De‐Implementing Low‐Value Care in Dentistry: The Case for Choosing Wisely Campaigns

ABSTRACT

De‐implementation refers to the practice within implementation science that targets reducing low‐value care; that is practices that have been proven to be outdated, unnecessary, potentially harmful and in some cases not cost‐efficient. Reducing and removing habitual practices, as well as introducing new care, is not easy, as there are multiple provider, patient and system related factors that can hinder these efforts. The Choosing Wisely campaigns have been one of the ways that de‐implementation of low‐value care has been targeted. Choosing Wisely campaigns consist of recommendations that are implemented through specialty‐specific guidance that can be used by providers, patients and the healthcare systems. While Choosing Wisely campaigns have gained widespread traction in medicine, the spread to oral health has been comparatively limited. This commentary explores some of the existing Choosing Wisely campaign recommendations within dentistry and takes a close look at how overprescription, overtreatment, overtesting, and the inclusion and prioritization of care are addressed through these campaigns. Current Choosing Wisely recommendations provide a useful basis that can be utilized to foster a broader movement towards the de‐implementation of low‐value care in dentistry, thereby facilitating substantive changes in oral health practice, policy, and service delivery.

1. Introduction: What Is the De‐Implementation of Low‐Value Care?

Dentistry, like all evidence‐driven health sciences, has significantly evolved over the past century. From “extension for prevention” to the current minimally invasive and digital‐oriented era, the profession has come a long way in the pursuit and commitment to improving oral health for all populations [1]. Clinical techniques, drug prescription practices and patient management strategies have been shaped by the available science, practitioner and patient preferences, as well as the structural, educational and economic resources for each period [2]. As the profession continues to evolve, it is crucial to optimize these resources and replace outdated practices and care with efficient, evidence‐based approaches [3, 4]. Embracing this transformation can help improve oral health outcomes at both the individual and systemic level.

One of the ways to catalyse this change within the profession is by adopting, when appropriate, de‐implementation procedures. De‐implementation is the area of knowledge within implementation science that studies how to best discontinue care that has low‐effectiveness, is poorly evidenced and has been demonstrated to be less cost‐efficient and potentially detrimental compared to the available alternatives [5, 6]; these practices are also collectively known as low‐value care [7]. De‐implementation has been likened to “working smarter, not harder” and is highly relevant in the context of healthcare overuse, which may take shape as overdiagnosis, overtreatment, overprescription and overtesting [8, 9].

It is important to highlight that de‐implementation will not necessarily be followed by the introduction of an innovation or implementation strategy but might just have the objective to reduce or eliminate low‐value care, as well as restrict or narrow by whom and/or where the interventions are delivered [10, 11]. However, introducing recommendations and novel strategies into practice can be challenging, especially for oral health professionals who often work in solo practice and can be slow to adopt changes [12, 13].

2. Main Hurdles in De‐Implementation

Though de‐implementation might seem counterintuitive or appear to be a routine activity that accompanies progress within healthcare, this process represents a complex cognitive challenge for all involved [14]. A focus on de‐implementation research has increased over the past decades, yet most de‐implementation schemes (e.g., measured in randomized controlled trials) have been physician‐oriented, particularly those practising within family medicine and general practice settings [15]. Within dentistry, it has been recognized that professionals might not routinely be employing evidence‐based practices (especially those derived from clinical guidelines), suggesting that resistance to change might be prevalent in the profession [12, 16]. Identified barriers that potentially influence dental professionals' uptake of evidence‐based practices include lack of time to review available evidence, financial limitations and insufficient training in methodological and statistical nuances required to evaluate findings [17, 18]. In a time when evidence‐based knowledge is increasingly questioned by some sectors of the population, it is more critical than ever to ensure the faithful implementation of evidence‐based practices and to facilitate and support their consistent uptake among oral health professionals across all practice settings [19]. Furthermore, it has been argued that specialist groups and professional societies may be playing a role in the inappropriate promotion of recommendations that are not feasible in real‐world practice. For example, Raittio et al. critically analysed the European Federation of Periodontology's recommendations (derived from changes introduced in the AAP/EFP 2017 periodontal classification) and presented the case that implementing the proposed supportive periodontal therapy protocols would consume approximately 71% of the estimated clinical hours of dental professionals in their context (a county in Norway) [20]. Such observation underscores the potential lack of consideration of real‐world contextual factors when formulating clinical recommendations, and with it the risk of promoting low‐value care.

