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Treatment planning

A study of the patient experience of toothache

Key Points

In Brief

  • Patients express helplessness, dependency, loss of control, despair and isolation to indicate their perceived inability to cope with toothache.

  • Patients with toothache exhibit different patterns of care-seeking: multiple visits to the same dentist; multiple visits to different dentists; visits to hospitals, doctors and pharmacists.

  • The perceived inability to cope may have predictive ability in care-seeking patterns.


Aims To explore the subjective experience of a sample of patients attending a dental teaching hospital emergency clinic with toothache.

Materials and methods Subjects 21 female and 14 male dental patients, of different ages, marital status, employment status and levels of education, presenting with toothache at a dental teaching hospital emergency clinic. Data collection Unstructured in-depth interviews, following a topic guide. Analysis Transcribing, sifting, indexing and charting data according to key issues and themes.

Findings A dimension of toothache pain that emerged was the perceived inability to cope. Patients reported a dependency on a dentist or other person to alleviate their pain, suggesting connotations of helplessness, disempowerment and incapacitation. The perceived inability to cope was also expressed in terms of loss of control, despair and isolation. A number of care-seeking patterns for toothache was identified: repeated visits to the same dentist for emergency care, repeated visits to different dentists, attendance at the dental hospital emergency clinic and consulting non-dental health workers such as doctors and pharmacists.

Conclusions The perceived inability to cope and care-seeking patterns are two unexplored dimensions of the toothache pain experience. Both dimensions may be associated with pain intensity, the clinical conditions that manifest as toothache, quality of treatment provided and management of demand for emergency dental care. A conceptual framework is proposed for future research to investigate these relationships.


Perceived inability to cope and care-seeking in patients with toothache: a qualitative study by A. K. H. Pau, R. Croucher and W. Marcenes Br Dent J 2000; 189: 503–506


The authors of this paper have focused on an important area of dental healthcare: the patient experience of toothache. The impact of toothache on the patient and demands for services has alerted these authors to study, in some depth, the subjective experience of patients suffering with this dental pain.

The study uses qualitative methodology. The authors resisted using commonly available pain assessment instruments such as the McGill Pain Questionnaire. Patients were asked directly about a whole range of issues pertinent to their experience. The selection of a wide range of different types of patient, the employment of in-depth interviews and meticulous analysis of transcripts from tape recordings has revealed substantial features which were likely to be ignored using more traditional quantitative approaches. Checks on the reliability of coding and careful description of methods demonstrate a well crafted study technique. The results section has been filtered to describe to the reader the essential findings. The discussion of this paper rewards careful inspection. Herein lies what I consider to be some important messages to the researcher and practitioner alike.

First, an important psychological construct: 'perceived inability to cope' has been identified and is put forward as a potential candidate for understanding why some patients appear to attend their dentist speedily and frequently whilst others delay, apparently withstanding highly visible evidence of pathology (eg swelling, abscess). The authors continue by saying that the expression of poor coping ability may result in pain behaviour such as demands for immediate or frequent care. The assessment of perceived inability to cope is recommended as a proxy for the measurement of pain intensity. These claims are firmly presented in the form of a new conceptual model and are eminently testable. It is hoped that alongside the development of a coping measure that further effort is expended in other pain assessments. There are examples of developing qualitative pain descriptors into valid measures of pain perception that are consistent across lay, professional and cultural boundaries.1 The exploration of the new model will require work on both fronts.

Secondly, part of this new model includes the link between toothache and the patient's expression of that pain. This relationship requires further study. It is known, in the medical area, that the strategy of stating one is unable to cope is effective in challenging health professionals' willingness to treat, especially in the case of unexplained symptoms – a parallel, not unknown in the dental field.2 Pau and colleagues draw attention to taking a patient-centred perspective and is to be welcomed. Hence one of the important practical implications of the work reported is the call for a detailed case history to be collected. The ability of the oral healthcare team to derive this history is dependent on their communication skills. Further support is therefore presented for the key role of listening to patients and improving the likelihood of diagnosing accurately.


  1. Moore R, Brodsgaard I, Miller M L, Mao T K, Dworkin S F . Consensus analysis: validity, and informant accuracy in use of American and Mandarin Chinese pain descriptors. Ann Behav Med 1997; 19: 295–300.

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  2. Peters S, Stanley I, Rose M, Salmon P . Patients with medically unexplained symptoms: sources of patients' authority and implications for demands on medical care. Soc Sci Med 1998; 46: 559–565.

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Humphris, G. A study of the patient experience of toothache. Br Dent J 189, 492 (2000).

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