanding of the patient's decision-making course. The socioeconomic position of the patients was classified using Kuppuswamy's socioeconomic scale, which covers education level, monthly income, and occupation.[12345]

As a result, socioeconomic status was divided into five categories: upper (I), upper-middle (II), lower-middle (III), upper-lower (IV), and lower-lower (V).

Part B of the questionnaire included a closed-ended MCQ that the patient had to complete. To improve data processing and avoid ambiguity, it was written in both English and the regional language Malayalam. The options were a list of the top 12 reasons for refusing or agreeing to an alternative treatment strategy. These factors were discovered after speaking with ten dentists. All of the patients were informed about the research and were enrolled in the trial after giving their consent. The Statistical Package for Social Sciences software was used to conduct all of the data analyses (IBM SPSS Statistics V 21.0). The Chi-square test was used to statistically assess the collected data at a significance level of P = 0.05.

RESULTS

A total of 500 patients (250 males and 250 females) amid the ages of 18 and 88 were included in the trial (mean age: 44.29 years). Only 10% of the total 500 plaintiffs accepted the dentist's treatment plan, while 90% refused or accepted alternate treatment. As a result, “N” refers to the number of participants who refused the anticipated treatment plan (N = 450). Table 1 lists the 12 reasons why participants declined to have the prosthetic therapy completed.

Table 1

Reasons for not accepting the proposed treatment plan

Reason for not accepting treatment	Percentage out of n=450 (%)
I am not convinced about the treatment plan	1
I do not have time/I am busy	1
The treatment is expensive	35
I am dependent on someone for else for health/travel/money who is not agreeing	6
I do not feel fit to come for the required number of appointments	1
I do not feel the need for this treatment	15
I am fearful of the treatment/the dentist	20
I do not have confidence in the dentist	1
The hospital is far from my house	1
I do not want to undergo the required preprosthetic treatment	11
I need urgent/quick treatment	1
I have a bad past dental experience	7
Total	100

The top five reasons were excessive costs (35%), fear of dental treatment (20%), lack of need (15%), unwillingness to undergo pre-prosthetic therapy (11%), reliance (6%), and other factors (13%). They were then statistically analyzed using the Chi-square test to determine whether the factors were significant. To study factors connected to the reasons mentioned by the respondents for not being compliant with the offered treatment plan, a statistical analysis of sociodemographic features and prosthetic treatment decision-making was conducted. Table 2 displays the statistical significance of the association table between “fear” and gender. There is apparently a link between “fear” and previous dental experience [Table 3].

Table 2

Association between reasons cited as “fear” and gender

Gender	Yes (n=90) (%)	Level of significance
Female	12.4	0.005
Male	7.6	0.004

Test used: Pearson’s Chi-squared test with Yates’ continuity correction. P=0.005.

Table 3

Descriptive statistics between reasons cited as “fear” and past dental experience

Past dental experience	n=32 (7%)	Level of significance
Very good	0	0
Good	0	0
Satisfactory	1	0.005
Bad	4	0.004
Very bad	2	0.005
No experience	0	0

Test used: Pearson’s Chi-squared test with Yates’ continuity correction. P=0.005.

DISCUSSION

Patients conveyed a wish to substitute their missing teeth since tooth loss has cosmetic, functional, phonetic, psychological, and social consequences for them. For tooth prosthetic reconstruction, there are various treatment methods available, including removable and fixed prosthetics.[91011] Complete dentures, interim, and cast partial dentures are examples of removable prostheses, whereas crowns, bridges, and implants are examples of fixed prostheses.[12] The selection of a prosthesis is a joint verdict between the dentist and the patient. Many researchers have looked into the elements that influence dentists' clinical decision-making when it comes to prosthesis selection.[1314] The happiness of patients with prosthetic treatment after it has been completed has also been investigated.[15] Investigation on how to effectually train dental graduates in clinical decision-making in prosthodontics is also available in the literature. However, there is less evidence in the literature for evaluating patients' treatment decisions before they begin treatment.[16] This information relates to whether patients agree to take the optimal treatment strategy offered to them or choose a substitute, as well as the excuses behind their decision. There are various reasons for this, embracing age, expense, time, and fear of therapy. It is noteworthy in various ways. One example is its ramifications in innumerable government healthcare strategies that must be maneuvered because ours is still a developing country and these strategies are based on the general population's healthcare requirements. If we understand patients' attitudes toward tooth auxiliary and the different factors that influence their treatment choices, we may take steps to improvise the standard of care, particularly in rural areas. Patient acquiescence with prosthetic compliance can also be improved.[1415161718] Furthermore, based on the findings of such surveys, trials might be directed toward developing newer prostheses/materials that meet the needs and wants of patients. Dental insurance should be included in the government's planned programs so that people can pay for the dental treatment that is best for them. Even though there was an exceedingly significant relationship between the motive for deterioration being “high expenditure” and income, it is worth noting that there was no significant relationship between socioeconomic status and high disbursement, emphasizing the magnitude of education and profession in an individual's decision-making ability. In comparison to 7.6% of males, nearly 12.4% of females cited “fear” as the purpose for denying the anticipated treatment plan, indicating that women are extra prone to be concerned about dental prosthetic therapy than men. Table 2 shows that people who have had a terrible dental experience in the past are more “frightened” of the treatment than those who have had a positive dental experience. Table 3 shows how dental education camps, the use of print media such as newspapers, adverts, banners, and posters, as well as visual media such as short films and videos can be used to raise public knowledge of treatment processes and their advantages. According to Osterberg et al.,[19] cosmetic rather than functional aspects govern an individual's subjective demand for missing tooth auxiliary, which was validated in the current investigation. This indicates that the mandate for missing tooth auxiliary and acceptance of the suggested treatment strategy are both substantially influenced by the missing teeth's position. More trials from the perception of patients should be undertaken so that better policies may be developed to help patients achieve their optimal treatment plan.

CONCLUSION

This study has a few drawbacks, including a small sample sizing and an institutional setting where prosthetic therapy costs are lower than in private dental care centers. The majority of patients turned down the anticipated treatment plan in favor of the alternate. The most prevalent ground for this denial is excessive spending. Females were more apprehensive about dental prosthetics than males. Men were not much cognizant of the treatment's advantages. As a result, prompt intercession in the form of measures to raise general population prosthetic cognizance, supply of dental insurance coverage, and research on cost-effective materials is essential to address these difficulties.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.