Professional Uncertainty in Providing Dental Care for Special Needs Children

Objectives: The aim of the study was to determine whether scientific (incomplete knowledge base), practical (inadequate clinical infrastructure) or personal (sense of social justice) sources of uncertainty among general dentists in British Columbia, Canada posed the greatest barriers to their ability to treat children with special health care needs (CSHCN) and whether they differed for children with physical or developmental disorders.
Methods: A 74-item self-administered electronic questionnaire was distributed to a random sample of 1200 general dentists registered with the British Columbia Dental Association. Variability in clinical practice (examine and treat, examine and refer, refer) was assessed using 3 case scenarios featuring CSHCN with a: 1) behavioral difficulty (autism spectrum disorder); 2) physical disability (bleeding disorder) or; 3) combination (cerebral palsy). Respondents used a 5-point Likert-type scale to rate uncertainty levels in each case scenario. Data were analyzed and classified based on a novel taxonomical approach.
Results: The response rate was 19% (n=226). Ninety-one percent of dentists reported that <5% of patients in their practice were CSHCN. Seventy-two percent of dentists referred one or more cases for treatment. A higher percentage of dentists were willing to examine and treat a child with a bleeding disorder (60%) or cerebral palsy (64%) than a child with autism (45%). Among those who referred CSHCN, the most common sources of uncertainty were scientific (knowledge of management) and practical sources (staff and practice setup) (p<0.05).
Conclusions: Dentists who demonstrated high scientific and practical uncertainty were more likely to refer CSHCN for treatment. Children with behavioral difficulties were also more likely to be referred than children with physical disorders. Educational opportunities, increasing awareness of hospital dental services, and expanding general dentists’ professional referral network may help reduce barriers to accessing care for CSHCN, especially children with a limited ability to cooperate for dental treatment.