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Access to Care for the Endodontic Treatment of Pediatric Patients: A Qualitative Study
Melissa Mathews1, Julian Boykins2, Antoinette M Schoenthaler3
1Department of Pediatric Dentistry, New York University College of Dentistry, New York, New York, USA.
Background:
Clinical approaches for pediatric patients requiring endodontic treatment have been associated with specialty type.
Aim:
The purpose of this study was to elucidate the nuanced clinical decision-making process for endodontic treatment of pediatric patients' permanent teeth.
Design:
A qualitative design was used to explore the experiences and decision-making of general dentists, pediatric dentists, and endodontists. Clinicians practicing in the United States were recruited to interview using purposive sampling methods. A framework, thematic analytic approach was used to evaluate the data.
Results:
In total, 26 dentists participated in the study: 7 general dentists, 11 pediatric dentists, 6 endodontists, and 2 dual-trained specialists. Overall, clinicians reported that caries on permanent first molars were the most common reason that pediatric patients required endodontic treatment. Access to care was influenced by practitioner clinical training and knowledge; patient behavior; and financial considerations. Treatment planning was influenced by parents, referrals, and clinical philosophy.
Conclusions:
The findings explain how clinician decision-making and system-level factors influence access to care for pediatric patients in need of endodontic treatment and propagate oral health disparities. Barriers to accessing care were most limiting for children and adolescents from low-income households and were likely to result in premature tooth loss.
