Factors shaping demand for prostethic dentistry treatment with special focus on implant dentistry

Abstract: Aim: The main aim of this thesis was to investigate how attitudesinfluence the latent and manifest need, desire, demand, and utilizationfor dental implant treatment, considering the gatekeeping processbetween need and demand, and between demand and utilization ofdental treatment.Material and Methods: A conceptual analysis of the need anddemand concept from the literature was a first step in the study. Asecond step was to examine changes in attitudes toward desire forimplant treatment over time, also in relation to dental status, in apopulation of middle aged and older individuals in Sweden based ontwo questionnaire studies, one in 1989 and the other in 1999 amongthe same 3000 participants. The individuals who responded bothin 1989 and 1999 constituted a panel of 56% of the 1989 surveysample. Logistic regression models were done with desire of implanttreatment as dependent variable. In paper V, a qualitative studyusing grounded theory was done on the treated patients’ subjectiveperspective on receiving a fixed implant-supported denture.Results: An emancipatory perspective with the patient-dentistdialogue was regarded as central for an optimal treatment result inthe prosthetic treatment decision-making process. A main findingwas that need is established only in a communicative dialoguewith mutual respect between the profession and the patient. Thestudy implied that the gatekeeping concept relates to a complexprocess rendering great differences between demand and actualutilization. The main result from the questionnaires was the huge11increase in interest for implant-treatment from 1989 to 1999. In1999 almost all (94%) of the study population expressed desirefor implant treatment; as many as 92 % percent of those who didnot express a desire for implants in 1989 had changed their mind10 years later. The regression analysis showed that older people,non-city residents, and those with one or several missing and unreplacedteeth, changed desire for implant treatment between thestudy years. Effects of age, residence, and better dental statusdisappeared during the ten year study period. Those edentulousand those with removable dentures expressed less desire than thosewith all teeth remaining, or only one or a few teeth missing, in1989. High income significantly increased the probability to desireimplant treatment for the study panel at both study occasions. Thequalitative study, using the method for grounded theory, gave ascore category and main finding the importance of the patients´trust and confidence in the dentist and his/her staff, in the processof transforming desire for dental implant treatment into manifestdemand, and also making it more likely for the patients´ to becomesatisfied with the treatment result regardless of complications.Conclusion: There is no objective need in prosthodontic treatment.Manifest need and demand change over time, and are influencedby the patients´ attitude and situation, and by the dentist’s practiceprofile. True need can only be identified in a dialogue between theprofessional and the patient.Income and dental status, but not age, place of residence, norconcern for dental appearance, influence desire for implant treatmentat the end of the studied 10-year period. Individuals with removabledentures, or those being edentulous in one or both jaws have a lowerprobability to desire implant treatment than those with all teethremaining, or with missing teeth replaced by fixed partial dentures.The qualitative study underlined the importance of the relationshipbetween the professional and the patient. The patients´ trust andconfidence in the dentist and his/her staff were decisive in the processof making a demand for implant treatment manifest and turningit into actual utilization. The informants from this study describedtheir confidence and trust as dependent on a communicative dialoguewith mutual respect between the patient and the professional.