Patterns of balancing and compensating primary tooth extractions amongst paediatric dentists

Abstract

Introduction: Balancing and compensating extractions (BCEs) of primary teeth aims to minimize the development of more severe malocclusions and reduce the need for subsequent complex orthodontic treatment. Purpose: To assess the demographics, practice characteristics, and clinical preferences of United Kingdom (UK) paediatric dentists for BCEs of primary teeth, to determine adherence to national clinical guidelines and whether paediatric dentists refer patients to orthodontists before deciding on BCEs. Methods: This was a total population online survey of members of the British Society of Paediatric Dentistry (BSPD). A pre-tested, self-administered electronic questionnaire was accessed through a secure website. Questions offered frequency options (always/frequently, often/sometimes and rarely/never) for a range of clinical scenarios in patients up to 5 years and those between 6 and 9 years. Descriptive statistics in the form of percentages were presented. To compare single population/sample percentages, a Pearson Chi-square goodness-of-fit (GOF) test with post hoc pairwise binomial analysis and Bonferroni adjustments was performed. Results: Of the 288 specialists invited, 67 (23.3%) completed the questionnaire. Respondents were mostly female (n=55; 82.1%), with most respondents working in secondary care (n=51; 77.3%). The majority (n=54; 81.8%) supported the application of guidelines for primary teeth extractions. Thirty-nine paediatric dentists (58.2%) always/frequently encountered BCEs, with 29 (46.2%) performing BCEs in over 40 patients in the past year. Forty respondents (59.7%) reported always/frequently complying with national clinical guidelines for primary teeth extractions. Data from 65 respondents indicates that 83.6% (n=56) rarely/never made referrals to an orthodontist, whilst 65.7% (n=44) rarely/never consulted an orthodontist (p < 0.001). Conclusions: The results reveal significant decision variation across clinical scenarios, with good adherence to guidelines in BCEs of primary teeth among paediatric dentists. However, there is limited interdisciplinary collaboration, as indicated by the infrequent referrals or consultations with orthodontists when considering BCEs of primary teeth.