Third molar treatment outcome: a comparison of patients' preferences in Sweden and Wales

Abstract

A Ai im m To elucidate and compare patients' outcome preferences for removal and retention of mandibular third molars in Sweden and Wales. S Su ub bj je ec ct ts s a an nd d m me et th ho od d The subjects comprised patients referred and scheduled for removal of one or both mandibular third molars in Sweden and Wales. The multi-attribute utility (MAU) methodology was applied to study patients' preferences for outcomes of removal and retention of the mandibular third molar. R Re es su ul lt ts s Relative weighting of domains was similar in the two countries. 'Home and social life' received the highest relative weighting in Sweden and 'general health and wellbeing' in Wales. 'Your appearance' received the lowest relative weighting in both countries. In both Sweden and Wales operative jaw fracture was considered to be the outcome with most impact and dentigerous cyst and imbricated incisors the least impact. Outcome ranking was similar in both countries and operative outcomes were considered by patients to be more detrimental to health than retention outcomes. C Co on nc cl lu us si io on ns s This comparison showed that patients' preferences in Sweden and Wales were similar and that the outcomes of surgery were considered worse after third molar removal than retention. Patientorientated treatment decisions were less subject to variation than clinician-orientated decisions. INTRODUCTIONEvidence-based healthcare incorporates the 'conscientious, explicit and judicious use of current best evidence in making decisions about the care of individual patients' . 1 This approach to healthcare encourages clinicians to interpret evidence on an individual patient basis and to include assessment of patient outcome preference in decision making. Patients' preferences in healthcare settings reflect many factors. It is increasingly appar- ent that these are both medical and non-medical, and include social, cultural and economic factors. Whilst traditional utility assessment methods fail to integrate non-medical factors, 2 multi-attribute utility (MAU) methodology, allows assessment of both medical and non-medical factors. 3

Incidence of symptoms in previously symptom-free impacted lower third molars assessed in general dental practice

“…A study that compared patients' outcome preferences for removal and retention of mandibular third molars in Sweden and Wales found that the outcomes of surgery were considered worse after third molar removal than retention. 17 In another study where patients had a third molar removed, more patients found that the effect on intake and enjoyment of food was a more adverse event than pain following surgery. 18 In the distally impacted lower third molar issue we must remember that there is a chance that some impacted lower third molars which are mesially or vertically impacted will change their position to a disto-angular position.…”

Prophylactic removal of impacted mandibular third molars: a systematic review and economic evaluation

“…Of these, 34 papers were considered for inclusion after stage 1. As shown in Figure 2, eight studies 17,20,[71][72][73][74][75][76] were initially included at stage 2. However, on further inspection, five [71][72][73][74][75] of the eight studies did not include information that was relevant to the population of interest; these papers were, therefore, subsequently excluded from the review.…”

“…As shown in Figure 2, eight studies 17,20,[71][72][73][74][75][76] were initially included at stage 2. However, on further inspection, five [71][72][73][74][75] of the eight studies did not include information that was relevant to the population of interest; these papers were, therefore, subsequently excluded from the review. Bibliographic details and summary data from these five studies [71][72][73][74][75] are available in Appendix 2.…”

“…However, on further inspection, five [71][72][73][74][75] of the eight studies did not include information that was relevant to the population of interest; these papers were, therefore, subsequently excluded from the review. Bibliographic details and summary data from these five studies [71][72][73][74][75] are available in Appendix 2. Of the 34 papers considered for inclusion after stage 1, 31 were excluded during stage 2, which left three papers 17,20,76 to be included in the review.…”