Discussions regarding dental recall interval: preferences for shared decision-making in dentistry

Problem

In 2004, the NICE published guidelines recommending that dentists should tailor the interval between patients’ check-ups according to their disease risk. This would mean that those patients who were deemed low risk should be recalled at 12-24 months, instead of every six months, subsequently freeing up resources that could be used to improve access to NHS dental care. Research has shown, however, that few dentists implement risk-based recall guidelines. Since the publication of guidelines has not changed dental recall behaviours, it is important to understand how these decisions are made and the role patients play in them. Shared decision-making, whereby the patients and practitioners work in partnership to make decisions about care, is now considered an integral part of medicine and dentistry. It is therefore important to understand the barriers and facilitators to both risk-based recall intervals, from the point of view of both dentists and patients, and the implementation of shared decision-making techniques into consultations about dental recall.

Approach

Semi-structured telephone interviews were conducted with 25 dentists and 25 NHS dental patients, to explore current practices regarding recall interval setting, and barriers and facilitators to shared decision-making.This work was undertaken as part of a study to develop a patient decision aid that can be used by dentists and patients to support dental recall interval setting in general dental practice.

Findings

Dentists believed that shared decision-making was an important part of their practice, despite a lack of clarity of how this differed from informed consent. Reasons for involving patients in decisions about their care largely centred on the desire to encourage patients to take ownership of their health, as well as mitigating the threat of litigation faced by dentists. Dentists’ perceptions of their patients’ willingness and ability to engage in shared decision-making varied; dentists reported some patients wanting to be heavily involved in decisions about their dental care, and others wanting the dentist to make the decisions. Some patients were not aware that dental recall intervals could be anything but six months and had never previously discussed their recall interval with their dentist. Some wanted to be involved in a discussion with the dentist and demonstrated prior involvement in decisions about their restorative dental care. However, others were of the opinion that the dentist was the ‘expert’ and should therefore be the one making the decision, or expressed ambivalence regarding the frequency of their dental appointments.

Consequences

These findings highlighted a need to support patients and practitioners to collaboratively engage in shared decision-making in dental care. They will inform the development of a concise and patient-friendly shared decision aid suitable for use in busy NHS general dental practice.