General dentists’ attitudes and perceived barriers in providing domiciliary dental care to older adults in long‐term care facilities or their homes in Northern Ireland: A descriptive qualitative study

Abstract

Objective Many older patients, housebound or living in long‐term care facilities (LTCFs) have limited access to dental care. This descriptive qualitative study aimed to understand general dental practitioners (GDPs) attitudes and perceived barriers to undertaking Domiciliary Dental Care (DDC) for those patients in Northern Ireland (NI). Methods Semi‐structured telephone interviews were conducted with a purposive sample of 12 GDPs in Northern Ireland. Interviews were digitally recorded and transcribed verbatim. An iterative coding process using theme‐analytic methods was used. Results The data were characterised into four major themes—risk of professional litigation, remuneration for those undertaking DDC, complexity of treatment, and the overall framework of the dental care system in NI. Two minor themes identified were practice culture and reasons for undertaking DDC. The GDPs in the study identified a number of barriers to undertaking DDC including a legal requirement to transport oxygen, lack of organisation and limited oral hygiene care provision in LTCFs, and confusion around their responsibilities for provision of DDC. Those GDPs who were providing DDC indicated that they did so out of kindness and a sense of loyalty to their long‐standing patients. Conclusion The GDPs in this study identified a number of significant barriers to provision of DDC at organisational, structural and clinical levels. The GDPs indicated that they required clarification of their responsibilities around DDC with clear guidelines necessary given the increase in demand for this service.

Contacts with general practitioners, dentists, and medical specialists among nursing home residents: a cross-sectional study in 44 German nursing homes

“…This could provide useful information for the design of future interventions that would be most effective for improving dental care provision in nursing homes. Furthermore, the implementation of tools for the assessment of dental care needs and clear pathways for the organization of dental care in the nursing home and, where necessary, at a practice, could help to increase dental care utilization [35][36][37].…”

Barriers Perceived by the Dentists in Providing Oral Health Care to the Elderly: A Narrative Review

“…One of the most felt by dentists that hindered them from providing oral health care for the elderly was that they thought they had limited knowledge of geriatric dentistry. [12][13][14][15][16] Geriatric dentistry can be defined as 'part of the dental curriculum that deals with the specific knowledge, attitudes and technical skills required in the provision of oral health care for older adults.' 17 Dentists obtain this knowledge through education and training during their undergraduate dental education or any additional courses they may participate in.…”

“…13,19,21 The complexity of this treatment is the biggest obstacle for dentists because the treatment will require more time and high skills. [12][13][14][15]18,19,21 Dentists are also often confused about getting approval for treating the elderly with physical and mental disabilities. 21 According to dentists, older people with physical and mental disabilities are challenging to comply with treatment and follow recommendations, so dentists cannot optimally provide oral health care.…”

“…26 Another factor that dentists are concerned about is the risk of complications, medical emergency conditions, and professional litigation, thus making dentists afraid and more careful in treating the elderly. 13,14 This concern encourages dentists to refer the elderly to colleagues or specialists. However, some dentists still have limitations in referring the elderly because of the availability of special oral health care facilities provided for the elderly.…”

Caries management using silver diamine fluoride and providing domiciliary dental care for dependent older adults: A qualitative study of Swiss dentists

“…Furthermore, the number of GDPs providing DDC in many countries is low. 13,[27][28][29] Management of dental caries, especially root caries, in older adults should follow a minimally invasive approach including disease prevention given the logistical challenges of delivering operative care. 30,31 Application of high-fluoride topical agents is a well-established approach.…”