Mapping the Conflict Between Oral Health and Patient Autonomy in Dentistry: A Unified Qualitative-Quantitative Study

Patients' interests encompass both medical indication and their autonomous requests; however, these two aspects often conflict. We aimed to map this ethical dilemma considering dentists' and patients' perspectives.

We included patient and dentist subsamples, applying quotas for sex and leadership experience among dentists, and quotas for sex and age among patients. We conducted semi-structured interviews, developed codes using prior theory, and inspected the coded dataset using Epistemic Network Analysis, a method that visualizes code co-occurrence patterns.

Dentists' narratives indicated a preference for performing esthetic procedures that also had a medical indication; albeit, they encouraged patients to make treatment decisions by informing adequately. Patients often justified esthetic procedures by associating esthetics with health, while in other cases, they based decisions on prior experiences and perceived comfort.

Ethical theory adopted from literature was insufficient to fully capture complexities, particularly in-patient narratives. These findings indicate a need for novel ethical approaches that better reflect patients' reasoning.

If individual dentists or higher-level stakeholders advocate for change, they must account for patient's subjective perspectives and lived experiences.