Management of dental trauma in primary care: a postal survey of general dental practitioners

N G Jackson, P J Waterhouse, A Maguire
British Dental Journal 2005 March 12, 198 (5): 293-7; discussion 281

OBJECTIVES: To determine the self-perceived knowledge and attitudes of general dental practitioners (GDPs) concerning management of dental trauma in primary care. To identify potential barriers to the management of dental trauma in primary care.

DESIGN AND SETTING: A self-completion postal questionnaire survey of 417 GDPs in six local health authority districts in northeast England.

MAIN OUTCOME MEASURES: Likert scale responses to 20 statements designed to test self-perceived knowledge and attitudes. Following descriptive statistical analysis. Factor analysis with principle components analysis was undertaken to identify areas of correlation in questionnaire responses, followed by Chi squared test, Spearman's Rank Correlation and analysis of variance (ANOVA) to measure association between variables.

RESULTS: The response rate was 74%. Enamel and dentine fractures were the most common injury, with 45% of GDPs responding seeing more than 10 cases of dental trauma in the preceding year and 53% of respondents seeing one to three cases of complicated crown fracture. Seventy-eight per cent believed that NHS remuneration was inadequate, but only 8% would refer patients with dental trauma to secondary care for this reason. Half of the GDPs believed that trauma could be treated more effectively in practice if NHS payments were greater. GDPs were significantly more likely to agree with this statement if they had previously undertaken a postgraduate course in the treatment of dental trauma (p=0.002). Single handed GDPs were statistically significantly more likely to agree with the statements 'I would not treat dental trauma cases at my practice because the NHS payment is inadequate' (p=0.008) and 'Treating dental trauma at my practice requires too much of my clinical time to be worthwhile' (p=0.002). Ninety-six per cent of GDPs disagreed that treatment of dental trauma rested solely within secondary care. Ninety-six per cent of GDPs agreed that they had a responsibility to provide initial emergency treatment for trauma patients prior to referral. Eighty-eight per cent of GDPs felt that aids to management would be useful.

CONCLUSIONS: Although GDPs believed that financial remuneration was inadequate, this did not prevent them treating trauma cases. They strongly agreed that they had responsibility for the management of dental trauma in primary care and that they believed trauma could be treated more effectively in practice if payment was greater. Time constraints were perceived as a barrier to long-term management of complex trauma cases in primary care. GDPs would welcome the use of management aids.

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