Perceived Patient Barriers to Tooth-Retaining Treatment in Tanzania

Abstract

Background: Dental caries is the most common chronic health condition of humankind and goes untreated in many resource-limited settings. When clinical dental care is accessible, tooth extraction is often chosen over potentially more quality-of-life favorable restorative services. Objectives: To identify patient-perceived barriers to utilization of dental restorative services among Tanzanian dental patients. Methods: A cross-sectional study was conducted among adult patients in 5 public dental facilities in Tanzania. Participants ( N = 736) were interviewed before and after their dental visit on the same day using structured questionnaires. Sociodemographic characteristics, oral care–seeking behavior, previous experiences with dental restorations, and perceived barriers toward utilization of dental restorative services were assessed. Among patients treated for dental caries, logistic regression models estimated associations between patient factors and receipt of either dental extractions or restorative treatment. Results: About one-third (36.3%) of patients who reported being diagnosed with dental caries received a dental restoration. Stated barriers to utilization of restorative care included uncertainty about treatment outcomes (43.1%), cost (31.5%), and fear of treatment (31.0%). Among all patients who had received restorative treatment in the past, almost two-thirds (61.7%) reported ≥1 negative experience associated with the treatment. In multivariable adjusted modeling, higher education and income levels, having health insurance, and less perceived uncertainty about treatment outcomes were positively associated with receiving restorative treatment. Conclusions: In this setting, most public dental patients with caries received extractions over restorative care. Addressing cost, quality of care, and other patient concerns may all be needed to increase utilization of tooth-retaining procedures. Knowledge Transfer Statement: For many public dental patients in Tanzania, dental caries is addressed with extractions over restorative care. To advance greater utilization of tooth-sparing treatment, patient factors, including uncertainty about the quality of restorative care and delayed dental care–seeking behavior, should be addressed. Targeted interventions to increase patient awareness on positive outcomes of restorative care and strengthen preventive dental visits are required.