Perceived barriers encountered by oral health professionals in the Australian public dental system providing dental treatment to individuals with special needs

Abstract

Aims: To investigate barriers experienced by clinicians treating individuals with special needs in the Australian public dental system. Methods and results: Oral health professionals working at primary care clinics in the public dental system were invited to participate in semi-structured interviews or focus groups to discuss the challenges they faced in managing patients with special needs. Qualitative methods, employing inductive thematic analysis, revealed two primary barriers: 1. clinicians lacked confidence in their ability to treat patients with special needs because of insufficient training and experience, and difficulties obtaining information about their patients, and 2. barriers within the public dental system, including inadequate funding, equipment and facilities, and productivity pressures prevented clinicians from being able to provide the care patients required. The priority and understanding of the oral health for these individuals within the public dental system and wider disability sector was also raised. Conclusion:A perceived lack of training and experience in managing individuals with special needs was a barrier to treating patients with special needs. Other significant barriers were under-resourcing of the public dental system and a lack of priority and understanding regarding oral health among carers of individuals with special needs and other health professionals. K E Y W O R D Sdental, disabled persons, general practice, health care utilization, medically underserved area INTRODUCTIONIn Australia, special needs dentistry is a recognized dental specialty that "supports the oral health care needs of people with an intellectual disability, medical, physical, or psychiatric conditions that require special methods or techniques to prevent or treat oral health problems,

Perspectives of the public dental workforce on the dental management of people with special needs

“…Adults with special health care needs may experience many barriers to accessing regular dental care, 2,5 but finding dentists with adequate skills and knowledge, and who are willing to treat them, have been prominent and recurrent issues raised by these individuals 3,4 . The findings of the current study reinforced concerns about the lack of experience or inadequate training of oral health professionals in special needs dentistry discussed throughout the literature 4,7,8,20–22 . In particular, the most common challenge, regardless of patient group, was determining how dental treatment could be provided safely given the complex health issues, frailty, or behavioural issues and impairments which are often encountered in managing this group of patients.…”

“…In the current study, clinicians acknowledged and appreciated limited resources and funding as something that was beyond the control of their local clinical environments 4 . However, issues related to funding, access to general anaesthetic facilities and suitable equipment, and appropriate clinical infrastructure to manage those with physical impairments have been established as barriers, 7,8,10,15,16,23 and need to be considered and addressed if meeting the needs of individuals with special needs is considered a priority. Unfortunately, other forms of support will only go so far if clinicians do not have the means by which to address the current oral health issues of this population 44–48 …”

“…Although the participants in the current study largely focussed on patient‐related factors, barriers experienced by clinicians in the clinic setting, and wider health system, were discussed and reiterated those discussed in the literature 7,8,10,16,23 . These include, but are not limited to, the lack of integration of health care systems to promote multidisciplinary care for those with special needs, workforce capacity and capability, suitable facilities, productivity pressures, and the absence of public policies and funding to address the health care disparities of these individuals and have been described in both the Australian public health system and others internationally.…”

“…Adults with complex health issues, disabilities, and other special health care needs continue to have difficulty accessing regular dental care 1 . Although a number of potential barriers have been proposed, 2–6 what has been identified has been partly attributable to the perceived lack of knowledge or experience of oral health professionals in managing this patient group, leading to a reluctance to manage their more complex needs 4,7,8 . Recent evidence also suggested that the ability of clinicians to provide the level of care required may be limited by constraints within the Australian public dental system 8 …”

“…There is growing advocacy in Australia and internationally to improve the training of oral health professionals to ensure the dental workforce appreciates the needs of these individuals and has the skills to confidently address them 2,11–18 . However, little is known of what clinicians find challenging about managing this group of individuals and whether additional support would improve their willingness to treat those with special needs 8 . To ascertain this information, this study aimed to understand the views of clinicians in the public dental system in relation to these issues.…”