Patients’ factors of choice in dental care and impact of the Covid-19 pandemic – a systematic review

BACKGROUND: Patients often face individual challenges at their dentist, e.g., high co-payments. Why patients decide for or against dental treatment can be determined by many factors: own financial resources, preferences, and external circumstances. The study's aim is to identify these factors with an international perspective. METHODS: We systematically searched for literature in three biomedical databases. Factors of choice etc. were extracted from relevant publications. We used a qualitative approach for analysis, and the MMAT (Mixed Methods Appraisal Tool) for quality assessment. RESULTS: After multistage screening of n = 4,226 publications by two reviewers, n = 233 relevant articles of different study types [qualitative (n = 42), quantitative (n = 177), and mixed-methods (n = 14)] were included in the analysis. Data collection was realized across different settings [e.g., practice (n = 18)] and approaches (e.g., interviews) in n = 49 countries. Included studies focused on specific treatments (e.g., caries treatment) or treatments in general (e.g., dental tourism). Across countries, various factors of choice (n = 101) were identified, divided into three categories: (I) ‘dentist & dental institution’ (e.g., communication), (II) ‘patient’ (e.g., fear), and (III) ‘treatment’ (e.g., durability). Cost and dental fear were mentioned most frequently (n = 148, n = 73). In countries with most articles [UK (n = 28), Saudi Arabia (n = 23), USA (n = 22), India (n = 19), and Brazil (n = 14)], the cost factor was identified most often [e.g., USA (n = 16, 73%)]. One publication addressed the Covid-19 pandemic reporting that treatment appointments were cancelled by patients due to their fear of infection with SARS-CoV2. Study quality is highly variable. CONCLUSIONS: A variety of factors influence patients’ choice regarding dental treatment. There is little research on impact of the Covid-19 pandemic. Regulatory measures and information efforts should be adapted to reduce patients’ access barriers to dental care. KEY MESSAGES: • A variety of factors influence patients’ choice regarding dental treatment. • Fear of SARS-CoV2 infection is a new factor of choice in dental care from patients’ perspective.