Patients' perceptions of the decision‐making process leading to extraction of permanent teeth in Norway

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Abstract
Extraction is the final step in a continuous process in which oral health‐related factors and psycho‐social processes play a role. The purpose of the present study was to investigate the patient's perception of the decision‐making process leading to the extraction of permanent teeth and to determine whether and how patient‐associated characteristics might influence who made the decision to extract and if the patients felt they had any influence on the dentist's decision. A national random sample of Norwegian dentists (n=500) recorded reasons for tooth extraction during a period of 2 weeks in 1988. A total of 437 patients responded (73%), of whom 54% were women. Nearly 33% of the respondents slated that it was their own decision to extract, while about two thirds said that the dentist had suggested extraction. Whether the dentist or the patient made the decision to extract teeth was significantly influenced by the patient's dental attendance pattern, place of residence, number of teeth and belief in retention of his/her own teeth for life (P < 0.05). There was no significant bivariate effect of patients' age, sex. educational level, or score on Corah's Dental Anxiety Scale on who made the decision to extract. Only 0.4% of patients said that family, friends or colleagues had influenced the decision to have teeth extracted. A logistic regression analysis with: “Was it the dentist or the patient who made the suggestion to extract teeth?” as the dependent variable, and the four bivariately significant independent variables showed for all patients that none had a significant effect. For the group of patients with no extractions of third molars and because of orthodontic reasons, only the variable education was found to be significant. It is concluded that even when the decision to extract was the dentist's, most patients felt that they had an influence on it. Family, friends and colleagues had almost no influence on the decision. The only patient characteristic having a significant effect on who made the decision to extract was educational level.

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