What is stopping GPs from reporting child dental neglect?

An exploratory study investigating the barriers to reporting child dental neglect concerns among general medical practitioners in Greater Manchester. Br Dent J 2022; https://doi.org/10.1038/s41415-022-5221-7

Reporting child dental neglect is tricky for all of us. It must be even tricker for general medical practitioners (GPs) given their limited dental training. However, just what are GPs' views on this?

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This study answered that very question. A 31-point questionnaire was distributed to 100 GPs within Greater Manchester. Data were collected over a 12-week period and 25 questionnaires were returned.

The results focused on several key areas. All the GPs who responded only treated NHS patients. Interestingly, only 60% of the GPs received child protection training during their undergraduate training; however, 96% had participated in this training after completing their medical degree. Sixty-four percent of the GPs felt they were not appropriately trained to identify child dental neglect and 80% reported a lack of confidence in escalating and referring these patients. Eighty-eight percent of the GPs felt more training and guidance on child dental neglect was needed.

Four areas were identified as being of concern for child dental neglect. These were:

• Irregular dental attendance

• Repeat dental general anaesthetics

• Emergency GP appointments for dental pain

• Severe and untreated caries obvious to the lay person.

Forty-four percent of GPs have had suspicions of paediatric dental neglect during the last five years; however, this was only recorded in the patient's records 80% of the time. In addition, 32% of GPs who suspected child dental neglect did not make an onward referral. There was also wide variation regarding who GPs would refer these cases to, ranging from the local children's safeguarding board to the school nurse.

The most common barriers to reporting these cases were uncertainty over the diagnosis, limited confidence in their suspicions and limited knowledge on referral procedures. Only 44% of GPs believed they were well placed to recognise child dental neglect, but 84% were willing to support the detection of it.

GPs were asked to leave comments and this evidenced a desire for more training, difficulties in identifying neglect due to reduced face-to-face contact because of the COVID-19 pandemic, and a feeling that this was a dental issue rather than a medical one. However, there was an appreciation that dental neglect can be a sign of wider neglect.

This study highlighted limited training, confidence and knowledge around recognising, escalating and referring cases of suspected child dental neglect amongst GPs. Dentists may be able to play a key role in the provision of training for GPs in the area and supporting guidance development.