Modern Dentistry and Critical Thinking

Advancements in healthcare technology have revolutionized clinical dentistry and related research. Over the years, much of the research has emphasized on the etiopathogenesis, diagnosis, and management of oral conditions such as dental caries, periodontal and peri‐implant diseases, endodontic diseases, oral premalignant and malignant lesions, and malocclusion [1–9]. Moreover, various modern diagnostic (such as use of artificial intelligence), and therapeutic (including photobiomodulation, photodynamic therapy, and probiotic therapy) strategies have been incorporated into routine dental practice and have shown to facilitate diagnosis and management of oral diseases. There are, however, a variety of factors that influence the outcomes of such diagnostic and therapeutic protocols. Firstly, oral healthcare providers are routinely challenged with difficult situations in terms of making decisions that are in the best interest of patients with regards to their oral health‐related conditions. A situation commonly encountered in a dental setting is “to extract or not to extract” questionable dentition. From a periodontal perspective, placement of dental implants in patients with a history of periodontitis may compromise the long‐term success and survival of dental implants. In such situations, operator and/or oral health care provider’s knowledge, adequate training, and clinical experience/skills are critical factors help formulate a diagnosis and treatment plan that is in the best interest of the patient. Such factors may also assist early diagnosis and successful management of oral health‐related conditions such as those mentioned above [10–12]. Thus, clinicians must follow an evidence‐based diagnostic and treatment approach that is unbiased for the determination of the most effective yet realistic therapeutic plan for patients [13–16].

Complications in Dental Procedures and Their Consequences

Complications and failures during and after dental treatment are not unusual in clinical dentistry; and may occur for procedures performed by the most experienced and knowledgeable dental professionals [17]. Moreover, it is not uncommon for patients to solely nominate dental professionals as the primary cause of complications and/or failure of the treatment performed. Such attitudes and perceptions are risk factors for dental anxiety and phobia [18]; and may compromise communication and feeling of professional “trust” among patients and dental professionals [19]. Furthermore, postage of criticisms and comments on the internet and social media platforms based on dissatisfactory/negative personal experiences of patients with healthcare usually brings dental providers and related offices to the spotlight. People read online reviews about dental professionals and their offices; and this information usually influences the perceptions of readers toward dental professionals and their practices. Readers often use public opinions, which may either be constructive or critical to judge the skills of dental professionals; however, it is important to mention that negative feedback that often targets dental professionals may not necessarily patients’ own compliance toward post‐operative care [20]. In other words, the ultimate objective of any form of medical treatment is to attain certain desired outcomes; and an essential factor that influences the occurrence and prevention of post‐operative complications and success of the performed dental procedure is “patient compliance.” [21] “Non‐compliance” is a shortfall that may compromise and even have serious effects from the aspect of disease management [21–23]. In this context, “patient compliance” is a continuous area of concern for clinicians as well as researchers in healthcare practice and related research, respectively.

Compliance and Non‐compliance in Healthcare

In healthcare, compliance is described as the patient’s attitude or behavior in terms of taking medications, following dietary and pre/post‐operative instructions, routine follow‐up visits and/or implementing changes in life‐style (such as quitting smoking and routine exercise) based upon advice and recommendations from healthcare professionals [24, 25]. The World Health Organization has defined compliance as an extent to which, a patient is willing to take a medication, follow recommendations on nutrition or lifestyles, and comply with healthcare provider’s instructions [26]. The term “adherence” is often used as a synonym for compliance in a healthcare setting [27].

“Non‐compliance” or “non‐adherence” occurs when patients’ attitudes toward advices and recommendations by healthcare providers demonstrate a lack of analogy. Non‐ or lack of compliance is associated with lower quality of life, poor clinical outcomes, increased hospitalizations, and financial burdens in relation to healthcare [28]. Various types of non‐compliance associated with general and oral healthcare systems are summarized in Figures 23.1 and 23.2.

Patient‐related Factors

Dental Anxiety/Phobia

Research studies [30–34] have shown that dental anxiety (DA) or dental phobia (DP) affects up to 20% of the adult population; and compromises dental attendance and related therapy and oral health in general [34]. Results from a survey‐based study reported that nearly 15.5% of the respondents avoided dental visits due to DP [35]; and 36.5% of the respondents had not visited a dentist for over 12 months [35]. A common reason for DA and DP is “needle phobia or NP,” and the thought of being “poked” in the mouth with a sharp needle often contributes toward worsening DA and DP [36]. It has been reported that NP has psychologic (such as unconsciousness and convulsions), physiologic (such as bradycardia and hypotension) and social (such as avoidance behavior) consequences. People with high levels of DA often encounter increased DP which, in turn, compels them to (i) avoid routine dental visits and treatment, and (ii) seek dental care only when pain becomes inevitable. When such patients finally present themselves for treatment, the therapeutic needs are often extensive as well as invasive. Patients with DA and/or DP may not only skip dental check‐ups and routine dental visits but may even demonstrate reluctance to seek help from a dental professional in times of emergency such as severe dental pain [37]. It is worth mentioning that high levels of DA and DP are directly associated with a poorer oral health status and an increased number of missing teeth [38].