On the other hand, several studies have identified that dental professionals may not necessarily be inclined or open to dental care shared decision‐making with patients [21, 22]. Apelian et al. examined this phenomenon in Quebec, Canada and reported that dentists are generally open to accommodating patients' preferences, as long as doing so does not conflict with core principles of quality of care, though, this openness is often constrained by legal and social pressures (e.g., fear of peer judgement) [22]. Dentists were found to have different value judgements compared to their patients and were less willing to share decision‐making for restorative treatments, which they considered to provide higher returns or value, compared to preventive care [22]. Moreover, structure‐related factors, specifically in the labour market, are relevant when reflecting on this topic. The rise of commercial oral healthcare models, such as dental clinic chains or the McDonaldisation of dentistry (as described by Holden and Thomson) exemplify this shift [23]. One of the concerning aspects of said models is that they could potentially be motivating overtreatment for commercial gain, as professional incentives are given on the basis of “production” and not always on patients' needs [24].

The plethora of influencing factors that hinder the de‐implementation of low‐value care in dentistry have not been thoroughly explored. Table 1 exemplifies some of the identified multilevel factors in other medical healthcare settings. Given the complexity and context‐specific nature of de‐implementation, understanding these issues is essential for designing effective strategies and ensuring the success of de‐implementation initiatives.

TABLE 1.

Reported factors that hinder de‐implementation in healthcare settings.

Group or context	Potential influential factors
Patients (Clients) [25, 26, 27]	Prior/existing knowledge and anecdotal beliefs. Current health condition and status. Expectations from healthcare services. Patients may resist changes if they perceive the new approach is less comprehensive or inconsistent with previous advice.
Healthcare providers [14, 28, 29]	Cognitive biases. Confirmation bias: prioritizing preexisting beliefs. Loss aversion: When de‐implementation of routine practice is perceived as a loss which looms larger than the gain they obtained from implementation of that practice. Defensive medicine practices: fear of patient dissatisfaction or litigation. Providers can be hesitant to abandon long‐standing practices, even when they are no longer supported by evidence.
Social contexts [26, 27, 30]	Team and leadership support Interprofessional relationships and networks that facilitate de‐implementation. Collective resistance to change may lead to the fragmentation of efforts to reduce low‐value care.
External factors (economic and political) [26, 27]	Resource availability Financial incentives (e.g., systems that incentivize procedures or production over preventive care). Types of insurance/health systems (e.g., public vs. private) Regulatory measures System level factors can be crucial determinants in identifying, changing, reducing and being conducive to de‐implementing low‐value care.

3. Overcoming the Hurdles: The Choosing Wisely Campaigns

To face the complexities that change‐related effects like de‐implementation can have, campaigns like Choosing Wisely (CW) have emerged to promote the organization and implementation of structures that enable healthcare practitioners to make informed, evidence‐based decisions with their patients, ensuring that the latter receive the safest, most cost‐effective, and least harmful treatment options [31, 32]. There are currently CW campaigns in over 30 countries through which national clinician societies are encouraged to consult their key informants, develop, and then publish their CW recommendations [31, 33]. First launched in 2012 in the United States of America (USA), CW campaigns have subsequently spread globally and sparked interest among professionals and patients [9]. This evidence‐driven effort and call for the action of increasing the healthcare communities' resource and treatment‐related responsibility was influenced by predecessor efforts like the American Board of Internal Medicine's “Medical Professionalism in the New Millennium: A Physician Charter” [34], Brody H's (2010) invitation to create “Top 5” lists for inefficient treatments and procedures [35], the launch of the Journal of the American Medical Association's Less is More archive [36], among other initiatives that shaped the campaign's background [31].

