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The outcomes of mandibular third molar removal and non-removal: a study of patients' preferences using a multi-attribute method
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
Malmö högskola, Faculty of Odontology (OD).
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2000 (English)In: Acta Odontologica Scandinavica, ISSN 0001-6357, E-ISSN 1502-3850, Vol. 58, no 6, p. 293-298Article in journal (Refereed) Published
Abstract [en]

The aim was to study patients' preferences about outcomes of mandibular third molar removal and non-removal using multi-attribute utility (MAU) methodology. The study comprised three stages. Stage 1: Elicitation of domains, i.e. main areas of patients' lives which could be affected by third molar removal and non-removal. Stage 2a: Interdomain weighting was obtained by relative weighting of the domains elicited in Stage 1. Stage 2b: Intradomain weighting obtained by patients' designation of values for different health slates of each domain. Stage 3: Rating of outcomes. The patients were asked to imagine experiencing a variety of outcomes of mandibular third molar removal and non-removal, described in 19 short vignettes. The numbers of patients interviewed for the three stages were 30, 78, and 55, respectively. Five domains were identified. The mean relative weightings were approximately equal for the domains "Home and social life" and "General health and well-being", followed in order of importance by "Job and studies" and "Health and comfort of mouth, teeth and gums". "Your appearance" received the lowest mean relative weighting. The vignette, which described the presence of a fluid-filled sac and suggested that this tooth must be removed, received the highest mean preference (least effect on patients' lives). The lowest mean preference (most effect on patients' lives) was generated by the vignette, which stated that the jaw was broken and that the teeth must be wired together for 6 weeks. We conclude that, from the patient's perspective, outcomes of non-removal were preferable to outcomes of mandibular third molar removal.

Place, publisher, year, edition, pages
2000. Vol. 58, no 6, p. 293-298
Keywords [en]
decision analysis, decision-making, dental, third molar surgery, tooth extraction
National Category
Dentistry
Identifiers
URN: urn:nbn:se:mau:diva-66393DOI: 10.1080/00016350050217154ISI: 000166002000010PubMedID: 11196406Scopus ID: 2-s2.0-0034572275OAI: oai:DiVA.org:mau-66393DiVA, id: diva2:1845724
Available from: 2024-03-20 Created: 2024-03-20 Last updated: 2024-03-20Bibliographically approved
In thesis
1. Mandibular third molar removal: patient preferences, assessments of oral surgeons and patient flows
Open this publication in new window or tab >>Mandibular third molar removal: patient preferences, assessments of oral surgeons and patient flows
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [sv]

Operativt avlägsnande av visdomständer i underkäken utgör en stor del av verksamheten vidlandstingens specialistkliniker i käkkirurgi i Sverige. Under 1980- och 1990-talen beräknadesårligen 20-25.000 visdomständer ha avlägsnats vilket utgjorde ca 60 % av operationsvolymenvid dessa kliniker. Därtill kommer ett stort antal operationer av visdomständer som har utförtsav privata specialister och allmänpraktiserande tandläkare.Mot den här bakgrunden har målsättningen varit, avseende visdomstandskirurgi i underkäken,att: 1. Studera patienters preferenser för möjliga konsekvenser efter operativt avlägsnandejämfört med att man avstår från operation, d.v.s. att visdomstanden får sitta kvar. 2. Jämförapatienters preferenser i två olika länder, Sverige och Wales. 3. Studera käkkirurgers bedömning av indikationens styrka för tänder, med och utan sjukdom, som skall operativt avlägsnas.4. Beskriva och analysera vårdprocessen för patienter som remitterats till käkkirurgiska specialistenheter för operativt avlägsnande av visdomstanden.I de två första studierna presenterades resultaten av den svenska undersökningen som sedanjämfördes med resultaten från motsvarande undersökning utförd i Wales. Patienternas preferenser vid behandlingsbeslut att operativt avlägsna visdomstanden alternativt att avstå frånoperation, visade att trots att kulturer och ekonomiska system kan skilja sig åt, så var patienternas preferenser i de båda länderna likartade. Samstämmigt föredrog patienterna de konsekvenser som kan uppstå om visdomstanden får vara kvar (perikoronit, karies, rotresorption,follikularcysta) jämfört med de konsekvenser som kan uppstå vid operativt avlägsnande avvisdomstanden (värk, svullnad, känselstörningar på näraliggande nerver, postoperativ infektion).I den tredje studien konstaterades att käkkirurger som opererade visdomständer på patienter som var remitterade till specialistklinik visade stor variation då man skattade styrkan för indikationenatt utföra ingreppet. En Visual Analog Scale (VAS) användes, där 0 indikerademycket svag indikation och 100 mm mycket stark indikation, för att käkkirurgerna skulleregistrera hur de värderade styrkan på indikationen för planerad operation. Dessutom registrerades antalet sjukdomstillstånd i anslutning till aktuell visdomstand, patientens ålder, tandens läge i käken samt om tanden helt eller delvis var täckt med slemhinna/benvävnad. Andelen tänder i det undersökta materialet som avlägsnades utan att ha någon associerad sjukdom (s.k. profylaktiskt indikation) var 18 %. Styrkan på indikationen att operativt avlägsna denna gruppvisdomständer var lägre än för de med associerad sjukdom. Patientens ålder var den enda faktor,av de registrerade, som påverkade indikationen för profylaktisk operation. Indikationenvar högre i de yngre åldersgrupperna jämfört med de äldre. I den fjärde studien följdes det faktiska förloppet i vårdprocessen för 361 patienter som var remitterade för visdomstandsoperation i underkäken, vid fyra käkkirurgiska specialistenheter.Detta innebar att olika patientflöden identifierades. Dessa beskrev antalet patientbesök och dess innehåll, från remissmottagande till utförd operation. Åtta olika patientflöden kunde identifieras. Antalet patientbesök varierade mellan ett och tre. För majoriteten av patienterna bedömdes den röntgenundersökning som bifogades remissen vara otillräcklig som underlag för operationen. Kompletterande röntgenundersökning utfördes för drygt 10 procent av patienterna på specialistklinik för odontologisk röntgen. Resterande kompletterande röntgenundersökningarutfördes på den käkkirurgiska kliniken. Behovet av kompletterande röntgenundersökninghade med få undantag ingen påverkan på antalet besök för den planerade visdomstandsoperationen.Konklusionerna från resultaten i avhandlingen visar att:• Patienter föredrar de konsekvenser som kan inträffa om visdomstanden får vara kvarjämfört med de konsekvenser som kan inträffa vid ett operativt avlägsnande av visdomstanden• Patienters behandlingspreferenser är stabila i jämförelse mellan två olika länder som tycksha olika kulturer och ekonomiska system• Behandlingsbeslut fattade av patienter visar mindre variation än behandlingsbeslutfattade av kliniker• Olika patientflöden kan påverka kostnadseffektiviteten.

