GDPs' confidence in treating emergency dental trauma

Abstract

Objective To determine the self-perceived knowledge and attitudes of GDPs concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care. Design, setting and main outcome measures A postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England. Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance to measure association between variables. Results The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing 1–3 cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer dental trauma patients to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater, and were more likely to agree with this statement if they had attended a course in treating dental trauma (p=0.002). Single-handed GDPs were more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). The majority (96%) of GDPs disagreed that treatment of dental trauma rested solely within secondary care and 96% of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to referral. Conclusions Although GDPs believed that financial remuneration was inadequate, it did not prevent them treating trauma cases. They agreed that they had responsibility for management of dental trauma in primary care and that it could be treated more effectively in practice if payment was greater. Time constraints were seen as a barrier to long-term management of complex trauma cases in primary care.