Whose Responsibility Is It Anyway? Exploring Barriers to Prevention of Oral Diseases across Europe

Abstract

Introduction: Dental caries, gum disease, and tooth loss are all preventable conditions. However, many dental care systems remain treatment oriented rather than prevention oriented. This promotes the treatment of oral diseases over preventive treatments and advice. Exploring barriers to prevention and understanding the requirements of a paradigm shift are the first steps toward delivering quality prevention-focused health care. Objectives: To qualitatively explore perceived barriers and facilitators to oral disease prevention from a multistakeholder perspective across 6 European countries. Methods: A total of 58 interviews and 13 focus groups were undertaken involving 149 participants from the United Kingdom, Denmark, Germany, the Netherlands, Ireland, and Hungary. Interviews and focus groups were conducted in each country in its native language between March 2016 and September 2017. Participants were patients ( n = 50), dental team members ( n = 39), dental policy makers( n = 33), and dental insurers ( n = 27). The audio was transcribed, translated, and analyzed via deductive thematic analysis. Results: Five broad themes emerged that were both barriers and facilitators: dental regulation, who provides prevention, knowledge and motivation, trust, and person-level factors. Each theme was touched on in all countries; however, cross-country differences were evident surrounding the magnitude of each theme. Conclusion: Despite the different strengths and weaknesses among the systems, those who deliver, organize, and utilize each system experience similar barriers to prevention. The findings suggest that across all 6 countries, prevention in oral health care is hindered by a complex interplay of factors, with no particular dental health system offering overall greater user satisfaction. Underlying the themes were sentiments of blame, whereby each group appeared to shift responsibility for prevention to other groups. To bring about change, greater teamwork is needed in the commissioning of prevention to engender its increased value by all stakeholders within the dental system. Knowledge Transfer Statement: The results from this study provide an initial first step for those interested in exploring and working toward the paradigm shift to preventive focused dentistry. We also hope that these findings will encourage more research exploring the complex relationship among dental stakeholders, with a view to overcoming the barriers. In particular, these findings may be of use to dental public health researchers, dentists, and policy makers concerned with the prevention of oral diseases.

Perceived Barriers To Preventive Dental Care Among Practicing Dentists of Central India

“…16 Iranian and British dentists did not nd the practice of preventive dentistry to be reputable and nancially bene cial. 24,25 Several studies have reported that the current undergraduate dental education curriculum does not adequately prepare dentists for preventive dental care. 22,26,27 The lack of importance on evidence-based prevention strategies can adversely in uence student perception and views to the signi cance of incorporation into everyday dental practice.…”

“…21 The consistent ndings were reported by Leggett et al in qualitative research. 25 In a study by Nagarajappa et al, the absence of dental auxiliaries to deliver preventive care was not considered a major barrier by most Indian dentists. Traditional Indian dentistry does not rely on dental auxiliaries since they are very few.…”

“…To date, dental care has focused on restoration and surgical management of oral diseases even though most oral diseases are largely preventable. 11,25,29 In a study by Yokoyama et al positive patient perception for preventive dentistry was re ected as higher use of caries-preventive measures in Japan. Economic reasons may be a probable answer for this observation as dental insurance systems in Japan mainly cover treatment procedures.…”

The definition, assessment and perception of patient trust by dental professionals– A scoping review

“…The other study explored dentists' perceived barriers and facilitators to preventing oral diseases in six European countries 19 . Trust in dentist-patient relationship has been identi ed as a key factor.…”

'It's their mouth at the end of the day': dental professionals' reactions to oral health education outcomes

“…11 Conversely, frustration from poor outcomes following OHE activity have been noted to impact on some dental professionals' satisfaction with their work, their perceptions of OHE efficacy, the motivation to provide it and it's effectiveness. 12,13,14,15 Negative outcomes may also influence dental professionals' perceptions of patients. Lack of patient interest, perceived or real, has been cited as a barrier to OHE for dental professionals.…”