Title: 0206 - Does Competition Affect the Clinical Decision-Making of Dentists?


Abdulrahman Ghoneim (Presenter)
University of Toronto

Bonnie Yu, University of Toronto
Carlos Quinonez, University of Toronto
Herenia Lawrence, University of Toronto
ketan Shankardass, University of Toronto
Michael Glogauer, University of Toronto


Objectives: To investigate the association between dentists’ geographic density, perceptions of competition, and various non-clinical factors, with clinical decision-making

Methods: This was a cross-sectional, self-administered survey among a random sample of general dentists in Ontario, Canada (n=3,201). The 46-item survey collected demographic, professional, and practice information, and self-perceptions of competition and financial pressures. Competition was quantified using dentist density, defined as the number of dental clinics lying within a one-kilometer radius around a respondents’ clinic address. The outcome (clinical decision-making, or treatment-intensity), was measured using a set of clinical scenarios, which categorized dentists as either aggressive or conservative. Associations were assessed using bivariate analysis and logistic and linear regressions.

Results: One thousand and seventy-five dentists responded (33.6% response rate). Age (p=0.001), place of initial dental training (p<0.001), number of dependents (p=0.001), number of hours worked/week (p=0.043), billings/hour needed to be profitable (p<0.001), number of hygienists employed (p=0.001), perceptions of practice loans (p=0.02), satisfaction with practice busyness (p=0.084), and feeling competitive pressure from other dentists (p=0.037) were associated with treatment-intensity. Dentists who were <40-years old (OR=2.06, 95% CI:1.39-3.06), American-trained (OR=2.48, 95% CI:1.51-4.06), had student loans (OR=3.96,95% CI:1.88-8.33), large practice loans (OR=1.57, 95% CI:1.02-2.42), perceived other dentists as competitors (OR=1.77, 95% CI:1.01-3.10), and perceived large competitive pressure from other dentists (OR=1.63, 95% CI:1.07-2.49), were more likely to be aggressive in their treatment choices. Interestingly, dentists located in low dentist density areas (OR=1.31, 95% CI:1.03-1.68) were also more like to be aggressive.

Conclusions: This study is the first to explore the impact of competition and other non-clinical factors on the clinical decision-making of dentists in a Canadian context and will serve as a foundation for future research in this area.

Student Presenter

Disclosure Statement:
The submitter must disclose the names of the organizations with which any author have a relationship, the nature of the relationship, and the clinical or research area involved. The following is submitted: NONE