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Frequency of the treatment decision for the black vs. the white patient
Source publication
The aim of this study was to investigate the influence of the patient's race on the dentist's decision to extract or retain a decayed tooth.
A probabilistic random sample of 297 dentists from Recife, Brazil, was used. Two case scenarios were presented to the dentists. Both scenarios showed a molar that was extensively decayed, but indicated for con...
Context in source publication
Context 1
... analysis of data obtained in this way showed a high consistency in the dentists' responses, with Kappa values of 1 for categorical variables, including the dentist's treatment decision, and the intraclass correlation coefficient ranged from 0.97 to 1.00 for numerical variables. Table 1 shows the paired frequencies of the dentists' decisions for black vs. white patient. It can be seen that 9.4% of the dentists decided to extract for the black patient but retain for the white patient; however, no dentists decided to extract for the white patient but retain for the black patient. ...Similar publications
Background:
Planning the treatment of a compromised tooth is challenging but the choice should refer to evidence-based criteria. The Literature proved that patient-related factors influence the treatment plan, but what happens when the patient is a dentist? Aim of the study was to observe whether the dentist goes for the same option suggested to a...
Citations
... Quando questões discriminatórias não são problematizadas na formação em saúde, tem-se profissionais pouco reflexivos e que visualizam o outro como instrumento ou objeto, e não atores sociais capazes de questionar as estruturas sociais e contribuir para sua transformação 9 . Uma formação essencialmente técnica e pouco voltada para problemas definidos no campo das ciências humanas e sociais, entre eles o racismo, pode contribuir para que cirurgiões-dentistas baseiem suas decisões clínicas em ideias preconcebidas e equivocadas sobre grupos sociais 36 . ...
... Estudos mostram extensivamente a presença de viés clínico na tomada de decisão de tratamentos de acordo com a raça do paciente, com indicação de procedimentos mais invasivos, rápidos e de menor custo aos negros, quando comparados aos brancos [10][11][12]36,37 . ...
... Uma investigação realizada no Nordeste do Brasil demonstrou que, em um cenário clínico de total igualdade de condições entre os pacientes, cirurgiões-dentistas recomendaram a extração dentária com maior frequência para os usuários negros do que para os brancos 36 Plessas (2019) 11 buscou verificar o impacto que as características étnicas e sociais tinham na tomada de decisão de cirurgiões-dentistas no Reino Unido através da análise de casos clínicos. Como resultado, cerca de 86% dos profissionais recomendaram tratamento endodôntico para a paciente branca em comparação a negra, que foi de 60%. ...
O presente estudo teve como objetivo realizar uma revisão narrativa da literatura acerca das interfaces entre racismo e a Odontologia. A pesquisa bibliográfica foi realizada nas bases de dados Medline (Medical Literature Analysis and Retrievel System Online) via PubMed e BVS (Biblioteca Virtual de Saúde), entre janeiro e outubro de 2023, a partir da combinação dos descritores “racism”, “dentistry” e “oral health”. Foram selecionadas para compor esta revisão publicações sobre as intersecções entre o racismo, a educação e a prática odontológica. Foi possível identificar que a Odontologia sofre influência do racismo e atua na manutenção e na legitimação desse sistema de opressão. A falta de diversidade racial entre profissionais, docentes e estudantes da área, currículos de Odontologia pouco problematizadores, a falta de competência cultural dos profissionais e o viés racial na indicação de tratamentos odontológicos são pontos importantes elencados na literatura sobre as ligações entre racismo e Odontologia. Mudar esta realidade implica enquadrar o antirracismo como prioridade no ensino e na prática odontológica. Para que isso aconteça, é necessário, essencialmente, aceitar que o racismo existe e que seus fundamentos históricos ainda impactam e moldam a profissão.
... A study from Brazil in 2005 showed that patients' race may influence dental decision-making. [37] In 2022, Vianna et al reported that socioeconomic status was significantly involved in dental decision-making in Brazil. [38] Currently, this situation may have become more critical, owing to the COVID-19 worldwide pandemic since 2019, which has exacerbated the existing racial/ ethnic and socioeconomic disparities in public health. ...
