Factors Influencing Tooth Preservation Decisions Among U.S. General Dentists: A Cross-Sectional Vignette Study

The aims of this study were to evaluate the decision to extract or treat a tooth with initial root canal therapy (RCT) made by general dentists practicing in the United States; and evaluate the effect of clinical and non-clinical factors on decision-making.

Authors conducted a cross-sectional survey study. Participants read a clinical vignette presenting a questionably restorable tooth for consideration and provided their clinical recommendations. The primary treatment decision was analyzed as a binary variable: extraction or RCT. Other questions about clinical decision-making used the Likert-scale for capturing responses. Clinician related variables were evaluated: age, gender, years of experience, primary practice setting, and participation with payment systems. Kruskal-Wallis tests were used to compare the treatment decision with Likert-scale responses for clinical decision-making. A logistic regression model investigated the effect of clinician factors on the treatment decision.

113 eligible dentists completed the survey. For the presented case, a maxillary first molar, 54% of general dentists recommended initial RCT and 46% recommended extraction. 37.2% of dentists responded that the patient's tooth was somewhat or very likely restorable. None of the evaluated clinician factors were statistically significant in predicting the treatment decision. Borderline significance (p=0.05) was noted for general dentists primarily practicing in academic settings; they had 3.57 times the odds of recommending tooth extraction than dentists primarily in private practice (p=0.05).

This study found that general dentists' decision to either save a tooth with initial root canal therapy or extract was primarily associated with perceived tooth restorability.