The Impact of Cognitive Biases on Decision-Making in Dentistry

Decision-making is a fundamental task of human behavior, influencing everything from personal choices to professional undertakings. However, this process is not as rational as we might assume: The human mind can be susceptible to a myriad of cognitive biases that affect the quality and outcome of our decisions.?

Cognitive biases are systematic patterns of deviation from norm or rationality in judgment, which often lead us to make decisions based on subjective factors rather than objective information. It’s important to identify these biases and dissipate their often-pervasive effect: For dentists, they can affect clinical judgment, treatment planning, patient interactions, leading, and team building, and for patients, they may influence decision processes and behaviors. This article discusses some of the most common cognitive biases and how they can influence decision-making in dentistry.

Anchoring bias

The details: Anchoring bias occurs when individuals rely too heavily on the first piece of information encountered — the “anchor” — when making a decision. Subsequent information is often interpreted in relation to this anchor, which can skew decisions toward the initial reference point even if it’s irrelevant or arbitrary.?

In dentistry: Based on our initial conversation with a patient, we may make assumptions about their financial situation or preference toward potential treatment options, inferring that they can’t afford or aren’t interested in pursuing comprehensive care. We then present them with only limited therapy options, instead of building a stronger argument toward comprehensive interdisciplinary management.?

Patients don't know what they don't know — and why should they? — which means dentists need to engage in a proactive, co-discovery type of conversation that describes the patient’s clinical condition. By utilizing concepts such as a tour of the mouth or what I refer to as “the buyer's journey,” we focus on presenting findings to our patients instead of heading straight to solutions. This allows them to ask questions and engage in a different type of conversation than would arise if we presented patients with only limited therapy options, creating an optimal experience for patients and dental team alike.

Availability heuristic

The details: The availability heuristic is a mental shortcut where individuals rely on readily available information, often from personal experiences or recent events, to make decisions. This bias can lead to an overemphasis on vivid or memorable information, neglecting more relevant but less accessible data. In decision-making, the availability heuristic can contribute to the misjudgment of probabilities and the overlooking of critical information.?

In dentistry: If we recently had a suboptimal outcome with a specific clinical protocol, such as an immediate loading of an anterior implant, this shouldn’t stop us from trying the same protocol with another patient, so long as the clinical parameters meet the criteria for a successful outcome. A recent unfavorable experience doesn’t predict this will be the norm moving forward, and we shouldn’t be discouraged from using protocols that have a sound, evidence-based predictable result.

Sunk-cost fallacy

The details: The sunk-cost fallacy involves the tendency to continue investing resources — time, money, effort — into a decision based on the cumulative investment already made, rather than evaluating the current situation objectively. This can result in individuals persisting with failing projects or endeavors simply because they’ve invested significant resources, even if it’s more rational to cut losses and redirect efforts elsewhere.?

In dentistry: Sunk-cost fallacies can affect the techniques, equipment and materials we choose to utilize: sticking with your electrosurgery unit instead of buying a laser, or continuing to use the large stock of direct composite materials you bought after a weekend course but never seem to work predictably in your hands.?

Interpersonally, sunk-cost fallacy might lead to keeping a practice team member who’s never performed up to standard despite continued investment, or continuing to treat a patient who regularly creates problems. We’re better off terminating toxic professional relationships with these types of people, instead of continuing to foster them without any hope for improvement.?

Confirmation bias

The details: One of the most common cognitive biases, confirmation bias leads individuals to favor information that confirms their existing beliefs or values. They seek and interpret information in a way that reinforces their views, while disregarding or downplaying evidence that contradicts them. This results in a tendency to make choices based on incomplete or biased information.?

In dentistry: It’s common to see patients who’ve consulted with “Dr. Google” or saw posts on Instagram or Facebook courtesy of an algorithm that seems to know them too well — itself an example of confirmation bias at work. They’ll suggest veneers or composite bonding to optimize an esthetic discrepancy, even if it’s caused by tooth malposition that preferably would be addressed with orthodontic treatment.??

We must devote time and care to educating our patients about the potential price of “quick fix” approaches to misaligned teeth, and the benefits of less invasive solutions. (For more on this topic, I suggest this article about how to avoid overtreatment through thoughtful patient communication.)?

Selective attention

The details: The Baader-Meinhof phenomenon, also known as the “frequency illusion,” highlights the role of selective attention in decision-making: When someone encounters a new piece of information or a concept, they become more attuned to it and may give it undue importance in subsequent decision-making situations — even if the information isn’t inherently more relevant or significant.?

In dentistry: After taking a weekend course, it’s tempting to try to implement the concepts we just learned on every new patient who walks into our practice. What’s particularly important to remember is that these courses often focus on teaching how to do something — incorporating a certain technology or workflow into your practice, for example — instead of why you’d want to do it.??

For instance, if we’ve taken a hands-on course on handling patients with a terminal dentition in which the technique involved removing teeth, placing implants and performing an immediate-load provisionalization protocol, the Baader-Meinhof phenomenon may manifest as us more often considering this treatment, even though we could still make an argument for keeping the patient's teeth.?

Summary

Cognitive biases often play a substantial role in shaping our decision-making processes, leading to suboptimal choices and outcomes. Recognizing and addressing these biases are essential if we’re to make better decisions at both personal and professional levels.?

Acknowledging the existence of these biases is the first step toward mitigating their impact. Strategies such as critical thinking, self-awareness, and a willingness to consider alternative perspectives can help individuals make more rational decisions, while organizations and institutions can implement processes that account for cognitive biases to enhance overall effectiveness in decision-making.?