Five years ago, a review1 was published looking at research on the economic impact of dental treatments, preventions and services over the last 15 years. The review concluded that there was a “very significant gap in knowledge” regarding the economic impact of most facets of dentistry. They highlighted this as a significant problem at the macro-level for policy makers,
“Clearly, the poor quality of the economic studies in some dental disciplines, and the absence of any economic data in others, inhibits our ability to construct useful policies that might guide the development and direction of oral health care at any level of delivery, whether local, regional, national or international. This is a large gap in knowledge that warrants immediate attention.”
But, what about at the small scale, say at the level of a dental practice? Understanding the economics at the single unit level of a dental practice is surely important, for dentists at the very least. Dental anxiety is a very good example of a factor whose impact on dental productivity is little understood. Many studies have looked at the relationship between dental anxiety and patient behaviours. Studies have shown that those patients with dental anxiety are less likely to attend, more likely to cancel appointments and take longer to treat. But no studies to date have looked at the impact that these behaviours have on a dental practice’s productivity. We believe that they are significant.
The effects of dental anxiety can be difficult to detect. Its symptom of non-attendance can be easily attributable to other causes. Perhaps the biggest issue is that patient dental anxiety is often assumed to be an immutable given. In the UK, the Adult Dental Health Survey, conducted every decade since 1969, included a measure of dental anxiety for the first time in the history of the surveys in 2009. The Modified Dental Anxiety Scale (MDAS) is a five item scale which measures a person’s overall feelings about dental treatment. Over a third of adults (36 per cent) had an MDAS score indicating moderate dental anxiety, and a further 12 per cent had a score suggesting extreme dental anxiety. Results of other studies for the last 50 years and across many countries have shown a similar level of prevalence. It might be very easy to assume therefore that any dental practice will have a similar given level of dental anxiety.
But this assumption ignores the impact that successful anxiety management programmes can have on a patient’s level of anxiety. Research shows that by engaging in some relatively simple behaviours and practices, patient anxiety can be significantly reduced. But these programmes can take effort and a motivation to set up. If dentists are not aware of the impact that dental anxiety has across their practice, if they believe that dental anxiety is an immutable given and something to be lived with, then the motivation to will be weak. Dental anxiety has a significant impact on patients’ oral health but also on the economics of a dental practice. We just need the studies to prove it.
1Shariati, B., MacEntee, M. I., & Yazdizadeh, M. (2013). The economics of dentistry: a neglected concern. Community dentistry and oral epidemiology, 41(5), 385-394.