Dental decision-making represents the establishment of a common understanding between the dental professional and the recipient of the intervention, which determines oral healthcare and dental treatment policies. Dental decision-making for persons with dementia can be challenging, and there have been no systematic reviews on this topic. Therefore, this systematic narrative review aimed to identify the current state of dental decision-making in persons with dementia. Literature search was performed using PubMed, Web of Science, Cochrane Library, CINAHL, and Google Scholar databases. Through the process of research selection, 7 articles with a high risk of bias were included in this study. This review clarified that there is limited information on the dental decision-making processes for persons with dementia. In conclusion, although this may be difficult due to different medical and socioeconomic conditions, the dilemma between the need to establish evidence for dental decision-making and medical ethics that prioritize a patient-centered position should be discussed globally in the future.
... Most survey-based studies document the oral health effects of participants' extraclinical experiences of discrimination, often using overly broad measures such as single item measures of lifetime experience of discrimination [24,25,28,[37][38][39]. Among the scant research that examines minoritized individuals' experiences of racio-ethnic discrimination by oral care providers, most studies document anticipated or simulated discrimination [30][31][32][33][34][40][41][42]. One notable exception is Sokoto and colleague's community-based work, which found that over one third of pregnant Black/African American women in central Appalachia have experienced racism in an oral health care setting, and that dental fear and anxiety itself, statistically predicted by experiencing racism in oral care, reduced dental utilization [27]. ...
Racism, an oppressive and fallacious sociopolitical hierarchy, is a fundamental cause of oral health inequities worldwide. Everyday discrimination is associated with worse self-rated oral health, toothache and adult tooth loss, and lower oral care utilization. Few studies examine discrimination or microaggressions within oral care settings or their effects on oral health outcomes. We adapted the seven-item Everyday Discrimination Scale to the oral care setting (EDSOC); developed a four-item Dignity in Oral Care Scale (DOCS); fielded them to a probability-based nationally representative sample of US households as part of the 2022 State of Oral Health Equity in America survey (SOHEA, n = 5682); and examined associations between EDSOC and DOCS scores and three outcomes: self-rated oral health, duration since last oral care visit, and planning for future preventive/routine oral care. Nearly, all EDSCOC and DOCS measures were significantly associated with oral health outcomes. Discrimination experience in dental settings had an additive effect on reporting fair/poor oral health and a suppressive effect on planning a future dental visit. Indignity experience doubled-to-quadrupled the likelihood of reporting fair/poor oral health, not having visited a dentist in 2 years, and not planning a future oral care visit. Racio-ethnically minoritized patients may experience the unjust double bind of resolving urgent dental or completing preventive services needs amidst being treated in a discriminatory manner or without dignity. Oral health stakeholders should invest more effort to understand relationships between racism and oral health outcomes and introduce evidence-based interventions to ultimately abolish this societal harm.
... Based on previous reviews 16, 25 we identified the publications summarized in Table 1. 10,[26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45] All studies have addressed interpersonal discrimination, and only one study tested specific hypotheses based on an intersectional perspective. Few have investigated the direct effect of discrimination on tooth loss and periodontitis, with conflicting results. ...
Major sociohistorical processes have profound effects on oral health, with impacts experienced through structural oppression manifested in policies and practices across the lifespan. Structural oppression drives oral health inequities and impacts population‐level oral health. In this global perspective paper, we challenge old assumptions about oral health inequities, address misleading conceptualizations in their description and operation and reframe oral health through the lens of intersecting systems of oppression. Furthermore, we emphasize the need for oral health researchers to explore causal pathways through which oppression harms oral health and engage in social science concepts to understand the root causes of oral health inequities fully. Finally, we call on policymakers, dental scholars and decision makers to consider health equity in all policies and to take a systems‐oriented approach to effectively address oral health inequities.
... Studies have established implicit racial bias and cognitive racial stereotypes in the way clinicians prescribe treatment for their patients based on skin color. For instance, a 2005 study reported a higher referral rate for tooth extractions among black people compared to the white population [18]. A randomized controlled trial determined evidence of unconscious racial bias among dentists in clinical decision-making. ...
