Decision-making regarding dental treatments - What factors matter from patients' perspective? A systematic review

Achieving oral health for the population should be a concern of public health care systems, as it may affect their expenditures in the long term. Patients often face individual challenges in dental care. Why patients decide for or against dental treatments can be determined by many factors, e.g., their own financial resources, preferences, and external circumstances. This cross-country study aims to identify those factors.

We systematically searched for literature in the biomedical databases PubMed (including MEDLINE), the Cochrane Library, and Web of Science to identify factors influencing dental treatment decisions across different countries. Factors of choice were extracted from relevant articles to develop a codebook for subsequent qualitative analysis using an inductive thematic analysis approach. Study quality was assessed using the Mixed Methods Appraisal Tool (MMAT). This systematic review followed the guidelines of the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) and the Synthesis Without Meta-analysis (SWiM) statements.

After multistage screening of N = 4,226 publications by two reviewers, N = 233 relevant articles of different study designs (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., dental practices (N = 18)) and approaches (e.g., interviews) in 49 countries. Included articles focused on specific treatments (e.g., caries treatment) or treatments in general (e.g., dental tourism). Across the countries, various factors of choice (n = 101) were identified, divided into three categories: (I) "Dentist & dental institution" (e.g., communication), (II) "Patient" (e.g., dental fear), and (III) "Treatment" (e.g., durability). The factors 'out-of-pocket payment' and 'dental fear' were identified in most of the articles (N = 136, N = 64) and were mentioned most frequently (code frequencies: n = 151, n = 73). In countries with the most articles (e.g., the UK (N = 28), Saudi Arabia (N = 23), the USA (N = 22), India (N = 19), and Brazil (N = 14)), also 'out-of-pocket payment' was identified most often (e.g., the UK: in 56% of the articles; India: 68%). Frequency of the factor 'dental fear' varied by country. One publication addressed the COVID-19 pandemic. It reported that treatment appointments were postponed and canceled by patients due to their fear of infection with SARS-CoV-2. The quality of the included studies varied considerably.

A range of factors influence patients' choice regarding dental treatments. Understanding patients' motivation for seeking dental care can guide the development of interventions (e.g., awareness campaigns and health literacy efforts) that support proactive dental care. To improve oral health outcomes and reduce access barriers, tailored regulatory and informational strategies are essential.