To what extent do patients' racial characteristics affect our clinical decisions?

Abstract

Design The study employed a randomised controlled trial methodology and it was delivered electronically as a survey. Intervention Fifty-seven primary and secondary care dentists were randomised to two experimental groups. The participants in both groups assessed a vignette (clinical scenario, clinical photograph and radiograph) with the only difference between the vignettes in the two groups being the patient's race (skin colour: Black or White). The scenario was a case of a severely carious first lower molar with signs and symptoms of irreversible pulpitis.Outcome measures The dentists' clinical treatment decisions (recommendation of root canal treatment or extraction) were recorded. A previously validated Brief Implicit Association Test (BIAT) was used to measure implicit racial bias.Results A statistically significant difference in dentists' recommendations was observed. Recommendation of root canal treatment was greater for White patients (86.21%) compared to the Black patients (60.71%) and dentists were far more likely to recommend extraction in the Black patient group. The BIAT scores also indicated that pro-White unconscious racial bias was prevalent amongst the participants. Conclusion A patient's race may influence a dentist's decision whether to extract or retain a decayed tooth.