Ph. D. ThesisAlmost 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.National Institute for Health
Research (NIHR), European Society of Endodontolog
