Register      Login
Australian Journal of Primary Health Australian Journal of Primary Health Society
The issues influencing community health services and primary health care
RESEARCH ARTICLE (Open Access)

Perceptions of general practitioners towards managing dental presentations in Australia: a qualitative study

Ruby Biezen https://orcid.org/0000-0003-1736-9675 A , Angel Leong B and Leanne Teoh https://orcid.org/0000-0002-9138-813X B *
+ Author Affiliations
- Author Affiliations

A Department of General Practice and Primary Care, The University of Melbourne, Melbourne, Vic. 3010, Australia.

B Melbourne Dental School, The University of Melbourne, Melbourne, Vic. 3010, Australia.

* Correspondence to: leanne.teoh@unimelb.edu.au

Australian Journal of Primary Health 30, PY23217 https://doi.org/10.1071/PY23217
Submitted: 20 November 2023  Accepted: 20 March 2024  Published: 15 April 2024

© 2024 The Author(s) (or their employer(s)). Published by CSIRO Publishing on behalf of La Trobe University. This is an open access article distributed under the Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License (CC BY-NC-ND)

Abstract

Background

Patients presenting with dental pain are common in general practice, despite dental infections being most appropriately managed with dental treatment to address the cause of the infection. Although antibiotics are not appropriate for the management of localised toothache without signs of systemic spread, general practitioners (GPs) often prescribe antibiotics and analgesics for the management of dental pain. The aim of this study was to explore GPs’ perceptions and management of dental presentations in Australia.

Methods

Twelve semi-structured interviews were conducted with GPs across Victoria, Australia, between October 2022 and January 2023. Data were thematically analysed.

Results

The study found that dental pain was the most common presenting complaint for patients attending general practice with a dental problem. Five major themes were identified in this study: knowledge, beliefs about capabilities, emotion, environmental context and resources, and social influences/social professional role and identity. In terms of knowledge and capabilities, GPs would advise patients to seek dental care, as they are aware that antibiotics would not resolve the underlying issue. Challenges for GPs included limited training in oral and dental treatment, as well as emotions, such as patient anxiety and phobia resulting in patients seeking dental care through a GP rather than a dentist. Barriers due to the context, such as access to dental care, long waiting lists within the public dental system and cost, were some of the reasons patients present to general practice rather than a seeing a dentist. Furthermore, issues that influenced GPs’ antibiotic prescribing included patients’ expectations for antibiotics to treat their dental pain, as well as dentists advising their patients to attend their GP for antibiotics prior to dental treatment.

Conclusions

This study identified factors that influenced GPs’ management of patients with dental conditions. To address these issues, it is imperative to develop interventions addressing patients’ knowledge around oral health, as well as providing improved access to dental care for these patients.

Keywords: antibiotic, antibiotic prescribing, dental, dentist, general practitioner, patient healthcare, primary care, toothache.

References

Adams C, Slack-Smith L, Larson A, O’Grady M (2004) Dental visits in older Western Australians: a comparison of urban, rural and remote residents. Australian Journal of Rural Health 12, 143-149.
| Crossref | Google Scholar | PubMed |

AIHW (2018) A discussion of public dental waiting times information in Australia: 2013–14 to 2016–17. Available at https://www.aihw.gov.au/reports/dental-oral-health/discussion-of-public-dental-waiting-times/summary [Accessed 28 May 2023]

AlQahtani HA, Ghiasi FS, Zahiri AN, Rahmani NI, Abdullah N, Al Kawas S (2019) Self-medication for oral health problems among adults attending the University Dental Hospital, Sharjah. Journal of Taibah University Medical Sciences 14, 370-375.
| Crossref | Google Scholar | PubMed |

Alsharif AT, Kruger E, Tennant M (2015) Dental hospitalization trends in Western Australian children under the age of 15 years: a decade of population-based study. International Journal of Paediatric Dentistry 25, 35-42.
| Crossref | Google Scholar | PubMed |

Anderson R, Calder L, Thomas DW (2000) Antibiotic prescribing for dental conditions: general medical practitioners and dentists compared. British Dental Journal 188, 398-400.
| Crossref | Google Scholar | PubMed |

Australian Dental Association (ADA) (2020) Australia’s adult oral health tracker 2020: technical paper. Mitchell Institute, Victoria University, Melbourne.

Bhattarai R, Khanal S, Shrestha S (2020) Prevalence of self-medication practices for oral health problems among dental patients in a dental college: a descriptive cross-sectional study. Journal of the Nepal Medical Association 58, 209-213.
| Crossref | Google Scholar | PubMed |

Biezen R, Brijnath B, Grando D, Mazza D (2017) Management of respiratory tract infections in young children – a qualitative study of primary care providers’ perspectives. npj Primary Care Respiratory Medicine 27, 15.
| Crossref | Google Scholar | PubMed |

Biezen R, Grando D, Mazza D, Brijnath B (2018) Why do we not want to recommend influenza vaccination to young children? A qualitative study of Australian parents and primary care providers. Vaccine 36, 859-865.
| Crossref | Google Scholar | PubMed |

Biniecki E, Foote C, Gilbert G, Abbott P (2018) General medical practitioners’ knowledge and management of oral and dental problems. Australasian Medical Journal 11, 390-396.
| Crossref | Google Scholar |

Cope AL, Wood F, Francis NA, Chestnutt IG (2015) General practitioners’ attitudes towards the management of dental conditions and use of antibiotics in these consultations: a qualitative study. BMJ Open 5, e008551.
| Crossref | Google Scholar | PubMed |

Cope AL, Chestnutt IG, Wood F, Francis NA (2016a) Dental consultations in UK general practice and antibiotic prescribing rates: a retrospective cohort study. British Journal of General Practice 66, e329-e336.
| Crossref | Google Scholar | PubMed |

Cope AL, Francis NA, Wood F, Chestnutt IG (2016b) Antibiotic prescribing in UK general dental practice: a cross-sectional study. Community Dentistry and Oral Epidemiology 44, 145-153.
| Crossref | Google Scholar | PubMed |

Cope AL, Wood F, Francis NA, Chestnutt IG (2018) Patients’ reasons for consulting a GP when experiencing a dental problem: a qualitative study. British Journal of General Practice 68, e877-e883.
| Crossref | Google Scholar | PubMed |

Department of Health (2016) Dentists. Fact Sheet. Australian Government Department of Health, Canberra.