Abstract [en]

Mandibular third molar removal is one of the most common treatments conducted at oral andmaxillofacial surgery clinics in Sweden. During the 1980’s and 1990’s, 20-25,000 mandibularthird molars were removed annually which represents about 60% of the total operation volume. Removals performed in private specialist clinics and general dental clinics are not included in these figures. The aims of the present studies on mandibular third molars were to: 1) study values thatreflect patients’ preferences about possible outcomes of removal and non-removal; 2) makecomparisons between Sweden and Wales with respect to patient’s preferences; 3) studyassessments of oral surgeons’ indications for molars to be removed ; 4) describe patient flowsin the care process of removal.The multi-attribute utility (MAU) method was used to quantify patients’ preferences about outcomes following removal and non-removal. Whilst there were clear cultural and economic differences between the Swedish and the Welsh, there was a high degree of correlation in patients’ ranking of the different outcomes for patients from the two countries (rs= 0.93, P<0.001). Generally, situations describing the outcomes of non-removal had a higher ranking than those describing the outcomes of removal i.e. patients seemed to prefer non-removal.Oral surgeons at seven specialist clinics registered data for 666 patients i.e. patient age and sex, the angular position and extent of eruption of the molar and whether or not there was an associated disease related to the molar proposed for removal. The indication for the removal was assessed on a Visual Analogue Scale (VAS), and the recorded results found to show agreat variety. The mean VAS for removal of molars without disease was significantly lowerthan that for molars with associated disease. The differences between the mean VAS formolars with one disease compared with molars with two or three diseases were not significant.The patients´ age was the only factor that had a significant effect on the assessment ofthe indication for molars without disease. The indication was higher for patients of the youngestage group than for patients of the oldest age group (P< 0.05).In four specialist units in southern Sweden, the patient flows (the number of visits and whatthe visits comprise of) was registered for 361 patients. All details were recorded from arrivalof the referral to the unit to performed mandibular third molar surgery. Eight different patient flows were found. The number of patient visits varied from one to three. For about 60 percent of the patients, attached radiographs to the referral were considered not appropriate and had to be completed, e.g. to be retaken. For a minority of the patients, the radiographic examination was completed at the radiological clinic included in the specialist unit and, in the oral and maxillofacial clinic for the others. The number of patient visits seemed not to depend on whether the attached radiographs were judged to be appropriate or not.In conclusion:• Patient preferences seem to be more stable than the preferences of oral surgeons acrossthe boundaries.• Patients prefer outcomes of third molar non-removal as compared to outcomes followingremoval.• Different patient flows may influence the cost-effectiveness in mandibular third molar surgery.

Place, publisher, year, edition, pages
Malmö University, Centre for Oral Health Sciences, 2005. p. 125
Series
Swedish Dental Journal : Supplement, ISSN 0348-6672
Keywords
Patient preferences, Decision making, Molar, third, Tooth extraction, Patient care management, Radiology
National Category
Dentistry
Identifiers
urn:nbn:se:mau:diva-7724 (URN)1797 (Local ID)91-628-6590-0 (ISBN)1797 (Archive number)1797 (OAI)
Note

Paper II and IV in dissertation as accepted manuscripts.

Available from: 2020-02-28 Created: 2020-02-28 Last updated: 2024-03-20Bibliographically approved

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Liedholm, RolfKnutsson, KerstinRohlin, Madeleine

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