Patients' preferences for selective versus complete excavation: A mixed-methods study

Objectives: Despite increasing evidence supporting selective caries tissue removal, the technique is not adopted by most dentists, one possible reason being that patients might reject it. We aimed to assess patients' preferences for selective versus complete excavation, and to identify predictors of this preference. Methods: A sequential mixed-methods approach was taken. First, semi-structured focus group discussions on two convenience samples were performed. Verbatim transcripts were evaluated using content-analysis to inform quantitative study design. The subsequent survey employed convenience, snow-ball and deviant-case sampling, yielding 150 respondents. The relevance of treatment attributes (risks of nerve damage, root-canal treatment, recurrent caries, restorative complications, treatment costs, aesthetic consequences) on patients' treatment preferences was measured using case-vignettes. Dental experience and anxiety as well as patients' personality and socio-demographic details were recorded. Association of predictor variables (age, gender, education, partnership status, personality items, dental experience, anxiety) with treatment preference was assessed using regression analysis. Results: Focus group participants perceived complete excavation as reliable, but feared endodontic treatment. The vast majority of survey respondents (82.7%) preferred complete over selective excavation. The preference for selective excavation was significantly increased in patients with an emotionally stable personality (p < 0.001), university entrance degree (p < 0.001), none or little dental anxiety (p = 0.044), few dentist changes in the past (p = 0.025), and who accepted that sealed lesions could progress (p < 0.002). Conclusion: Treatment attributes, socio-demographic characteristics, personality and dental experiences shape patients' preference towards caries excavation. Clinical significance: Clinical decision-making regarding carious tissue removal might be affected by dentists on both an informative and an empathic level. (C) 2016 Elsevier Ltd. All rights reserved.