Department of Health, Behavior & Society Department of Health, Behavior & Society David Holtgrave, PhD, Professor & Chair © 2005, Johns Hopkins University. All rights reserved.

Overview of Presentation (Session 4156.0 Abstract 165494) “Translating Evidence Into Practice: A Patient Perspective on Third Molar Extraction” First-person, consumer perspective How I came to be on this panel Life course experiences with dentists regarding third molars Scope of extant literature (a patient perspective) Research / practice suggestions from a first person perspective

Clinical Case Male patient Mid 40s Generally good health Generally good oral health Small number fillings One root canal with cap Tetracycline staining from childhood Four partially erupted third molars; good condition

A health literacy conference story Invited speaker at Pfizer Health Literacy Conference Speaking on HIV prevention During discussion needed another example of patient empowerment (my third molars) Participant after participant revealed they too had third molars

Dentist #1: Shared Decision Making (Patient brings up options) Dentist saw third molars and recommended potential removal Patient examined clinical decision making literature Patient and dentist discussed literature in detail Benefits Side effects Probabilistic concepts Other-cause mortality / context Decision trees Shared decision made for watchful waiting

Dentist #2: Prescriptive Directions Dentist recommended third molar removal Prescription fashion Patient mentioned clinical decision making literature on third molar extraction, and began discussion Dentist response was surprise and then silence Conversation ended “before it began”

Dentist #3: Shared Decision Making (Dentist brings up options) Dentist noted option of third molar extraction Dentist also noted pros and cons of extraction Patient mentioned reading of the literature and engaged in discussion of pros and cons Dentist welcomed the discussion Dental team included in discussion Shared decision made for watchful waiting

Scope of Extant Literature Key Word Crossed With PubMed Hits Third Molar No cross terms 3974 Decision Analysis 30 Cost-effectiveness 22 Health Literacy 3 Patient Perspective All terms above 53 unduplicated hits

Suggestions From a Consumer Research on health literacy and third molars needs expansion Research on decision aids for shared decision making needs expansion At least one consumer wants the best scientific information presented, uncertainties acknowledged, and decisions truly shared

Department of Health, Behavior & Society Department of Health, Behavior & Society David Holtgrave, PhD, Professor & Chair © 2005, Johns Hopkins University. All rights reserved.