Choosing Wisely campaigns are not meant to be prescriptive or restrictive, as the initiative invites national clinician specialty societies to recommend their members to reconsider overused and unnecessary tests, treatments and procedures [33]. As it is common within the implementation science field, context matters, and it is encouraged that each clinician society analyse their specific needs. Nevertheless, CW has established guiding principles that can be used as a stepping stone in the efforts to design a list of recommendations [37]; these are illustrated in Figure 1. Resources to start CW campaigns have been developed by Canadian and German initiatives and can serve as examples of how to kickstart CW endeavours [38, 39]. While at first glance it might appear that CW campaigns' goals of providing recommendations overlap with clinical guidelines, important distinctions exist. Clinical guidelines provide comprehensive, evidence‐based syntheses intended to standardize practices across the entire care pathway, whereas CW campaigns generate concise recommendations that spotlight low‐value practices, aim to stimulate clinician‐patient discussions and support de‐implementation efforts [40, 41]. Clinical guidelines are undoubtedly valuable in terms of disseminating evidence‐based knowledge, but their focus is more restricted to healthcare professionals, while CW campaigns are more “front‐facing” in terms of the audiences and strategies.

FIGURE 1.

Principles of a choosing wisely campaign.

While CW boast years of applications across different fields, a critical analysis of its effectiveness is warranted to discuss the initiative's success. Successful decreases in low‐value care championed by CW campaigns have been documented in the context of back pain imaging (USA) [42], the use of benzodiazepines in older adults (USA, Canada, Australia) [43], and population‐based vitamin D screening (USA and Canada) [44]. Systematic explorations into the effectiveness of published evidence on CW campaigns have shown that its impact tends to be context‐specific, is more pronounced immediately after release, and appears to be greater when accompanied by multiple components, such as behavioural nudges, clinical education, or with the introduction of new clinical pathways [45, 46]. Furthermore, it has been argued that CW campaigns remain overtly physician‐centric and should be expanded to include patient engagement and grassroots conception in the adoption and promotion of desired care, so as to empower shared patient‐provider decision‐making [9, 47]. Additionally, it has been noted that low‐value care recommendations could benefit from incorporating economic analyses, such as those explored through economic evaluations [48]. Understanding the economic impact of low‐value care could further encourage behaviour modifications and policy change.

4. Choosing Wisely in Dentistry

While various specialized societies and organizations across the globe have successfully adopted and implemented CW campaigns, dentistry has not enjoyed this same widespread momentum. Calls from within oral health research to embrace CW efforts have been made, yet the lack of CW initiatives in the field suggests that these appeals have not necessarily been addressed [49, 50]. Unfortunately, there is little to no scientifically driven recorded evidence of the campaign's use and impact within the oral health field. The fact that thorough, scientifically driven explorations into what low‐value care practices prevail in oral healthcare are scarce speaks to the need to build consensus on this topic [51, 52]. Considering that oral conditions represent significant quality of life, social and economic burdens (estimated to have been US $387B in direct costs in worldwide expenditures in 2019), it is worth considering devoiding from low‐value oral healthcare, as proposed by CW [53].

Some of the existing oral health‐adjacent CW campaigns have been presented by the American Dental Association (ADA) [54], the Canadian Dental Association (CDA) [55], the Italian Society of Dental Surgery (SIdCO) [56], the Norwegian Dental Association (NTF) [57], the Finnish Medical Association (Duodecim) [58], and the College of Stomatology Specialty of the Portuguese Medical Association (OM) [59]. Each of these professional bodies has provided recommendations that range in type and nature, and as suggested by CW principles, are particular to their context. The authors suggest exploring the campaigns' webpages, as some of these are updated on an ongoing basis. Most of the recommendations from the cited associations can be grouped into those that target overprescription, overtreatment, overtesting, and the inclusion and optimization of care. While the breadth of oral health CW recommendations is broad, we will use some of the most recurrent ones across existing campaigns to exemplify the problems of low‐value care within dentistry and how CW campaigns are targeting these issues.

