Clinicians' Perspectives on Special Care Dentistry in New Zealand

Abstract

Introduction: Special Care Dentistry in New Zealand is relatively underdeveloped. With its workforce persistently scarce, its training and career pathways remain unclear. Little is understood about the specialty’s role within the New Zealand public oral health sector. With the ageing population and the increase in demand for public oral health services, it is perhaps timely to explore this specialty to understand its implications for the future of Special Care Dentistry in the context of New Zealand.

Aim: The aim of this research was to explore the perspectives of New Zealand clinicians who practise Special Care Dentistry on the current and future status of Special Care Dentistry in New Zealand.

Methods: A qualitative approach was used, and semi-structured interviews were conducted with nine registered Special Care Dentistry Specialists, a Dental Public Health Specialist, and a general dentist who predominantly practised Special Care Dentistry. Interview data were audio-recorded and transcribed. A general inductive approach was used to thematically analyse the data and emerging themes were identified.

Results: Three broad themes were identified: the profession, interprofessional interactions, and the issues in Special Care Dentistry. Under each of these themes, subcategories were further identified. This study revealed that the participants preferred ‘Special Care Dentistry’ to ‘Special Needs Dentistry’, which challenges the current term and definition used in New Zealand. In addition, the participants provided insights into career choices and their roles as Special Care Dentistry practitioners. Also highlighted were the career and training prospects of Special Care Dentistry and the associated limitations in New Zealand. Participants perceived that their professional interactions with their medical peers were better than their interactions with general dentists. Participants also indicated that there is a general reluctance of dentists to treat older people and patients who require special needs. The main barriers to provide Special Care in private practice were financial hurdles, time pressures, and limited medical knowledge. This study also identified critical issues such as older people’s oral health and an increasing demand for Special Care Dentistry in public practice, suggesting a greater need for the development of Special Care Dentistry in primary health care. Recommendations were proposed for the improvement of career and training pathways, Special Care Dentistry education among undergraduates and general dentists, and the promotion of the specialty within the medical and dental professions.

Conclusion: Special Care Dentistry is a specialty of dentistry in its own right. However, Special Care Dentistry in New Zealand is still in its infancy and there is much room for improvement, particularly in the aspects of education and career pathways to provide a healthy self-sustaining workforce. There should be a focus to promote Special Care Dentistry by all levels of oral health care stakeholders including the Faculty of Dentistry, NZDA, and the Ministry of Health. With the findings in this study, Special Care Dentistry can be defined as a discipline that provides patient-centred oral health care for those within the spectrum of disabilities and activities restrictions that affect their oral health, within the personal and environmental context of the individual.