Original article Subjective values of different age groups in Japan regarding treatment for missing molars Kazunori Ikebe, Tomohiro Hazeyama, Taiji Ogawa, Ryosuke Kagawa, Ken-ichi Matsuda, Masahiro Wada, Tomoya Gonda and Yoshinobu Maeda Department of Prosthodontics and Oral Rehabilitation, Osaka University Graduate School of Dentistry, Osaka, Japan doi: 10.1111/j.1741-2358.2009.00357.x Subjective values of different age groups in Japan regarding treatment for missing molars Objective: To determine how patients and dentists in Japan value the outcomes of different treatment options for missing molars. Materials and methods: Elderly removable-denture wearers and dentate persons (senior group), pre- clinical dental students (young group), and prosthodontists were presented with five possible treatment options for missing lower bilateral first and second molars. The participants indicated on a visual analogue scale how they would value the treatment (utility value: UV), if they had received each of the treatments. Two-way repeated measures ANOVA was used for statistical analyses. Results: The UV for the shortened dental arch (SDA) without replacement was the lowest in every group. The young group rated the value of cantilever fixed partial dentures (FPD) and implants significantly higher than removable partial dentures (RPD), while the senior group rated the value of FPD and RPD significantly higher than implants. Those having experience with removable dentures were likely to place a higher value on the acrylic RPD. The prosthodontists rated the value of implants significantly higher than any other options. Conclusions: The participants in every group placed the lowest value on the outcome from the SDA in Japan. The denture wearers preferred the RPD, while prosthodontists preferred implants. Keywords: treatment options, missing molars, shortened dental arch, visual analogue scale. Accepted 4 September 2009 Introduction Clinical decision-making is a significant intellectual activity engaged in not only by health-care pro- fessionals but also by patients themselves. The decision as to whether and how to treat a patient depends upon the balance among the perceived advantages, such as self-image or aesthetics, the objective advantages, such as occlusion, chewing or improved appearance, and the disadvantages, such as invasiveness, treatment period, possible side effect or cost-effectiveness. It is now generally accepted, especially for chronic medical conditions, that a ‘patient-oriented system (POS)’ for clinical decision-making leads to greater success than a ‘doctor-oriented system (DOS)’, that is, a traditional bio-mechanical approach 1,2 . Therefore, there is a philosophy that patient’s values and preferences should be placed central to optimal clinical decision-making 3 . It is essential that a clinician is prepared to accept the patient’s choice of treatment, even if it does not agree with the most effective treatment from the clinician’s view. However, clinicians and patients often evaluate outcomes of treatment differently. For example, clinicians assign high value to benefit, while patients assign very low value to the process and side effects of treatment 4 . Unfortunately, discrepancies between their evaluations can lead to poor treatment planning. Utility is a general concept for measuring the value individuals attach to the consequences of various courses of action 5 . The concept of utility refers to the level of subjective satisfaction, distress or desirability that people associate with a partic- ular outcome 6 . The utility approach is now a viable alternative for investigators to use in measuring health-related quality of life 7 . Although the 192 Ó 2010 The Gerodontology Society and John Wiley & Sons A/S, Gerodontology 2011; 28: 192–196