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The Perception and Socially Constructed Practises of Dental Sedation

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The Perception and Socially Constructed Practises of Dental Sedation Patients, Performance and Parlours: the perception and socially constructed practises of dental sedation clinics Stephen Mark Woolley A thesis presented in fulfilment of the requirements for the degree of Doctor of Philosophy at Cardiff University. 2012 Declaration No portion of this work has previously been submitted in substance for any other degree or award at this or any other university or place of learning, nor is being submitted concurrently in candidature for any degree or other award. Signed..(Candidate) Date STATEMENT 1 This thesis is being submitted in fulfilment of the requirements for the degree of PhD . Signed..(Candidate) Date STATEMENT 2 This thesis is the result of my own independent work/investigation, except where otherwise stated. Other sources are acknowledged by explicit references. The views expressed are my own. Signed..(Candidate) Date STATEMENT 3 I hereby give consent for my thesis, if accepted, to be available for photo-copying and inter-library loan, and for the title and summary to be made available to outside organisations. Signed..(Candidate) Date i Acknowledgements Whilst this doctoral thesis is the result of my own independent investigation, there have been many people whose input has helped me to complete this study. There are too many to list them all, but some deserve to be specifically acknowledged. I would like to thank Professors Ruth Freeman and Lindsay Prior for spending the time to explore the argument presented in this thesis Sincere and profound appreciation must be given to my supervisors Professor Barbara Chadwick, Dr. Lesley Pugsley and Dr. Rob Evans, and my original supervisor Dr. Kate Stewart, for their encouragement, help, guidance, inspiration and considerable patience. Their belief in my ability and the relevance of my research were invaluable. With feedback from diverse interests and areas of expertise there was always a risk that so many cooks would ‘spoil the broth’. The variety of input they provided however has enriched and enhanced both the process and product of my research. It has been a pleasure learning from them, and I hope I will continue to do so. I am also grateful for the help, advice and support given to me in various ways by other people without an official supervisory role. Thanks must go to Dr. Shelagh Thompson for supporting me throughout the process, encouraging me to undertake a higher degree, ‘gatekeeping’ my research and showing interest in my progress; Helen McFarlane for starting me down the qualitative route in the first place; Rhiannon Jones and Ilona Johnson for their encouragement and input as my fellow ‘qualitative research group’ members; Dr. Mick ‘Gordon’ Allen for reading and commenting upon aspects of the thesis; Dr. Sara Delamont for doing likewise as ii well as suggesting areas of literature to explore and providing various aspects of training; Professor Amanda Coffey for helping to arrange supervision and for assessing my progress over the duration of this research; and Dr. Emma Hingston for her P.M.A. and willingness to demonstrate interest in the progress of this research over countless lunchtime conversations. I am also extremely grateful to those researchers I contacted who spared the time to help me with requests for papers, or discussed aspects of my research. In particular, thanks is due to Professors Kathy Charmaz, Adele Clarke and David Guston for not immediately deleting unsolicited emails from a postgraduate student across the pond in Cardiff. I am very grateful to the patients, referrers, and secondary care providers who generously gave me their time, told me their stories and entrusted me with their thoughts and feelings. Without them, this thesis could not exist. Finally I owe a huge debt of thanks to Louise. Her quick-thinking and enquiring mind, her understanding, her support and sacrifice have challenged and encouraged me throughout this venture. Whilst I struggled to produce this ‘baby’, she grew, birthed and nurtured some of our own. Thanks for the sacrifices you’ve made and the patience you’ve shown, I really do appreciate them! ...Two roads diverged in a wood, and I - I took the one less traveled by, And that has made all the difference. Robert Frost (1916) iii Dedication To L.E.A, J.F.W, B.K.J and N.S.D ¡Porque las moscas! iv Table of Contents Declaration ........................................................................................................... i List of Figures..................................................................................................... ix List of Tables ...................................................................................................... ix Abbreviations....................................................................................................... x Abstract..............................................................................................................1 Chapter One - Introduction ...............................................................................3 1.1 Introduction....................................................................................................3 1.2 Dental Anxiety and Sedation..........................................................................4 1.3 Secondary Care Sedation Clinics...................................................................6 1.4 The Technical Provision of Sedation..............................................................8 1.5 The Problem of Sedation Provision..............................................................11 1.6 The Choice of Research ..............................................................................12 1.7 The Theoretical and Methodological Approach ............................................14 1.8 The Reflexive Approach...............................................................................17 1.9 Thesis Layout ..............................................................................................19 Chapter Two - Literature Review ....................................................................23 2.1 Introduction..................................................................................................23 2.2 Dental Anxiety..............................................................................................23 2.2.1 Introduction ............................................................................................23 2.2.2 The Prevalence of Dental Anxiety ..........................................................24 2.2.3 The Impact of Dental Anxiety on Dental Practitioners.............................26 2.2.4 The Impact of Dental Anxiety on Patients...............................................27 2.2.5 Managing Dental Anxiety .......................................................................29 2.2.5.1 The Importance of the Dentist:Patient Relationship........................30 2.3 Conscious Sedation for Dentally Anxious Patients.......................................32 2.3.1 Introduction ............................................................................................32 2.3.2 The Development of Sedation within the United Kingdom......................34 2.3.3 The Need for Conscious Sedation within the UK....................................35 2.3.4 The Demand for Sedation within the UK ................................................37 2.3.5 The Purpose of Conscious Sedation for Anxious Patients......................39 2.3.6 The Benefits and Disadvantages of Conscious Sedation .......................39 2.3.7 The Location of Conscious Sedation Provision ......................................42 2.3.8 The Impact of Conscious Sedation.........................................................44 2.3.9 Conscious Sedation Education ..............................................................47 2.3.10 Experiences of Sedation ......................................................................49 2.4 Summary .....................................................................................................50 2.5 The Social Science of Frontiers ...................................................................51 2.5.1 Introduction ............................................................................................51 2.5.2 Social Worlds.........................................................................................51 2.5.3 Frontier-definition ...................................................................................54 2.5.4 Frontier-spanning...................................................................................56 2.5.5 Frontier display ......................................................................................61 2.5.6 Frontier transition ...................................................................................66 2.5.7 Summary ...............................................................................................71 2.6 Conclusion...................................................................................................72 v Chapter Three - The Research Process .........................................................74 3.1 Introduction..................................................................................................74 3.2 The Research Question ...............................................................................74 3.3 Method Choice.............................................................................................75 3.3.1 Ethnography ..........................................................................................75
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