Dental professionals’ experiences of managing children with carious lesions in their primary teeth – a qualitative study within the FiCTION randomised controlled trial

Abstract

Background The lack of evidence for the effective management of carious lesions in children’s primary teeth has caused uncertainty for the dental profession and patients. Possible approaches include conventional and biological management alongside best practice prevention, and best practice prevention alone. The FiCTION trial assessed the effectiveness of these options, and included a qualitative study exploring dental professionals’ (DPs) experiences of delivering the different treatment arms. This paper reports on how DPs managed children with carious lesions within FiCTION and how this related to their everyday experiences of doing dentistry. Methods Overall, 31 DPs from FiCTION-trained dental surgeries in four regions of the UK participated in semi-structured interviews about their experiences of the three treatment arms (conventional management of carious lesions and prevention (C + P), biological management of carious lesions and prevention (B + P) or prevention alone (PA)). A theoretical framework, drawing on social practice theory (SPT), was developed for analysis. Results Participants discussed perceived effectiveness of, and familiarity with, the three techniques. The C + P arm was familiar, but some participants questioned the effectiveness of conventional restorations. Attitudes towards the B + P arm varied in terms of familiarity, but once DPs were introduced to the techniques, this was seen as effective. While prevention was familiar, PA was described as ineffective. DPs manage children with carious lesions day-to-day, drawing on previous experience and knowledge of the child to provide what they view as the most appropriate treatment in the best interests of each child. Randomisation undermined these normal choices. Several DPs reported deviating from the trial arms in order to treat a patient in a particular way. Participants valued evidence-based dentistry, and expect to use the results of FiCTION to inform future practice. They anticipate continuing to use the full range of treatment options, and to personally select appropriate strategies for individual children. Conclusions RCTs take place in the context of day-to-day practices of doing dentistry. DPs employ experiential and interpersonal knowledge to act in the best interests of their patients. Randomisation within a clinical trial can present a source of tension for DPs, which has implications for assuring individual equipoise in future trials.

Stakeholder perspectives on barriers and enablers to recruiting anxious children undergoing day surgery under general anaesthetic: a qualitative internal pilot study of the MAGIC randomised controlled trial

“…MAGIC was generally seen as an important study, but where clinical gatekeepers had successful practices using other pre-medications, or nonpharmacological techniques, stakeholders reported an unwillingness to engage with MAGIC. Using an unfamiliar approach, particularly when there are high stakes if it is not successful, can also be a challenge for stakeholders [13]. Again, this points to the potential benefits of engagement work by researchers involved in an RCT, as well as qualitative research as part of feasibility studies to understand opinions and concerns about an intervention [9].…”

“…As well as understanding why patients do and do not agree to participate in RCTs, recruitment needs to be considered from the perspective of stakeholders, such as clinicians, research nurses and those involved in designing the trial. Qualitative research on stakeholders' experiences highlights the challenges involved in operationalising the trial protocol into usual practice, fully understanding the intervention, and issues relating to professional roles [6,[11][12][13][14][15]. Barriers and enablers to recruitment relate to various factors, including those among patients, practitioners and within particular settings, as has been identified by French and Stavropoulou and Team and colleagues [12,15].…”

Children and parents’ perspectives on the acceptability of three management strategies for dental caries in primary teeth within the ‘Filling Children’s Teeth: Indicated or Not’ (FiCTION) randomised controlled trial – a qualitative study

“…The trial found no evidence of a difference between arms in its primary outcome; dental pain and/or dental infection, nor were any differences detected in the trial's secondary outcomes of caries incidence, child oral health-related quality of life or dental anxiety between the three caries management strategies [5,6]. When acceptability of the management strategies was evaluated from the perspective of the DPs providing the treatment, they described their responsibility to select an appropriate strategy for each individual child, based on discussions with the child and parent and their own clinical experience [7]. Consequently, the trial recorded cross-arm deviations for 6% of the total visits.…”

“…The FiCTION trial included clinical, economic and patient-reported outcomes, which have been reported elsewhere [5,6]. The trial also aimed to explore the acceptability of the treatment strategies for the DPs delivering the treatment [7] the children receiving the treatment and their parents. There is growing recognition of the importance of evaluating the acceptability of health interventions, in addition to their effectiveness [8].…”

The lived experience of performing a periodontal treatment in the context of general dentistry

“… 19 There are few studies that have dealt with the lived experience of performing dental treatment, e.g. when dental professionals manage children with carious lesions 20 but no study has yet explored what it means to perform a periodontal treatment in the professional context of general dentistry.…”