Barriers experienced by GPs in reporting child dental neglect

A summary of: Whyatt, L., Barry, S. An exploratory study investigating the barriers to reporting child dental neglect concerns among general medical practitioners in Greater Manchester. Br Dent J (2022)

Child dental neglect is considered by the British Dental Association as an indicator of broader neglect in children. It is relatively common & can cause children to suffer from ‘dental pain, poor nutrition and compromised social skills.’

This study used questionnaires given to GPs in Greater Manchester to gather quantitative & qualitative data on the recognition & management of child dental neglect; as well as explore the barriers of GP’s to report dental concerns. 

25 questionnaires were completed by GP’s of a sample of 100, which limits the validity of the study as it is hard to determine if these views are indicative of GPs as a whole.

It’s highlighted that what is deemed to be a feature of concern for dental neglect varies from practitioner to practitioner.

  • 96% of those surveyed expressing that ‘severely untreated dental caries obvious to the lay person’ is a perceived feature of concern,
  • Only 56% of those surveyed thought ‘repeat general anaesthetic for dental treatment’ is a perceived feature of concern.

This is despite the National Institute for Health & Care Excellence (NICE) recognises ‘repeat general anaesthetic for dental treatment’ as a feature of concern for dental neglect.

The key areas that were highlighted from this study are:

*Where GPs are mentioned to, this refers to those who took part in the study in Greater Manchester at the time the study took place.

  1. GPs* need more training in recognising dental neglect

Despite 96% having completed some form of child protection training after their undergraduate medical degree:

  • 64% of respondents didn’t feel adequately trained to recognise the signs of child dental neglect 
  • 80% of respondents were not confident on how to refer/escalate a suspected case of dental neglect 
  • 88% responded that GP’s require more guidance and training on child dental neglect  
  1. There are barriers which influence a GP’s decision to refer a suspected case of child dental neglect.

Two most common:

  1. Lack of certainty in diagnosis (84%)
  2. Lack of confidence in suspicions (84%)

Barriers to reporting safeguarding concerns reported by GPDs & GPs were found to be similar.

  1. There is a lack of awareness among GPs that dental neglect is an indicator of general child neglect  

One respondent reported that they would not refer a suspected case ‘if the child was otherwise well-cared for’, which may imply the normalisation of neglected dentitions among their patients.

  1. There is a perception among GPs that detection is solely reliant on the dentist 

56% of respondents believed that GPs aren’t well placed to recognise behaviour and signs of child dental neglect. One comment from a participants read “(there is a) perception that this is a dentistry and not a medical issue – why are dentists not sorting this issue out?”

The main finding of this study was the distinct gap between suspicion and referral of child dental neglect among GPs. Of those suspicious of child dental neglect, 32% did not complete an onwards referral.

The findings may suggest that there is limited emphasis on dental health during general safeguarding training received by GPs. 

More specified dental training may increase GP’s confidence in the identification of dental neglect. The COVID-19 pandemic has resulted in fewer opportunities for the identification of dental neglect too. 

This study highlights a need for further research on a national scale as results are exploratory in nature.

Research Summary Written By: Rashmini Arnold, University of Manchester – BDS 4

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