Dental ExtraCtion versus filling of adult teeth In chilDren: an Economic evaluation (DECIDE)

Abstract

Introduction This thesis identifies the most efficient pathway for children with compromised first permanent molar (cFPM) adult teeth, comparing extraction versus restoration, including establishing and incorporating public willingness to pay (WTP). Adolescents’ and adults’ views and experiences of managing cFPM were qualitatively established. cFPM, most commonly due to dental caries and molar-incisor hypomineralisation, cause pain and impact children across England. Clear guidance on whether to restore or extract cFPM in children does not exist. Methods This thesis comprises three complementary studies. Online semi-structured interviews were undertaken with adolescents and adults. Transcripts were thematically analysed. A discrete choice experiment was designed and disseminated to 430 members of the public. Conditional (fixed effects) logistic regression established public preferences, and WTP. An individual patient-level microsimulation model was built, and parameterised, to compare the relative efficiency of initial cFPM strategies over the life course of a child. Results Several internal and external factors influence adolescents’ and adults’ management of cFPM. Any decision should be made in a shared-care approach, ensuring active involvement of adolescents. There is no clear public preference to restore or extract cFPM in a child, providing the resultant space was closed spontaneously or orthodontically. A preference exists for management by a general dental practitioner or a specialist. The public prefer decisions to be made by a parent, or in conjunction with the dentist. Base-case analysis, and scenario analyses, suggests the most efficient approach is to extract cFPM between the age of seven and ten. Definitively restoring is an efficient option but is less so than extraction. In the scenario modelled, active monitoring and temporary filling, followed by extraction at the optimum time, are dominated strategies and should not be offered.

Discussion Clinical and policy implications of these findings, limitations of the methods used and recommendations for future research are discussed.