Investigating Problem-Orientated Patient Pathways, Toothache to Treatment: ImPacT Study

Abstract

Almost one-third of adults will only seek professional dental care when suffering with acute dental pain rather than engaging in routine preventive dental care, so called problem-orientated dental attenders. These individuals can wait a long time before seeking care resulting in: greater impacts on everyday activities, and greater potential for serious adverse events. They can present to a range of services including emergency dental services, medical emergency departments, and general medical practitioners (GMPs). The reasons for this attendance pattern and care pathway are under-researched. To encourage these patients to engage in routine dental care it is important to build an understanding of: (1) why they only attend when symptomatic, (2) where they present and why. The aim of this thesis was to build an understanding of problem-orientated attendance to subsequently develop an intervention to encourage regular dental attendance. This thesis involved four studies. The first was a retrospective observational study examining dental attendances at Welsh GMPs. The second and third were qualitative studies exploring: (1) problem-orientated attenders’ perspectives and experiences of seeking repeated emergency dental care (2) adolescents’ experiences of dental care and their future plans for dental attendance. The final study co-designed an intervention to prevent problem-orientated dental attendance. Dental attendance rates at GMPs varied over the study period and appeared to relate to key policy change dates. Predictors of being a repeat dental attender included deprivation, residential area, and appointment outcome. Reasons for problemorientated attendance were complex and multifactorial, with overarching reasons related to knowledge and dentist characteristics. Adolescents faced multiple barriers to dental care-seeking as they transitioned to independence subsequently affecting decision-making to continue to seek regular care. Finally, an intervention was developed targeted at adolescents and young adults to encourage continued regular dental attendance as they transitioned to independence, hence preventing problemorientated attendance.