4.1. Overprescription

Pharmacological prescribing practices feature prominently in contemporary oral health discussions, a situation that is reflected in current CW recommendations. Among existing recommendations, the careful prescription of opioids and antiplatelet agents is emphasized, with particular attention to antibiotic use and overprescribing. Given the burden that antimicrobial resistance (AMR) poses on society, the contribution of dentistry cannot be overlooked, as dental providers are estimated to account for approximately 10% of antibiotic prescriptions within healthcare [60, 61, 62]. This figure becomes more relevant when paired with evidence that indicates that up to 80% of antibiotic use within dentistry may be inappropriate (when evaluated in the context of clinical guideline recommendations) [62, 63, 64]. Dental providers' factors and attitudes behind antibiotic perception are undoubtedly complex, with set habits, healthcare contexts/resources, the need to delay treatments and patients' expectations, influence, and satisfaction all playing a role [65, 66]. While patient factors have been less explored within dentistry, it has been identified that prior experiences, expectations (e.g., antibiotics need to be taken when there is dental pain), and accessibility issues (e.g., costs or availability to attend dental appointments) are aspects that play into patients' desires for requesting antibiotics in dentistry, even when they might not be warranted [67, 68, 69]. The escalating challenge of AMR has prompted the development of antimicrobial stewardship strategies, which can operate synergistically with CW initiatives. For example, CW Canada has developed the “Taking the Bite Out of Tooth Pain” toolkit, aimed at dentists, physicians and other healthcare providers to support antibiotic prescribing decision‐making [70]. This mirrors, in a targeted manner, the World Health Organization's (WHO) AWaRe (Access, Watch, Reserve) antibiotic book, which provides antibiotic prescription recommendations in various primary healthcare scenarios, including those for dental infections [71]. Thus, the CW Canada example serves as a practical, context‐specific extension of the WHO's global stewardship framework, enhancing its impact within dental and primary care settings.

Within the context of overprescription in dentistry, opioid prescription warrants attention as well. Trends in opioid prescriptions vary country to country, yet in places like the USA, it has been reported that dentists who have high opioid prescription rates are also characterized by having a greater proportion of their opioid prescriptions being high risk (> 50 MME per day) [72]. Though downward prescription trends are desired, more must be done to promote opioid alternative prescription within dentistry, especially when options like nonsteroidal anti‐inflammatory drugs and acetaminophen have been suggested to be safer and just as effective in combating pain after dental procedures [73, 74, 75]. Relevant to this matter, Evans et al. (again in the USA) reported that dental providers who had higher rates of antibiotic prescription also had higher rates of opioid prescription (adjusted OR = 8.40, 95% CI 6.00–11.76); a finding to contemplate when designing de‐implementation and stewardship approaches [76].

4.2. Overtreatment

Overtreatment within the cited CW recommendations is centred on inviting oral health professionals to avoid irreversible treatments, such as those for caries removal of incipient lesions, as well as unjustified procedures, for instance, the replacement of restorations just because they are “old.” These evidence‐based approaches recommended by CW campaigns align with the contemporary evidence of dental tissue preservation, or what has become more holistically known as the minimally invasive dentistry philosophy [77]. Unnecessarily replacing old restorations represents a cost to the payer (i.e., the patient or the healthcare system) and could also lead to the patient receiving more invasive care, such as an endodontic treatment or extraction [78]. This is particularly relevant as evidence increasingly suggests that conservative repair of existing proper restorations is usually at least as effective as replacement [79, 80]. Moreover, dental providers have reported that they perceive that patients are generally accepting of restoration repair, compared to a replacement [81]. The Finnish CW platform provides a comprehensive webpage (https://www.kaypahoito.fi/hoi50117) that serves as an excellent example of how recommendations, additional information, and pictures and diagrams can be presented and made available to help both practitioners and patients make more restoration‐related informed decisions.

