To our knowledge, this is the first study to examine the use of a comprehensive range of diagnostic methods, preventive agents, and restorative decisions for caries between male and female dentists. Overall, among general dentists who were members of The Dental Practice-Based Research Network and practicing in the US, female dentists had a greater orientation for caries prevention and made more-conservative clinical decision in caries treatment in some situations than male dentists. However, there were as many areas of practice where they are similar as different.
It has been shown that male and female dentists both performed similar numbers of procedures per patient and received similar income per patient seen in practice (4
). In further support of this conclusion, this study shows that when only full-time dentists were considered, males and females had equal amounts of patients. Although total income was not asked, these data also showed that fees charged by female dentists for restorations were similar to their male counterparts, and female dentists were equally likely to see patients with dental insurance. If differences in income per patient do exist, they could relate to the types of procedures performed, as one previous study has found that female dentists refer complex and potentially more-profitable cases to specialists more often than male dentists (6
Although the dental literature is mixed (6
), female dentists had a greater overall preventive orientation than male dentists for both adult and pediatric patients. Consistent with increases in the proportion of females graduating from US dental schools, female DPBRN dentists were younger and more-recent graduates than their male colleagues. These graduation patterns coincide with findings from other DPBRN studies that show dentists with fewer years since graduation were more likely to have recommended preventive treatment than those with more years since graduation (26
). Brennan and Spencer found that for both genders, dentists aged 29 years and younger had higher preventive treatment rates than those over 65 years of age (12
). Adjustments for gender-related differences in the graduation year and related interactions were made in the statistical analysis. The only finding contrary to the hypothesis for greater prevention among female dentists was that males tend to use in-office fluoride more often on pediatric patients.
There are many elements that can affect rate of preventive services in dental offices which could be associated with gender (27
). For example, residing in a lower socioeconomic status location was associated with a lower preventive rate among Australian dentists (12
). Another study found that 62% of the dental respondents indicated that the patient’s behavior influenced decisions to place a sealant (28
). Other important factors could include whether the patient has dental insurance, local norms for prevention, caries risk of the dentist’s patient pool, or even that patients with a high priority for caries prevention also seek out a female dentist (29
). One study has linked reimbursement rates and the use of in-office administered fluorides by dentists (28
) and another found that increased financial incentive significantly increased sealant use on the molars of children, whereas education in evidenced-based practice did not (30
). Neither of these studies tested for gender effects. There were no gender differences in the percent of patients seen in a practice who have dental insurance in this sample, suggesting minimal gender bias associated with financial incentives.
Caries risk assessment has been examined in several recent studies. Caries risk assessment determines the probability of caries incidence in a certain period of time (29
), and this study suggests that female dentists consider caries history as more important in treatment planning than male dentists. There were few differences in diagnostic methods employed by male and female dentists, and both agreed on the effectiveness of caries risk assessment. However, our previous report has indicated that while gender was not associated with the practice of risk assessment, it did show considerable variability in how risk was determined (31
). There were few gender differences in diagnostic methods. Although not differing by gender, 90% of network dentists reported that they use an explorer to probe the margin of an existing restoration, a procedure thought to be inadequate for caries detection and with potential for iatrogenic injury (32
Female dentists took a more-conservative approach to restoration on the case scenario that involved patients with interproximal lesions. However, it was fewer years since graduation, and not gender, that was associated with restoration at a greater lesion depth (more-conservative approach) for the occlusal lesion scenarios. One reason for avoiding early restorations is that it reduces the probability of multiple replacements, which in turn further weakens the tooth structure (33
). However, as stated previously, another study found no difference between male and female dentists with regard to the number of procedures performed per patient (4
Some limitations to these data should be noted. The study sample is not a random sample of general dentists in the United States. However, based on comparisons to dentists who responded to the 2004 ADA Survey of Dental Practice, DPBRN dentists have much in common with dentists at large (23
). DPBRN dentists represent a substantial diversity with regard to practice settings, patient populations, rural-urban area of residence, and geographic locations. Participation rate was lowest in the AL/MS region and the majority of dentists recruited in that region were enrolled in DPBRN to participate in other studies before DPBRN became a network that comprises five regions, and this may explain their lower participation rate. The questions about preventive treatments were asked separately; consequently, we are unable to infer to what extent individual patients were given or had recommended single or multiple treatments. It should be noted that the gender tests on the importance of caries risk were comparing a binary coded variable moderately or less important with very or extremely important and that we do not imply that dentists differed on whether caries risk in a treatment plan is of general importance.