In Australasia, Head and Neck Cancer (HNC) is more common and survivable than ever before. As a result, the population prevalence of HNC patients (including HNC survivors) in our communities is ever-increasing. Most of these patients are, at least, partially dentate, and are at high risk of dental disease. Most will seek dental care in the private sector with general dentists. Problematically, little is known about the capacity of general dentists to provide treatment for these complex patients.
This study, which is believed to be the first of its kind in this space, will seek to describe the knowledge, attitudes and behaviour of general dentists providing treatment for HNC patients.
A cross-sectional survey of a random and representative sample of 800 New Zealand general dentists was undertaken. The survey was self-administered, from a digital platform. Participants were invited into the study by email, and this email contained an embedded hyperlink to the survey. Data were collected on sample demographics and various aspects of the knowledge, attitude and behaviour of general dentists treating patients with a history of HNC. A total of 156 surveys were completed (20.4% response rate).
Data was analysed using SPSS software (version 25), by the investigator. Qualitative interview of four key informants was undertaken to provide depth of understanding to the data.
The majority (73.4%) of registered general dentists who responded to the survey invitation felt that providing dental treatment for HNC patients fell within their scope of practice, however one quarter of dentists had not seen any HNC patients during the previous year in practice, and only 1 in 20 had seen significant numbers (20 or more HNC patients). HNC patient flow was positively associated with the dentist being female, in a metropolitan-based practice, having had work experience in the public sector and currently working in both public and private practices.
General dentists were found to have sufficient knowledge to treat HNC patients, in practise if not in theory. On average, dentists answered 9.6 questions correctly out of total of 15 questions (64% of questions answered correctly, on average). HNC patient flow over the preceding year, being aged 50 to 59 years, and having 30 to 39 years of clinical experience, were associated with superior knowledge.
The study found that dentists lacked confidence in providing dental treatment for HNC patients. Only one quarter of New Zealand graduates and about 10% of overseas graduates reported that they were confident treating HNC patients. Willingness to provide basic dental treatment for a HNC patient was related to the invasiveness of the treatment itself; typically, the more invasive a procedure, the fewer dentists who would consider undertaking it. Similarly, a clinician’s experience providing basic dental care to HNC patients during the previous year in practice was also dependent on procedural invasiveness.
Almost all dentists would give oral hygiene instruction to HNC patients, but only one third would drill down into dietary strategies for oral health. Of greatest concern was the low rate of smoking cessation intervention provided, although this was consistent with rates reported in the evidence base.
New Zealand graduates tended to score better than their overseas-trained counterparts in knowledge, attitudes and behaviour aspects of providing dental care for HNC patients.
In general, dentists have a good level of knowledge about HNC, but they are not able to confidently translate this into practise to provide basic dental treatment for this complex group of patients who are at high risk of dental disease.
This study has not been able to clearly identify and describe the barriers to this conversion. Some evidence exists that the majority of dentists do not feel that their undergraduate qualification had adequately prepared them to see HNC patients. Further study in this area is needed, and greater use of qualitative techniques is recommended.
Contextual frameworks in this space must be reviewed in order to support access to dental care for HNC patients. Dental education requires revision across the scholastic spectrum- including undergraduate learning, seasoning of new-graduates and strategies to update experienced clinicians with current evidence-based knowledge. Funding of public dental services should be reviewed so that it is viable for public dental clinics to integrate their dentists into established cancer care teams. Patient care pathways by which HNC patients can access dental services should be clarified and made transparent to both primary healthcare providers and patients.||