... Os profissionais de saúde, além de prestarem serviços relacionados à saúde, também devem defender os direitos humanos, visando alcançar a igualdade de oportunidade de acesso aos serviços de saúde. No Brasil, porém, isso muitas vezes não acontece, e tanto os serviços públicos quanto os privados acabam por reproduzir comportamentos discriminatórios frente aos pacientes [139][140][141] . ...
A elaboração do Protocolo Clínico e Diretrizes Terapêuticas (PCDT) da Hanseníase, instituído por meio da Portaria SCTIE/MS nº 67, de 7 de julho de 2022 (Anexo A), consistiu em uma iniciativa da Coordenação-Geral de Vigilância das Doenças em Eliminação – CGDE/DCCI/SVS/MS no sentido de normatizar, no âmbito do Sistema Único de Saúde (SUS), uma diretriz baseada em evidências, conforme estabelecido pela Lei nº 12.401, de 28 de abril de 2011, pelo Decreto nº 7.508, de 28 de junho de 2011, e pelo Decreto nº 7.646, de 21 de dezembro de 2011.
Para além de estabelecer os critérios para diagnóstico e tratamento de indivíduos acometidos pela hanseníase, este Protocolo tem como um dos principais objetivos a promoção da efetiva descentralização do cuidado em hanseníase para a Atenção Primária à Saúde (APS), considerando que a APS é, em geral, o primeiro ponto de contato do paciente com os serviços de saúde e que o atendimento abrangente, acessível e baseado na comunidade pode atender de 80% a 90% das necessidades de saúde de uma pessoa ao longo de sua vida. Por ser altamente eficaz e eficiente em relação às principais causas de problemas de saúde e riscos ao bem-estar, bem como lidar com os desafios emergentes que ameaçam a saúde e o bem-estar no futuro, a APS é uma estratégia fundamental para o cuidado em hanseníase. Ainda, a APS é custo-efetiva, pois há evidências de redução de gastos totais em saúde e melhoria da eficiência, por exemplo, no que se refere à dimimuição das internações hospitalares. As complexas necessidades de saúde exigem uma abordagem multissetorial que integre: políticas de promoção da saúde e prevenção; soluções que atendam às comunidades; e serviços de saúde centrados nas pessoas. A APS também inclui os principais elementos necessários para melhorar a segurança sanitária e prevenir ameaças à saúde, como epidemias e resistência antimicrobiana, por meio de medidas como educação e engajamento comunitário, prescrição racional de medicamentos e um conjunto básico de funções essenciais de saúde pública, incluindo a vigilância em saúde.
Da mesma forma, o PCDT da Hanseníase busca promover e garantir o atendimento aos princípios da universalidade, equidade e integralidade no contexto do SUS, ao estabelecer diretrizes para além da prática curativa, com acesso a serviços em todos os níveis de complexidade, como a prevenção e a reabilitação de incapacidades, o direcionamento ao apoio e ao cuidado psicossocial para aqueles indivíduos que necessitarem de tal abordagem por meio da Rede de Atenção Psicossoacial (RAPS), assistência farmacêutica, dentre outras ações que podem ser demandadas por um índivíduo acometido pela hanseníase.
Ainda, o Protocolo atende ao objetivo estratégico 4 – otimizar o uso dos medicamentos antimicrobianos na saúde, mediante o aprimoramento das intervenções com qualificação da prescrição e dispensação e uso desses medicamentos, estabelecido pelo Plano de Ação Nacional de Prevenção e Controle da Resistência aos Antimicrobianos no Âmbito da Saúde Única além de acompanhar a Estratégia Global de Hanseníase 2021-2030 da Organização Mundial da Saúde e a Estratégia Nacional de Enfrentamento da Hanseníase do Ministério da Saúde.
... 17 This issue occurs throughout society and inevitably affects the clinical setting, even if the professional has the best intentions, as individuals usually refer involuntarily to one's characteristics with stereotyped beliefs. 14,16 However, studies assessing whether children's appearance influences others' first judgment are lacking, especially in the health care setting. The hypothesis of the present study is that children's facial type, sex and skin color are associated with subjective perspectives of the dentist, such as empathy and self-confidence. ...
