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Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study

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Abstract

Objective

To investigate whether patients’ skin color could exert an influence on the dentist’s decision-making for treatment, in four different cities in Brazil.

Material and methods

Lists of dentists were obtained and the sample selection was performed systematically. Two questionnaires were produced for the same clinical case, but the images were digitally manipulated to obtain a patient with a black and a white skin color. Dentists were free to choose treatment without any restrictions, including the financial aspects. A random sequence (white or black) was generated which was placed at random in sealed, opaque envelopes. Dentists were questioned about the decision on the treatment of a severely decayed tooth and an ill-adapted amalgam restoration.

Results

A total of 636 dentists agreed to participate in the study. After adjustments (multinomial logistic regression), it was observed that the black patient with a decayed tooth had a 50% lower risk of being referred for prosthetic treatment (p = 0.023) and a 99% higher risk of receiving a composite resin restoration, compared to the white patient (p = 0.027). No differences were observed regarding recommendation for tooth extraction (p = 0.657). In relation to an ill-adapted amalgam, the black patient had less risk of receiving a referral replacement with composite resin (0.09 95%CI [0.01–0.82]) and finishing and polishing (0.11 5%CI [0.01–0.99]) compared with the white patient.

Conclusion

Patient skin color influenced the dentist’s choice of treatment. In general, black patients receive referrals for cheaper, simpler procedures.

Clinical significance

Skin color played an important role in dentists’ treatment decisions. Professionals may contribute unconsciously to the propagation and replication of racial discrimination.

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References

  1. Chisini LA, Conde MC, Correa MB, Dantas RV, Silva AF, Pappen FG, Demarco FF (2015) Vital pulp therapies in clinical practice: findings from a survey with dentist in southern Brazil. Braz Dent J 26:566–571. https://doi.org/10.1590/0103-6440201300409

    Article  PubMed  Google Scholar 

  2. Schwendicke F, Meyer-Lueckel H, Dorfer C, Paris S (2013) Attitudes and behaviour regarding deep dentin caries removal: a survey among German dentists. Caries Res 47:566–573. https://doi.org/10.1159/000351662

    Article  PubMed  Google Scholar 

  3. Demarco FF, Baldissera RA, Madruga FC, Simoes RC, Lund RG, Correa MB, Cenci MS (2013) Anterior composite restorations in clinical practice: findings from a survey with general dental practitioners. J Appl Oral Sci 21:497–504. https://doi.org/10.1590/1679-775720130013

    Article  PubMed  PubMed Central  Google Scholar 

  4. Cabral ED, Caldas Ade F Jr, Cabral HA (2005) Influence of the patient's race on the dentist’s decision to extract or retain a decayed tooth. Community Dent Oral Epidemiol 33:461–466. https://doi.org/10.1111/j.1600-0528.2005.00255.x

    Article  PubMed  Google Scholar 

  5. Schulman KA, Berlin JA, Harless W, Kerner JF, Sistrunk S, Gersh BJ, Dube R, Taleghani CK, Burke JE, Williams S, Eisenberg JM, Escarce JJ (1999) The effect of race and sex on physicians’ recommendations for cardiac catheterization. N Engl J Med 340:618–626. https://doi.org/10.1056/NEJM199902253400806

    Article  PubMed  Google Scholar 

  6. Phelan J, Link B (2015) Is racism a fundamental cause of inequalities in health? Annu Rev Sociol 41:311–330

    Article  Google Scholar 

  7. Sabbah W, Tsakos G, Chandola T, Sheiham A, Watt RG (2007) Social gradients in oral and general health. J Dent Res 86:992–996. https://doi.org/10.1177/154405910708601014

    Article  PubMed  Google Scholar 

  8. Dalazen CE, De Carli AD, Bomfim RA, Dos Santos ML (2016) Contextual and individual factors influencing periodontal treatment needs by elderly Brazilians: a multilevel analysis. PLoS One 11:e0156231. https://doi.org/10.1371/journal.pone.0156231

    Article  PubMed  PubMed Central  Google Scholar 

  9. Vettore MV, Marques RA, Peres MA (2013) Social inequalities and periodontal disease: multilevel approach in SBBrasil 2010 survey. Rev Saude Publica 47(Suppl 3):29–39

    Article  PubMed  Google Scholar 

  10. Schwendicke F, Dorfer CE, Schlattmann P, Foster Page L, Thomson WM, Paris S (2015) Socioeconomic inequality and caries: a systematic review and meta-analysis. J Dent Res 94:10–18. https://doi.org/10.1177/0022034514557546

