Treating Children With Extensive Dental Needs

BACKGROUND: Severe or extensive caries is a condition that affects a large number of children yearly. This could lead to serious consequences for the affected child such as pain, many dental visits, risk for poorer oral health, and poor esthetics. In many cases, there is a connection to lack of care, whereby dental professionals has an obligation to file a report to social services regarding concerns of maltreatment.

The dental care includes a wide spectrum of measures, from information och oral health preventive actions, to filling therapies and tooth extractions. I many cases the disease is so extensive that the child needs to be referred to a pediatric dentistry specialist clinic in order to get treatment under sedation or general anesthesia. This is more prevalent the younger the child is. Dental treatments performed under general anesthesia or sedation is often more radical and tooth extraction is a common therapy for teeth with extensive decay.

As a dentist, in charge of initial care and treatment, taking care of children who might not know or understand why they have to undergo treatment, or that maybe are scared or suffer from pain, might affect the general wellbeing of the dentist. Perception of stress, especially ethical stress, can further affect how dentists make treatment decisions, among other things. Despite this, the knowledge of how dentists perceive and are affected by meeting and treating children with extensive need for dental care, is unsatisfactory.

RESEARCH QUESTION How do dentists experience meeting and treating children with an extensive need for dental care? How is extensive need for dental care looked upon in relation to potential report to social services?

METHODS AND INFORMANTS This project will use Grounded Theory, that is a qualitative research method. When knowledge and theories are lacking within a certain area, common hypotheses testing methods are less suitable. Instead, by using qualitative research methods, information can be collected from individuals with experience from the area of interest. Some methods, like Grounded Theory, can lead to results that might form a base for formulating hypothesis that later can be tested in studies using quantitative/hypotheses testing methods.

In this project, interviews will be held with dentists (informants) that work within public dental care, and specialised dental care, i.e. specialists in pediatric dentistry. During the interviews a so called thematic interview guide with open themes is used, rather than using semi-structured that might lead what the informants choose to talk about. Intended themes in the interview guide concerns the following: experiences of treating children with extensive need for treatment, reflections upon reporting to social services, experiences of child patients reactions and abilities to handle dental treatment, thoughts about legal guardians being present in the operating room, experiences of different coping strategies, or anything else that the informant brings to the table. Informants will be general dental practitioners working with child dental care, mainly from county of Scania, and specialist in pediatric dentistry or post-graduate students becoming such specialists. The specialist cohort is recruited from all over Sweden.

The investigators plan to interview up to 25 dentists. The informants will be recruited to include different experiences, and backgrounds, e.g. different ages, years as dentist, general dental practitioner or specialist, public dental clinic or private clinic, working in city or rural area.

The interviews will take approximately one hour and will be recorded digitally, and the interviews can be performed both digitally or in a direct meeting, but over telephone is also a possibility. The interviews will be transcribed verbatim and analyzed according to preset routines according to to the chosen method, Grounded Theory. Interviews and analyses takes place parallell. The transcribed interviews will be analyzed, and through these analyses so called categories emerges, that describes what the experiences are about. These codes will then be merged into preliminary categories. In the following axial coding process, the preliminary categories will be further developed by identifying dimensions and characteristics, leading up to sub-categories. Relations data and categories is sought for, thus creating a "new whole". Selective coding will lead to data saturation and validation. The former can also be achieved by re-code already retreived data. In the results, there is also a core category that can be described as the most central and crucial aspects of the research questions being studied.

it is not applicable to calculate sample size when using qualitative method such as Grounded Theory. Instead, participants will be included until saturation in data is achieved, meaning that new information can not any longer be obtained.

KNOWLEDGE GAINS Grounded Theory is a theory generating method, especially suitable for research areas where existing theories are scarce or totally lacking. Today, a lot of research within medical and dental fields takes the investigator's perspective. It is highly crucial that also the directly affected are involved, i.e. the patients.