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Knowledge of paediatric dentistry by recently-qualified general dentists: a pilot study.

Abstract

Aim: To determine an overview of opinions and knowledge of paediatric dentistry amongst a group of recently-qualified dentists working within the Scottish Hospital Dental Service. Study design: A prospective questionnaire-based survey undertaken at Dundee Dental Hospital and School, NHS Tayside, Scotland. The survey evaluated dentists' opinion of managing the child patient and the location of dental treatment as well as knowledge of trauma, minor oral surgery, developmental disorders, mixed dentition problems and joint paediatric/orthodontic scenarios. Results: Data were available for 15 dentists (M: 7; F: 8), median age 25.00 (inter-quartile range 25.4, 27.2) years. Of the respondents, 73.3% enjoyed treating children, although concerns regarding the management of both dental trauma and paediatric minor oral surgery cases were noted by 93.3% and 100% of dentists respectively. Concerning the location of treatment for the child patient, 66.7% believed that this should be 'shared-care' between the general dental practitioners (GDP) and Community Dental Service (CDS), whilst 20.0% and 13.3% observed that this should be undertaken within the CDS and by the GDP respectively. None of the dentists felt that treatment should be undertaken either privately or within the hospital services. Overall, dentists were best able to answer questions relating to mixed dentition and paediatric/orthodontic problems and least able to do so for minor oral surgical conditions. Conclusion: This pilot study offers baseline data regarding both opinions and also knowledge of paediatric dentistry amongst a group of recently-qualified dentists. Further educational opportunities in this discipline at the postgraduate level may be beneficial.

Key words: Paediatric dentistry; knowledge; graduate education.

Introduction

The aim of undergraduate dental education is to produce both a knowledgeable and also a competent dentist who is able, on graduation, to accept professional responsibility for the effective and safe care of patients whilst being aware of both their limitations and also their responsibility for life-long learning [Hjorting-Hansen and Dent, 1996; General Dental Council, 2002]. New or recent graduates from dental schools in Great Britain (GB) complete one year of mandatory post-qualification training. Alternatively, recently-qualified clinicians may choose to undertake a further period of postgraduate education working in the Hospital Dental Service.

Dental caries remains the most common oral disease process encountered in children, but a wide range of other conditions may present within the mouth and knowledge of their presence ensures that clinicians have a better understanding of the diagnosis and hence, either the appropriate management or knowledge of the necessity for onward referral [Jones and Franklin, 2006]. In an increasingly litigious society, patients and their carers are more likely to bring a negligence action against their dentist(s); a large proportion of claims relate to restorative and minor oral surgery procedures [Moles et al., 1998]. Between 2003 and 2005, the number of complaints considered under the British General Dental Council's fitness to practice procedures increased by 363% representing a complaint against 8.5% of registered dentists; most claims for negligence occur within the first 5 years of initial qualification [General Dental Council, 2002]. Although the dental literature has reported on the undergraduate experience, to date there is a lack of information regarding recent graduates' perception and knowledge of the practice of paediatric dentistry [Finucane et al., 2004; Seddon, 2004]. As such, the aim of the present study was to determine an overview both of recently-qualified practitioners' opinions of paediatric dentistry and also their knowledge of disease processes observed in the child patient.

Material and Methods

This pilot study was designed as a prospective, questionnaire-based pilot survey undertaken within Dundee Dental Hospital and School (DDH&S), during a lunchtime service-based training event in May 2006. All staff employed as either junior hospital staff (JHS) or general recently qualified dentist (GQD) were invited to attend the session. Dentists were given a brief introduction to the session and questionnaires were distributed which sought information on age and gender and on:

* year and place of initial qualification;

* weather paediatric dentistry well-taught at undergraduate level;

* postgraduate qualifications;

* previous or current junior hospital as general practice trainee appointment in paediatric dentistry.

In addition the following were asked for: opinions on paediatric dentistry:

* do you enjoy treating children;

* which aspects of treating children do you find difficult and for what reasons;

* are there any particular treatments which you would find difficult to undertake?

