Primary Care Dentists’ management of permanent dentition traumatic dental injuries in 7‐ to 16‐year‐olds: A sequential mixed‐methods study

Abstract

Background/Aims Primary care dentists play a pivotal role in the management of traumatic dental injuries in children, despite little evidence on the barriers they face in providing care. The aim of this study was to explore and contextualize the knowledge and attitudes of general dental practitioners regarding their management of permanent dentition traumatic dental injuries in children aged 7–16 years old. Material and Methods A two‐phase sequential mixed‐methods study included a questionnaire that was disseminated to all 619 primary care dentists, identified via a triangulated sampling strategy, based across the north‐east of England (Phase I). Statistical analyses were performed using Mann–Whitney U‐ and Kruskal–Wallis tests, Spearman's correlation and chi‐square test. Multivariate factor analysis, with principal components extraction, was used to test between multiple ordinal variables. Respondents were invited to a face‐to‐face or telephone semi‐structured interview (Phase II). Interviews were transcribed verbatim and analysed using inductive thematic analysis. Results Primary care dentists were less confident in managing complex dental trauma. Inadequate financial remuneration was the main reason for not providing care, often prompting a referral to the local dental hospital. This was more apparent for those who qualified before 2000. More recently qualified dentists felt the long‐term costs, related to traumatic dental injuries, were insufficiently remunerated. Most still provided emergency management, irrespective of remuneration, as long as they had the requisite knowledge and skills. Four major themes arose: impact of traumatic dental injuries on patients, parents and primary care dentists; barriers to providing treatment; educational opportunities for primary care dentists; and interactions between primary and secondary care services. Conclusions There is high confidence in managing simple traumatic dental injuries but less for complex injuries. A lack of sufficient financial remuneration associated with the long‐term management of dental trauma was the main barrier for dentists to manage these cases.

Improving data quality from routine clinical appointments—Development of a minimum dataset for traumatic dental injuries in children and adolescents

“…Ultimately, it may only truly be successful if recording the MDS‐TDI defined outcomes act as a driver for payment. A lack of sufficient financial remuneration associated with the long‐term management of dental trauma was the main barrier for dentists to manage TDI in primary care 29 . This has long been identified as an issue in NHS primary dental care 30 …”

Fundamentos de Odontología Tomo 2

“…La comunicación y la colaboración entre estos profesionales son esenciales para garantizar un tratamiento integral y eficaz de las lesiones traumáticas faciales. (22) Las lesiones traumáticas de la boca y la cara pueden ser desafiantes debido a la complejidad anatómica y la importancia de preservar la función y la estética. Un enfoque estructurado y un manejo adecuado de las lesiones traumáticas de la boca y la cara son fundamentales para lograr resultados óptimos y prevenir complicaciones a largo plazo.…”

Dental trauma: preparing for success

“…2 A recent questionnaire revealed that the majority of General Dental Practitioners (GDPs) had not managed an intrusion, extrusion or avulsion in the last year. 3 While GDPs feel confident in managing simple dental trauma, such as uncomplicated and complicated crown fractures, they are less confident in managing complex dental trauma. 3 The infrequent and unpredictable presentation combined with a lack of confidence and a distressed patient, results in an emotive situation and can be a significant cause of stress for the dental team.…”

“…3 While GDPs feel confident in managing simple dental trauma, such as uncomplicated and complicated crown fractures, they are less confident in managing complex dental trauma. 3 The infrequent and unpredictable presentation combined with a lack of confidence and a distressed patient, results in an emotive situation and can be a significant cause of stress for the dental team. Unfortunately, excessive stress has been shown to compromise operative performance as well as having a negative impact on non-technical skills, such as communication and decision making.…”