Analysis of care pathways of children who present with an avulsed permanent tooth

This thesis, examining care pathways of children who present with an avulsed permanent tooth, is divided into four parts. Chapter 1 presents a literature review, which looks specifically at the aetiology and treatment of tooth avulsion injuries. There is also a short review on the costs, both direct and indirect, associated with treating tooth avulsion injuries Chapter 2 investigates data sources for the prevalence of tooth avulsion injuries in the Yorkshire region. Two major sources of epidemiological data on child dental health are available in the UK, decennial and annual surveys. Decennial surveys have been run in England and Wales since 1973 and in the whole of the UK since 1983 whilst the annual NHS Dental Epidemiology Programme was started in 1985 and is now run by Local Authorities. It surveys five-year-olds every other year, and older children in intervening years. The 2003 Child Dental Health Survey reported data on accidental damage to teeth but only unpublished data on traumatic damage to teeth is available from the 2008/2009 NHS Dental Epidemiology Programme surveys of 12-year-olds. This was obtained from The Dental Observatory for the purpose of this thesis. On examining the data neither survey was able to provide accurate information on the prevalence of tooth avulsion injuries in our child population. This lack of information potentially complicates the local commissioning of healthcare services, if this is to be based on the available epidemiological data. Chapter 3 investigates the experience of Yorkshire dentists’ in relation to the management of avulsed permanent incisors. The study was designed as a selfcompletion postal questionnaire of a random sample of dentists working in primary care in the Yorkshire region. A response rate of 59.7% was achieved. Thirty nine per cent of respondents had replanted an avulsed permanent tooth. The replantations took place most often in the primary dental care services. Almost forty per cent of all respondents currently have a child who has sustained an avulsion injury on review. Many dentists in the Yorkshire region have limited experience of treating children with avulsed permanent teeth. A significant percentage currently has children with avulsion injuries under their care. Current guidance advises an early specialist multi-disciplinary team consultation for children following an avulsion injury. Chapter 4 investigates parents’ experiences of accessing emergency and follow-up care for their child following a tooth avulsion injury. This study used a qualitative approach and semi-structured interviews were undertaken to explore on how parents access emergency and follow-up care. Eight parents attending the Leeds Dental Institute were recruited to the study using purposive sampling. The framework analysis approach was used to analyse the data. Two core concepts of knowledge and access were inferred from the analysis. Parents found it difficult to access emergency dental care for their child. The knowledge of the parents, laypeople at the site of the accident and health care professionals involved in providing the emergency care had a direct impact on how emergency care was accessed. Accessing follow-up care proved more straightforward in our sample as could be expected from a cohort attending a tertiary service. A further core concept of emotion was also evident – parents were distressed by what happened to their child and also frustrated and disappointed with the difficulty in accessing emergency care. The final chapter presents the conclusions of this research, together with some recommendations for further work.