    Article  PubMed  Google Scholar 

  11. Correa MB, Peres MA, Peres KG, Horta BL, Barros AJ, Demarco FF (2013) Do socioeconomic determinants affect the quality of posterior dental restorations? A multilevel approach. J Dent 41:960–967. https://doi.org/10.1016/j.jdent.2013.02.010

    Article  PubMed  Google Scholar 

  12. Peres MA, Peres KG, de Barros AJ, Victora CG (2007) The relation between family socioeconomic trajectories from childhood to adolescence and dental caries and associated oral behaviours. J Epidemiol Community Health 61:141–145. https://doi.org/10.1136/jech.2005.044818

    Article  PubMed  PubMed Central  Google Scholar 

  13. Mielck A, Vogelmann M, Leidl R (2014) Health-related quality of life and socioeconomic status: inequalities among adults with a chronic disease. Health Qual Life Outcomes 12:58. https://doi.org/10.1186/1477-7525-12-58

    Article  PubMed  PubMed Central  Google Scholar 

  14. Hunt B, Whitman S (2015) Black: white health disparities in the United States and Chicago: 1990-2010. J Racial Ethn Health Disparities 2:93–100. https://doi.org/10.1007/s40615-014-0052-0

    Article  PubMed  Google Scholar 

  15. Franks P, Muennig P, Lubetkin E, Jia H (2006) The burden of disease associated with being African-American in the United States and the contribution of socio-economic status. Soc Sci Med 62:2469–2478. https://doi.org/10.1016/j.socscimed.2005.10.035

    Article  PubMed  Google Scholar 

  16. Do DP, Frank R, Finch BK (2012) Does SES explain more of the black/white health gap than we thought? Revisiting our approach toward understanding racial disparities in health. Soc Sci Med 74:1385–1393. https://doi.org/10.1016/j.socscimed.2011.12.048

    Article  PubMed  Google Scholar 

  17. IBGE (2013) Brazilian Institute of Geography and Statistics. Ethnic-racial Population Characteristics: Classifications and identities. Available in 07/27/2017 in: http://biblioteca.ibge.gov.br/visualizacao/livros/liv63405.pdf

  18. Baumgarten A, Bastos JL, Toassi RFC, Hilgert JB, Hugo FN, Celeste RK (2018) Discrimination, gender and self-reported aesthetic problems among Brazilian adults. Community Dent Oral Epidemiol 46:24–29. https://doi.org/10.1111/cdoe.12324

    Article  PubMed  Google Scholar 

  19. Ben J, Jamieson LM, Priest N, Parker EJ, Roberts-Thomson KF, Lawrence HP, Broughton J, Paradies Y (2014) Experience of racism and tooth brushing among pregnant aboriginal Australians: exploring psychosocial mediators. Community Dent Health 31:145–152

    PubMed  Google Scholar 

  20. Bastos JL, Celeste RK, Paradies YC (2018) Racial inequalities in oral health. J Dent Res. https://doi.org/10.1177/0022034518768536

  21. Williams DR, Collins C (2001) Racial residential segregation: a fundamental cause of racial disparities in health. Public Health Rep 116:404–416. https://doi.org/10.1093/phr/116.5.404

    Article  PubMed  PubMed Central  Google Scholar 

  22. Williams DR (1999) Race, socioeconomic status, and health. The added effects of racism and discrimination. Ann N Y Acad Sci 896:173–188

    Article  Google Scholar 

  23. Yoo W, Kim S, Huh WK, Dilley S, Coughlin SS, Partridge EE, Chung Y, Dicks V, Lee JK, Bae S (2017) Recent trends in racial and regional disparities in cervical cancer incidence and mortality in United States. PLoS One 12:e0172548. https://doi.org/10.1371/journal.pone.0172548

    Article  PubMed  PubMed Central  Google Scholar 

  24. Freire Mdo C, Reis SC, Figueiredo N, Peres KG, Moreira Rda S, Antunes JL (2013) Individual and contextual determinants of dental caries in Brazilian 12-year-olds in 2010. Rev Saude Publica 47(Suppl 3):40–49

    Article  PubMed  Google Scholar 

  25. Chisini LA (2017) Evaluation of factors that influencing amalgam restorations replacment by composite resins in posterior teeth in the life course: a study in a birth cohort. Dissertation, Federal University of Pelotas

