title: Dental care of a child in pain -- a comparison of treatment planning options offered by GDPs in California and the North-west of England.
abstract: OBJECTIVE
  To compare the treatment plans offered by general dental practitioners (GDPs) in the North-west of England (UK) and California (USA) in dealing with a child in pain.
  
  
  METHODS
  A cross-sectional postal survey of a convenience sample of 135 UK and 170 USA GDP. These GDPs were asked to consider a case scenario of a 5-year-old child with pain from a lower first primary molar and to offer a treatment plan. The plan was to have three phases: immediate care, follow-up care and longer term preventive strategy. The influence of cost on treatment plans was also recorded.
  
  
  RESULTS
  Response rates for the GDPs were 117 (86.6%) from the UK and 139 (81.8%) from the USA. The major differences in immediate care were as follows: 98% of Americans would take a radiograph, 41% would consider extraction, 37% would place a space maintainer and 4% would use general anaesthesia to extract a tooth. Comparable proportions for the English dentists were 20%, 21%, 2% and 40%. Later clinical options also showed differences: 39% of UK dentists would extract all first primary molars compared to only 1% of Americans. Eighty-eight per cent of USA dentists would place a nickel chrome crown compared to 4% of UK respondents. There were also differences in the longer term preventive measures. Greater proportions of American dentists would offer fluoride varnish (30%) and fluoride mouthrinse (37%). Comparable UK responses were 13% and 28%. Cost of care was only mentioned by 3% of UK dentists, whereas 70% of USA dentists mentioned cost as a factor in treatment planning.
  
  
  CONCLUSIONS
  There were marked differences in the treatment of a child in pain between general practitioners in the UK and the USA. Further investigations are required to elucidate the reasons for these differences.
authors.affiliation: University Dental Hospital of Manchester, Manchester, UK. Anthony.Blinkhorn@man.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Blinkhorn
authors.forename: R
authors.initials: R
authors.lastname: Zadeh-Kabir
mesh_terms: D000768:Anesthesia, General; D002140:California; D002327:Cariostatic Agents / Q000627:therapeutic use; D016009:Chi-Square Distribution; D002675:Child, Preschool; D003430:Cross-Sectional Studies; D003442:Crowns; D003729:Dental Care; D003731:Dental Caries / Q000000981:diagnostic imaging / Q000517:prevention & control / Q000628:therapy*; D004739:England; D005459:Fluorides / Q000627:therapeutic use; D005460:Fluorides, Topical / Q000627:therapeutic use; D005500:Follow-Up Studies; D005792:General Practice, Dental; D017048:Health Care Costs; D006801:Humans; D008963:Molar / Q000473:pathology; D010347:Patient Care Planning; D019239:Practice Patterns, Dentists'; D011859:Radiography; D013027:Space Maintenance, Orthodontic / Q000295:instrumentation; D014081:Tooth Extraction; D014094:Tooth, Deciduous / Q000473:pathology
chemical_list: D002327:Cariostatic Agents; D005460:Fluorides, Topical; D005459:Fluorides