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September 14, 2015
BSODR
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Triggers for patients’ referral for NHS dental implant treatment and the subsequent decision making process;
Patients’ encounters and Clinicians’ views
Background
Dental implants may be indicated in many clinical scenarios to replace missing teeth, in particular when other
options have failed to perform satisfactorily. Within the NHS, implant provision is restricted in order to manage a
limited resource and prioritise those with greatest need. Referral guidelines1 reflect the need to ration implant
provision which also places some restriction on a fully ‘shared ‘decision making process.
Objectives
This study aims to explore 1) the main triggers for referral of patients for implant treatment via NHS secondary care,
and, 2) patients’ and clinicians’ thoughts of, and their roles in, the decision making process in the context of
‘restricted’ NHS implant provision
Methods
This qualitative study used audio-recorded semi-structured interviews with a purposive sample of patients and
clinicians at a NHS secondary care clinic. Thematic content analysis was undertaken to reveal emerging themes.
Sample ; Patients (, 38 interviews with 34 individuals, 50% edentulous, 21 women and 13 men, age range 19-76 with
50% under age of 40) and clinicians (n=8)
Results
Three core themes in relation to patients’ experiences of the decision stage were identified;
1) The ambiguity of patient selection criteria
2) The length of time for the decision process to be undertaken
3) The “risk” of ineligibility for implants restorations within the NHS and the subsequent impact on patients’
quality of life and tolerance of other treatment options.
In contrast the two themes emerging from the clinician interviews were;
1) The status of current guidelines (RCS, 2012)
1
which are open to personal interpretation
2) The decisions on implant provision were dependant on local conditions (i.e. the implant team and local
resource allocation)
In addition, patients’ referrals from primary care to NHS clinic were mainly steered by RCS implant
guidelines.
Conclusions
More robust national NHS implant selection criteria may be required to facilitate shared decision making within
primary and secondary care. Patients need clearer information about the planning stages for implants and how this
can affect selection and treatment progression. Duration of treatment stages and the need for implant maintenance
should be highlighted & discussed early during the decision making process as these factors influence patient’s
decision to proceed with implants if offered.
1
Royal college of Surgeons, Faculty of Dental Surgery: Guidelines for Selecting Appropriate Patients to Receive Treatment with
Dental Implants: Priorities for the NHS