  26. Paradies Y (2016) Whither anti-racism? Ethn Racial Stud 39:1–15. https://doi.org/10.1080/01419870.2016.1096410

    Article  Google Scholar 

  27. Finlayson T, Lemus H, Becerra K, Kaste L, Beaver S, Salazar C, Singer R, Youngblood M (2018) Unfair Treatment and Periodontitis Among Adults in the Hispanic Community Health Study/Study of Latinos (HCHS/SOL). J Racial Ethn Health Disparities 11

  28. Feagin J (2000) Racist America: roots, current realities, and future reparations. Routledge, New York

    Google Scholar 

  29. Pager D (2003) The mark of a criminal record. Am J Sociol 108:937–975

    Article  Google Scholar 

  30. Jamieson LM, Steffens M, Paradies YC (2013) Associations between discrimination and dental visiting behaviours in an aboriginal Australian birth cohort. Aust N Z J Public Health 37:92–93. https://doi.org/10.1111/1753-6405.12018

    Article  PubMed  Google Scholar 

  31. Alexander GC, Sehgal AR (1998) Barriers to cadaveric renal transplantation among blacks, women, and the poor. JAMA 280:1148–1152

    Article  PubMed  Google Scholar 

  32. Ayanian JZ, Cleary PD, Weissman JS, Epstein AM (1999) The effect of patients’ preferences on racial differences in access to renal transplantation. N Engl J Med 341:1661–1669. https://doi.org/10.1056/NEJM199911253412206

    Article  PubMed  Google Scholar 

  33. Manhart J, Chen H, Hamm G, Hickel R (2004) Buonocore memorial lecture. Review of the clinical survival of direct and indirect restorations in posterior teeth of the permanent dentition. Oper Dent 29:481–508

    PubMed  Google Scholar 

  34. Morimoto S, Rebello de Sampaio FB, Braga MM, Sesma N, Ozcan M (2016) Survival rate of resin and ceramic inlays, onlays, and overlays: a systematic review and meta-analysis. J Dent Res 95:985–994. https://doi.org/10.1177/0022034516652848

    Article  PubMed  Google Scholar 

  35. Angeletaki F, Gkogkos A, Papazoglou E, Kloukos D (2016) Direct versus indirect inlay/onlay composite restorations in posterior teeth. A systematic review and meta-analysis. J Dent 53:12–21. https://doi.org/10.1016/j.jdent.2016.07.011

    Article  PubMed  Google Scholar 

  36. Chisini LA, Collares K, Cademartori MG, de Oliveira LJC, Conde MCM, Demarco FF, Correa MB (2018) Restorations in primary teeth: a systematic review on survival and reasons for failures. Int J Paediatr Dent 28:123–139. https://doi.org/10.1111/ipd.12346

    Article  PubMed  Google Scholar 

  37. Da Rosa Rodolpho PA, Donassollo TA, Cenci MS, Loguercio AD, Moraes RR, Bronkhorst EM, Opdam NJ, Demarco FF (2011) 22-Year clinical evaluation of the performance of two posterior composites with different filler characteristics. Dent Mater 27:955–963. https://doi.org/10.1016/j.dental.2011.06.001

    Article  PubMed  Google Scholar 

  38. Demarco FF, Correa MB, Cenci MS, Moraes RR, Opdam NJ (2012) Longevity of posterior composite restorations: not only a matter of materials. Dent Mater 28:87–101. https://doi.org/10.1016/j.dental.2011.09.003

    Article  PubMed  Google Scholar 

  39. Stavropoulou AF, Koidis PT (2007) A systematic review of single crowns on endodontically treated teeth. J Dent 35:761–767. https://doi.org/10.1016/j.jdent.2007.07.004

    Article  PubMed  Google Scholar 

  40. Sequeira-Byron P, Fedorowicz Z, Carter B, Nasser M, Alrowaili EF (2015) Single crowns versus conventional fillings for the restoration of root-filled teeth. Cochrane Database Syst Rev CD009109. https://doi.org/10.1002/14651858.CD009109.pub3

  41. Nagasiri R, Chitmongkolsuk S (2005) Long-term survival of endodontically treated molars without crown coverage: a retrospective cohort study. J Prosthet Dent 93:164–170. https://doi.org/10.1016/j.prosdent.2004.11.001

    Article  PubMed  Google Scholar 

  42. Zachar J (2015) Should retention of a tooth be an important goal of dentistry? How do you decide whether to retain and restore a tooth requiring endodontic treatment or to extract and if possible replace the tooth? Aust Endod J 41:2–6