The location of the dental management of child patients:

* General Dental Service, general dental practitioners (GDS);

* Community Dental Service, public dental health service (CDS);

* Hospital Dental Service (HDS);

* private practice;

* combination of any of the above.

The second part of the questionnaire was delivered to the group by Microsoft[R] Office Powerpoint[R] presentation. Images (30) were projected, both of clinical photographs and radiographs and a number of questions asked in relation to each image. The questions were organized into five sections which consisted of the following topics:

* trauma;

* mixed dentition;

* paediatric/orthodontic interface;

* developmental anomalies;

* minor oral surgery.

Within these groups, a range of topics were covered and these are given in Table 1. In order to avoid collaboration, the respondents were allowed one minute/projected image to complete each question. Subsequently, all answers were marked according to a previously determined marking scale with a maximum overall score/topic group as follows: trauma (35); mixed dentition (32); paediatric/orthodontic (28); developmental (24) and minor oral surgery (31), i.e. a maximum total of 150 points/dentist.

Data Analysis. Because of the relatively small sample size, it was not possible to make intra-operator comparisons and hence, data within topic groups were combined and converted to an overall percentage score/topic group. Percentage scores were rejected as being normally distributed (Kolmogorov-Smirnov Test) and hence, median values were calculated. Significant differences between groups were defined using Mann-Whitney U Tests at the 0.05 level of significance (MINITAB[TM] Statistical Software, Release 13.31, State College, PA, USA).

Results

Of 21 JHS/GQD invited to attend, data were collected from 15 clinicians (M: 7; F: 8, median age 25, inter-quartile range 25.4, 27.2 years), all of whom had qualified from either Dundee or Glasgow Dental Schools. With the exception of one individual who qualified in 1993, all others had done so between 2002 and 2004. Two had obtained postgraduate qualifications of a Membership of a Royal College of Dental Surgery (MFDS) and one a Master in Public Health degree (MPH).

Some 80% felt that the subject had been taught well, the rest were unsure but none believed that the discipline had been poorly taught. There were 10 dentists who had participated in a clinical rotation involving paediatric dentistry, although the remainder had not. There were 11 dentists who enjoyed treating children. Concerns were noted regarding the management of trauma cases and paediatric minor oral surgery by virtually all (14/15) dentists (Table 2). For the location of treatment for the child patient, 10 believed that this should be 'shared-care' between general dentists in practice (GDS) and the public health dental services (CDS). None of the respondents felt that treatment should be undertaken either privately or within the Hospital Dental Service.

Responses for the second part of the questionnaire (median percentage scores) are given in Table 3. These ranged from 32.3% (inter-quartile range 19.4, 41.9) for responses concerning paediatric minor oral surgery to 57.1% (inter-quartile range 46.4, 75.0) for answers to questions on the paediatric/orthodontic interface. Combining median scores for both those who had postgraduate experience of paediatric dentistry and for those who had not, the median scores were 48.4% (inter-quartile range 32.3, 57.1) and 41.8 (inter-quartile range 34.2, 53.5%) respectively. The difference between median values was not statistically significant (Mann Whitney U, W = 996.0, P = 0.786).

Discussion

This pilot study was designed to determine both opinions and knowledge of paediatric dentistry amongst a group of recently-qualified dentists working within a dental hospital setting. Although, the sample size was small and hence the results cannot be generalised, this study is indicative of both the views and knowledge within this group of dental professionals. The author acknowledges that data could have been collected by interview, although the use of a questionnaire allowed data to be gathered over a specific period of time in a standardised and comprehensive manner. In relation to previous training either at the undergraduate or postgraduate level, the majority of respondents believed that the subject had been well taught at dental school and just under two-thirds had undertaken a clinical period in the discipline post-qualification. Other workers have reported that a cohort of students gained a wide range of experience of paediatric dentistry which compared favourably with both other units and accepted guidelines [Rodd, 1994; General Dental Council, 2002; Finucane et al., 2004] in the British Isles.