... Invasive procedures have been shown to be more frequently recommended to black people compared to white individuals with the same clinical signs and symptoms. 14,15 Racial disparities can influence the access, quality of survey. Third and ninth semester students were invited to participate, which corresponded, respectively, to the least and the most clinically experienced groups. ...
... Income inequalities among races are remarkable in Brazil and implicit racial bias in the dentist's decision-making has been shown to induce more invasive, simple and cheap procedures for some racial groups. 14,34,35 It is relevant to note that the dental treatment provided in Brazilian public universities is covered by the government through the National Health Service, and most patients are black and come from socially vulnerable populations. 36 Thus, the apparent apprehension faced by dental students in the care of white children may have occurred due to the lower frequency of white patients, possibly associated with a higher income background 36 and insecurities regarding the adequate clinical quality to be provided, 11,16 as pro-white physicians' bias has been observed to be similar among adult and pediatric patients. ...
Purpose: To assess the levels of empathy and self-confidence of pre- and post-doctoral dental students during the dental care of children of different facial types, sex and skin color.
Methods: A cross-sectional survey was conducted with 170 Brazilian dental students. Photos of four mesofacial pediatric patients of different sex (male, female) and skin color (white, black) were digitally altered to dolichofacial and brachyfacial facial types. The 12 photos obtained (four originals and eight digitally altered) were projected during lectures and students reported their level of empathy (scores from zero to 10) and self-confidence (not confident/confident) using a structured questionnaire, based exclusively on children's appearance. Bivariate analysis and Poisson robust regression were performed (P <0.05).
Results: Students' lower empathy was observed among brachyfacial children (preva- lence ratio [PR] = 0.940; 95 percent confidence interval [95 percent CI] = 0.904 to 0.978). Female (PR=1.202; 95 percent CI=1.162 to 1.243) and black children (PR=1.068; 95 percent CI=1.035 to 1.103) received students' higher empathy scores. Higher percentages of self-confidence were associated with mesofacial (P =0.049), female (P <0.001), and black (P =0.001) children. Students' lower self-confidence was associated with brachyfacial (PR=1.106; 95 percent CI=1.066 to 1.147), male (PR=1.202; 95 percent CI=1.165 to 1.239) and white (PR=1.056; 95 percent CI =1.025 to 1.088) pediatric patients.
Conclusions: Brachyfacial children were associated with dental students' lower levels of empathy and self-confidence while female and black children received higher levels of empathy and self-confidence. However, dental students felt less confident regarding the dental care of white children.
... Probably similar results could be found among dentists. According to some studies, a patient's ethnicity and skin colour can influence the treatment decisionmaking in dentistry and what treatment option is suggested for a patient [15][16][17]. ...
Objective:
The population in many countries is becoming more diverse. The number of people from foreign backgrounds is growing in Finland as well. The aim of this study was to better understand how the foreign background of a patient affects the dentist's work.
Methods:
The research was carried out as a semi-structured interview. Six dentists from Helsinki municipality public dental care were interviewed between December 2019 and January 2020. After the interviews were transcribed verbatim, two members of the research group read individually the interviews to find emerging themes.
Results:
The most common problems that arose in the interviews were problems within communication and interpretation. Periodontal diseases and the importance of self-care in treating them were observed to be unfamiliar to many foreign-background patients. The dentists also noticed different expressions of pain among foreign-background patients compared with native Finnish patients. The interviewed dentists thought that the length of time a patient had lived in Finland affected the experienced difficulties and the prejudice that the patients and dentists faced.
Conclusion:
In this qualitative research, we were able to identify some of the common difficulties that the dentists experience while treating patients from foreign backgrounds, despite the small number of participants.
... Students declared to feel more confident about providing nonvital bleaching than vital bleaching. Besides, the complete understanding of mechanisms that professional decision making is a hard task and can englobe several levels of comprehension, beginning in the professional knowledge 17,24 , influenced by the school of dentistry and, also, can be influenced by patients' characteristics [25][26][27] . Some patient's characteristics could influence the decision making of health professionals [25][26][27] . ...
