An investigation into the factors influencing decision making regarding the management of carious primary teeth under general anaesthetic

Abstract

Caries in primary teeth remains a common reason for Paediatric Dental General Anaesthesia (PDGA) in the United Kingdom (UK). Different treatment options are available for carious primary teeth under general anaesthesia (GA), ranging from restorative treatments to extraction. Variation in treatment planning has been observed in practice, but the reasons underlying these decisions are not well understood.

Aim: To explore the factors that influence paediatric dentists’ decision-making, when planning treatment for children with carious primary teeth under GA in the UK.

Method: A qualitative cross-sectional study, informed by an interpretivist- constructivist approach. using focus groups was conducted with paediatric speciality trainees, specialists and consultants within the UK, who were all recruited through the British Society of Paediatric Dentistry (BSPD). Focus groups were conducted online and recorded, then transcribed. Data were analysed using reflexive thematic analysis to explore clinicians’ reported views and experiences of treatment planning carious primary teeth under GA.

Results: Nineteen participants took part in three focus groups. Participants described variation in treatment planning under GA, which they related to different treatment philosophies, training backgrounds and organisational arrangements. Modified Hall technique, was the treatment of choice, when aiming to preserve teeth. Participants described reluctance to provide vital pulp therapy (VPT) under GA, despite supportive evidence-based guidelines, because of predictability concerns and risk of repeat GA. Decision making was reported to be influenced by experience, workplace hierarchy and service pressures, including waiting lists, workforce limitations and the type of GA list available. Participants also emphasised the importance of parental expectations, shared decision-making and perception of families’ ability to maintain oral health.

Conclusion: Treatment planning for carious primary teeth under GA was described to be influenced by interactions between clinical, family and service-related factors. The findings provide insights into how UK paediatric dentists explain their decision-making and highlight the importance of aligning treatment planning with current evidence, supporting shared decision-making and address organisational barriers to comprehensive care.