What is the role for shared decision-making in dental recall interval setting?

Problem

Clinical guidelines recommend that the frequency of dental check-ups should be tailored to patients’ risk of oral disease. Risk-based recall interval for adult patients may range from 3-months (for patients at high risk of disease) to 24-months (low risk patients). However, there is still uncertainty as to whether risk-based recalls are more clinically or cost-effective than regular 6-month recalls. In situations where there is no clear evidence of the superiority of one management strategy over another, how patients value the risks and benefits of different options becomes particularly important. Since it is known that patients may have preferences regarding both the frequency and costs of dental visits, shared decision-making may have a role to play in decisions about dental recall interval.

Approach

This study aimed to describe current arrangements regarding dental recall interval setting and explore the potential role for shared decision-making in these decisions. Semi-structured telephone interviews were conducted with 25 NHS patients and 25 NHS general dental practitioners in Wales, UK. Transcripts were thematically analysed.

Findings

In contrast to decisions about operative treatment, in which many patients wanted to actively participate, most patients expected their dentist to guide them in advising about recall interval. Most patients reported they would happily accept small changes to their recall interval having considered the impact on time, travel and cost of care. However, most would be unhappy to extend their recall interval beyond 12 months.

Although dentists’ understanding of shared decision-making varied, practitioners placed importance on involving patients in decisions about their dental care. However, some dentists thought that decisions about recall interval should be clinically led. Since having in-depth discussions about treatment options can be time-consuming, dentists may prioritise the extent to which they engage patients on different decisions. As a result, discussions about oral health education and operative treatment may be prioritised over those about dental recall.

Consequences

Patients are likely to have preferences about the frequency of their dental check-ups, as evidenced by a strong desire to be seen at least once a year. Since uncertainty exists about the most clinically and cost-effective dental recall strategy, consideration should be given to whether greater emphasis should be placed on eliciting patient preference in relation to decisions about dental recall.

The current study has also highlighted a number of barriers to the use of shared decision-making more widely in primary dental care. There is a need for evidence as to how educational interventions could increase dentists’ awareness, understanding, and implementation of shared decision-making. Furthermore, if there is a desire to increase the use of shared decision-making in NHS general dental practice, contracting arrangements should incentivise the involvement of patients in decisions about their care.