... Besides, the complete understanding of mechanisms that professional decision making is a hard task and can englobe several levels of comprehension, beginning in the professional knowledge 17,24 , influenced by the school of dentistry and, also, can be influenced by patients' characteristics [25][26][27] . Some patient's characteristics could influence the decision making of health professionals [25][26][27] . Moreover, it was observed that competition affected the clinical decision-making of dentists in Canada 28 . ...
Aim: The present study aimed to investigate if the Guatemalan dentist's options on tooth bleaching could be influenced by their time in clinical practice, the level of specialization or their working place. Methods: A representative sample of dentists working in clinical practice in Guatemala was selected. Data were collected using a self-administered questionnaire with information related to gender, professional characteristics (time since graduation in years and working place) and preferences regarding vital (at-home or in-office; type and concentration of bleaching agent) and the nonvital tooth bleaching (bleaching agent used). The analysis was performed and the association between preference for bleaching technique and independent variables were investigated using Fisher's exact test. Results: 200 dentists were interviewed. More than half of dentists were male (57.0%) with time since graduation between 11 and 20 years (n= 64; 32.3%). Dentists mostly (60.5%) preferred in-office technique for vital bleaching, with 10-20% Carbamide peroxide (CP) as the preferred agent (50%). For nonvital teeth, the preferred agent (46.8%) was 37% Hydrogen Peroxide (HP). About the associations, younger dentists (< 20 years of graduation) selected mostly in-office technique, while those with more than 20 years indicated more the at-home technique. Also, the dentists working in private practice chose more frequently in-office technique. Thus, the in-office technique was more popular among Guatemalan dentists, with 10-20% CP and 37% HP selected as favorite bleaching agents for vital and nonvital techniques, respectively. Conclusion: The time of clinical practice and working place influenced some choices.
... Students declared to feel more confident about providing nonvital bleaching than vital bleaching. Besides, the complete understanding of mechanisms that professional decision making is a hard task and can englobe several levels of comprehension, beginning in the professional knowledge 17,24 , influenced by the school of dentistry and, also, can be influenced by patients' characteristics [25][26][27] . Some patient's characteristics could influence the decision making of health professionals [25][26][27] . ...
... Besides, the complete understanding of mechanisms that professional decision making is a hard task and can englobe several levels of comprehension, beginning in the professional knowledge 17,24 , influenced by the school of dentistry and, also, can be influenced by patients' characteristics [25][26][27] . Some patient's characteristics could influence the decision making of health professionals [25][26][27] . Moreover, it was observed that competition affected the clinical decision-making of dentists in Canada 28 . ...
Aim: The present study aimed to investigate if the Guatemalan dentist’s options on tooth bleaching could be influenced by their time in clinical practice, the level of specialization or their working place. Methods: A representative sample of dentists working in clinical practice in Guatemala was selected. Data were collected using a self-administered questionnaire with information related to gender, professional characteristics (time since graduation in years and working place) and preferences regarding vital (at-home or in-office; type and concentration of bleaching agent) and the nonvital tooth bleaching (bleaching agent used). The analysis was performed and the association between preference for bleaching technique and independent variables were investigated using Fisher’s exact test. Results: 200 dentists were interviewed. More than half of dentists were male (57.0%) with time since graduation between 11 and 20 years (n= 64; 32.3%). Dentists mostly (60.5%) preferred in-office technique for vital bleaching, with 10-20% Carbamide peroxide (CP) as the preferred agent (50%). For nonvital teeth, the preferred agent (46.8%) was 37% Hydrogen Peroxide (HP). About the associations, younger dentists (< 20 years of graduation) selected mostly in-office technique, while those with more than 20 years indicated more the at-home technique. Also, the dentists working in private practice chose more frequently in-office technique. Thus, the in-office technique was more popular among Guatemalan dentists, with 10-20% CP and 37% HP selected as favorite bleaching agents for vital and nonvital techniques, respectively. Conclusion: The time of clinical practice and working place influenced some choices.