    Article  PubMed  Google Scholar 

  43. Brennan DS, Spencer AJ (2006) Longitudinal comparison of factors influencing choice of dental treatment by private general practitioners. Aust Dent J 51:117–123

    Article  PubMed  Google Scholar 

  44. Warren JJ, Hand JS, Levy SM, Kirchner HL (2000) Factors related to decisions to extract or retain at-risk teeth. J Public Health Dent 60:39–42

    Article  PubMed  Google Scholar 

  45. Pucca GA Jr, Gabriel M, de Araujo ME, de Almeida FC (2015) Ten years of a National Oral Health Policy in Brazil: innovation, boldness, and numerous challenges. J Dent Res 94:1333–1337. https://doi.org/10.1177/0022034515599979

    Article  PubMed  Google Scholar 

  46. Pires A, Gruendemann J, Figueiredo G, Conde M, Corrêa M, Chisini L (2015) Secondary oral health care in the state of Rio Grande do Sul: descriptive analysis of the specialized production in cities with dental specialty centers from the outpatient information system of the unified health system. Revista da Faculdade de odontologia - UPF 20:325–333. https://doi.org/10.5335/rfo.v20i3.5407

    Article  Google Scholar 

  47. Elderton RJ (1988) Restorations without conventional cavity preparations. Int Dent J 38:112–118

    PubMed  Google Scholar 

  48. Silva FBD, Chisini LA, Demarco FF, Horta BL, Correa MB (2018) Desire for tooth bleaching and treatment performed in Brazilian adults: findings from a birth cohort. Braz Oral Res 32:e12. https://doi.org/10.1590/1807-3107bor-2018.vol32.0012

    Article  PubMed  Google Scholar 

  49. Calvasina P, Muntaner C, Quinonez C (2015) The deterioration of Canadian immigrants’ oral health: analysis of the longitudinal survey of immigrants to Canada. Community Dent Oral Epidemiol 43:424–432. https://doi.org/10.1111/cdoe.12165

    Article  PubMed  Google Scholar 

  50. Lawrence HP, Cidro J, Isaac-Mann S, Peressini S, Maar M, Schroth RJ, Gordon JN, Hoffman-Goetz L, Broughton JR, Jamieson L (2016) Racism and oral health outcomes among pregnant Canadian aboriginal women. J Health Care Poor Underserved 27:178–206. https://doi.org/10.1353/hpu.2016.0030

    Article  PubMed  Google Scholar 

  51. San Martin A, Chisini L, Martelli S, Sartori L, Ramos E, Demarco F (2018) Distribution of dental schools and dentists in Brazil: an overview of the labor market. Revista da Abeno. https://doi.org/10.30979/rev.abeno.v18i1.399

  52. Stefanac SJ (2007) CHAPTER 3 - Developing the treatment plan. In: Treatment planning in dentistry, 2nd edn. Mosby, Saint Louis, pp 53–68

    Chapter  Google Scholar 

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Funding

The work was supported by the National Council for Scientific and Technological Development (CNPq).

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Authors and Affiliations

  1. Federal University of Pelotas, 457, Gonçalves Chaves St. 5th floor, Pelotas, Rio Grande do Sul, 96015-560, Brazil

    Luiz Alexandre Chisini, Thaís Gioda Noronha, Ezequiel Caruccio Ramos, Kaio Heide Sampaio & Marcos Britto Corrêa

  2. Department of Dentistry, Federal University of Sergipe, Cláudio Batista St., Aracaju, 49060-108, Brazil

    Reginaldo Batista dos Santos-Junior & André Luis Faria-e-Silva

Authors
  1. Luiz Alexandre Chisini
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  2. Thaís Gioda Noronha
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  3. Ezequiel Caruccio Ramos
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  4. Reginaldo Batista dos Santos-Junior
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  5. Kaio Heide Sampaio
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  6. André Luis Faria-e-Silva
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  7. Marcos Britto Corrêa
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Correspondence to Marcos Britto Corrêa.

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The Ethics Committee of the Dental College of the Federal University of Pelotas approved this project (number of 1,422,885).

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Chisini, L.A., Noronha, T.G., Ramos, E.C. et al. Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study. Clin Oral Invest 23, 1023–1030 (2019). https://doi.org/10.1007/s00784-018-2526-7

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  • DOI: https://doi.org/10.1007/s00784-018-2526-7

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