Objective: The decision to extract a tooth is a complex process involving input from patient and dentist. This study investigated patient and dentist factors influencing the decision to extract a permanent tooth. Methods: Survey instruments consisting of multiple choice and fill-in questions were completed when the decision was made to extract a tooth at the Univ. of Iowa College of Dentistry. A research assistant ensured that each completed case included a patient consent, along with patient and corresponding dentist survey's, answered by the patient and the supervising faculty dentist. Kappa statistics were used as measures of agreement between the patient and the dentist.(0=no agreement beyond chance, 1=complete agreement) Results: The patient sample (N=80) was 54% female and had a mean age of 55(range 20-93). Primary reasons listed by patient's for extraction were pain(29%), decay(25%), and fracture(16%). Non-disease factors that influenced patient's decisions were lack of insurance (36%) and expense (35%). The primary reason for extraction cited by the dentist was gross caries (50%), followed by non-restorable(10%), periodontal disease (9%) and trauma/root fracture(9%). Non-disease factors influencing the dentist's decision were the patient's age (10%) and health(10%). Agreement between the dentist and patient regarding the primary reason for tooth extraction was very poor, (Kappa=0.08; CI –0.04-0.20). Patients estimated their percent of influence in the extraction decision was 63%, while dentist felt that the patient had only 56% influence in the decision. Conclusions: Results indicate poor agreement between the dentist and patient on reasons for tooth extraction. Both patients and dentists report that patients have a greater influence on the extraction decision. Patients most often listed pain, decay and cost concerns as factors in the decision while dentists most often listed advanced decay and the patient's health and age. NIH P30 DE10126 and Univ. of Iowa Dental Research Award

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