The British Society of Paediatric Dentistry have suggested that approximately 1 % of the GB child population need to be seen by a Paediatric Dentist (either a specialist or a consultant) in any one year [The British Society of Paediatric Dentistry, 2005]. The American Academy of Paediatric Dentistry has advocated, however, that a target ratio of 5.2 specialists in the discipline per 100,000 child patients whilst the European Academy of Paediatric Dentistry has indicated that a ratio of specialist: child patient of 1:20,000 (Klingberg et al., 2006). Currently, within GB, there are 229 dentists registered on the General Dental Council's Specialist List in Paediatric Dentistry working as hospital consultants, specialist practitioners and community dental service specialists. The latest population estimates give the child (under 16 years) population of just under 12 million which to meet current BSPD guidelines would require over 550 specialists in Paediatric Dentistry. Clearly, there is a shortfall in suitably-trained dentists in the discipline, particularly to undertake dental treatment in the primary care setting, where the majority of dentistry is undertaken. The observation by the group of dentists reported on here, that dental care of the child patient should take place only within the primary care setting would suggest that these individuals were unfamiliar with the role of this discipline in the comprehensive nature of oral health care for infants, children and adolescents. Perhaps this is a reflection of their exposure to the discipline at the undergraduate level where there is an emphasis on examination, treatment planning, preventative measures and simple restorative treatment [Finucane et al., 2004; Seddon, 2004].

Responses concerning difficulties in treating child patients, suggested that this was deemed by some to be stressful. One recent nationwide, anonymous cross-sectional survey of 2,441 general dental practitioners (GDPs) working within GB determined that a significant proportion of them reported high levels of psychological stress symptoms, i.e. nervy, tense and depressed and with alcohol use being related to stress [Myers and Myers, 2004]. Others have found that depression was a finding amongst a group of dentists involved in treating children [Mathias et al., 2005]. Furthermore, other workers have noted that dentists agree that children's coping skills compromise dental care and that those individuals who treat children less often find the provision of care more stressful [Pine et al., 2004]. Concerns were noted in this study in relation to managing dental trauma and minor oral surgery. Other workers have noted deficiencies in experience in managing traumatised teeth amongst late-phase dental undergraduate students [Finucane et al., 2004]. Another large study undertaken across five regions in England recorded that both recently-qualified dentists in their post-qualification training year and their supervisors said that undergraduate training in paediatric dentistry had been covered well; the same group reported, however, that the undergraduate experience had not prepared young dentists in orthodontics or minor oral surgical procedures [Patel et al., 2006].

These findings are interesting and a much larger study involving young dentists throughout Great Britain and, perhaps, Europe is indicated. We need to know what aspects of paediatric dentistry, at the undergraduate level, may need to be expanded or covered by immediate postgraduate courses.

Conclusion

A pilot study of recently-qualified dentists working within the Hospital Dental Service in Great Britain indicates that there would appear to gaps in knowledge concerning some conditions seen in children (trauma and minor oral surgery) and it would seem that further post-graduate courses in this discipline at the postgraduate level are needed.

References

Finucane D, Nunn JH, O'Connell AC. Paediatric dentistry experience of the first cohort of students to graduate from Dublin Dental School and Hospital under the new curriculum. Int J Paediatr Dent 2004; 14: 402-8.

General Dental Council (UK). The First Five Years: A Framework for Undergraduate Dental Education. 2002.

General Dental Council (UK). Annual Report. 2005.

Hjorting-Hansen E, Dent D. The future dental educational process. J Dent Educ 1996; 60: 778-82.

Jones AV, Franklin CD. An analysis of oral and maxillofacial pathology found in children over a 30-year period. Int J Paediatr Dent 2006; 16: 19-30.

Mathias S, Koerber A, Fadavi S, Punwani I. Specialty and sex as predictors of depression in dentists. J Am Dent Assoc 2005; 136: 1388-95.

