Triggers for patients’ referral for NHS dental implant treatment and the subsequent decision making process; Patients’ encounters and Clinicians’ views

Objectives: Within the NHS, implant provision is restricted in order to manage a limited resource and prioritise those with greatest need. This study aims to explore 1) the main triggers for referral of patients for implant treatment via NHS secondary care, and, 2) patients’ and clinicians’ thoughts of, and their roles in, the decision making process in the context of ‘restricted’ NHS implant provision
Methods: This qualitative study used audio-recorded semi-structured interviews with a purposive sample of patients and clinicians at a NHS secondary care clinic. Thematic content analysis was undertaken to reveal emerging themes.
Sample ; Patients (, 35 interviews with 31 individuals, 50% edentulous, 12 women and 19 men, age range 19-76 with 50% under age of 40) and clinicians (n=7)
Results: Three core themes in relation to patients’ experiences of the decision stage were identified;
1)The ambiguity of patient selection criteria
2)The length of time for the decision process to be undertaken
3)The “risk” of ineligibility for implants restorations within the NHS and the subsequent impact on their quality of life and tolerance of other treatment options.
In contrast the two themes emerging from the clinician interviews were;
1) The status of current guidelines (RCS, 2012)[1] which are open to personal interpretation
2) The decisions on implant provision were dependant on local conditions (i.e. the implant team and local resource allocation)
In addition, patients’ referrals from primary care to NHS clinic were mainly steered by RCS implant guidelines.


[1] Royal college of Surgeons, Faculty of Dental Surgery: Guidelines for Selecting Appropriate Patients to Receive Treatment with Dental Implants: Priorities for the NHS
Conclusions: More robust national NHS implant selection criteria may be required to facilitate shared decision making within primary and secondary care. Patients need clearer information about the planning stages for implants and how this can affect selection and treatment progression. Duration of treatment stages and the need for implant maintenance should be highlighted & discussed early during the decision making process as these factors influence patient’s decision to proceed with implants if offered.