Comparable concerns regarding overtreatment, such as the routine extraction of asymptomatic third molars, and the use of irreversible interventions for temporomandibular disorders, are also reflected in several existing CW campaigns. Their recommendations are consistent with contemporary evidence indicating that, in many cases, the potential risks of such procedures may outweigh their expected benefits [82, 83]. While overtreatment warrants greater attention, particularly in terms of understanding how to facilitate decision‐making, oral health professionals ought to always present all appropriate treatment options and prognostic information transparently, so that patients have the opportunity and support needed to make an informed choice; an approach that aligns closely with the core philosophy of the CW movement.

4.3. Overtesting

Recommendations related to dental imaging are the focus of oral health‐adjacent CW recommendations that seek to reduce overtesting. It has been estimated that approximately 20%–50% of healthcare imaging is deemed low‐value care, while the economic implications of this matter are estimated to be in the billions of dollars [84]. General dental imaging estimates have yet to be systematically reported, but studies like that of Weyh et al. have reported that, in an emergency department setting in the USA, close to 50% of computed tomography scans for odontogenic infections were found to be unnecessary [85]. From the paediatric dental field, the “CARies DEtection in Children” (CARDEC) trial, in Brazil, has presented evidence that, in preschool children, adding bitewing radiographs to visual inspection for caries detection might offer no substantial clinical benefit and rather is associated with increases in restorative interventions and false positives in diagnosis [86, 87]. Additional challenges in dental imaging overtesting (drawing on data from Scotland) have shown that provider payment systems, such as fee‐for‐service models, are associated with a significantly higher use of dental X‐rays compared with salaried provider models [88, 89]. This illustrates the multifactorial nature of overtesting practices, which may be driven by complex system‐level determinants, rather than solely clinical need.

While dental imaging, namely radiographs, are part of routine dental diagnostics and care, its overuse, especially in patients that undergo multiple radiographic procedures in their lifetime may carry minor radiation cumulative effects [50, 90]. Practicing dental imaging within the principles of ALARA (As Low As Reasonably Achievable) is the accepted and strived‐for norm within the field [90]. CW Italy recommendations state that dental imaging must be requested “after clinical examination and in presence of a valid working diagnosis” [56]. This would seem like an intuitive practice, yet Gillies et al. reported that in a sample of over 1000 Canadian dentists, imaging overtesting practices were strongly associated with dentists that requested radiographs before even seeing the patients [91]. The trends in medical imaging overtesting, cumulative radiation effects of dental imaging and lack of a broader knowledge base of these practices within dentistry require that this topic garners more attention.

4.4. Inclusion and Optimization of Care

There is a broader category of CW recommendations that have been put forth that do not fall strictly within overprescription, overtreatment, and overtesting practices, and might be better conceptualized as those suggestions that are geared towards the inclusion and optimization of care.

Within the recommendations that promote the inclusion of care, there is an interesting overlap between various CW campaigns that advise on the use of fluoridated toothpastes. Recommendations regarding the use of fluoridated products are increasingly relevant at a time when fluoride resistance and hesitancy are a growing concern [92]. The topic of resistance and hesitancy towards fluoride use for caries prevention illustrates how patient concerns and preferences, whether related to perceived fluoride harm or feeling “pushed” to accept fluoride, must be addressed through adequate, bidirectional communication by dental providers [93, 94, 95].

