An evaluation of an alternative Child Friendly Dental Pathway for Paediatric patients

The aim of this research is to determine the performance of Child Friendly Dental Practices compared to a traditional Specialist Paediatric Dental pathway on the long term oral health and treatment under General Anaesthetic for children referred to specialist care due to severe decay. Background Rising demand for specialist paediatric dental services, including hospital-based dental general anaesthetic services has resulted in extensive waiting times to access care for the patients referred into this system. This was always a fragile system, with demand far exceeding capacity and subsequently long wait lists of up to 12 months. Such delays in accessing dental care are known to be accompanied by the significant consequences of untreated dental caries, including pain, infection, sleepless nights and poor quality of life. The emergence of Covid-19 created a perfect storm and pushed the system to breaking point. In late 2020, as a response to the increased pressure caused by Covid-19, a new model of enhanced primary care was piloted in Greater Manchester, the Child Friendly Dental Practice (CFDP) Scheme. The aim was to provide timely access to dentists who have an interest in treating young children and have received some additional training. A robust evaluation of the scheme is required to determine the longer-term impacts on children and NHS services and if successful how the scheme can be adopted more widely. Our primary and secondary research questions are as follows: Primary Does treatment through a CFDP reduce dental treatment under General Anaesthetic when compared to the traditional pathway? What are the health economic impacts of using CFDP? Secondary What are the long-term impacts of treatment in terms of antibiotic use, pain experienced, further treatment required by CFDP compared to a traditional pathway? What are dental teams' beliefs and views on CFDPs? Are patients satisfied with their experience in using CFDPs and traditional services? Looking only at the CFDPs - what proportion require an onward referral and what characteristic necessitate an onward referral? - Methods The evaluation of CFDPs will utilise a realist approach. This will involve both qualitative data collected through interviews with dentists, stakeholders and families as well as quantitative data through longitudinal follow up of patient dental records. Outcomes will therefore include referral back into the specialist paediatric system, or for dental general anaesthetic, patient satisfaction through text message surveys with families and cost data. The integration of the data at analysis stage using triangulation and the Context Mechanism Outcome configuration will be used to explain the outcomes. The final programme theory will be validated through group discussions with relevant stakeholders. Timelines for delivery Participants will be followed up for 2 years to ensure sufficient data is captured to inform the evaluation. Adequate time has been include for recruitment, write up and dissemination. Anticipated impact and dissemination The research has the potential to make a significant impact throughout dental paediatric services. If the service is shown to be successful long term this could lead to a positive, permanent change in the treatment children who are referred from their own dentist receive, whilst reducing how long they wait, in pain, the amount of antibiotics required and reducing costs to the NHS.