Decision-making dilemmas in selecting prosthodontic treatment among older adults with partial tooth loss: a qualitative study

Older adults with partial tooth loss must often choose among removable dentures, fixed dental prostheses, and implant-supported prostheses, which differ in cost, anticipated treatment burden, expected function, and maintenance requirements. This study explored the lived decision-making dilemmas experienced by older adults when selecting prosthodontic treatment. A descriptive phenomenological design was used. Fifteen adults aged 60 years or older who had partial tooth loss and were considering at least two clinically feasible prosthodontic options were purposively recruited from the Department of Prosthodontics of a tertiary stomatological hospital in China between April and October 2025. Data were collected through face-to-face semi-structured interviews and analyzed using a modified Colaizzi-informed descriptive phenomenological approach. Three interrelated overarching themes and six subthemes were identified. The first theme, individual trade-off dilemmas, reflected tensions between affordability and expected functional benefit, and between fear of pain and expectations of treatment effectiveness. The second theme, cognitive appraisal dilemmas, concerned fragmented or difficult-to-interpret information and misconceptions about pain, longevity, maintenance, and risk. The third theme, clinical and social support dilemmas, comprised limited individualized clinical guidance and insufficient support from family and community services. These interacting difficulties reduced confidence, prolonged hesitation, and sometimes delayed treatment. Prosthodontic treatment decision-making among older adults involved interrelated individual trade-offs, cognitive appraisal difficulties, and limitations in clinical and social support. These findings suggest that patient-centered decision support may need to address these concerns in an integrated manner. Shared decision-making, accessible communication, individualized assessment, and continuity of support represent potential approaches for future evaluation rather than interventions whose effectiveness was established in this study.