Among the suggestions geared towards the optimization of care, recommendations regarding not delaying urgent care, avoiding implants in periodontal non‐compliant patients and the use of virtual care stand out. The latter guidance resonates profoundly after the COVID‐19 pandemic, as virtual care delivered via teledentistry has been reported to improve access to care in remote communities and enable the assessment and early detection of oral conditions in a potentially cost‐effective manner [96, 97]. When considering these inclusion and optimization recommendations, it is helpful to turn to the Norwegian Dental Association's CW resources that invite participants to pose four central questions when receiving care: “Why do I need this test/treatment?”; “What are the risks and side effects?”; “What happens if I don't do anything?”; “Is there an alternative?” [57]. The latter system is akin to the NHS England “Ask 3 questions” campaign (https://aqua.nhs.uk/resources/shared‐decision‐making‐ask‐3‐questions/), which is an example of how CW does not necessarily “reinvent the wheel” but rather refreshes and structures ideas on how to optimize clinical decision‐making. The inclusion of such patient‐friendly and forward resources can open conversations with providers, such that the latter can also identify what the patient's main concerns, expectations and desires are.

5. Discussion

At the centre of this appraisal is the authors' desire to highlight the importance of developing and expanding Choosing Wisely campaign recommendations across dentistry. We have illustrated the work that has been done by existing campaigns and through this, emphasize the need for the adoption of more CW initiatives across oral health. By no means is it this communication's intent to suggest that oral healthcare should be scaled back, limited or that it is not needed. On the contrary, it is a call for the conscientization on how practices and services can be best improved in favour of patients, providers, and health systems at large, while taking into account the needs of the entire population. We suggest that overprescription, overtreatment, overtesting and the prioritization and inclusion of care in certain aspects of the oral health profession could benefit from review and renewal. Preparedness in the optimization of resources, with a focus on promoting and providing the best value care possible, is imperative in times where the constant fluctuation of sociopolitical climates is leading to priority realignments and resource redistributions.

The potential discontinuation of low‐value care in oral health must be pursued, but the plethora of social, personal, system and commercial‐derived factors that may influence its success (or failure) must be addressed in parallel. As mentioned, de‐implementation efforts seem to be more fruitful when they are accompanied by multicomponent interventions, underscoring the importance of comprehending the diversity of de‐implementation strategies that are available for use. When mapping de‐implementation strategies within the Expert Recommendations for Implementing Change (ERIC) tool [98], a 2024 overview of systematic reviews reported that strategies within the “adapt and tailor to context,” “development of stakeholder interrelationships,” and “change infrastructure and workflow” clusters were among those that consistently yielded a reduction in low‐value care [99]. Furthermore, strategies in clinical decision support (i.e., information or alerts that give information about service value), as well as having clinician champions that advocate for CW recommendations, have been deemed successful [45].

Within dentistry, both the Reducing Antibiotic Prescribing in Dentistry (RAPiD) and the De‐Implementing Opioids for Dental Extractions (DIODE) cluster randomized trials provide valuable insights as to what may and may not work in dental settings [100, 101]. In the RAPiD trial (National Health Service: Scotland), it was reported that individualized audit and feedback, especially when paired with a brief behaviour change message, produced a measurable reduction in dentists' antibiotic prescribing [100]. In the DIODE trial (Consumer‐governed, non‐profit healthcare organization: USA), it was found that providing dentists with clinical decision support (CDS), with or without patient education, did not enhance the de‐implementation of opioid prescribing, most likely due to limited utilization of the CDS resources, COVID‐19 shutdowns and potential natural‐happening downward trends in prescription [101]. Both cited trials demonstrate the variability of de‐implementation strategies' success within oral health practice. Understanding the complexity of factors that facilitate de‐implementation and having them work in synergy with CW campaigns are different ways that the reduction of low‐value care can be pursued. It is noteworthy that most of the documented de‐implementation efforts in dentistry are concentrated within the pharmaceutical overprescription field. While the work in this area is critical, lessons from these endeavours must be translated, studied and applied in the fields of overtesting and overtreatment as well.

