Bouma J, Westert G, Schaub R M, van de Poel F
Department of Social Sciences in Dentistry, University of Groningen, The Netherlands.
Community Dent Oral Epidemiol. 1987 Oct;15(5):268-72. doi: 10.1111/j.1600-0528.1987.tb00535.x.
Full mouth extraction is the final step in a continuous process in which not only dental but also social processes play a role. In a research project concerning the reasons for full mouth extractions in The Netherlands, it was found that over one-third of the patients had considered full mouth extractions at least once before, and 16% considered it frequently over a period of many years. Anxiety was the most important reason for not visiting a dentist. In the patients' view in 86% of the cases they were the initiator of the decision to have all their teeth extracted. According to the dentist the patients initiated full mouth extraction in 70% of the cases. Dentists and patients agreed that irregular attenders more often took the initiative than regular attenders. Most patients (87%) had discussed the decision to have all teeth extracted with one or more persons; different contacts were reported by 14% percent of the patients. According to Freidson's lay referral theory two groups could be identified: a group with a severely truncated lay referral structure and a group characterized by a more extended lay referral structure. The first group was older (46 versus 36 yr) and had a more positive attitude towards full dentures. In order to avoid problems dentists are recommended to involve (a representative of) the patient's social network when important decisions have to be taken.
全口拔牙是一个连续过程的最后一步，在这个过程中，不仅牙科过程，社会过程也发挥着作用。在一项关于荷兰全口拔牙原因的研究项目中发现，超过三分之一的患者此前至少考虑过一次全口拔牙，16%的患者在多年时间里经常考虑此事。焦虑是不看牙医的最重要原因。在患者看来，86%的情况下他们是决定拔除所有牙齿的发起者。据牙医称，70%的情况下是患者主动要求全口拔牙。牙医和患者一致认为，不定期就诊者比定期就诊者更常主动提出拔牙。大多数患者（87%）与一人或多人讨论过拔除所有牙齿的决定；14%的患者报告有不同的交流对象。根据弗里德森的外行转诊理论，可以识别出两组：一组外行转诊结构严重截断，另一组的特点是外行转诊结构更广泛。第一组年龄较大（46岁对36岁），对全口假牙的态度更积极。为避免出现问题，建议牙医在必须做出重要决定时让患者社交网络的（一名代表）参与进来。
