Does the skin color of patients influence the treatment decision-making of dentists? A randomized questionnaire-based study
- 146 Downloads
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.
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.
Patient skin color influenced the dentist’s choice of treatment. In general, black patients receive referrals for cheaper, simpler procedures.
Skin color played an important role in dentists’ treatment decisions. Professionals may contribute unconsciously to the propagation and replication of racial discrimination.
KeywordsSkin color Amalgam Decayed tooth Treatment
The work was supported by the National Council for Scientific and Technological Development (CNPq).
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
The Ethics Committee of the Dental College of the Federal University of Pelotas approved this project (number of 1,422,885).
All participants signed informed consent forms.
- 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 CrossRefGoogle 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
- 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 31:145–152Google Scholar
- 20.Bastos JL, Celeste RK, Paradies YC (2018) Racial inequalities in oral health. J Dent Res. https://doi.org/10.1177/0022034518768536
- 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 PelotasGoogle 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 11Google Scholar
- 28.Feagin J (2000) Racist America: roots, current realities, and future reparations. Routledge, New YorkGoogle 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 29:481–508Google 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 CrossRefGoogle 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
- 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 Google Scholar
- 47.Elderton RJ (1988) Restorations without conventional cavity preparations. Int Dent J 38:112–118Google 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 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 CrossRefGoogle 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