Central to CW campaigns is the pivotal role that patients play within the de‐implementation process. While patient‐related drivers that facilitate de‐implementation are still understudied, patient cost‐sharing, educational materials and facilitation of informed decision‐making seem to drive desired change [45]. Evidence suggests that most dental patients want to share responsibility for treatment decisions rather than remain passive, but their opportunity for choice is often limited by factors such as financial burden, as well as oral health professionals' tendencies to retain more control than patients would prefer [102, 103]. This lack of shared decision‐making within dentistry is a central factor that CW campaigns actively try to overcome. It has been identified that patient advocacy groups are largely absent from oral health initiatives; though this observation comes from the field of clinical guideline development, it underscores the importance of expanding patient involvement [13]. Verdugo‐Paiva et al. elaborate on this notion in their systematic examination of methodological processes and responsible organizations for oral health guideline development, underscoring that most organizations produce guidelines for and by clinicians, thereby excluding other key informants (e.g., patients, policymakers) [104].

Existing evidence gaps in the de‐implementation of low‐value care in dentistry must be underscored. It would be fair to say that one of the main bottlenecks for CW campaign implementation (and arguably clinical guideline use) is the limited evidence to support these efforts. Within the context of CW campaigns, Bathia et al. have proposed that evaluating CW campaigns' impact on low‐value care requires examining multiple dimensions, such as (i) the assessment of physician attitudes, knowledge and perceptions towards low‐value care, (ii) the measurement of provider behaviours and (iii) patient experience and outcomes [105]. Additionally, it is highly encouraged that de‐implementation inquiries always be guided by theoretical underpinnings and structured approaches, such as the adoption of theories, models and frameworks [106]. Furthermore, we cannot emphasize enough how much there is still to do in terms of systematically identifying low‐value care in dentistry, understanding the barriers and facilitators to de‐implementation, and evaluating how strategies, such as the CW campaigns, can help. A “one size fits all” approach is unlikely to be successful, and thus these efforts must be driven by local conditions (such as tailored CW campaigns) and the evidence produced must be shared for others to understand what might be of use within their setting. Although the present discussion focuses primarily on individual professional behaviours, barriers to de‐implementation may also operate across multiple levels of the health system. From a socioecological perspective, organizational factors such as clinical workflow, service organization and structural determinants including payment models and regulatory environments can also influence the persistence of low‐value care practices. All of the delineated factors also warrant future attention.

As it has been outlined, de‐implementation is complex, and CW campaigns can serve as a piece of this multifaceted puzzle. Though oral health as a profession still has strides to go in developing, implementing, and evaluating CW campaigns, the reward is worth it. Limited progress within CW efforts and de‐implementation endeavours might be due to the difficulty of altering entrenched patient and clinician behaviours that sustain low‐value care, underscoring the need for innovative strategies [107]. Perhaps Levinson et al. put it best when they expressed that “most people are not eager to adopt new habits, and for this adoption to be successful, advantages have to be presented as part of the innovation” [47]. Thus, the oral health profession must be both engaging and creative in conceptualizing what CW will look like for each of their contexts.

6. Closing Thoughts

Choosing Wisely campaigns hold significant potential to ensure the delivery of high‐value care in oral health. Through comprehensive and collaborative de‐implementation efforts, it is possible to promote the uptake of evidence‐based care and interventions that can positively influence both health outcomes and system performance. CW campaigns in various countries and professional societies provide valuable examples for oral health to follow. The existing oral health CW recommendations serve as a foundation, demonstrating how the profession can approach such initiatives in terms of reducing overprescription, overtreatment, overtesting, and the inclusion and optimization of care. Moving forward, national societies and professional organizations must play a central role in understanding low‐value care in their settings and promoting and adopting CW initiatives to confront this. Expanding these efforts will require leadership, collaboration, and an unwavering commitment to improving patient care while optimizing available resources.

Author Contributions

F.A.‐P. and R.A.B. conceptualized the manuscript idea and content. F.A.‐P. drafted the initial manuscript draft. R.A.B., K.B., and H.P.L. all contributed to manuscript revision. All authors authorized the final submitted draft.

Funding

The authors have nothing to report.

Ethics Statement

The authors have nothing to report.

Consent

The authors have nothing to report.

Conflicts of Interest

The authors declare no conflicts of interest.

Data Availability Statement

Data sharing not applicable to this article as no datasets were generated or analysed during the current study.