Dental decision‐making under general anesthesia for patients with disabilities: A qualitative study

Abstract

Aims: This paper explores the variables which influence decision-making processes in dentists providing dental care for people with disabilities under general anesthesia (GA). Methods: Face-to-face semi-structured interviews were undertaken on a purposive sample. Audio recordings were transcribed and checked for accuracy. Using thematic content analysis methods open codes were developed inductively.Codes were analyzed further by three authors adopting a deductive approach, leading to final coding, sorting and themes, subtheme and framework development.Results: Three themes emerged. The first theme explored Shared Decision Making, or lack thereof, as it influenced clinical reasoning. The second (Systematic, Analytical) and third (Intuition, and heuristics) themes explored features of clinical judgment as considered under dual process theory. Dentists primarily used intuitive decision-making processes and heuristic styled processes (or cognitive mental frames) assisted in intuition to extract teeth, without engaging type 2 processes. Conclusion:The dentists experience subtle modifiers to their decision-making that ultimately promote extraction of teeth under GA for people with disabilities.Bias training, simulation and post-hoc reflection are examples of recommendations which may be used to improve decision-making in this area.

Determinants of Clinical Decision Making under Uncertainty in Dentistry: A Scoping Review

“…Seven studies assessed the influence of patient factors on confidence in clinical decision making [ 23 , 37 , 38 , 40 , 43 , 44 , 45 , 46 ]. The following inherent factors were considered important in clinical decision making: patient age, dental history, clarity of communication, social circumstances, functional aesthetic demands, smoking and alcohol consumption, and medical history [ 23 ].…”

Qualitative inquiry from multiple perspectives of barriers and facilitators of oral health care for adults with disabilities

“…Despite efforts to seek dental care, many ASHCN may be turned away due to their diagnoses and providers’ real or perceived inability to treat these more complex, challenging patients. Patients’ ability to understand cooperate with dental treatment, as well as their understanding of the process and procedures for oral health care impacts their behavioral tolerance of care 13–15 . Furthermore, inadequate insurance coverage or lack of providers who accept insurance available to ASHCN contributes to differential oral health outcomes 16 .…”

“…Furthermore, inadequate insurance coverage or lack of providers who accept insurance available to ASHCN contributes to differential oral health outcomes 16 . Without regular preventative care, increasingly expensive treatment modalities, such as sedation or general anesthesia (GA), and more invasive dental treatment may be required 13,17 …”

“…Patients' ability to understand cooperate with dental treatment, as well as their understanding of the process and procedures for oral health care impacts their behavioral tolerance of care. [13][14][15] Furthermore, inadequate insurance coverage or lack of providers who accept insurance available to ASHCN contributes to differential oral health outcomes. 16 Without regular preventative care, increasingly expensive treatment modalities, such as sedation or general anesthesia (GA), and more invasive dental treatment may be required.…”

“…16 Without regular preventative care, increasingly expensive treatment modalities, such as sedation or general anesthesia (GA), and more invasive dental treatment may be required. 13,17 Each of these factors confers its own limitations and challenges to patient care. A national survey of general dentists demonstrated that as few as 10% of general dentists treat children with SHCN "very often."…”