Barriers and facilitators safeguarding children in dental care: clinical practice, attitudes and cooperation with social welfare services Anne Rønneberg Department of Paediatric Dentistry and Behavioural Science Institute of Clinical Dentistry Faculty of Dentistry University of Oslo Norway © Anne Rønneberg, 2020 Series of dissertations submitted to the Faculty of Dentistry, University of Oslo ISBN 978-82-8327-047-1 All rights reserved. No part of this publication may be reproduced or transmitted, in any form or by any means, without permission. Cover: Hanne Baadsgaard Utigard. Print production: Reprosentralen, University of Oslo. 2 Copyright© AIRN The “Problem Child” is a Child, not a Problem Suzanne Bouffard 3 4 CONTENTS ACKNOWLEDGEMENT ....................................................................................................... 7 LIST OF PAPERS ................................................................................................................. 9 ABBREVATIONS .............................................................................................................. 10 EXPLANATIONS OF DIFFERENT EXPRESSIONS WITH THE SAME MEANING ........................ 11 SUMMARY ...................................................................................................................... 12 INTRODUCTION .............................................................................................................. 17 Best interest of the child ......................................................................................................... 17 Sphere of impacts affecting the individual during childhood and adolescence .......................................... 18 Best interest of the child in a biopsychosocial perspective in dental paediatric context with a focus on behavioural management techniques (BMTs) and ethical considerations ................................................. 20 1. Performing restorative treatment in children .................................................................. 21 Dentists´ workload and occupational stress ................................................................................................ 21 Behavioural management techniques (BMT)s, dental fear (DF), and dental anxiety (DA) ......................... 21 Use of restraint during dental procedures .................................................................................................. 24 Children and pain: sedation and analgesia .................................................................................................. 25 Caries and ‘right treatment at the right time’ ............................................................................................. 29 Operative treatment of caries ..................................................................................................................... 29 2. Dentists´ and physicians’ responsibilities regarding child maltreatment ........................... 30 Child maltreatment ..................................................................................................................................... 30 Dentists´ and physicians’ responsibilities regarding child maltreatment .................................................... 32 AIMS OF THE THESIS ....................................................................................................... 33 Overall aim ............................................................................................................................ 33 Specific aims of the papers ..................................................................................................... 33 Paper I .......................................................................................................................................................... 33 Paper II ......................................................................................................................................................... 33 Paper III ........................................................................................................................................................ 33 Paper IV ........................................................................................................................................................ 34 Paper V ......................................................................................................................................................... 34 MATERIALS AND METHODS............................................................................................. 35 Study groups Papers I, II, and III .................................................................................................................. 36 Paper IV ....................................................................................................................................................... 36 Paper V ........................................................................................................................................................ 36 Methods ................................................................................................................................ 37 Study 1: Papers I–III ..................................................................................................................................... 37 Questionnaire in Study 1: Papers I–III ......................................................................................................... 37 Study 2: Papers IV–V .................................................................................................................................... 44 Questionnaire in Study 2: Papers IV–V ........................................................................................................ 44 Information, consent, and ethical considerations .................................................................... 49 Papers I and II .............................................................................................................................................. 49 Paper III ........................................................................................................................................................ 49 Paper IV ....................................................................................................................................................... 49 Paper V ........................................................................................................................................................ 49 Statistical analyses ................................................................................................................. 50 Paper I .......................................................................................................................................................... 50 Paper II ......................................................................................................................................................... 50 5 Paper III ........................................................................................................................................................ 50 Paper IV ....................................................................................................................................................... 51 Paper V ........................................................................................................................................................ 51 RESULTS.......................................................................................................................... 52 Paper I ................................................................................................................................... 52 Dentists’ self-perceived stress when performing restorative treatment in children aged 3–5 years and 6-9 years ............................................................................................................................................................ 52 Dentists’ use of LA when performing restorative treatment in children aged 3–5 years and 6–9 years .... 53 Paper II .................................................................................................................................. 53 Dentists’ use of BMTs and attitudes towards DA ........................................................................................ 54 Paper III ................................................................................................................................. 55 Treatment options when approaching severe caries in the primary dentition ........................................... 55 Use of restraint in the context of performing acute treatment in preschool children with pain due to caries............................................................................................................................................................ 57 Assembly of the main results from Papers I, II, and III (not published) ....................................................... 58 Paper IV ................................................................................................................................. 61 Barriers for reporting when suspecting child maltreatment ....................................................................... 62 Paper V .................................................................................................................................