Failure on all fronts: general dental practitioners' views on promoting oral health in high caries risk children--a qualitative study.

Ahmad K Aljafari,Marie Therese Hosey,Jennifer Elizabeth Gallagher

doi:10.1186/s12903-015-0032-8

Abstract

BackgroundDespite overall improvements in oral health, a large number of children in United Kingdom (UK) are affected by dental caries; and the implementation of oral health promotion in some families remains a challenge. As such, children from those families suffer high caries rates, and are frequently referred for tooth extraction under General Anaesthesia (GA), one of the commonest reasons for paediatric hospital admissions. The aim of this investigation is to explore referring primary care General Dental Practitioners’ (GDPs) views and experiences in trying to promote better oral health for those children.MethodA qualitative study, utilizing face-to-face, semi-structured interviews with GDPs in three London boroughs who refer children for extraction of decayed teeth under GA selected based on referral rate. Qualitative Framework Analysis was used to present the results.ResultsEighteen GDPs (56% male) were interviewed: average age 42 years (range: 26–73 years). informants reported challenges to promotion of oral health categorised as: (1) child’s young age, poor cooperation, and high treatment need; (2) parental skills to face up to modern day challenges and poor attitudes towards good oral health (3); social inequality, exclusion and cultural barriers in immigrant families; (4) National Health Services (NHS) primary care practice remuneration, constraints and training; (5) inadequate secondary care communication and engagement; and (6) failure in establishing national policy to grasp the width and depth of the problem.ConclusionGDPs feel frustrated and isolated in their efforts to promote oral health in those children. These findings suggest difficult challenges on all fronts. Reform of preventive dentistry funding and delivery, as well as a multiagency multidimensional approach that is mindful of the social determinants of children’s oral health and barriers to application of oral and wider health initiatives are needed to address this important public health issue.

Highlights

Despite overall improvements in oral health, a large number of children in United Kingdom (UK) are affected by dental caries; and the implementation of oral health promotion in some families remains a challenge
Thematic saturation was reached; “Thematic saturation” occurs when the content of new interviews repeats that of previous interviews and is a common method of determining if sufficient data has been collected in qualitative research [24]
There is an undercurrent of despair and helplessness in the General Dental Practitioners’ (GDPs) we’ve interviewed, who see those children when they present for the first time to their surgeries with multiple decayed teeth, in pain, and typically coming from families who, in their eyes, have poor parenting skills or don’t speak English or have cultural differences

Summary

Introduction

Despite overall improvements in oral health, a large number of children in United Kingdom (UK) are affected by dental caries; and the implementation of oral health promotion in some families remains a challenge. Children from those families suffer high caries rates, and are frequently referred for tooth extraction under General Anaesthesia (GA), one of the commonest reasons for paediatric hospital admissions. The aim of this investigation is to explore referring primary care General Dental Practitioners’ (GDPs) views and experiences in trying to promote better oral health for those children. Tooth extraction, mainly under General Anaesthesia (GA), is the main reason for hospital admissions of 5–9 year old children [7]. Repeat treatments are frequent (20%-25% of cases) [8,9,10], in many instances due to failure in reducing risk and altering treatment patterns

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Conclusion