Pain in Pediatric Dentistry - a Grounded Theory Study on the Experiences of Dental Professionals and Students

BACKGROUND Pain in conjunction with dental treatment should be avoided, especially when treating children. Many dental procedures may result in procedural and/or postoperative pain. There is a well-documented relationship between perceived pain during dental treatment, and the development of dental fear and anxiety. This may lead to suffering for the patient, avoidance of dental care, and increasing treatment costs for the individual and society. Dental care professionals are responsible for providing as painless dental treatments as possible to their child patients. Earlier studies have pointed towards an underusage of local anesthetics when providing dental care to children. Though previous studies have not been able to fully answer why this is. Thus, the aim of this study is to gain knowledge into how dental professionals and students experience and relate to the child patient's experience of pain during and after dental treatment.

METHOD This is a qualitative study using Grounded Theory (GT). Dental students in their last two years of education and dental professionals (dentists, dental hygienists, and dental assistants), will be consecutively enrolled after signing an informed consent form.

In-depth interviews of approximately one hour each will be performed with the informants at a place of their convenience. Appropriate measures will be taken regarding public health recommendations in effect due to the Covid-19 pandemic.

In GT no sample size calculation is done. Participants will be included until saturation in data is reached, i.e. no new information can be obtained from further interviews. In GT this is often achieved after 10-15 interviews, but due to the scope of this study involving several different professionals and students it is likely the number of informants will be closer to 25. All interviews will be tape recorded, and without delay, the interviews will be transcribed verbatim. Data analyses and data collection will be done in tandem. The transcribed interviews will be analyzed, and codes identified. These codes will then be merged into different preliminary categories. In the following axial coding process, each category will be further developed by identifying common dimensions and characteristics (subcategories). Relations between data and categories is sought, and hereby a new whole is created. Selective coding will lead to data saturation and validation. Saturation can also be achieved by already retrieved data being re-coded.

KNOWLEDGE GAINS GT is a theory generating method. This is especially suitable for research areas where theories are scarce or lacking. A lot of research within the medical and dental field today, takes the perspective of the investigator, and far too seldom is the subjective experience of those directly affected (e.g. professionals and/or patients) heard. From this study we will gain new knowledge into dental professionals' and students' perception of the child patients' experiences of procedural and postoperative pain. These knowledge gains will be important for future research strategies related to pain. In the longer run the results can help lead to a better training of undergraduate students and professionals.

CHANGES TO ORIGINAL STUDY PLAN After the initial interviews were made, we saw that dental students had a pedagogical focus in their interviews. Therefore, we decided to split informants into two groups - dental students and dental professionals. Findings will be presented in two separate scientific papers, one for each group of participants. Interviews with dental students have been completed, while interviews with dental professionals are ongoing.