A qualitative investigation of the influence of time since graduation on English dentists' approach to the care of young children

Management of Post-Traumatic Dental Care Anxiety in Pediatric Dental Practice-A Clinical Study

BACKGROUND

It is important to avoid giving children traumatic dental experiences that induce post-traumatic dental care anxiety (PTDA) in clinical dental practices. The aim of this study was to evaluate whether non-pharmacological behavior management procedures can effectively reduce the use of pharmacological behavior management in children who have PTDA and are referred for regular dental treatments under general anesthesia (GA) and sedation.

METHODS

This clinical study consisted of two groups. The treatment group involved 20 healthy children aged 4-14 with PTDA and also those referred by other institutions for dental treatment with/without GA. The control group was sampled retrospectively from the patient records and involved 20 healthy uncooperative children aged 4-14 with PTDA who had been treated under GA.

RESULTS

The number of multiple appointments was significantly higher in the treatment group than in the control group. Only 25% of children in the treatment group underwent GA and the rest (75%) were managed with non-pharmacological management techniques. Nine (60%) children who were treated with minimally invasive techniques did not require GA.

CONCLUSIONS

It is important to treat children as much as possible without causing PTDA by using appropriate behavior management techniques. This study emphasizes the usefulness of thoroughly employing non-pharmacological behavior management methods before directing a child with PTDA for dental treatment under pharmacological behavior management, which can prevent the over-utilization of sedation and GA.

Molar-incisor hypomineralisation combat: exploratory qualitative interviews with general dental practitioners in England regarding the management of children with molar-incisor hypomineralisation

Introduction Molar-incisor hypomineralisation (MIH) presents as a spectrum, with severe cases becoming increasingly complex to manage. This study aimed to investigate the perceptions and experience of general dental practitioners (GDPs) in England when managing children with MIH.Method Semi-structured telephone interviews with GDPs who regularly treat children took place in May 2020. A sample of four male and six female GDPs with 1-15 years of experience was achieved through purposively sampling interested parties following advertisement via professional groups. Thematic analysis using a realist and inductive approach was used in analysis.Results The overarching theme was of managing uncertainty, with four subthemes: setting the scene; fighting the tooth; working within the system; and self and interpersonal insight. Despite being knowledgeable, participants expressed varying levels of confidence in many aspects while managing children with MIH. There was a great deal of uncertainty surrounding 'doing the right thing' across the themes. Systemic barriers to managing children with MIH within the general dental service were identified.Conclusion The challenges of managing children with MIH was experienced as 'uncertainty'. Barriers within the general dental service made managing children with MIH difficult and participants relied on colleagues in secondary care to manage severe cases.

Use of general anaesthesia in paediatric dentistry: barriers to discriminate between true and false cases

PURPOSE

The use of general anaesthesia (GA) has shown significant increase in child dental patients. This study aimed to assess whether behaviour management strategies can be the effective methods for decreasing the need for GA and its over-utilisation in paediatric dentistry.

METHODS

The patients (n = 240) aged 3-6 years old were selected from referrals by paediatric dentists (PD) or general dentists (GD) for dental treatment under GA. Each child's behaviour during first and subsequent appointments was assessed using the Frankl Behaviour Rating Scale. A first visit included clinical examination and fluoride therapy. In all sessions, a hierarchy of anxiety-reducing behaviour guidance strategies was implemented over nine steps in a logical treatment order.

RESULTS

Overall, 47.5% of children referred for dental treatments under GA were retrained to be treated routinely. False referrals were significantly higher in GD compared to PD group. 80.0% of the referred children by PD and 6.7% of those referred by GD were true GA cases and still needed GA. 20.1% of retrained children and 67.4% of true GA cases received conscious sedation. There was no significant change in the frequency of children considered uncooperative as the years of experience increased among GD, while this value was significant for PD.

CONCLUSIONS

The findings may highlight the importance of using behaviour management techniques thoroughly prior to referring an uncooperative child for treatment under GA, and may discourage its over-utilisation. Specifically, these skill sets and their efficient practice should be improved among general dentists.

Impact of the Hall technique for preformed metal crown placement on undergraduate paediatric dentistry experience

The Hall technique, a novel method of placing preformed metal crowns (PMCs) without local anaesthesia or tooth preparation, was introduced to our undergraduate dental curriculum in 2009. This study aimed to describe student experience of, and attitudes towards, PMCs before and after exposure to this new technique. Clinical data were extracted from student logbooks to determine the number of PMCs placed for cohorts graduating in 2005 (n = 55), 2009 (n = 61) and 2010 (n = 75). Five focus groups were also conducted with 29 final-year dental students. Students graduating in 2005, 2009 and 2010 had placed a mean (range) of 0.03 (0-1), 0.63 (0-5) and 1.15 (0-9) PMCs, respectively. The proportion of students who had placed a PMC increased significantly from only 1.9% in 2005 to 75% in 2010 (P < 0.05, ANOVA). Students reported some positive experiences of the Hall technique. However, concern over perceived lack of future clinical support, an anticipated increase in time and financial pressures, and the ease of use of glass-ionomer cement as an alternative were described as potential barriers to PMC use. Findings suggest that the introduction of the Hall technique has had a marked impact on the use of PMCs as a treatment modality for carious primary teeth.

How primary care dentists perceive and are influenced by research

INTRODUCTION

Little is understood as to how primary care dentists alter their clinical practice.

AIM

To develop an understanding of how primary care dentists view and use research to inform their clinical practice.

METHODS

An iterative approach was followed using two methods of data collection. A focus group was undertaken with dentists and researchers who had been involved in primary care dental research. Subsequently phased, qualitative interviews were undertaken with primary care dentists with a range of research experiences. Focus group and interviews were audio-recorded and transcribed verbatim. Six people participated in the focus group. Eighteen dentists participated in the interviews. Interviews were undertaken in four phases until saturation was achieved. Data were analysed using constant comparison.

FINDINGS

Evidence-based dentistry was considered the ideal. However, the research base for primary care dentistry was thought to lag behind clinical services, to focus on incorrect endpoints, to disregard the patients' voice and failed to consider the impact of conducting research on dental practices. Dentists modified their clinical practice based upon research, colleagues' opinions, courses and ad hoc personal evaluation. Uptake of research was affected by the ethos of the practice, which determined whether the dentists were early or late adopters of research and financial viability of new interventions.

CONCLUSION

  Dentists wanted concise, timely evidence-based guidance to aid their management of patients. Further research needs to be undertaken to understand how to develop an evidence-based culture in primary dental care.