Perceived Patient Barriers to Tooth-Retaining Treatment in Tanzania.

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.

Costs of dental care and its financial impacts on patients in a population with low availability of services.

OBJECTIVES: To determine the direct and indirect costs of accessing and utilizing dental services in Tanzania and the proportion of patients experiencing economic burden due to treatment costs. BASIC RESEARCH DESIGN: Survey of 489 dental patients utilizing an out-of-pocket payment modality was carried out in four regional hospitals. Direct and indirect costs for service utilization were calculated. Financial expenditures were used to assess significant financial impacts of utilization of dental services on household economies. RESULTS: Direct costs comprised 80% of the total treatment costs, whereas indirect costs comprised 20%. About half of the patients experienced significant financial impacts as a result of their utilization of dental services. Proportionately more patients from low-income households (92.2%) experienced significant financial impacts. Most patients attended the clinics due to toothache and the most widely expected treatment was dental extraction. Only 7.1% of the patients received a filling. The costs for dental restorations were three-times those for tooth extraction. CONCLUSIONS: Dental service utilization leads to significant financial impacts on many of the households in this setting. Increasing the rate of prepayment for health services and reducing income inequality may help to mitigate these impacts.

Patients' willingness to pay for dental services in a population with limited restorative services.

OBJECTIVES: To determine and compare patients' willingness-to-pay (WTP) for tooth extraction and filling services in Tanzania and to assess the socio-demographic factors that are associated with such valuations. METHODS: Contingent valuation survey utilizing an open-ended willingness-to-pay format was administered among 1522 outpatients in four regional hospitals in Tanzania. WTP for extraction and tooth filling services for various tooth categories were determined and compared using Mann-Whitney and Kruskal-Wallis tests. The association of WTP values with socio-demographic background factors was assessed using multiple regression analysis. RESULTS: The mean WTP amounts for tooth filling were Tanzania shillings (Tshs) 7,398 (3.4 US$) and Tshs 7,726 (3.5 US$) for anterior and posterior teeth respectively. The mean WTP for tooth filling services was lower than the average charged fees in dental facilities. The mean WTP amounts for tooth extraction were Tshs 5,448 (2.5 US$) and Tshs 6,188 (2.8 US$) for anterior and posterior teeth respectively. WTP amounts were shown to vary by age, income, outpatient status and previous experience with the dental services. Belonging in youngest age group (18-24 years) and having a high-income level was associated with increased odds for high WTP valuations irrespective of tooth and treatment types. CONCLUSIONS: WTP reveals a preference for tooth filling rather than extraction services in this population. More studies are needed to address the discrepancy between the stated preferences and utilization patterns for dental services.