Private practice dentists’ conceptions of overtreatment: A qualitative study from Norway
DOI:
https://doi.org/10.2340/aos.v83.42269Keywords:
Ethics, working life, contractor, employee, working environmentAbstract
Objective: As overtreatment has gained attention and is a threat to sustainable healthcare, the objective of this study is to investigate Norwegian private practice dentists’ conceptions of overtreatment.
Material and Methods: Six private practice dentists were interviewed. Interviews were transcribed verbatim and analyzed by thematic analysis in a six-step process including coding and identifying main- and sub-themes.
Results: The main themes identified were conceptions of overtreatment, internal factors, and external conditions of importance for overtreatment. Norwegian private practice dentists are familiar with the concept overtreatment and provide several examples of overtreatment. Although they see overtreatment as a problem, they express that the boundaries of what is considered necessary or professionally justified treatment have changed over time – particularly towards aesthetic and cosmetic treatment. Overtreatment is considered to be less problematic if the patients are informed and consent. The participants point to several internal factors and external conditions furthering overtreatment: professional status and prestige, general social trends, social media, demographic changes, overcapacity, and the expansion of commercial chains. The dentists in the interviews demonstrated that they are aware of their power, but also acknowledge their responsibility.
Conclusion: Private practice dentists in Norway are aware of overtreatment and their drivers. They acknowledge their power to promote overtreatment, but also that this gives them responsibility. This raises important issues about dentists’ professional accountability and integrity.
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References
Berwick DM, Hackbarth AD. Eliminating waste in US health care. JAMA. 2012;307(14):1513–6. https://doi.org/10.1001/jama.2012.362
Colla CH, Morden NE, Sequist TD, Schpero WL, Rosenthal MB. Choosing wisely: prevalence and correlates of low-value health care services in the United States. J Gen Intern Med. 2015;30(2):221–8. https://doi.org/10.1007/s11606-014-3070-z
Lyu H, Xu T, Brotman D, et al. Overtreatment in the United States. PLoS One. 2017;12(9):e0181970. https://doi.org/10.1371/journal.pone.0181970.
Oakes AH, Chang H-Y, Segal JB. Systemic overuse of health care in a commercially insured US population, 2010–2015. BMC Health Serv Res. 2019;19(1):280. https://doi.org/10.1186/s12913-019-4079-0
OECD. Tackling wasteful spending on health. Paris: OECD Publishing; 2017.
Chifor R, Badea IC. Preventing overtreatment in dentistry: causes, types and how to be avoided. Rom J Stomatol. 2022;68(2): 63-68. https://doi.org/10.37897/RJS.2022.2.5
Coli P, Sennerby L. Is peri-implant probing causing over-diagnosis and over-treatment of dental implants? J Clin Med. 2019;8(8):1123. https://doi.org/10.3390/jcm8081123
Elderton R. Overtreatment with restorative dentistry: when to intervene? Int Dent J. 1993;43(1):17–24.
Ghosh I, Dayal P, Das S. Overtreatment in caries management? A literature review perspective and recommendations for clinicians. Dent Update 2016;43(5):419–29. https://doi.org/10.12968/denu.2016.43.5.419
Holden AC, Adam L, Thomson WM. Overtreatment as an ethical dilemma in Australian private dentistry: a qualitative exploration. Community Dent Oral Epidemiol. 2021;49(2):201–8. https://doi.org/10.1111/cdoe.12592
Kazemian A, Berg I, Finkel C, et al. How much dentists are ethically concerned about overtreatment; a vignette-based survey in Switzerland. BMC Med Ethics. 2015;16:1–8. https://doi.org/10.1186/s12910-015-0036-6
Moreno T, Sanz JL, Melo M, Llena C. Overtreatment in restorative dentistry: decision making by last-year dental students. Int J Environ Res Public Health. 2021;18(23):12585. https://doi.org/10.3390/ijerph182312585
Somasundara SY, Jayakumar H. Overtreatment in dentistry: points to ponder. J Indian Assoc Public Health Dent. 2010;8(15):173–6. https://doi.org/10.4103/2319-5932.197484
Hartshorne J, Hasegawa Jr TK. Overservicing in dental practice – ethical perspectives. SADJ. 2003;58(9):364–9.
Pacey L. There is an overuse of implants in the world and an underuse of teeth as targets for treatment. Br Dent J. 2014;217(8):396–7. https://doi.org/10.1038/sj.bdj.2014.930
Hayuningtyas R, Soesanto S, Natassya P, Gutierez S. Armelia Sari Widyarman, Muhammad Ihsan Rizal, Moehammad Orliando Roeslan, Carolina Damayanti Marpaung, editors. A systematic review to evaluate the role of antibiotics in third molar extraction. In: Quality improvement in dental and medical knowledge, research, skills and ethics facing global challenges. 2024. p. 468–71.
Grytten J, Skau I, Dobloug A, Barkvoll P. Trengs det 1 500 flere om 20 år. Tannlegetidene. 2015;125:384–8. https://doi.org/10.56373/2015-3-17
Moezzi M, Hofmann BM. Helsepersonell eller selger? Den Norske Tannlegeforenings Tidende. 2023;133(3):192–200. https://doi.org/10.56373/2023-3-3
Grytten J, Listl S, Skau I. Do Norwegian private dental practitioners with too few patients compensate for their loss of income by providing more services or by raising their fees? Community Dent Oral Epidemiol. 2023;51(5):778–85. https://doi.org/10.1111/cdoe.12750
Tjora A. Kvalitative forskningsmetoder i praksis. Oslo: Gyldendal Akademisk; 2012.
Braun V, Clarke V. Using thematic analysis in psychology. Qual Res Psychol. 2006;3(2):77–101. https://doi.org/10.1191/1478088706qp063oa
Ellen ME, Wilson MG, Vélez M, et al. Addressing overuse of health services in health systems: a critical interpretive synthesis. Health Res Policy Syst. 2018;16:1–14. https://doi.org/10.1186/s12961-018-0325-x
Berwick DM. Avoiding overuse – the next quality frontier. Lancet. 2017;390(10090):102–4. https://doi.org/10.1016/S0140-6736(16)32570-3.
Kvale S, Brinkmann S. Det kvalitative forskningsintervju (3. utg.). Oslo: Gyldendal Akademisk Forlag; 2015.
Braun V, Clarke V. To saturate or not to saturate? Questioning data saturation as a useful concept for thematic analysis and sample-size rationales. Qual Res Sport Exerc Health. 2021;13(2):201–6.
Sødal ATT. Oral health status among 65-year-olds in Oslo, Norway; periodontitis, chemosensory disorders, and oral health-related quality of life. University of Oslo, Oslo Norway: 2023.
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Copyright (c) 2024 Julie Skrede Edvinsen, Bjørn Hofmann
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Acta Odontologica Scandinavica publishes original research papers as well as critical reviews relevant to the diagnosis, epidemiology, health service, prevention, aetiology, pathogenesis, pathology, physiology, microbiology, development and treatment of diseases affecting tissues of the oral cavity and associated structures including papers on cause and effect or explanatory/associative relationships for experimental or observational studies.