Klinberg G, Dahllof G, Erlandsson Al et al. A survey of specialist prediatric dental seminars in Sweden. Int J Paediatric Dent 2006; 16:89-94

Moles DR, Simper RD, Bedi R. Dental negligence: a study of cases assessed at one specialised advisory practice. Brit Dent J 1998; 184: 130-3.

Myers HL, Myers LB. 'It's difficult being a dentist': stress and health in the general dental practitioner. Brit Dent J 2004; 197: 89-93; discussion 83; quiz 100-1.

Patel J, Fox K, Grieveson B, Youngson CC. Undergraduate training as preparation for vocational training in England: a survey of vocational dental practitioners' and their trainers' views. Brit Dent J 2006; Suppl: 9-15.

Pine CM, Adair PM, Burnside G,et al. Barriers to the treatment of childhood caries perceived by dentists working in different countries. Community Dent Health 2004; 21: 112-20.

Rodd HD. Change in undergraduate experience in clinical pediatric dentistry. J Dent Educ 1994; 58: 367-9.

Seddon RP. Undergraduate experience of clinical procedures in paediatric dentistry in a UK dental school during 1997-2001. Eur J Dent Educ 2004; 8: 172-6.

The British Society of Paediatric Dentistry. Report on Consultants and Specialists in Paediatric Dentistry. 2005.

J. Foley, Department of Paediatric Dentistry, Dundee Dental Hospital, Dundee, UK

Postal address: Dr. J. Foley, Paediatric dentistry, Edinburgh Postgraduate Institute, 4 Lauriston Building, Edinburgh, Scotland, EH3 9HA

Email: jfoley@nhs.net
Table 1. Topics covered within the study identified by keywords in
a questionnaire to assess general dentists' knowledge of dental care
for children.

 Groups Topics covered

 Trauma Soft tissue injuries; complicated crown
 fractures; pulpotomy technique; splinting
 times; replacement resorption; external
 inflammatory resorption; sensibility tests;
 post-trauma radiographic changes.

 Mixed dentition Impacted permanent maxillary canine; poor
 prognosis first permanent molar teeth;
 infra-occluded primary molar.

Paediatric/orthodontic Median diastema; supernumeraries;
 non-erupted permanent maxillary incisor;
 hypodontia; IOTN scor es; cross-bites.

 Developmental Talon cusp; taurodont teeth; molar incisor
 hypoplasia; amelogenesis imperfecta;
 cleft lip and palate.

 Minor oral surgery Suture types; surgical removal impacted
 canine and supernumerary teeth; mattress
 sutures; dentigerous cysts; retained roots;
 cover plate; dilacerated teeth; apically
 repositioned flaps.

Table 2. Sample of comments received from the dentists
in a questionnaire to assess general dentists' knowledge of
dental care for children.

Comments in relation to treating children

"Stressful"

"They never behave"

"They wriggle and it's always a compromise"

Comments in relation to managing dental trauma

"Not done enough, anxious about re-implantation of
an avulsion"

"Always catches you by surprise and not common"

"I don't see it regularly"

"Not seen enough, would seek advice"

Comments regarding paediatric minor oral surgery

"Never done one"

"Never seen a procedure done"

"It's not my job at present and never done it"

Table 3. Median percentage values for responses by general
dentists to a questionnaire on their knowledge of care
for children, according to topics with 25% and 75%
quartiles in parentheses.

 Median Inter-quartile
 % value range (%)

Trauma 48.6 (a) 31.4, 57.1
Mixed dentition 53.3 (a) 46.7, 60.0
Paediatric/orthodontic 57.1 (a) 46.4, 75.0
Developmental 41.7 (ac) 37.5, 50.0
Minor oral surgery 32.3 (bc) 19.4, 41.9

Note: a b c = Within groupings, those followed by the same letter
are not significantly different from each other (Mann-Whitney U,
P < 0.05).
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Author:Foley, J.
Publication:European Archives of Paediatric Dentistry
Article Type:Report
Geographic Code:4EUUK
Date:Sep 1, 2007
Words:2694
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