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Referral Patterns of Paediatric Oral Surgery Cases: A Pilot UAE Survey of Dentists' Opinions

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Referral Patterns of Paediatric Oral Surgery Cases: A Pilot UAE Survey of Dentists’ Opinions
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Referral Patterns of Paediatric Oral Surgery Cases:
A Pilot UAE Survey of Dentists' Opinions
MADI H.A.1, DARWISH S.2, KHAMIS A.H.3 & HUSSEIN I.4
Departments of Oral Surgery and Paediatric Dentistry, Hamdan Bin Mohammad College of Dental Medicine (HBMCDM), Mohammad Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai Health Care City, Dubai, United Arab Emirates
1BDS, MSc, MFDRCSI(Ireland), Resident in Oral Surgery Department;2 BSc BDS MSc MClinDent LLM DipDSed MFDRCS MRDRCS FDSRCS, Assistant Professor in Oral Surgery, Consultant & Specialist Oral Surgeon, Specialist Periodontist, Medico-legal Advisor & Educator; 3PhD, DEA,
MSc, BSc Associate Prof of Biostatistics & Genetic Epidemiology 4DDS, MDentSci, GDCStat.Exam (UK), MFDSRCPS (Glasg), UK Specialist in Paediatric Dentistry, Clinical Assistant Professor, Paediatric Dentistry.
Introduction
The study was designed as a cross-
sectional survey.
The ethical approval was obtained
from the Research and Ethics
committee at HBMCDM, MBRU.
GDPs and PDs in the UAE attending
postgraduate conferences
Data were collected by means of an
interview based questionnaire
including:
Demographics
A total of twelve clinical
photographs/radiographs of
different common POS cases
93 were interviewed but only 82 were
analysed because 11 did not treat children
There were 42 GDPs and 40 PDs
Chi square. *Statistical significance 0.05
Aims & Objectives
Questionnaire Summary POS Cases
Results (Total N=82 GDPs n=42, PDs n=40)
References
Discussion
When referring patients, the referral should be made
in the patients’ best interests1.
A referring dentist has a duty of care to refer a
patient to the specialty best suited to treat the case if
the case falls out with boundaries of their
competency1.
The Paediatric-Oral Surgery (POS) interface
involves cases that present to General Dental
Practitioners (GDPs) and Paediatric Dentists (PDs).
To assess the referral patterns of GDPs and PDs in the
United Arab Emirates (UAE) when faced with a range of
POS cases.
Management of POS cases varies from dentist to
dentist and country to country.
There are no clear referral patterns guidelines in the
UAE regarding POS.
UAE has similar Scope of Practice guidelines to the
UK1,2. GDPs should limit clinical practice to
procedures which are within the scope of his/her
education, training, competence and indemnity.
The results of the survey were surprising as the
majority of participants would manage POS cases
themselves. The second most common practice
would be a referral to OS.
GDP referrals to PDs or MDC were very limited.
Financial incentives play a huge role in referral
patterns in UAE, as dental treatment is mostly
provided in private practice with insurance coverage.
Availability of specialist services, or lack of, has an
effect on referral patterns.
Dental multidisciplinary care of POS cases is not
commonly accepted practice in the UAE. This concept
therefore requires encouragement.
Statistical analysis
Study Design
Ethical approval
Eligibility criteria
Data collection
Final Sample
Size
SURVEYED
GROUPS
PAEDIATRIC
-
ORAL SURGERY
CASES (POS)
REFERRAL OUTCOMES
General Dental
Practitioners
(GDPs)
Lower lip
mucocele
Do nothing
Specialists in
Paediatric
Dentistry (PDs)
Tongue
tie
Do it
yourself
Extraction of
multiple carious
deciduous teeth
Refer to an oral surgeon
(OS)
Exposure of
impacted
maxillary canine
Refer to a/another
paediatric dentist (PD)
Labial
f
raenectomy
Refer to a
multidisciplinary clinic
(MDC)
Odontogenic
infection with
swelling
Primary herpetic
gingivo
-
stomatitis
Ankylosed
submerged
primary molar
Dental trauma
Dento
-alveolar
trauma
Lip laceration
Unerupted
mesiodens
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Do Nothing Do it your
self Refer to OS Refer to
a/another PD
GDP
PD
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Do it your self Refer to
a/another PD Refer to MDC
GDP
PD
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Do it your
self Refer to OS Refer to
a/another PD Refer to
MDC
GDP
PD
0.00%
5.00%
10.00%
15.00%
20.00%
25.00%
30.00%
35.00%
40.00%
45.00%
50.00%
Do it your
self Refer to OS Refer to
a/another PD Refer to
MDC
GDP
PD
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Do it your
self Refer to OS Refer to
a/another
PD
Refer to
MDC
GDP
PD
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Do
Nothing Do it your
self Refer to
OS Refer to
a/another
PD
Refer to
MDC
GDP
PD
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
100.00%
Do it your
self Refer to OS Refer to
a/another
PD
Refer to
MDC
GDP
PD
0.00%
20.00%
40.00%
60.00%
80.00%
100.00%
120.00%
Do it your self Refer to
a/another PD Refer to MDC
GDP
PD
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
Do it your
self Refer to OS Refer to
a/another PD Refer to
MDC
GDP
PD
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
Do it your
self Refer to OS Refer to
a/another PD Refer to
MDC
GDP
PD
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
80.00%
90.00%
Do it your
self Refer to OS Refer to
a/another PD Refer to
MDC
GDP
PD
Fig 4: exposure of impacted
maxillary canine Fig 8:ankylosed submerged
primary molar: (p=0.01) Fig 12: unerupted mesiodens
Fig 11: lip laceration
Fig 7: primary herpetic
gingivostomatitis: (p=0.000)
.
Fig 3: multiple carious primary
molars: (p=0.01)
Fig 10: alveolar ridge trauma:
(p=0.04)
.
Fig 6: odontogenic infection
with facial swelling: (p=0.002)
.
Fig 2: tongue tie
0.00%
10.00%
20.00%
30.00%
40.00%
50.00%
60.00%
70.00%
Do it your self Refer to OS Refer to
a/another PD
GDP
PD
Fig 9: dental trauma: (p=0.01)
Fig 5: labial fraenectomy
Fig 1: lower lip mucocele (p=0.005)
Conclusion
While PDs and GDPs referred some POS cases to
OSs, GDPs were reluctant to refer to PDs,
preferring to manage the majority of cases
themselves.
The authors recommend a further study with a
view to the development of guidelines to address
POS referrals between GDPs and specialists.
Materials & Methods
1 General Dental Council, "Scope of Practice," General Dental Council, London, UK, 2013.
2 Dubai Health Authority, “Scope of Practice for Dentistry” Health Regulation Department
Dubai, UAE, 2011.
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