HealthPathways (2023) HealthPathways Melbourne. Available at https://melbourne.communityhealthpathways.org/LoginFiles/Logon.aspx?ReturnUrl=%2f

IACG (2019) No time to wait: securing the future from drug-resistant infections. Report to the Secretary-General of The United Nations. (Interagency Coordination Group on Antimicrobial Resistance) Available at https://www.who.int/docs/default-source/documents/no-time-to-wait-securing-the-future-from-drug-resistant-infections-en.pdf

Michie S, Johnston M, Abraham C, Lawton R, Parker D, Walker A (2005) Making psychological theory useful for implementing evidence based practice: a consensus approach. Quality and Safety in Health Care 14, 26-33.
| Crossref | Google Scholar |

Michie S, van Stralen MM, West R (2011) The behaviour change wheel: a new method for characterising and designing behaviour change interventions. Implementation Science 6, 42.
| Crossref | Google Scholar | PubMed |

Mittal P, Chan OY, Kanneppady SK, Verma RK, Hasan SS (2018) Association between beliefs about medicines and self-medication with analgesics among patients with dental pain. PLoS ONE 13, e0201776.
| Crossref | Google Scholar | PubMed |

Nagarakanti S, Epari V, Athuluru D (2013) Knowledge, attitude, and practice of medical doctors towards periodontal disease. Journal of Indian Society of Periodontology 17, 137-139.
| Crossref | Google Scholar | PubMed |

Nguyen S, Ahmed L, Villarosa A, George A, Yaacoub A (2023) The use of antibiotics in acute oral health patients presenting at public dental clinics in the Western Sydney region. Family Practice 40, 9-15.
| Crossref | Google Scholar | PubMed |

Painter JE, Sales JM, Pazol K, Grimes T, Wingood GM, DiClemente RJ (2010) Development, theoretical framework, and lessons learned from implementation of a school-based influenza vaccination intervention. Health Promotion Practice 11, 42S-52S.
| Crossref | Google Scholar | PubMed |

Park JS, Page AT, Shen P-H, Price K, Tennant M, Kruger E (2022) Management of dental emergencies amongst Australian general medical practitioners – a case-vignette study. Australian Dental Journal 67, 30-38.
| Crossref | Google Scholar | PubMed |

Scott SE, Walter FM, Webster A, Sutton S, Emery J (2013) The model of pathways to treatment: conceptualization and integration with existing theory. British Journal of Health Psychology 18, 45-65.
| Crossref | Google Scholar |

Sen Gupta T, Stuart J (2020) Medicine and dentistry: shall ever the twain meet? Australian Journal of General Practice 49, 544-548.
| Crossref | Google Scholar | PubMed |

Stormon N, Sowa PM, Anderson J, Ford PJ (2021) Facilitating access to dental care for people experiencing homelessness. JDR Clinical & Translational Research 6, 420-429.
| Google Scholar | PubMed |

Suda KJ, Calip GS, Zhou J, Rowan S, Gross AE, Hershow RC, Perez RI, McGregor JC, Evans CT (2019) Assessment of the appropriateness of antibiotic prescriptions for infection prophylaxis before dental procedures, 2011 to 2015. JAMA Network Open 2, e193909.
| Crossref | Google Scholar | PubMed |

Teoh L, Marino RJ, Stewart K, McCullough MJ (2019) A survey of prescribing practices by general dentists in Australia. BMC Oral Health 19, 193.
| Crossref | Google Scholar | PubMed |

Teoh L, Hopcraft M, McCullough M, Manski-Nankervis J-A, Biezen R (2023) Exploring the appropriateness of antibiotic prescribing for dental presentations in Australian general practice – a pilot study. British Journal of Clinical Pharmacology 89, 1554-1559.
| Crossref | Google Scholar | PubMed |

Therapeutic Guidelines (2019) ‘Therapeutic guidelines oral and dental version 3. Oral and dental expert group.’ (Therapeutic Guidelines Pty Ltd: Melbourne, Victoria)

Thompson W, Williams D, Pulcini C, Sanderson S, Calfon P, Verma M (2020) The essential role of the dental team in reducing antibiotic resistance. FDI World Dental Federation, Geneva.

Trivedy C, Kodate N, Ross A, Al-Rawi H, Jaiganesh T, Harris T, Anderson JE (2012) The attitudes and awareness of emergency department (ED) physicians towards the management of common dentofacial emergencies. Dental Traumatology 28, 121-126.
| Crossref | Google Scholar | PubMed |

WHO (2022) Global oral health status report: towards universal health coverage for oral health by 2030. World Health Organization, Geneva. Available at https://www.who.int/publications/i/item/9789240061484

Yeng T, O’Sullivan AJ, Shulruf B (2020) Medical doctors’ knowledge of dental trauma management: a review. Dental Traumatology 36, 100-107.
| Crossref | Google Scholar | PubMed |