Dental neglect as a marker of broader neglect: a qualitative investigation of public health nurses’ assessments of oral health in preschool children

BMC Public Health

Julie Taylor²  Fiona Ballantyne³  Dafydd Evans¹  Nicola Innes¹  Caroline Bradbury-Jones⁴ 

[1] Preventive and Children’s Section, Unit of Dental and Oral Health, Dental School, University of Dundee, Park Place, Dundee, Scotland, UK;University of Edinburgh/NSPCC Child Protection Research Centre, Moray House, 3.15 St Leonard’s Land, Holyrood Road, Edinburgh, Scotland, UK;NHS Fife, Greenfield Clinic, Willow Drive, Whyteman’s Brae, Kirkcaldy, Fife, Scotland, UK;School of Nursing & Midwifery, University of Dundee, 11 Airlie Place, Dundee, Scotland, UK

关键词: Threshold;    Qualitative;    Public health;    Oral;    Nurse;    Neglect;    Dental;    Children;   

Others  :  1162311
DOI  :  10.1186/1471-2458-13-370

 received in 2012-11-30, accepted in 2013-04-16,  发布年份 2013

【 摘 要 】

Background

Child neglect is a pernicious child protection issue with adverse consequences that extend to adulthood. Simultaneously, though it remains prevalent, childhood dental caries is a preventable disease. Public health nurses play a pivotal role in assessing oral health in children as part of general health surveillance. However, little is known about how they assess dental neglect or what their thresholds are for initiating targeted support or instigating child protection measures. Understanding these factors is important to allow improvements to be made in care pathways.

Methods

We investigated public health nurses’ assessment of oral health in preschool children in relation to dental neglect and any associations they make with child neglect more broadly. A qualitative study was conducted in Scotland during 2011/12. Sixteen public health nurses were recruited purposively from one health region. Individual, semi-structured interviews were undertaken and data were analyzed inductively using a framework approach. Categories were subsequently mapped to the research questions.

Results

Public health nurses assess oral health through proxy measures, opportunistic observation and through discussion with parents. Dental neglect is rarely an isolated issue that leads on its own to child protection referral. It tends to be other presenting issues that initiate a response. Threshold levels for targeted support were based on two broad indicators: social issues and concerns about child (and parental) dental health. Thresholds for child protection intervention were untreated dental caries or significant dental pain. Barriers to intervention are that dental neglect may be ‘unseen’ and ‘unspoken’. The study revealed a communication gap in the care pathway for children where a significant dental problem is identified.

Conclusions

Public health nurses take their child protection role seriously, but rarely make a link between dental caries and child neglect. Clear guidance on oral health assessment is required for public health nurses. Establishing formal communication pathways between child dental care providers and public health nurses may help close gaps in care pathways. However, further research is required into how these communication mechanisms can be improved.

【 授权许可】

   
2013 Bradbury-Jones et al.; licensee BioMed Central Ltd.

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