Predictors of treatment preference for mandibular fracture

• Published in: Journal of public health dentistry 2010, Vol.70 (1), p.13-18
• Main Authors: Der-Martirosian, Claudia, Gironda, Melanie W., Black, Edward E., Belin, Thomas R., Atchison, Kathryn A.
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Decision Making; Dentistry; Fracture Fixation - psychology; Humans; Jaw Fixation Techniques - psychology; Linear Models; mandibular fracture; Mandibular Fractures - surgery; Mandibular Fractures - therapy; Middle Aged; MMF; Molar, Third - surgery; patient preference; Patient Preference - statistics & numerical data; Prospective Studies; RIF; Risk-Taking; Severity of Illness Index; standard gamble; Tooth Extraction - psychology; United States; Young Adult
• ISSN: 0022-4006; 1752-7325
• DOI: 10.1111/j.1752-7325.2009.00138.x

Background: Patient treatment preferences do not necessarily remain stable over time. Objective: This study focuses on predictors of patient treatment choice and on the extent to which patients are willing to take risks by choosing surgical versus non‐surgical treatment for mandibular fracture. Methods: Surveys of African‐American and Hispanic adults receiving treatment at King/Drew Medical Center for either a mandibular fracture (n = 98) or third‐molar removal (n = 105) were used to investigate patterns of patient preference over the course of a 4‐month study period using generalized estimating equations controlling for age, gender, income, and fracture versus third‐molar patient. The study examined the effects of symptom rating and a “standard gamble” measure reflecting a patient's willingness to accept scarring or nerve damage. This analysis is based on 169 patients who participated in four waves of data collection. Results: The most salient predictor of patient treatment was the standard gamble measure at 1‐month follow‐up. Subjects with higher risk tolerance were more likely to select surgery versus jaw wiring. A higher likelihood of choosing surgery was associated with higher income and greater symptom severity. Fracture patients were more likely to select surgery compared with third‐molar patients. Conclusions: The significance of symptom severity 1‐month post‐surgery raises an important issue regarding the healing process. Moreover, the significance of standard gamble as a predictor of treatment choice for mandibular fracture should encourage other researchers to use this measure of willingness to accept risk when studying acute conditions such as jaw fracture.