Minimally-invasive dental anesthesia: Patients' preferences and analysis of the willingness-to-pay index

Socioeconomic Determinants of Willingness to Pay for Emergency Public Dental Services in Saudi Arabia: A Contingent Valuation Approach

Dental diseases remain major health problems worldwide, leading to pain, discomfort, and even death. In Saudi Arabia, public dental care services (i.e., services provided by government-owned health facilities) are provided free of charge for all Saudi citizens. However, public dental care facilities are overburdened and overcrowded, resulting in long waiting times to access dental care services. The consequent limited access to dental services can prolong discomfort and delay pain management, thereby exacerbating the suffering of patients. Therefore, the aim of this study was to examine the socioeconomic determinants of the willingness to pay for immediate public dental care in the face of a dental emergency in Saudi Arabia. A cross-sectional design was employed to obtain data from adult citizens of Saudi Arabia who were residents of the Holy City of Makkah. A pre-tested online questionnaire was used to obtain the responses from 549 individuals, selected through a snowball sampling technique, from 15 July to 10 August 2021. Descriptive statistics (frequencies and percentages), Pearson's chi-square test, and binary probit regression were used as estimation techniques. The findings showed that 79.4% of the respondents were willing to pay for immediate public dental services, with the majority (86%) expressing a willingness to pay less than 500 Saudi Riyal (SAR). The binary probit regression estimates showed that respondents who were unemployed, those with a high school level of education or below, and those without private health insurance were less likely to be willing to pay for immediate public dental services. Thus, policies and initiatives aimed at enhancing the willingness to pay for immediate public dental services should target the unemployed, those with a high school level of education or below, and people without private health insurance.

Prevalence of Missing Values and Protest Zeros in Contingent Valuation in Dental Medicine

Background: The number of contingent valuation (CV) studies in dental medicine using willingness-to-pay (WTP) methodology has substantially increased in recent years. Missing values due to absent information (i.e., missingness) or false information (i.e., protest zeros) are a common problem in WTP studies. The objective of this study is to evaluate the prevalence of missing values in CV studies in dental medicine, to assess how these have been dealt with, and to suggest recommendations for future research. Methods: We systematically searched electronic databases (MEDLINE, Web of Science, Cochrane Library, PROSPERO) on 8 June 2021, and hand-searched references of selected reviews. CV studies in clinical dentistry using WTP for valuing a good or service were included. Results: We included 49 WTP studies in our review. Out of these, 19 (38.8%) reported missing values due to absent information, and 28 (57.1%) reported zero values (i.e., WTP valued at zero). Zero values were further classified into true zeros (i.e., representing the underlying preference of the respondent) or protest zeros (i.e., false information as a protest behavior) in only 9 studies. Most studies used a complete case analysis to address missingness while only one study used multiple imputation. Conclusions: There is uncertainty in the dental literature on how to address missing values and zero values in CV studies. Zero values need to be classified as true zeros versus protest zeros with follow-up questions after the WTP elicitation procedure, and then need to be handled differently. Advanced statistical methods are available to address both missing values due to missingness and due to protest zeros but these are currently underused in dental medicine. Failing to appropriately address missing values in CV studies may lead to biased WTP estimates of dental interventions.

An overview of the methodological aspects and policy implications of willingness-to-pay studies in oral health: a scoping review of existing literature

Background

Demands for dental services seem to be beyond the capacities of most healthcare systems these days. Patient preferences have been increasingly emphasized to be considered in the joint decision-making process. Willingness-to-pay (WTP) is a recommended method for measuring the utility of health services; increasingly being used in recent decades. Taking these points into consideration, this article aims to provide an overview of the methodological aspects and policy implications of WTP studies in the field of oral health.

Methods

The research was conducted in ISPOR, PubMed and Google Scholar databases. In addition, reference lists of included articles were checked to identify the relevant studies. All studies published were included that were in the English language and reported using WTP for oral health-related goods and services. A data-charting form was developed by a focus group discussion panel of seven experts to derive the main methodological aspects of WTP. Also, Core policy suggestions were categorized through thematic content analysis of the included papers.

Results

The search strategy yielded 389 studies of which 52 were included. WTP studies in oral health show an increasing trend in global publications. The UK and Canada have a greater share in published material than in any other country. The dominant field of these researches is in restorative and prosthetic dentistry, and a wide range of different methodological aspects was documented. Policy suggestions were categorized in three main themes: (A) setting new tariffs or subsidizing the item, (B) provision of the item due to population preferences, and (C) improving literacy regarding the item.

Conclusions

An urgent need for a common framework regarding the design of WTP studies in dentistry seems paramount. Some policy suggestions seem not to be applicable, perhaps due to insufficient familiarity of the researchers with the complexities of the public policymaking process.

Influence of information concerning a computerized anesthesia system on dental anxiety: a randomized controlled clinical trial

BACKGROUND

A single-blinded randomized controlled trial among patients requiring an upper third molar extraction was performed to evaluate the anxiety degree after receiving information or not about the functioning of The Wand system. Secondarily, perceived pain and the need of re-anesthesia were assessed.

MATERIAL AND METHODS

Patients were randomly assigned to the experimental group (detailed explanation about The Wand) or control group (no specific information). Local anesthesia with The Wand consisted in a supraperiosteal infiltrative technique injection 1.6 mL at the buccal and 0.2 mL at the palatal side. Distinct questionnaires for assessing dental anxiety and 100-mm visual analog scales to assess pain were delivered. Demographic data, radiological parameters, operative time and type of intervention were also registered. A descriptive bivariate analysis by non-parametric tests to detect differences in anxiety, pain and re-anesthesia was performed by SPSS 22.0 (SPPS Inc. Chicago, USA).

RESULTS

A total of 85 patients were assessed for eligibility but 17 participants were lost due to the cancellation of the visit for the surgical intervention. Finally, sixty-eight patients were included (34 participants in each group), 47 women (69.1%) and 21 men (30.9%), with an average age of 28.8 (± 9.3) years.

CONCLUSIONS

Patients that received a detailed explanation of The Wand did not have a significant reduction of the anxiety degree and perceived pain during the anesthetic act compared to patients that received no information. The need of re-anesthesia was not related to the anxiety level but was significantly related to increasing operative time.