Caries prevention-education and payment increases delivery

Dental caries remains a significant public health problem the burden of which is greatest among poor and disadvantaged group. Treatment of dental disease can account for 5-10% of health care spending yet it is almost totally preventable. However, the provision of caries prevention measures by dentists is highly variable.

The aim of this systematic review was to analyze studies that have investigated the factors that drive dentists towards or away from dental caries preventive measures and conduct a metasummary of the results found.

Methods

The PubMed, Embase, PsycoInfo, Scielo, Scopus, Web of Science, BBO, Lilacs York databases and Google Scholar were searched. Qualitative studies and surveys factors that drove dentists (public and private) towards or away from incorporating dental caries preventive measures in their practice were considered. Two reviewers independently selected studies and abstracted data. Study quality was assessed. A qualitative metasummary was conducted which allowed the calculation of frequency and intensity effect sizes (ES).

Results

48 studies were included, 7 qualitative studies (390 participants) and 41 surveys (36,111 participants).
24 of the surveys were assessed to be at high risk of bias, 17 at low risk.
6 of the qualitative studies were considered to be at low risk and 1 at moderate risk of bias.

Frequency effect sizes (ES)
to drive dentists away from prevention		For dentists adherence to preventive measures
Biologicism	27%	Team work	21%
Remuneration for prevention	25%	Postgraduation	12%
Time since graduation	22%	Professional understanding of benefits	12%
Male dentists	19%

Conclusions

The authors concluded:

Despite the questionable quality of the included reports, the evidence that emerged seems to indicate that further education and training coupled with a fairer pay scheme would be a reasonable approach to change the balance in favor of the provision of dental caries preventive measures by dentists. The results of this review could be of value in the planning and decision making processes aimed at encouraging changes in professional dental practice that could result in the improvement of the oral health care provided to the population in general.

Commentary

This is an interesting review that pulls together a small number of qualitative studies and a larger selection of surveys. It identifies an number of elements affecting dentists’ motivation to perform or not preventive measures in their patients; dentists’ dental education and training, personal beliefs on prevention, remuneration, work conditions, gender, place of residence. Education and training was seen to have an important impact with those more actively involved in continuing professional development and education being seen as more likely to embrace prevention. Funding mechanisms were also seen to be important which as the authors note agree s with recent Cochrane review by Brocklehurst et al (Dental Elf 15^th Nov 2013).